- WESTPORT, CT (Reuters
Health) - Oral sex is perceived by many US adolescents as a safe substitute
for intercourse " or not even as sex at all, Lisa Remez, associate
editor of Family Planning Perspectives, reports in a special commentary
in the November/December issue of that journal.
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- Although no definitive data are available, oral sex seems
to gaining in popularity among adolescents, according to reports in the
popular press, marketing research surveys, and evaluations of abstinence
education programs, Remez says. Based on interviews with several physicians,
she suggests that sexual histories need to be more detailed so that clinicians
can ensure they are appropriately counseling teenage patients.
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- Several clinicians who spoke with Reuters Health made
specific recommendations about counseling adolescents regarding modes of
sexual activity that may be perceived as being safer than vaginal intercourse.
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- Dr. Mark Schuster, director of the UCLA/RAND Center for
Adolescent Health Promotion in Santa Monica, California, pointed out, "When
we as physicians talk to adolescents about sexual activity, we shouldn't
divide them in our minds into those who are sexually active or not based
on whether they have had vaginal intercourse."
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- "I would counsel adolescents that sex - even oral
sex - with lots of different partners probably increases their risk of
infection," said Dr. J. Dennis Fortenberry of the Indiana University
School of Medicine in Indianapolis. "I would also try to make sure
that patients understand that sexually transmitted infections are possible
from oral sex."
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- Linda Dominguez, assistant medical director of Planned
Parenthood of New Mexico in Albuquerque, stated, "The clinician must
be willing to risk some discomfort by asking more specific questions regarding
sexual activity." Dominguez added that time pressures may inhibit
more in-depth discussion.
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- "But would we short-shrift our patients by listening
to only one lung or examining only one breast, or in this case, asking
for only part of the history?" she asked.
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- "How to do the verbal assessment is difficult and
is where the art of healing meets the science," Dominguez continued.
"I use oblique statements such as 'Some of my teen patients have told
me that they worry about infections and germs they might have caught from
heavy petting or oral sex. Have you been worried or have questions about
problems like that?' "
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- Remez describes an outbreak of pharyngeal gonorrhea among
middle-school students that was found only because throat swabs were being
taken to screen for meningitis. This brings up the question of whether
screening for sexually transmitted diseases should be expanded to include
STDs that result from oral sex.
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- Dr. Schuster recommended, "If [patients] say they've
been engaging in oral sex and they have a sore throat, then I will certainly
screen them. But we don't know enough to say that we should be routinely
screening adolescents and how often."
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- "Qualitative and quantitative data on sexual behaviors
other than intercourse are clearly needed," Remez concludes in her
report, "to close the gaps in knowledge about practices that may expose
young people to emotional and physical harm."
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