"These findings suggest that adults should discuss more than one type of sexual practice when they counsel teens," said Bonnie Halpern-Felsher, PhD, associate professor of adolescent medicine at the University of California, San Francisco (UCSF). She conducted a survey of 580 ethnically diverse Northern California ninth-graders in the first study to investigate adolescents' perceptions of the consequences of having oral sex as opposed to vaginal sex.

Peer Approval

Young teens participating in the UCSF survey considered oral sex to be significantly less risky to their health than vaginal sex. The adolescents believed that oral sex also was less likely to have negative social and emotional consequences, such as a bad reputation, getting into trouble, feeling bad about themselves, feeling guilty, or endangering a relationship.

The study findings also showed that teens considered oral sex less of a threat to their values and beliefs. Oral sex is more acceptable than vaginal sex for adolescents, when the partners are dating each other and also when they are not dating, the surveyed teens said. They also expected that more of their peers would have oral sex than vaginal sex in the near future.

Approximately one-fifth (19.6 percent) of the ninth graders reported that they had tried oral sex, compared to 13.5 percent who said they had experienced vaginal sex. Almost one-third (31.5 percent) said they intended to have oral sex within the next six months, compared to 26.2 percent who intended to have vaginal sex.

Engaging in Discussions

"The fact that young adolescents around age 14 are having or considering oral sex and consider it safer and more acceptable than vaginal sex is important information for parents, health care providers and others who work with youth," Halpern-Felsher said. "When we counsel adolescents about the risks and benefits associated with sex, we need to understand how they perceive it among themselves."

Guidelines for adolescent health care call for physicians and other health providers to discuss sex and other risky behaviors during regular medical checkups. Those sessions are one opportunity to work with adolescents on the topic of risks and preventive measures with oral sex, as well as vaginal and anal sex, Halpern-Felsher said.

"Parents and caregivers also should find opportunities to engage teens in discussions about the emotional and social aspects of all types of sex, to get them thinking about whether their perceptions match their own situations," she said.

STD Risk

One troubling finding of the study was the teens' perception of the health risks of oral sex. Most of the participants recognized that there is some risk of infection with sexually transmitted diseases, such as chlamydia and HIV, and accurately ranked this risk less than with vaginal sex. However, one in seven participants thought that the risk of STDs from oral sex would be zero.

The UCSF researchers noted other studies that show a general misperception that oral sex entails no risk at all or very little risk. When oral sex is more frequent, sexually transmitted infection rates could rise if those who engage in oral sex do not use barrier protection, they pointed out.

"There is not much data about the chances of sexually transmitted infections due to oral sex, but there is a real risk," Halpern-Felsher said. "When teens are engaging in or considering oral sex, they need to know about methods to keep themselves safe from physical as well as emotional risks."

Study Participants

The findings come from a larger longitudinal study on the relationship between adolescents' perceptions and their actions when behaviors pose health and emotional risks. In previous research, Halpern-Felsher has shown that teenagers are highly aware of risks, and that time and experience lead to changes in their perception of the danger to themselves.

Participants in the study were students at two California high schools who completed a questionnaire during class after their parents consented to their participation. The mean age of the participants was 14.5 years; 58 percent were girls and 42 percent were boys.

Their ethnic diversity was similar to that of their schools: approximately 40 percent White, 24 percent Latino, 17 percent Asian with others describing themselves as Pacific Islander, African American, American Indian/Alaskan Native and mixed or other.