Adolescent sexuality and sexual abuse : a swedish perspective

University dissertation from Stockholm : Karolinska Institutet, Karolinska Institutet, Stockholm Söder Hospital

Abstract: In the late 1980´s, teenage abortions and genital chlamydial infections were increasing adolescent health problems in Sweden, indicating unsafe sex practices among young people. The emergence of HIV highlighted the need for research on adolescent sexual health issues. The cross-sectional questionnaire-based survey SAM 73-90 was conducted in 1990 among 1,943 high school students and 210 school drop-outs born in 1973, response rate 92% and 44%, respectively. Consensual sexual experience was varied. Coital experience was reported by 54% of the boys and by 64% the girls. Factors associated with coital experience were early puberty, not living with both parents, vocational study program or school non-attendance, and risk-taking behavior with regard to smoking, alcohol and drugs. Non-coital sexual experience included cunnilingus and fellatio. Early starters, with the first heterosexual intercourse before age 15, reported risky sexual behavior with multiple partners, casual sex and varied sexual practices as part of a generalized adolescent risk-taking behavior. Consequently, early starters were, compared to later starters, at increased risk for unwanted pregnancy and sexually transmitted infections. School drop-outs constituted a group at risk. Child sexual abuse was reported by 11.2% of female and 3.1% of male students, and by 28% of female and 4% of male non-schoolers. Alcohol and drug abuse, and suicidal ideation, was reported significantly more often by abused youths of both genders. Girls reporting abuse were overrepresented among the early starters of coital activity. Few adolescents had told any "professional" about the abuse. Medicolegal examinations of girls alleging abuse confirmed the findings from SAM 73-90. Adolescent girls alleging sexual abuse may exhibit signs of admitted self-inflicted extragenital injury. Diagnosis of alleged non-acute cases of sexual abuse relies on a detailed history. Genital examination confirm that non-penetrative sexual acts leave no lasting signs, but that repeated abusive genital pentration may do. Few cases were taken to court. In cases with a confessing perpetrator, no discordance was found between the testimony of the victim, the medicolegal conclusion and the testimony of the perpetrator. HIV did not become epidemic in Sweden, and in the early 1990´s, teenage abortions and chlamydial infections decreased. Since 1995, a shift has occurred, with a gradual increse of abortions and STDs. The questionnaire-based study SEXSAM-99 was performed among 258 high-school students in a low income multicultural suburb in greater Stockholm in 1999. Participants´ mean age was 17 years, response rate 76%. School drop-outs could not be reached. Experience of vaginal intercourse was reported by 56%, with no gender difference. Factors associated with coital experience were the same as in SAM 73-90. Drug use, casual sex, multiple partners, homo- and bisexual experience and anal intercourse was reported more frequently than in SAM 73-90, with no difference with regard to gender or immigrant background. These findings may indicate a shift in adolescent sexual behavior, an issue for further investigations.

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