Over the past few decades, nationally representative surveys have accumulated a wealth of data on levels of adolescent sexual activity. Thanks to such surveys, we know how the proportion of 15-19-year-olds who have ever had intercourse has changed over the years. Similar data exist on age at first intercourse, most recent sexual intercourse and current contraceptive use.

Yet all of these measures focus on--or relate to the possible results of--vaginal intercourse. This is natural, given that attention to adolescent sexual activity arose initially out of concerns over the far-reaching problems associated with teenage pregnancy and childbearing. More recently, infection with sexually transmitted diseases (STDs), particularly with HIV, has fueled further public and scientific interest in teenage sexual behavior.

But to what extent does adolescent sexual activity consist of noncoital behaviors--that is, mutual masturbation, oral sex and anal intercourse--that are not linked to pregnancy but involve the risk of STDs? Some of these activities may also be precursors to vaginal intercourse. Yet, health professionals and policymaker

How valid are these anecdotal reports? Unless and until data to verify them become available, we have only impressions to go on, and there is by no means a consensus among adolescent health professionals. Some believe the level of participation in oral sex and other noncoital behaviors is probably higher now than it was in the past, while others have a "hunch" that oral sex is no more common, just much more talked about.

Two early-1990s surveys based on total high school enrollment, instead of single-subject college classes, came out of efforts to evaluate condom availability programs for HIV prevention.35 In 1992, baseline data collected for such a program in Los Angeles among 2,026 ninth-12th graders indicated that 29-31% of the virgins in this sample had engaged in masturbation with a partner, and 9-10% of those who had not yet had coitus had nonetheless had oral sex. Very few (1% of noncoitally experienced students) revealed that they had ever engaged in anal intercourse.36 Another study from 1992, also designed to collect baseline data for a condom program evaluation, was conducted in suburban high schools in the New York City metropolitan area. The director of that study said it unexpectedly uncovered considerably higher rates of oral intercourse than of vaginal intercourse.37

The lack of guidelines on what activity is appropriate when is a common concern among professionals who work with adolescents. Educators who endorse comprehensive sexuality education support giving adolescents the criteria they need to decide when to abstain or when to participate across the full continuum of sexual behaviors. Abstinence proponents are wrestling with how to handle an evolving dilemma that pits those who stress the need to be as precise as possible in specifying the range of behaviors to be abstained from against others who insist that such specificity violates the core of abstinence-only education.

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