1. Factors Associated to the Occurrence of the First Intercourse in Adolescents Authors: Prof. Dr. Jorge Pelaéz Mendoza Dr. Orlando Rodríguez Pons Dr. Raúl Bermúdez Sánchez JPM/SIJ.SCOG/1999

2. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Today’s adolescent are affected by a disproportionately high prevalence of unplanned pregnancies, sexually transmitted diseases, including AIDS, and other serious problems that affect their reproductive health. A risky sexual behaviour is considered responsible of all of this problems

3. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Precocious first intercourse. Poor recognition of the risks involved in relationships held in inappropriate circumstances and places. Frequent changes of couples. Ignorance about sexuality. Birth control is not considered as a couple’s problem. Lack of essential knowledge and use of contraceptive methods. Insufficient knowledge about STD and their prevention. Risky Sexual Behaviour

4. Factors Associated to the Occurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Defined as the first coitus seen as an intimate experience of communication of desires, affections and instincts between two human beings, which could take part voluntarily or involuntarily. Sexual Initiation:

5. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 It is considered as a sexual relationship that begins before the adolescent’s arrival to the consolidation stage, between ages 17 and 19 (Bloss & Erickson 1989) Precocious Sexual Initiation:

6. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Adolescent Psychosexual Development : Adapted from Bloss and Erickson

7. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Adolescent Psychosexual Development: Adapted from Bloss and Erickson

8. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Commitment in a couple does not end in the mutual preoccupation about sexual pleasure, but extends up to include the reciproque responsability on birth control and the results of such union, in other words, pregnancy. Master and Jhonson, 1989

9. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Frustrating experiences favouring sexual dysfunction. Continuous changes of couple resulting in a risky sexual behaviour. Increased risk of STD, genital infections and their sequels(CIN-PID). Higher risk of abortion. Unplanned pregnancies and their consequences. Higher risk to suffer from PID and its medium & long term consequences (infertility/ectopic pregnancy). Increased reproductive risk. Precocious sexual initiation, consequences:

10. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 1.To know the frequency of adolescents attending secondary school that have initiated intercourse. 2.To determine the causes that lead them to have a precocious intercourse. 3.To study the adolescent’s environment to establish risk and protective factors for precocious intercourse. 4.To know the characteristics and motivation for the first intercourse. Objectives of the study:

11. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Eight junior high, technical and high school institutions from Havana City were randomly selected. A self responded and anonymous questionnaire was applied to the totality of students who went to classes on the day established by the study. Four multidisciplinary teams were created who were responsible for the application of the questionnaire. Method:

12. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 A total of 2713 students filled the questionnaire. Seventy three questionnaires were excluded due to incompleteness or mistakes, totalling 2640 students (1425 males, 1215 females) Informed consent was obtained from each individual and Institution. Method:

13. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Adolescents included in the survey by gender 1215 46% 54% 1425 Sources: Adolescent Sexuality Survey Havana 1998

14. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Distribution by age Sources: Adolescent Sexuality Survey Havana 1998 Ages

15. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Sexual initiation by Gender Sources: Adolescent Sexuality Survey Havana 1998 P<0,005

16. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 Sexual initiation by age and gender Sources: Adolescent Sexuality Survey Havana 1998 Ages P<0,005

17. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 First Intercourse: Characteristics of the partner. Sources: Adolescent Sexuality Survey Havana 1998

18. Factors Associated to the Ocurrence of the First Intercourse in Adolescents JPM/SIJ.SCOG/1999 First Intercourse: Causes or motivation. Sources: Adolescent Sexuality Survey Havana 1998 P<0,005

19. Factors Associated to the Ocurrence of the First Intercourse in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 Characteristics of Peers Groups Sources: Adolescent Sexuality Survey Havana 1998 P<0,005 Peers Group

20. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 Antecedents of abortion in Peers Groups Sources: Adolescent Sexuality Survey Havana 1998 P<0,005 Peers Group

21. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 Characteristics of the family. Sources: Adolescent Sexuality Survey Havana 1998 Relationships P<0,005

22. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 Adolescent Convivence. Sources: Adolescent Sexuality Survey Havana 1998 Convivence P<0,005

23. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 First Intercourse: Judgement by Gender Sources: Adolescent Sexuality Survey Havana 1998 P<0,005

24. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 First Intercourse: Use of contraceptive methods Sources: Adolescent Sexuality Survey Havana 1998

25. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 Sources: Adolescent Sexuality Survey Havana 1998 First Intercourse: Reasons given for not use contraceptive

26. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 Sources: Adolescent Sexuality Survey Havana 1998 First Intercourse: Where it happened

27. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 Sexuality information level Sources: Adolescent Sexuality Survey Havana 1998 Information level P<0,005

28. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 Life Project Sources: Adolescent Sexuality Survey Havana 1998

29. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 Life Project Sources: Adolescent Sexuality Survey Havana 1998 Life Project P<0,005

30. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 There is a high percentage of adolescent that initiate precociously their sexual relationships, more frequently among males. The majority of adolescents start their first intercourse voluntarily, although some of them under some degree of pressure from their counterparts and groups. Belong to a group in which the majority have begun sexual relationship, as well as to belong to a dysfunctional family behaved as risk factor of precocious sexual initiation. Conclusions:

31. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 A vast majority of adolescents had their first intercourse in inappropriate places and circumstances, did not use contraceptive methods. A great percentage of female referred a non-pleasant experience for their first intercourse. The convivence with both parents, as well as a clear definition of their life project behaved as a protective factors of the precocious sexual initiation Conclusions:

32. Sexual Practices in Adolescents Sexual Initiation JPM/SIJ.SCOG/1999 An intense work should be developed aimed to the elimination, modification or control of reproductive risk factors in adolescents, with special attention to the precocious sexual initiation. The following aspects should be considered: Gender perspectives Education in sexual health Programs for the development of youth Psicologic and social pressures Media participation Recommendations: