Sexual behavior of adolescents with chronic disease and disability

Purpose: This study aimed to assess sexual behaviors, sexual orientation, pregnancy, and abuse history among adolescents with and without chronic conditions. Methods: Analyses were based on a statewide survey of 36,284 young people in the 7th through 12th grades for analytic purposes; subsets were defined using a specialized cohort design including adolescents with visible and nonvisible conditions plus controls. Principle outcome measures included self report of ever having sexual intercourse, age of sexual debut, reasons for not having intercourse, ever causing or having a pregnancy, ever having a sexually transmitted disease (STD), contraceptive use and reasons for their nonuse, history of sexual abuse, and sexual orientation. Results: No differences were evident between adolescents with and without chronic conditions in the proportion ever having intercourse, age of sexual debut, pregnancy involvement, patterns of contraceptive use, or sexual orientation. No differences were evident among girls or boys with visible compared with invisible conditions. A significantly greater proportion of girls and boys with invisible conditions than controls reported a history of sexual abuse. More index boys than controls reported ever having an STD, whereas more girls with visible conditions than controls reported this. Conclusions: Adolescents with chronic conditions are at least as sexually involved as their peers, and significantly more likely to have been sexually abused. Visibility of chronic conditions does not appear to affect the sexual behaviors of adolescents. The need for comprehensive sexuality education in this population is high, and discussion of sexuality, contraception and abuse must be part of standard psychosocial assessment and anticipatory guidance for all teenagers, including those with chronic conditions.