ORIGINAL RESEARCH

Characteristics of teenage sexual behavior

Kellyne Mayara do Nascimento Maciel^I; Magna Santos Andrande^II; Lorena Zuza Cruz^III; Chalana Duarte de Sena Fraga^IV; Gilvânia Patrícia do Nascimento Paixão^V; Rudval Silva Souza^VI

^I Undergraduate degree in Nursing from the State University of Bahia, Campus VII. Senhor do Bonfim, Bahia, Brazil. E-mail: kellyne120@hotmail.com
^II PhD student in Community Health. Professor, State University of Bahia, Campus VII. Senhor do Bonfim, Bahia, Brazil. E-mail: magnaenf@yahoo.com.br
^III Graduate degree in Nursing from the State University of Bahia, Campus VII. Senhor do Bonfim, Bahia, Brazil. E-mail: lorenazuza@gmail.com
^IV Master in Nursing. Assistant Professor, State of Bahia, Campus VII. Senhor do Bonfim, Bahia, Brazil. E-mail: chalanaduarte@hotmail.com
^V PhD in Nursing. Assistant Professor of Nursing Undergraduate Course at the State University of Bahia, Campus VII. Senhor do Bonfim, Bahia, Brazil. E-mail: gilvania.paixao@gmail.com
^VI PhD in Nursing. Adjunct Professor of Nursing Undergraduate Course, State University of Bahia, Campus VII. Senhor do Bonfim, Bahia, Brazil. E-mail: rudvalsouza@yahoo.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2017.23496

ABSTRACT

Objective: to describe the sexual behavior of adolescents at state schools in the municipality of Senhor do Bomfim, Bahia. Method: in this descriptive, quantitative study of 185 adolescents aged 16 to 19 years, data were collected by semi-structured questionnaire and analyzed descriptively by calculating simple frequencies and their proportions. Research project approved by ethics committee (CAAE No. 26849914.3.0000.0057). Results: most of the adolescents had had their first sexual intercourse, approximately one third used no contraception in the first relation, and a significant number of them (or their partners) were now pregnant. Only half the young people reported using contraception in all relationships, and the method most used was the condom. Conclusion: the young people were observed to be vulnerable to sexually transmitted infections and early pregnancy, since the frequency of those having unprotected sex was high, showing the need for promotion and prevention actions.

Keywords: Adolescent; sexuality; sexual behavior; primary prevention.

INTRODUCTION

Adolescence is understood as the transition period of the human being from the infantile to the adult stage, and it is characterized by intense anatomical, physiological, and social transformations that contribute to the construction of sexuality¹.

According to the Pan American Health Organization and the World Health Organization (WHO), adolescence is characterized as a biological process in which structuring of personality and acceleration of cognitive development occur, consisting of the period between 10 and 19 years of age, in which pre-adolescence occurs from 10 to 14 years and adolescence from 15 to 19 years².

Sexuality is a fundamental element for the formation of the identity of the adolescent, since it is not limited to only human reproduction or sexual act but also includes feelings, desires and interpersonal relationships ².

In the context of the adolescence process and the construction of sexual behavior, it is observed that the number of adolescents who initiate active sex life has increased, which, associated with the high percentage of unprotected relationships, can make young people vulnerable to undesired situations such unplanned pregnancy, abortion and sexually transmitted infections (STIs)^3,4.

Worldwide, approximately 12 million people infected with the Human Immunodeficiency Virus (HIV) are between 15 and 24 years old, and 16 million births occur annually in mothers aged 15 to 19^5,6. In Brazil, in 2013, about 20.0% of the children born alive were daughters of adolescent mothers^5,7. In 2014, in the municipality of Senhor do Bonfim, Bahia, 128 pregnant women aged 10 to 19 years underwent prenatal care, which corresponds to 23.1% of the total of pregnant women seen in the public network of the municipality in that period⁸.

Regarding HIV infections, 21.3% of the cases reported in Brazil in 2015 occurred in the age range between 15 and 24 years⁹, evidencing the high frequency of contamination at early ages, considering that in many cases the individual takes years to discover the infection.

Thus, studying on adolescent sexual behavior is relevant to identify risk behaviors and to support schools, the health sector and society in the implementation of measures to raise awareness of young people regarding safe sex practices, thus reducing gestation, abortion and contamination by STIs in this population.

Thus, this study aims to describe the sexual behavior of adolescents from state schools in the municipality of Senhor do Bonfim, Bahia.

LITERATURE REVIEW

The insertion in the adult universe promotes changes in the sexual behavior of the adolescent, and the interrelation between genders allows the stimulation of the sexual expressions, besides the process of psychological maturation in the face of new experiences and discoveries¹⁰.

However, physiological and psychic changes occurring in the adolescent, the search for sexual discoveries, the insertion in the adult environment, besides the deficiency of family and school guidance on issues about sexuality, contribute to the exposure of young people to violence, prostitution, use of licit and illicit drugs, early pregnancy and STIs ².

In adolescence, the young person lives their sexuality intensely, with sexual practices often unprotected and without adequate knowledge about their own body. In addition, sexual experiences gained at this stage of life may reflect on practices carried out throughout life^10,11.

Thinking about sexuality in adolescence requires a critical view of the various meanings that discoveries and changes occur in genders, and one should consider aspects related to the time and place where these events occur. In addition, social practices and lifestyle are determined by different social, religious and cultural aspects among the various social groups¹⁰.

METHODOLOGY

This is a descriptive, quantitative study developed in state schools located in the urban area of the municipality of Senhor do Bonfim, Bahia, and it consists of the cut of a research project titled Adolescence and Sexuality.

The inclusion criteria used were: adolescents aged between 15 and 19 years, of both genders; regularly enrolled in the third year of high school in one of the three state schools in the urban area of the municipality; prior authorization of parents and/or guardians for participation of minors; consent of the adolescent to participate in the study.

The age cut of the population surveyed was performed according to the definition of adolescents established by the World Health Organization (WHO)^5,6.

A pre-test was performed, with 17 high school students from one of the state schools in the city, with the objective of testing the questionnaire. From the inconsistencies found, the adjustments were made.

The population of young people enrolled in the third year of high school in the three schools studied totaled 476 students. A total of 185 adolescents between the ages of 16 and 19 were surveyed, and there were no young people aged 15 years or less found in the groups surveyed. The study proposal was to carry out a census, studying all adolescents aged 15 to 19 enrolled in the third year of high school in the three state schools of Senhor do Bonfim. However, increased school dropout reduced the target population of the study.

Data were collected in school visits during class time, between August and December 2014, from the application of a structured questionnaire, consisting of 52 questions divided into five blocks: socioeconomic and family characteristics; sources of information and knowledge on reproductive health; relationship and use of contraceptives; knowledge about STIs; condom use, knowledge and attitudes. The research instrument was developed based on the literature review on the subject and using information from the questionnaire for research with adolescents, developed by WHO¹².

For the present study, a set of 27 questions of the data collection instrument was used to obtain the variables surveyed.

Prior to the application of the research instrument, participants were guided by the researchers about the purpose of the study, completion of the questionnaire, reading and signing the Free and Informed Consent Form (FICF) for adults, minors and for those responsible/guardians. In addition to the first visit to the schools for data collection, a further visit was made with the objective of researching young people who were not present at the first moment. Additional visits were not carried out in order not to jeopardize the progress of school activities.

The identity of the adolescents interviewed was preserved, and each one was identified with an Arabic numeral for identification in the database. The research project was submitted to the Research Ethics Committee (REC) of the State University of Bahia, approved with an opinion no. 635.932 and CAAE protocol no. 26849914.3.0000.0057 and was elaborated in accordance with Resolution 466/2012 of the National Health Council/Ministry of Health ¹³.

The data collected were entered in the Statistical Package for Social Sciences (SPSS) version 9.0, and typing was performed twice. In the first step of the data processing, with the objective of evaluating the quality of the typing, the database consistency analysis was performed from the simple frequency listing, comparing the variables originated from each typing, and the correction of errors found was made.

Subsequently, an exploratory and descriptive analysis of the sample was developed based on the calculation of simple frequencies and respective proportions of the studied variables: socio-demographic (place of residence, gender, age, having children, ethnicity/skin color, marital status, religion, monthly income), sexual orientation, first sexual intercourse (age, number of partners so far, partner of first relation, use of contraceptive method, method used), use of contraceptive methods and prevention of STI (frequency of method use, method in use at the moment, where he/she acquires the contraceptive device, embarrassment in buying the condom, concern about being contaminated by STI, having had STI, frequency of condom use, reason not to use condoms in all relationships, knowing how to use condoms, having been pregnant or partner having got pregnant, if yes, what happened).

RESULTS AND DISCUSSION

According to the sociodemographic characteristics, the sample was mainly characterized by young women living in the urban area, female, heterosexual, aged between 16 and 19 years old, had no children, single, Catholic and with monthly family income of less than one salary minimum, as shown in Table 1.

TABLE 1: Sociodemographic characteristics of third-year high school students enrolled in state schools. Senhor do Bonfim, BA, 2014. (N=185)

^(*) Minimum Wage in force in 2014: R$ 724.00.

It should be emphasized that sexual orientation is closely related to pre-established concepts through cultural and/or religious values present, which, for the most part, reinforce the view that heterosexuality should be the predominant sexual orientation¹⁴. Thus, young homosexuals and bisexuals may not take their orientation in studies like this due to fear, shame or fear of rejection of society, whose values are closely associated with the valuation of heteronormative behavior.

The majority of young people interviewed started their sexual life mainly between 14 and 17 years, but 15 (11%) adolescents had the first sexual intercourse between 10 and 13 years, as shown in Table 2. A research conducted in Embu, SP, pointed out that the age of onset of sexual activity occurred in the age group of 14 years or younger for 91% of boys and 61% of girls¹.

TABLE 2: Characteristics of the first sexual intercourse of the students of third-year high school students enrolled in state schools. Senhor do Bonfim, BA, 2014. (N=138)

^(*) 138 adolescents of the sample had had sexual intercourse.
^(**) It included only young people who used the contraceptive method in the first sexual intercourse.

Deficiency and/or lack of guidance on the changes teenagers go through and curiosity about new experiences leave young people vulnerable to risk situations. In this context, the beginning of an active sexual life may occur early, with young people more likely to experience sexuality through unprotected and irresponsible sexual practices,³ which increases the risk of STI contamination, early gestation and a greater search for abortion, raising the risk of maternal mortality in adolescence.

With respect to the first sexual partner, 87 (63%) participants reported having had their first experience with their lover (boyfriend/girlfriend), which may show that aspects such as bonding and trust can be important prerogatives in the first sexual relationship.

Regarding the use of contraceptive method in the first relation, 99 (74.4%) students used some method. A study carried out in Montes Claros, MG, showed that less than half of the adolescents used some contraceptive method in the first relation¹⁵.

Maternity prevention is still placed in society as a responsibility of women, as evidenced by the fact that in many countries reproductive planning actions are directed primarily at women¹⁶, which contributes to the perpetuation of gender inequality in relationships and to reduced use of contraceptive method also among young people, since both genders are not aware nor considered responsible in the same way about contraception.

Among those who had used some method at the first sexual intercourse, 66 (67%) reported using condoms. Similar behavior was observed in a study conducted with students from São Paulo, SP, in which the majority of respondents who had used some method in the first relation referred to the condom as the most used method¹⁷.

Non-use of condoms can occur due to factors such as lack of communication with the partner on issues related to sex, forgetfulness, lack of confidence in the method, lack of knowledge about the risk of unprotected sexual practices, partner rejection for claiming interference in sexual pleasure ^1,4 and reliance on non-contamination in stable relationships.

The difficulty of negotiation between men and women about the use of condoms is a relevant gender issue. One of the measures that may contribute to greater freedom and empowerment of young women is the encouragement of the use of the female condom. But for this, there is a need for greater familiarity of health professionals with the method, so that they have tools that facilitate the adaptation of young women to the acceptance of the method¹⁸.

However, there is a need for better training of professionals for this action, because there are still technical and scientific needs regarding the particularities of adolescent health care in health professionals' interventions. Such unpreparedness to deal with adolescents was observed from reports of nurses researched in family health strategy in Fortaleza, CE¹⁹, which is an important obstacle for the implementation of promotion and prevention actions targeted at adolescents.

Regarding the current frequency of the use of methods to avoid pregnancy, 76 (55.9%) young people referred always using contraceptive methods and 53 (46%) used only condoms and 34 (29%) used the condom associated with some other method (double protection), according to Table 3. It is a trend that the frequency of condom use is higher in the first sexual relations, as observed in the present study, and it was later replaced by the pill or other methods, which may be related to a trust in the partner's loyalty ¹⁷.

TABLE 3: Description of the use of contraceptive methods and prevention of sexually transmitted infections among third-year high school students enrolled in state schools. Senhor do Bonfim, BA, 2014. (N=185)

^(*) 138 adolescents had had sex. ^(**)98 young people do not use condoms often.
^(***) It included only situations in which gestation had already occurred.

The drugstore stood out as the place where the young people most sought the contraceptive device in use, a fact that also prevailed in a study carried out with adolescents from the public and private schools in the municipality of Gurupi, TO²⁰, and that shows the deficiency in primary care in relation to establishing links between young people and health services, since they do not go to the health center to acquire the necessary device. In order to change the distance between health service and adolescents, there must be a restructuring of health policies directed to this group with emphasis on preventive actions and not only on healing actions²¹.

Among the adolescents studied, 122 (67.4%) reported knowing how to use condoms properly, but this did not reduce the concern about acquiring an STI, since 159 (86.3%) of the adolescents reported concern about the risk of contamination. It is observed that even though condom is a prevention method widespread in society, the fact of knowing it does not mean that all adolescents know how to use it properly. In the present study, when asked if they know how to use condoms properly, 8 (4.4%) young people reported that they did not know how to use the method and 51 (28.2%) did not know how to answer.

In this context, school, family and health sector have a fundamental role in guiding the correct use of this method and the importance of safe sexual practices.

The present study also points out that almost all of the interviewees reported never having been contaminated by STIs. However, epidemiological research shows that there are 33.4 million HIV-infected people in the world, and of these, one-third are between 10 and 24 years old²² .

STIs among young people represent a serious public health problem because of the physical, psychic and social consequences of life in the individual with these conditions. Among the physical sequelae, there is a problem in reproductive health such as pelvic inflammatory diseases, sterility, cervical cancer, ectopic pregnancy and infections during puerperium ²².

The low frequency of reports of STI contamination in this study may be related to the young person's fear of admitting that he or she has already become infected and that other people become aware of this situation, even though the anonymity of the research was guaranteed.

As to the frequency of condom use in all sexual relations, only 46 (34.3%) of the young people reported using condom, and among those who did not use it frequently, half reported that the reason for irregular use or not using condoms was because they only has sexual relations with people they know/partners.

In a research carried out in state schools in Cuiabá, MT, less than half of adolescents stated always using condom during sexual intercourse ³. A worrying result was also observed in a study carried out with university students in Rio de Janeiro, in which only 21.3% of the young people who had relationships with casual partners in the last 12 months had made use of condoms and approximately 50% of those who had sexual relation with a stable partner in this same period had used condom ²³.

Among the adolescents interviewed, 27 (19.4%) reported that they had already been pregnant or their partner had become pregnant at some point, which may represent failures in reproductive planning for this population. In this context, it is essential to guide young people about the importance of adherence to contraceptive methods and the morning-after pill in case of failure of the method or non-use thereof.

Regarding what happened when the teenager became pregnant or when a partner became pregnant, in 4 (14.8%) situations there was an abortion. A study carried out in schools in Cuiabá, MT, pointed out that among the young people who reported having already got their partner pregnant, 40% said that their girlfriends had performed an abortion²⁴.

Approximately half of pregnancies in Brazil are not planned; about one third end in abortion and, of these, 7% to 9% are performed by adolescents ^25,26.

Abortion among adolescents can be closely related to the intrinsic immaturity of this phase, as well as the lack of confidence that young people face in this situation, often not getting the support of their partner or even their parents¹⁴.

It is worth mentioning that other factors can be pointed as reasons for abortion, such as the fact that the woman or the couple simply does not wish to have a child or does not have social and financial support to care for a child.

CONCLUSION

The present research showed that most of the young people started their sexual life early, parallel to the vulnerability to STI and early pregnancy, considering that all adolescents interviewed do not always use condoms and other contraceptive methods. This justifies the fact that a significant portion had had an episode of gestation.

Since the first sexual relationship, condom use is nor adopted by all young people, and, over time, its frequent use is reduced. In this context, the relationship with a fixed partner should be highlighted as their justification for the unprotected sexual practice, which is a distorted notion of protection.

It is also important to emphasize the reduced interaction between the young and the health services, as the condom was predominantly purchased in pharmacy, which shows the need to review the communication process of this group, valuing primary care.

The study had as limitation the significant school dropout in the classes surveyed, which made it difficult for a greater number of young people to participate. In addition, adolescents tend to be afraid to reveal aspects related to their intimacy, which may in some moments compromise the trustworthiness of information.

Therefore, orientation and discussion about sexuality is a topic that must be addressed in the family environment as well as in the schools and health services in a permanent way, with the purpose of informing and raising adolescents awareness about the risks to which they are susceptible in this process of becoming an adolescent, encouraging them to perform safe practices and, consequently, to achieve a better quality of life.

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