These data demonstrate the marked variety within adolescent women’s sexual repertoire, as well as the multiple and often complex sources of influence on day-to-day expressions on that repertoire. In support of existing literature[3
], oral genital sexual experience was common, even among those who reported never having coitus [3
]. More young women reported ever receiving oral sex than performing oral sex [7
]; this contradicts some studies suggesting that fellatio is more prevalent among adolescent women [5
]. Approximately 6% of our sample reported having anal sex, consistent with data from other research[5
The significance of these data stems from the detailed insight into the complexity of sexual activity (coital, oralgenital, and anal) within specific sexual encounters. Although the event level patterns generally support effects observed in the cross-sectional studies, they also illustrate an intricacy insufficiently addressed in the present literature. Specifically these findings underscore a need for more precise language to represent the sexual behavior of adolescents. Many widely used terms inaccurately group together or mislabel behaviors which in fact have different structure and sources of influence. For example, “abstinence,” although imbued with political and public health meaning, has little behavioral meaning to adolescents: over 90% of their days contain no sexual activity, suggesting that for them, a majority of their days are “abstinent.” Furthermore, terms such as “sexually active”—long-used as a euphemism for coitus—ignores a substantial proportion of sexual encounters defined only by a noncoital sexual behavior or those in which both coital and noncoital behaviors occur. Although our data show that coitus is a predominant type of sexual activity, young women’s range of behavior encompass a much larger range of actions that may occur alone or in multiple combinations.
The phenomenologic, intra- and inter-personal differentiation of days with different types of sexual behaviors suggests an understanding and enactment of complex social, gender, and sexual scripts [10
]. This observation suggests that artificial distinctions between “adolescent” and “adult” sexuality should be more carefully considered in the construction of policy, with perhaps greater attention given to ways in which sexuality in adolescence reflects the development of and experience with sexuality across the lifespan.
Perhaps most importantly, the data demonstrate the importance of thinking about young women as proactive sexual agents capable of purposive sexual decision making. In contrast to the notion that adolescent sexual activity is completely opportunity-driven, sporadic, impulsive [1
], young women enact behaviors in ways congruent with emotional and sexual interests, larger gender and sexual norms, as well as relational and situational influences. Successful negotiation of these factors is remarkable in considering that social and educational models for sexual behavior are usually contradictory, indirect, or poorly illustrated [10
]. For example, our data show that abstinence or noncoital behaviors such as fellatio and anal sex are more likely on days with vaginal bleeding. This may suggest a relatively faithful enactment of social and religious prohibitions of coitus during menstruation [33
There is also evidence that young women are able to uphold norms about relationships, sexual desire, mood, and love within romantic/sexual partnerships. For example, the association of partner support and partner negativity with coitus rather than abstinence suggests that sexual activity may serve multiple within-dyad functions: on the one hand, as relationship affirmation and strengthening of the pairbond [36
], and on the other hand, as a method of conflict resolution or distress amelioration [37
]. Furthermore, sexual interest was associated with increased likelihood of coitus (rather than abstinence) and increased likelihood of all coital/noncoital behaviors (rather than coital-only). This suggests that young women are capable of recognizing sexual desire and behaving in a fashion consistent with that desire. In contrast, days associated with feeling “in love” were associated with greater likelihood of abstinence compared with days when only coitus occurred, but days of feeling “in love” were also associated with greater likelihood of fellatio-only rather than coital-only sexual behavior. These findings underscore the complex ways in which sex is enacted in young women’s relationships, as expression of the “sexual voice,” as well as a means of maintaining relationships and satisfying a partner’s sexual needs[13
]. The balance within this complexity found for any given sexual encounter may lead to events that are more or less healthy in the sense of satisfaction of sexual and relational needs, as well as risks of STI and unintended pregnancy [13
]. This may suggest that clinicians need continually to revisit sexual risk reduction with their adolescent patients—targeting specific relationships, partners, and behaviors on those relationships, rather than asking more general questions about sexual activity.
Our data should be considered in the context of its limitations. First, the sample is primarily selected from urban, low-to-middle-income areas marked by high rates of STI. Although these findings are therefore not representative of other adolescent populations, they do offer useful insight into the day-to-day sexual behaviors made in a high-risk population. Second, although the daily diaries do offer a level of behavioral specificity not available to most survey-based studies, within-day causal effects cannot be distinguished. Finally, although the data were collected at a partner-specific level, the models presented here do not incorporate information about the couples’ histories before a given day. Elaboration of the models presented here would be of interest, although several conceptual and statistical issues remain to be resolved. Future research may seek to implement a more complex event level selection of behavior or contraceptive variables or to explore multi-level models.
Almost 20 years ago, Fine [20
] pointed out that young women carried on an intense intra- and interpersonal discourse attempting to understand their own sexuality in the context of relationships and social expectations. The larger scientific and political community of the time largely missed this discourse while focusing on the emotional and physical dangers of sex, especially STI and unintended pregnancy. In a recent follow-up paper, Fine [39
] states that little has been done to amend this missing discourse. She also notes that a renewed emphasis on abstinence has per-petuated this paucity of information, such that much of our understanding of young women’s sexuality remains focused on its adverse outcomes rather than on its place in young women’s lives. Clinically, combating negative health outcomes requires a basic understanding of how young women’s sexual identity drives their sexual behavior. As illustrated by this research, the orchestration of sexual decision making is multi-faceted and complex, and requires a deeper analysis than a simple focus on coital risk.