Sexuality is often mistakenly equated with sexual activity. In fact, sexuality is multidimensional and composed of gender identity, gender role, hormonal influences, cultural attitudes, life experiences, physical, psychological and moral development, and sexual response. A person's sexuality is strongly influenced by friends, parents, society, and religious beliefs. Therefore, the development of sexuality is part biological and part learned behavior.

Physical changes, puberty, sexual responses, and reproduction comprise the biological component of sexuality. Sexuality is a life-long developmental process that begins at conception. Males and females have the same sex hormones, but the difference in levels of these hormones cause changes intheir bodies. Puberty refers to the period when secondary sexual characteristics are developed and ends when the ability to reproduce is obtained. This process may take anywhere from one-and-a-half to six years.

The physical changes associated with puberty usually begin around 11 years ofage. In girls these changes include the development of armpit and pubic hair, breasts, acne, a rounded body shape, and enlargement of the clitoris, labia, uterus, and ovaries. Menstruation begins, on average, around age 12or 13. During puberty, boys develop facial, armpit, chest, and pubic hair; acne; muscles; voice changes; enlargement of the breasts, penis, scrotum, prostate, and testes; and they begin to ejaculate. Puberty is characterized by lack of control over one's body. Girls can be stricken with painful periods causing cramping, nausea and vomiting, back pain, and headaches that severely affect their normal activities. Boys can experience spontaneous erections at inappropriate times.

Puberty is the transition period between childhood and adulthood and as a result it is often an emotionally difficult time. The adolescent has many questions concerning the physical changes occurring in his or her body as well as questions about sex itself. In the American culture, physical perfection and beauty are highly regarded and adolescents are bombarded with images of the ideal man and woman through television and movies. As a consequence, he or shemay be very upset that his or her body does not fit into this ideal. Fittinginto one's peer group and appearing to be "normal" are very important duringadolescence. Puberty is also the time period in which the adolescent begins aseparation from family and develops his or her own identity. In the processof developing a unique identity adolescents may change their appearance, makenew friends, and question family beliefs.

Unfortunately, in many cultures, sex is a taboo topic. Adolescents are usually uncomfortable discussing this personal topic with their parents. As a result, the adolescent will often learn about sexuality and sex from friends and the media. This frequently results in adolescents being misinformed about sex,birth control, and the risks of sexually-transmitted diseases (STD).In addition, it adds to the confusion and anxiety felt by many adolescents during this developmental period. Getting accurate information from a health education class, physician or nurse, or trusted adult may reduce the incidenceof unwanted pregnancies and STDs in adolescents.

Most resources focus primarily on the negative aspects of adolescent sexual activity. Adolescents are taught that sex is bad and should be delayed until adulthood is reached. This leaves them coping with feelings of guilt, shame, and anxiety during the development of their sexuality. In truth, masturbation and sexual intercourse are normal and healthy parts of human sexuality. The concepts that sex should be more communicative, pleasurable, responsible, respectful of the partner, and with equality between the partners is not conveyed to adolescents.

Experimentation is common during puberty as the adolescent struggles to achieve his or her identity. Homosexual fantasies and experiences during adolescence are not uncommon and do not mean that the adolescent is gay. Although it is impossible to know the exact number, it is estimated that at least 5% to 10% of adolescents may be gay. Homosexuality and bisexuality are not diseases or deviations but healthy expressions of sexuality. Due to society's continuedbelief that only heterosexuality is normal, gay, lesbian, and bisexual adolescents are at an increased risk for being victims of violence, being kicked out of their homes, and suicide.

Girls who have sexual intercourse before the age of 17 years are frequently just seeking love, stability, acceptance, or an escape from depression. Girlswho are at risk for dysfunctional sexual activity are those with poor self-esteem, feelings of isolation and rejection, an unsupportive environment, family problems, or have been abused or neglected. Girls with good self-esteem and a strong sense of responsibility are less likely to become pregnant or acquire an STD. Twenty-four percent of 15 year old girls, 50% of 17 year old girls, and 68% of 18 year old girls have had sex. Up to 75% of 18 year oldboys have had sex.

Adolescents rarely use birth control during their first sexual experience andgirls often wait up to one year before seeking a birth control method. Eachyear in the United States one in ten teenage girls becomes pregnant. One fifth of teenage first pregnancies occur during the first month of sexual activity. Teenage pregnancy places both the mother and the child at risk. The teenage mother is at risk for serious, sometimes fatal, complications during pregnancy. In addition, nearly 80% of teenage mothers drop out of high school, which leads to lower income levels later in life. The baby carried by a teenage mother is twice as likely to die than one carried by a woman older than 20 years of age. It is also at risk for prematurity, low birth weight, poor health status at birth, slow intellectual development, poor performance in school, and behavior problems.

Each year three million teenagers in the United States receive an STD. CommonSTDs include gonorrhea, syphilis, chlamydia, herpes, hepatitis, AIDS, genital warts, and trichomoniasis. Whilesome of these diseases can be cured, there are no cures for the viral diseases hepatitis, AIDS, and herpes. STDs can lead to infertility, cancer, pelvic inflammatory disease, and place one at an increased riskof acquiring the AIDS virus. Condoms and spermicidal products offer the best protection against STDs.

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