Contextual Issues

Family physicians should not assume that adolescent sexual experiences are consensual or desired, even when the teenager denies having been sexually assaulted or raped. Both young women and men should be asked about unwanted sexual contact. In the YRBS 2007, 7.8% of youth reported having been forced to have sexual intercourse they did not want (11.3% female, 4.5% male). Many teenagers who have had coercive sexual experiences do not identify these as rape or abuse. Asking a neutrally worded question (e.g., "Have you ever done anything sexual when you really didn't want to?") may open the door to further dialogue regarding exploitive or traumatic sex.

For adolescent patients, drug and alcohol use is a significant risk factor for unprotected sexual activity. In the 2007 YRBS, 23% of teenagers reported alcohol or drug use immediately before they last had sexual intercourse. Long-acting contraception is often the best option for young women who are at risk for pregnancy because of substance use. Referral for treatment of addiction should be considered for adolescents who combine drinking with driving or sex and who are unable to discontinue this risk behavior without assistance.

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