The onset of sexual maturation (puberty) typically is accompanied by an interest in sexual anatomy, which may be a source of anxiety. As adolescents mature emotionally and sexually, they may begin to engage in sexual behaviors. Masturbation is common among girls and nearly universal among boys. Sexual experimentation with a partner often begins as touching or petting and may progress to oral, vaginal, or anal sex. By late adolescence, sexuality shifts from experimentation to being an expression of intimacy and sharing. Doctors should provide appropriate advice on safe-sex practices as part of routine health care and should screen all sexually active adolescents for sexually transmitted diseases.

Few elements of the human experience combine physical, intellectual, and emotional aspects as thoroughly as sexuality. Helping adolescents put sexuality into a healthy context, including issues of morality and the formation of a family, is extremely important. Parents should share their values and expectations openly with their adolescent children.

Some adolescents struggle with the issue of sexual identity. Many of those who explore homosexual relationships ultimately do not continue to be interested in same-sex relationships, whereas others never develop interest in opposite-sex relationships. Homosexuality is a normal variation of human sexuality and not a disorder (see see Sexuality: Homosexuality). Although it is not understood exactly why homosexual feelings develop, experts do not think homosexuality is something adolescents learn from their peers or the media or something they choose the same way they select an after-school activity or a career path.

Homosexual adolescents may face unique challenges as their sexuality develops. Adolescents may feel unwanted or unaccepted by family or peers if they express homosexual desires. Such pressure (especially during a time when social acceptance is critically important) can cause severe stress. Fear of abandonment by parents, sometimes real, may lead to dishonest or at least incomplete communication between adolescents and their parents. These adolescents also can be taunted and bullied by their peers. Threats of physical violence should be taken seriously and reported to school officials. The emotional development of homosexual and heterosexual adolescents is best helped by supportive friends and family members.

Last full review/revision February 2009 by Sharon Levy, MD, MPH