Abstinence is a wise and safe choice at any life stage, particularly for young patients who do not feel ready for a sexual relationship. However, abstinence only programs are ineffective in delaying sexual debut or reducing sexual risk behaviors among teens that are already sexually active.(4) Comprehensive sexual education has been shown to significantly decrease teen pregnancy rates, increase age at first intercourse, and significantly increase the likelihood of contraception use at first intercourse.(4-6) Furthermore, female participants in comprehensive sexual education programs were more likely to choose age appropriate sexual partners, less likely to note first intercourse as an unwanted event and to express overall healthier partnerships associated with their first sexual encounter. Sexual education was not associated with an earlier onset of sexual debut.(4) Therefore, although a patient who notes abstinence as their form of contraception should be encouraged to continue on this path, the discussion of sexual health should not end there.
Noncoital sexual behavior, includes mutual masturbation, oral sex, and anal sex, and is a common expression of sexuality. The National Survey of Family Growth found that 45% of females aged 15-19 have had oral sex with an opposite-sex partner but these numbers have not increased over the past two decades. Compared with oral or vaginal sex, which is common in more than 90% of males and females by age 25 years, anal sex is less common (10% of female adolescents aged 15–19 years) and often is initiated later. Noncoital sexual behavior commonly coexists with coital behavior. The prevalence of oral sex among adolescents jumps dramatically in the first 6 months after initiation of vaginal intercourse, suggesting that both often are initiated around the same time and with the same partner. Although there is little risk of pregnancy with strictly noncoital activities, given this association, contraceptive discussion is warranted. Sexually transmitted infections, including HIV, HSV, HPV, hepatitis virus, syphilis, gonorrhea, and chlamydial infection, can be transmitted through noncoital sexual activity and should be strongly counseled. (7)
Coitus Interruptus/Withdrawal Method
This method simply involves the withdrawing of the penis from the vagina and away from the external genitalia prior to ejaculation. It is mentioned here, as a point of discussion, as it practiced widely, with 55% of adolescent women aged 15-19 years reporting having used the method before.(8)The efficacy of such technique is poor (78% with typical use) and it does not provide protection against sexually transmitted infections. (8)