Sexual behaviour and early coitarche in a national sample of 17-year-old Swedish boys.

AIM: To describe sexual behaviour as reported by 17-year-old boys in Sweden. METHODS: The national cross-sectional SAM 73-90 questionnaire survey was performed in 1990, and comprised 2% of students and school non-attenders born in 1973. The respondents included 814 students and 92 non-students, response rates 90.6% and 40.2%, respectively. Data from the two groups are treated separately. RESULTS: In the student group, 54.2% of boys had experienced vaginal intercourse and 16.7% were "early starters" with coitarche before 15 y of age. Independent predictors for coital experience were the vocational study programme OR (odds ratio) 1.91 (95% CI 1.31-2.78), early puberty OR 1.69 (95% CI 1.11-2.57), use of tobacco OR 5.32 (95% CI 2.43-11.7) and alcohol OR 4.09 (2.79-5.98). Sexually transmitted infections (STIs) were reported by 4.1% of coitally active student boys, and impregnating a girlfriend by 4.3%. Of the early starters, 14.6% reported having more than 10 sex partners as compared with 2.5% of the later starters (p < 0.0001) and this was predictive of STI, OR 5.4 (95% CI 1.5-19.7). First-date intercourse more than twice was predictive of pregnancy, OR 14.4 (95% CI 3.8-54.5). Among school non-attenders, 74.2% reported coital experience, 33.7% were early starters, and 12.5% had impregnated a girl. CONCLUSION: Boys' early sexual experience was related to early puberty, and to general adolescent risk-taking behaviour. Early coitarche per se was not predictive of STI or pregnancy, but the associated high number of "lifetime" sexual partners and first-date intercourse were predictive factors. School non-attenders constituted a group at risk.

Adolescent sexual health in Sweden.

In Sweden, society's attitudes towards teenage sexual relationships are liberal, and sexual and reproductive health issues are given high priority. Family and sex education has been taught in schools since the 1950s. The age of sexual consent is 15 years. Since 1975, abortion has been free on demand. Contraceptive counselling is free, easily available at family planning and youth health clinics. Screening for genital chlamydial infection is performed at these clinics, thus providing a "one stop shop" service. Condoms and oral contraception are available at low cost, emergency contraception is sold over the counter. Teenage childbearing is uncommon. However, sexual and reproductive health problems are on the increase among young people. During the 1990s, a period of economic stagnation in Sweden, schools have suffered budget cut backs. Sex education is taught less. Social segregation, school non-attendance, smoking, and drug use have increased. Teenage abortion rates have gone up, from 17/1000 in 1995 to 22.5/1000 in 2001. Genital chlamydial infections have increased from 14,000 cases in 1994 to 22,263 cases in 2001, 60% occurring among young people, and with the steepest increase among teenagers. Thus, a question of major concern is whether and how adolescent sexual behaviour has shifted towards more risky practices during the late 1990s.

An outbreak of syphilis in Oslo.

During 1999 and 2000, an outbreak of syphilis occurred in Norway: 93 cases were reported to the National Institute of Public Health. This report summarizes a retrospective investigation of the medical records of 60 patients with primary, secondary and early latent syphilis treated during 1999-2000 at the Department of STD at the Ullevål University Hospital in Oslo. Five women and 55 men were treated, mean age 38.6 and 44.9 years, respectively. Of the 60 cases, 14 (23.3%) had primary, 39 (65.0) secondary and seven (11.7%) early latent syphilis. Men who have sex with men (MSM) constituted 78.2% (43/55) of the male patients. Transmission among MSM was related to casual sexual contacts in bathhouses in Oslo. Two cases occurred among men with previously diagnosed HIV infection. Two new cases of HIV were reported. Condom use was inconsistent, and seldom used for oral sex.

Sexual behaviour and early coitarche in a national sample of 17 year old Swedish girls.

OBJECTIVE: To evaluate sexual behaviour in 17 year old girls, using data from a national survey on adolescent sexuality. METHOD: The study was based on two samples of 17 year olds, comprising 2% of the population born in 1973 and carried out in 1990. A school sample and a sample of school non-attenders were recruited in a two step procedure. Data were collected by anonymous self administered questionnaires. 2583 questionnaires were distributed. Response rates from students was 92%, for school non-attenders 44%. 1121 female students and 118 female school dropouts responded. RESULTS: 64% of the student girls had experienced their first intercourse; 16% were "early starters" with coitarche before age 15. STD and pregnancy were reported by 15% of early starters and pregnancy by 14%, p < 0.001 and 0.002 respectively when compared with later starters. The number of coital partners, experience of first date intercourse, and of oral and anal sex was higher in the early starters, p < 0.001. Early starters reported menarche at age 11 or earlier more often than the later starters (OR 2.30, 95% CI 1.48-3.56), as well as a perceived social age exceeding the chronological by 2 years (OR 1.94, 95% CI 1.34-2.80). Sexual abuse was reported by 20% of the early and 11% of the later starters, p = 0.002. Among school non-attenders no significant differences were found with regard to age for coitarche. A majority of 83% of the girls had experienced voluntary intercourse, and 49% were early starters. Five girls were mothers. STD was reported by 19% and induced abortion by 14%. Sexual abuse was alleged by 28%. CONCLUSION: Coitarche before age 15 is related to early menarche and high perceived social age. High number of partners and first date intercourse make early starters at increased risk for STD and unintended pregnancy. Sexual abuse is alleged more often by early starters.

Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen-year-old boys and girls.

The aims of this study, which was part of a survey on adolescent sexual behaviour, were to investigate adolescents' experience of child sexual abuse and to present possible abuse-related problems. Representative samples of 2% of Sweden's 17-y-old male and female students and school non-attenders were selected in a two-step procedure. In all, 1943 students and 210 school non-attenders answered a self-administered anonymous questionnaire, distributed by school nurses. Six out of 170 questions dealt with personal experiences of child sexual abuse, i.e. age at onset, frequency of abuse and relationship to the offender. Peer abuse was excluded by the definitions used. The overall response rate was 92.2% for students and 44.2% for school dropouts. Among male and female students, 3.1% and 11.2%, respectively, acknowledged sexual abuse, 2.3% and 7.1%, respectively, when exhibitionism was excluded. Mean age at onset was 9.1 y (SD 4.3) for boys and 9.0 y (SD 3.9) for girls; 1.2% of the boys and 3.1% of the girls reported abusive oral, vaginal and/or anal intercourse. Suicide attempts or other acts of self-harm were reported by 33.3% of the male students reporting abuse and by 5.1% (p < 0.001) of those who had not been abused, and by 30.4% of the abused student girls compared to 9.1% of the non-abused (p < 0.001). Sleep and eating disorders, use of alcohol at an early age and/or experimentation with illicit drugs and consensual coitarche before age 15 y was reported significantly more often by abused than non-abused girls (p < 0.001, differences not found among the student boys). Of school non-attenders, 4% of the boys and 28% of the girls reported sexual abuse. Of the abused girls, 49% reported abusive vaginal intercourse and 64% reported self-destructive behaviour or suicide attempts. No abused boys and few abused girls had confided in a teacher, health professional or social worker. Results from the student sample should be interpreted as markers of "minimum prevalence", as female school non-attenders report significantly higher prevalence of sexual abuse. Potential high-risk groups are better included in prevalence investigations of child sexual abuse. The fact that so few adolescents confided in "professionals" about the abuse, despite having severe symptoms and signs of distress, underlines the need to address sexual abuse when recording the social, medical and psychiatric histories of adolescents.

Adolescent girls investigated for sexual abuse: history, physical findings and legal outcome.

OBJECTIVE: The aim of the study was to summarize the history of assault and record the results of medicolegal examination in adolescent girls under investigation for alleged sexual abuse, and to monitor the outcome of the legal process. The investigation period was 1990-94. METHOD: A consecutive series of 94 0-para girls, aged 9-22, median age 15.0 years, were examined in the head-to-toe manner including anogenital examination. Girls were referred from investigating police and social authorities. Only non-acute examinations were performed. Findings considered consistent with abusive vaginal penetration were hymenal distortion including deep clefts, hymenal and vestibular scarring, and introital diameter permitting vaginal inspection with a 17 mm speculum in the absence of consensual intercourse. Perianal scarring was recorded. STD sampling was made on indication. Findings were documented on body sketches. Medicolegal conclusions were grouped into three categories according to history and physical findings. Information on the outcome of legal procedures was collected from referring authorities. RESULTS: For 82% (77/94) of the girls, referring agencies provided examining physicians with a detailed and consistent history of abuse, presented results comprise these 77 girls. Intrafamiliar abuse was alleged by 81% (62/77), onset prior to menarche by 53% (41/77), and repeated abuse by 74% (57/77) of the girls. Abusive genital penetration was reported by 77% (59/77) and anal penetration by 19% (14/77). Sequelae after admitted self-inflicted injury were found in 15% (12/77). Deep hymenal clefts and/or vestibular scars were found in 59% (35/59) of the girls reporting penetrative abuse, compared with 6% (1/16) when non-penetrative abuse was alleged, P < 0.001. Girls with experience of voluntary intercourse could all be examined with a 25 mm speculum. Of the 17 girls without experience of consensual intercourse but alleging abusive penetration, 47% (17/36) could easily be examined with a 17 mm speculum, compared to none of 13 reporting non-penetrative abuse, P < 0.001. Non-specific anal abnormalities occurred in 10 (13%) girls; more often when anal abuse was reported, P < 0.001. No specific STDs were found. The medicolegal conclusion supported a history of abusive genital penetration in 41 (69%) cases; findings were non-specific in 11 cases and a normal anogenital status was found in 25 cases. The alleged abuse of 34 of the 77 (44%) girls was tried in court. One suspect was acquitted, 32 men were convicted of the abuse of 33 girls. Eleven perpetrators admitted abuse, and their histories were in concordance with the abuse alleged by the victims, as well as with the physical findings. CONCLUSION: A medicolegal diagnosis of alleged non-acute cases of sexual abuse relies on a detailed history. Adolescent girls alleging abuse may exhibit signs of admittedly self-inflicted extragenital injury. Our findings confirm that non-penetrative sexual acts leave no lasting genital signs, but that repeated abusive genital penetration significantly more often than non-penetrative abuse leaves deep posterior hymenal clefts and/or vestibular scarring, and a hymenal opening allowing examination with 17-25 mm specula also in girls without experience of voluntary intercourse. In cases with a confessing perpetrator, no discordance was found between the history of the victim, medicolegal conclusion and the history of the perpetrator.

Sexual experience, abortion and sexually transmitted diseases among young women at a contraceptive clinic.

All visitors who during one year visited a contraceptive clinic in the Solna district of Stockholm County and were below the age of 26 were asked to fill in a questionnaire and offered a test for C. trachomatis. Three hundred and six women (97%) participated. Ninety percent had at some time used oral contraceptives and 91% had experience of condom use. One-fifth of the whole group had undergone one or more legal abortions, and one fourth had experience of a sexually transmitted disease (STD). The most common STD experienced was chlamydia, followed by condyloma. The actual prevalence of chlamydia in the group was 6%. Sexual contacts were often made early in on-going steady relations. Forty-two percent admitted casual sex, but the number of life-time partners was five or less among the majority.

PIP: All visitors to the contraceptive clinic in the Solna district of Stockholm County over a 1-year period who were under age 26 were asked to complete a questionnaire and were offered a test for C. trachomatis. 306 women (97%) participated; 90% had at some time used oral contraceptives and 91% had used a condom. 1/5 of the entire group had undergone 1 or more legal abortions and 1/4 had experienced a sexually transmitted disease (STD). The most prevalent STD was chlamydia, followed by condyloma. The actual prevalence of chlamydia in the group was 6%. Sexual contacts were often made early in the relationship. 42% admitted casual sex but the number of lifetime partners was 5 or less among the majority.