Trigger warning for brief mentions of rape and abuse.
According to the study, male sexual health is quite often overlooked within the clinical setting. Pediatricians are three times more likely to take sexual histories from female than from male clients and twice as likely to counsel female clients on the use of condoms. This is particularly bad, because male adolescents cite health care providers as one of their most important sources of sexual health information.
The other primary sources of sexual health education for adolescent boys are also falling down on the job. Both mothers and fathers have difficulty discussing sex with their sons, according to the paper. However, sons whose parents talk to them about sex report being closer to their parents, more comfortable talking to their parents in general, and more open about sex with their parents. In particular, gay male teens who have a supportive home environment during the coming-out process have much better psychological outcomes: without a supportive environment, they’re at risk for isolation, flunking school, substance abuse, depression, suicide, stigmatization, and a host of other negative consequences.
Sex education and HIV/AIDS prevention information is also important: it has been linked to more consistent condom use. However, as I’m sure everyone is reading this blog is aware, in America certain political forces have been waging a war on evidence-based, comprehensive sex education that says such controversial things as “if you have sex use a condom”; true sex-positive sex education that centers pleasure, enthusiastic consent, and sensible risk management is not even on the radar. Sex education is vitally important, because approximately three-quarters of male teenagers have engaged in some sexual behavior (including manual or oral sex) by graduation.
For adolescent men, puberty presents several important issues. Diseases like Klinefelter’s or Marfan syndrome may not be identified until adolescence; other issues, like gynecomastia (which occurs to between forty and sixty-five percent of male teenagers) or testicular torsion, may not appear until adolescence. Earlier-maturing boys tend to take more risks; later-maturing boys tend to be less confident and more likely to experience bullying, depression, and substance abuse.
Many young men engage in risky sexual behaviors: a quarter have used alcohol or drugs before last sex; 16% have four or more lifetime partners; 8% initiated sex before the age of 13; 28% reported no condom use at last vaginal sex; 11.1% had anal sex (which is at higher risk for STIs than PIV sex) with a female partner; 5.6% reported having sex with a sex worker or person living with HIV or often or always being high during sex. It is important to note that none of these are, in and of themselves, destructive choices; sluthood can be an awesome and fulfilling part of life. However, young men who make these choices require more guidance from sex-positive sexual health sources to make sure that they’re managing their risk and that it’s a level of risk they’re comfortable with.
But unfortunately many men are not actively choosing to participate in sex. 82% of men have experienced pressure from their friends to have sex; virgin-shaming is alive and well among men. More than half wish they had waited longer to have sex and more than one-third did not really want sex the first time it happened or had mixed feelings about it. Approximately 1 in 12 (higher for black men and those who had sex under the age of 15) were coerced into first-time sex, mostly by a female. (The percentage of men who were raped wasn’t discussed within the report.)
Men suffer from other risks. Although they only account for a quarter of the sexually active population, adolescents and young adults account of half of all new STI cases and 30% of new STI infections. Young people age 13 to 24 are estimated to account for 10% of undiagnosed cases of HIV. 7.2% of young men who have sex with men have HIV (people of color generally have higher rates than whites).
Being a survivor of dating violence is slightly more common among male (11%) than female (8%) high-school students. I know I sound like a broken record on this, but abuse and domestic violence are far more gender-equal than we think, and when we raise awareness of abuse we have to raise awareness of all kinds of abuse, not just the male-on-female kind we think of.
In addition, 1 in 8 male adolescents who have had PIV sex have impregnated a partner, and 4% are fathers. Because of lacking or inaccurate documentation of paternal age on birth certificates, the percentage might actually be much higher. Teaching adolescents pregnancy avoidance methods is a clear necessity.
The use of condoms by adolescent men, particularly men of color, is rising, with 70% reporting condom use at both first and most recent sex. However, less than half report consistent condom use. Barriers include embarrassment while buying them, reduced physical sensation, incorrect use, and inability to plan or discuss it with one’s partner. 10% use the withdrawal method which, while better than nothing, is not protection as good as a barrier method or hormonal contraception. Only a quarter use two methods (i.e. condoms with hormonal birth control). Young men are less likely to use condoms if the male’s partner used a contraception method, if the man is an older adolescent, and during a casual first sexual encounter. Adolescents who discuss contraception before sex, use dual contraception methods, and wait longer after beginning a relationship to have sex are more likely to use condoms. Men and white teenagers are less likely to discuss contraception and STIs before losing their virginity than women and people of color are.
Adolescent men experience many barriers to getting proper sexual health care. After losing their virginity, many men do not think about preventative care; traditional masculine beliefs preclude young men from seeking care even if they have symptoms. Young cis women tend to get reproductive health care from their gynecologists; young cis men do not have access. Shame, denial, fear, stigma, lack of social support, lack of confidential services, lack of health care, and not knowing where to go for care can place significant barriers in front of men getting treatment for STIs.