Dating Violence in Adolescence: Implications for Girls’ Sexual Health

Adolescents in the United States are too often involved in relationships characterized by coercion and violence. An emerging body of research suggests that dating violence is linked with other health risks in adolescent relationships, particularly sexual risk behavior. The confluence of risks conferred by dating violence and sexual risk behavior are particularly acute for adolescent girls. Adolescent gynecology providers need to understand the nature of dating violence in adolescence and the ways in which dating violence and sexual risk behavior are mutually influential. This article reviews the literature on the links between dating violence and sexual risk in adolescent girls’ relationships. The prevalence, risk factors, and consequences of dating violence in adolescence are discussed, followed by a review of the research linking dating violence and sexual risk, with a focus on common mechanisms underlying these relationship risk behaviors. The review concludes with implications for screening, prevention, intervention, and future directions for research.     

Increased Body Mass Index Associated with Increased Risky Sexual Behaviors

Study ObjectiveThe increasing prevalence of adolescent obesity has led to consideration of the potential effect of obesity on risky sexual behaviors. In the current study we examined whether body mass index (BMI) was related to age at sexual debut, type of sexual behavior, partner number, and condom use in a population of adolescent women at high risk for obesity and risky sexual behaviors.Design, Setting, and ParticipantsCross-sectional examination of 860 sexually active, predominantly minority, adolescent women who received medical care at an urban health center from 2007 through 2013.Intervention and Main Outcome MeasuresSelf-reported age at sexual debut, types of sexual intercourse, number of partners and condom use was compared with clinically assessed BMI.ResultsBMI was positively associated with number of sexual partners (P = .001) and history of attempted anal intercourse (P = .002). An inverse association was observed with age at first anal intercourse (P = .040).ConclusionIn this sample of adolescent women, increased BMI was associated with riskier sexual practices at a younger age. Results of this study suggest that overweight and obese adolescents are a vulnerable population who might need targeted sexual health counseling.     

Association of risk-taking behaviors with adolescent childbearing.

BACKGROUND AND PURPOSE: Risk-taking behavior has been shown to be associated with adolescent pregnancy or childbearing. However, the specific risk-taking behavioral factors and the extent to which they are associated with adolescent childbearing is less clear. The purpose of this study was to determine the risk-taking behavioral factors associated with adolescent childbearing. METHODS: In this case-control study, 198 mothers aged from 16 to 19 years with first-born infants born in Taichung City in 1997 were enrolled. The controls were adolescents with no history of childbearing or pregnancy matched for age and residential neighborhood of each case. A self-administered structured questionnaire inquiring about a variety of risk-taking factors was used to gather relevant information. The logistic regression model was used for univariate, combination of variables, and multivariate analysis. RESULTS: Compared to controls, childbearing adolescents were more likely to have risk-taking behaviors including smoking, drinking, use of illegal substances, working at bars or nightclubs, and lack of use of contraception at first sexual intercourse. Logistic regression analysis for various combinations of risk-taking behaviors revealed that the more items of risk-taking behaviors adolescents had, the higher their risk of childbearing. Multiple logistic regression analysis showed that use of alcohol (adjusted OR = 1.9, 95% CI 1.1-3.1), working at sex-related workplace (adjusted OR = 4.7, 95% CI 2.4-9.3), and no use of contraceptive device at first intercourse (adjusted OR = 3.1, 95% CI 1.3-7.2), were significant risk factors for adolescent childbearing in subjects with previous sexual intercourse. CONCLUSION: Adolescent females who used alcohol, worked at bars or nightclubs or used no contraception at first intercourse were more prone to adolescent childbearing, and a combination of risk-taking behaviors could increase the risk of childbearing. These risk-taking factors should be taken into consideration in the development of prevention programs.     

Married Women's Risk of STIs in Developing Countries: The Role of Intimate Partner Violence and Partner's Infection Status

Data for nationally representative samples of cohabiting couples in six developing countries show that intimate partner violence (IPV) increases the risk of self-reported sexually transmitted infections (STIs) for currently married women (ORs = 1.4-2.2) in all six countries, and that the strength of this relationship is not diminished by controls for proximate determinants such as husband's self-reported STI status and men's and women's higher-risk behaviors. The robustness of the IPV-STI relationship suggests the need to acknowledge IPV as an STI risk factor for women on par with other recognized risk factors such as multiple sexual partners and unprotected sexual intercourse.     

The Impact of the COVID-19 Pandemic on Sexual Behaviors: Findings From a National Survey in the United States

BackgroundStudies from the first months of the coronavirus disease 2019 (COVID-19) pandemic and the resulting lockdown and social distancing measures have shown that there have been decreases in sexual frequency and relationship satisfaction.AimTo evaluate the ongoing impact of the COVID-19 pandemic on sexual behavior, relationship satisfaction, and intimate partner violence in the United States using a large national convenience sample.MethodsAbout 1,051 participants across the United States were recruited in October 2020 to complete a cross-sectional online survey.OutcomesParticipants were asked to retrospectively report their sexual behavior frequency, relationship satisfaction, and intimate partner violence during the pandemic and prior to the pandemicResultsThere was a small but significant decrease in some retrospectively-reported partnered sexual activities, and men reported a small increase in masturbation and pornography use. There was no evidence for a change in relationship satisfaction or intimate partner violence, but both men and women reported a small decrease in sexual pleasure, and women reported a small decrease in sexual desire. The sexual behaviors with greatest reduction were casual sex, hookups, and number of partners, and the most diminished as aspect of sexual functioning was sexual enjoyment. Depression symptoms, relationship status, and perceived importance of social distancing emerged as predictors of these reductions. Less than half of individuals who engaged with casual sex partners before the start of the pandemic ceased this behavior completely after the start of the pandemic. Individuals waited on average 6–7 weeks before reengaging in casual sex.Clinical ImplicationsThese results inform public health response to the effects of the pandemic and add to our understanding of how the pandemic has continued to impact sexual behavior.Strengths and LimitationsThis is the first known study to evaluate sexual behavior several months into the COVID-19 pandemic using a large national sample. However, the results of this study are limited by its convenience sampling method and cross-sectional design.ConclusionThese results indicate that the changes in sexual behavior observed in the early months of the pandemic have continued, with small but significant decreases in many partnered sexual behaviors and a small increase in men's solitary sexual behaviors.Gleason N, Banik S, Braverman J, et al. The Impact of the COVID-19 Pandemic on Sexual Behaviors: Findings From a National Survey in the United States. J Sex Med 2021;18:1851–1862.     

Examining Links between Sexual Risk Behaviors and Dating Violence Involvement as a Function of Sexual Orientation

Study ObjectiveTo examine the association between dating violence perpetration and victimization and sexually risky behaviors among sexual minority and heterosexual adolescent girls.DesignAdolescent girls reported on sexual orientation, sexual behaviors, and risk-taking, and their use of, and experience with, dating violence in the past year. Data were analyzed using multinomial regression adjusted for race, poverty, living in a single parent household, and gender of current partner to examine (1) whether sexual minority status was associated with sexual risk behaviors after sociodemographic correlates of sexual risk were controlled; and (2) whether dating violence context accounted for elevated risk.SettingUrban, population-based sample of girls interviewed in the home.Participants1,647 adolescent girls (38% European American, 57% African American, and 5% other) aged 17 years. Over one-third of the sample lived in poverty.InterventionsNone.Main Outcome MeasureSexual risk-taking.ResultsSexual minority status differentiated girls engaging in high sexual risk-taking from those reporting none, after controlling for sociodemographic and relationship characteristics. Dating violence perpetration and victimization made unique additional contributions to this model and did not account for the elevated risk conferred by sexual minority status.ConclusionsSexual minority girls (SMGs) were more likely than heterosexual girls to report high sexual risk-taking and teen dating violence victimization. As with heterosexual girls, sexual risk-taking among SMGs was compounded by dating violence, which was not explained by partner gender. Adolescent girls' risky sexual behavior may be reduced by interventions for teen dating violence regardless of sexual minority status.     

Strategies for Conducting Adolescent Health Research in the Clinical Setting: The Mount Sinai Adolescent Health Center HPV Experience

BackgroundClinical research with adolescents can be challenging due to issues of informed consent, parental involvement, institutional review board requirements, and adolescent psychosocial development. These requirements present a dilemma, particularly in the area of sexual health research, as adolescents are disproportionately affected by sexually transmitted infections such as human papillomavirus (HPV). To successfully conduct adolescent research in the clinical setting, one requires an awareness of state statutes regarding adolescent confidentiality and consent for medical care, and a close partnership with the IRB.Case StudyIn 2007, the Mount Sinai Adolescent Health Center in collaboration with the Albert Einstein College of Medicine developed a longitudinal research study to examine the natural history of oral, cervical, and anal HPV in an adolescent female population engaged in high-risk sexual behaviors. We use this research project as a case study to explore the ethical, methodological, and clinical issues related to conducting adolescent health research.Summary and ConclusionsSeveral strategies were identified to promote adolescent study participation, including: (1) building a research team that is motivated to work with adolescents; (2) combining research and patient care visits to avoid duplication of services; and (3) establishing a personalized communication network with participants. Using these methods, adolescent sexual health research can successfully be integrated into the clinical setting. While retaining a prospective cohort of adolescents has its challenges, a persistent and multi-disciplinary approach can help improve recruitment, sustain participation, and acquire critical data that will lead to improved healthcare knowledge applicable to understudied populations of adolescents.     

Adolescent sexuality and sexual behavior

PURPOSE OF REVIEW: Adolescence is a time of self-discovery and physical, as well as cognitive, development. It is within this context that adolescent sexual development and sexual behavior occur. While curiosity and experimentation are normal, sexual behaviors, both coital and non-coital, place adolescents at risk for undesired consequences including sexually transmitted disease acquisition and pregnancy. Trends in adolescent sexual behavior are changing, and health care professionals must be aware of these trends to provide necessary medical care and education to this population. RECENT FINDINGS: While the sexual activity of teenagers garners much attention, attention must also be directed at non-coital activities such as masturbation, mutual masturbation and oral sex, as the riskier of these behaviors appear to be increasing. The trends in sexual activity and contraceptive use are encouraging with a decrease in the proportion of adolescents reporting sexual activity, and an increase in the proportion reporting using contraception. These trends, however, are not shared equally among racial groups with the greatest decline reported in the in lowest risk groups. Sexual minority youth continue to report a higher prevalence of high-risk behaviors, both sexual and non-sexual, as compared to their heterosexual peers. SUMMARY: These findings highlight the multiple roles health care professionals can play in caring for this unique population: firstly as health care providers, offering age appropriate, confidential health care; secondly, as reproductive health care educators providing factual, balanced, and realistic information to both teenagers and the community; and thirdly, as advocates lobbying for greater education and services for this at-risk population.     

Unfaithful Individuals are Less Likely to Practice Safer Sex Than Openly Nonmonogamous Individuals

IntroductionGiven the prevalence and harm of sexually transmitted infections (STIs), there is a need to examine safer sex strategies in the context of romantic relationships and extradyadic sexual encounters. Sexual infidelity is associated with a variety of detrimental psychosocial outcomes; however, little research has addressed the sexual health ramifications of sexually unfaithful partners and members of other high-risk nonmonogamous lifestyles.AimsTo determine whether sexually unfaithful individuals or “negotiated nonmonogamous” individuals are more likely to engage in sexual health risk reduction behaviors during extradyadic encounters and with their primary partner.MethodData were collected via an anonymous Internet-based study. Several hundred sexually unfaithful individuals and individuals with a negotiated nonmonogamy agreement completed a sexual health questionnaire.Main Outcomes MeasuresSelf-reported measures of risk reduction behaviors within the primary relationship and risk reduction behaviors during the extradyadic encounter were assessed.ResultsSexually unfaithful participants demonstrated significantly lower rates of protective sexual health behaviors both within their primary partnerships and during their extradyadic sexual encounters. Sexually unfaithful participants were also less likely to engage in frequent STI testing, and less likely to discuss safer sex concerns with new partners.ConclusionsThese data add to the literature on the negative effects of sexual unfaithfulness. Understanding rates of nonengagement in safer sex strategies will be helpful to those who lead efforts to increase condom use and other preventive STI measures. Conley TD, Moors AC, Ziegler A, and Karathanasis C. Unfaithful individuals are less likely to practice safer sex than openly nonmonogamous individuals. J Sex Med 2012;9:1559–1565.     

Gynecologic and Reproductive Health Concerns of Adolescents Using Selected Psychotropic Medications

Psychiatric disorders are common in adolescent girls and may require chronic therapies with psychotropic medications. Antipsychotic medications and mood stabilizers have been increasingly prescribed to and widely used by adolescents for a variety of both “on” an “off” label indications. Studies on the safety and monitoring of these medications in adolescent girls have shown important potential for gynecologic and reproductive adverse effects. The objective of this article is to review the mechanisms for and management of menstrual disorders mediated by hyperprolactinemia associated with antipsychotic medications, hypothyroidism associated with lithium and quetiapine, and the independent association of polycystic ovary syndrome (PCOS) in girls using valproic acid. Beyond their susceptibility to these disruptions in the menstrual cycle, adolescent girls with psychiatric illness also have increased sexual risk behaviors. These behaviors makes it all the more important to review teratogenicity and clinically relevant contraceptive drug interactions in adolescent girls using these psychotropic medications.     

Pregnancy Among Unmarried Adolescents and Young Adults

Objective(s)

To determine the risk factors for pregnancy among unmarried adolescents and young adults.

Method(s)

Case–control study was done over a period of 2 years. Data collected from 181 unmarried abortion seekers and 181 unmarried non-pregnant controls (≤24 years) attending three Medical Colleges of Kerala.

Results

Logistic regression analysis showed a strong association between unmarried adolescent pregnancy and lack of parental supervision and control (OR 8.74, P = 0.000), poor intra-family relationship (OR 7.01, P = 0.000), family problem (OR 4.41, P = 0.000), lack of knowledge on sexual and reproductive health (OR 4.95, P = 0.0003), and non-engagement of adolescent in any productive activity (OR 4.41, P = 0.0373).

Conclusion(s)

Lack of parental control, family problem, poor intra-family relationship, lack of knowledge on sexual and reproductive health, and lack of engaging in any productive activity were found to be significant predictors for unmarried adolescent pregnancy.     

Factors Associated with Unwanted Pregnancy among Adolescents in Russia

Study ObjectiveTo identify social and behavioral factors associated with unintended pregnancy among adolescents in Russia.DesignCross-sectional.Setting and ParticipantsThe investigation group consisted of 145 adolescents aged 15-19 years admitted to a youth-friendly clinic for induced abortion. The control group consisted of 77 sexually active never pregnant adolescent girls of similar age admitted for other reasons.InterventionsBoth groups completed a self-administered questionnaire about their occupation, educational level of their mother, family structure and socioeconomic status, relationship with their mother, sexual behavior, and substance use.Main Outcome MeasuresFactors associated with unintended pregnancy.ResultsIn the bivariate analysis pregnant adolescents tended to have a lower educational level, to live in a nonintact family, to prefer stronger alcohol drinks, and to have a younger age at sexual debut and more frequent sexual intercourse. In the log-linear model six factors appeared to be directly linked to pregnancy: mother's lower education, alcohol consumption, nonintact family structure, low academic grades, higher frequency of sexual intercourse, and lower age at sexual debut.ConclusionAlthough the issue of unwanted pregnancy and possible ways to prevent it should be kept in mind in the psychosocial assessment of any adolescent, the results of our study suggest that some adolescents are at increased risk of unwanted pregnancy. This group includes adolescent girls with low educational attainment, living in a disrupted family, and reporting other risk behaviors. These adolescents might specially benefit from specific preventive programs to reduce the number of adverse outcomes.     

The independent and combined effects of physical and sexual abuse on health. Results Of a national survey

Background: Although physical and sexual abuse have been linked to health risk behaviors as well as mental health problems, it is unclear whether those young women who have experienced both physical and sexual abuse are at greatest risk. To examine the independent associations between physical, sexual, and/or both types of abuse and health status, mental health, and health risk behaviors among a national school-aged sample of girls. We hypothesized that the magnitude of risk would be highest for those reporting both types of abuse compared to those reporting neither or one type of abuse. Methods: In 1997, 3,015 girls in grades 5 through 12 participated in the Commonwealth Fund Adolescent Health Survey and responded to both questions inquiring about physical and sexual abuse. This sample was derives from a nationally representative cross-section of 265 public, private, and parochial schools with an oversampling of 32 urban schools to obtain ethnic diversity. Data were analyzed using chi-square and binary or multinomial logistic regression stratified by type of abuse (none, physical abuse, sexual abuse, or both). Results: About 8% (n = 246) of girls reported a past history of only physical abuse, 5% (n = 140) reported only sexual abuse, and 5% (n = 160) reported experiencing both physical and sexual abuse. Logistic regression controlling for demographic characteristics (grade level, ethnicity, family structure, and socioeconomic status) found those who reported both types of abuse as compared to those who did not report any abuse were significantly more likely to experience moderate-to-severe depressive symptoms (OR = 5.1), moderate to high life stress (OR = 3.3), history of bingeing and purging behavior (OR = 4.4), regular smoking (OR = 5.9) regular drinking (3.8), illicit drug use in the past 30 days (RR = 3.5) and fair to poor health status (OR = 1.9). In contrast, lowered adjusted odds ratios (1.8-2. 5) were seen for those reporting one type of abuse as compared to no abuse across most health outcomes.Conclusions: Those experiencing any type of abuse are at risk; however, those adolescent females who report both physical and sexual victimization are at much greater risk.     

Sexual Satisfaction,Sexual Compatibility,and Relationship Adjustment in Couples: The Role of Sexual Behaviors,Orgasm, and Men's Discernment of Women's Intercourse Orgasm

IntroductionResearch indicated that (i) vaginal orgasm consistency is associated with indices of psychological, intimate relationship, and physiological functioning, and (ii) masturbation is adversely associated with some such measures.AimThe aim of this study was to examine the association of various dyadic and masturbation behavior frequencies and percentage of female orgasms during these activities with: (i) measures of dyadic adjustment; (ii) sexual satisfaction; and (iii) compatibility perceived by both partners.MethodsIn a sample of 85 Czech long‐term couples (aged 20–40; mean relationship length 5.4 years), both partners provided details of recent sexual behaviors and completed sexual satisfaction, Spanier dyadic adjustment, and Hurlbert sexual compatibility measures. Multiple regression analyses were used.Main Outcome MeasureThe association of sexual behaviors with dyadic adjustment, sexual compatibility, and satisfaction was analyzed.ResultsIn multivariate analyses, women's dyadic adjustment is independently predicted by greater vaginal orgasm consistency and lower frequency of women's masturbation. For both sexes, sexual compatibility was independently predicted by higher frequency of penile–vaginal intercourse and greater vaginal orgasm consistency. Women's sexual satisfaction score was significantly predicted by greater vaginal orgasm consistency, frequency of partner genital stimulation, and negatively with masturbation. Men's sexual satisfaction score was significantly predicted by greater intercourse frequency and any vaginal orgasm of their female partners. Concordance of partner vaginal orgasm consistency estimates was associated with greater dyadic adjustment.ConclusionsThe findings suggest that specifically penile–vaginal intercourse frequency and vaginal orgasm consistency are associated with indices of greater intimate relationship adjustment, satisfaction, and compatibility of both partners, and that women's masturbation is independently inversely associated with measures of dyadic and personal function. Results are discussed in light of previous research and an evolutionary theory of vaginal orgasm. Klapilová K, Brody S, Krejčová L, Husárová B, and Binter J. Sexual satisfaction, sexual compatibility, and relationship adjustment in couples: The role of sexual behaviors, orgasm, and men's discernment of women's intercourse orgasm. J Sex Med 2015;12:667–675.     

Anxious and avoidant attachment, vibrator use, anal sex, and impaired vaginal orgasm

IntroductionDisturbances in intimate relationships are among the risk factors for female sexual dysfunction. Insecure styles of anxious attachment (preoccupations about abandonment) and avoidant attachment (avoidance of closeness in relationships) are robustly associated with sexual problems, relationship difficulties, and several indices of poorer physical and mental health. Similar indices of poorer sexual, relationship, and health functioning are associated with impairment of orgasm triggered by penile‐vaginal stimulation (vaginal orgasm), but unrelated or related to greater frequency of other sexual behaviors. However, research examining the differential association of sexual activities with insecure attachment styles has been lacking.AimsThe aim of this study was to test the hypotheses that insecure attachment styles are associated with lesser vaginal orgasm consistency, and are unrelated or directly related to greater frequency of other sexual behaviors.MethodSeventy coitally experienced women recruited at a Scottish university completed the Revised Experience in Close Relationships scale, and reported their frequency of various sexual behaviors (and corresponding orgasms) in a recent representative month.Main Outcome MeasuresThe main outcome measures for this study are multivariate correlations of various sexual activities with insecure attachment styles, age, and social desirability response bias.ResultsAnxious attachment was associated with lesser vaginal orgasm consistency, but with higher frequency of vibrator and anal sex orgasms. Avoidant attachment was associated with higher frequency of vibrator orgasms. Neither anxious nor avoidant attachment was associated with lifetime number of penile‐vaginal intercourse partners.ConclusionsThe results provide evidence that inability to attain a vaginal orgasm is associated with anxious attachment, among other indices of poorer mental health and relatedness. Vaginal orgasm might be the relevant sexual activity for the maintenance of a secure attachment style with a sexual partner and/or more insecurely attached women might have difficulties in attaining vaginal orgasms and be more inclined to sexual activities characterized by more emotional and physical detachment, as part of a characterological discomfort with intimacy. Costa RM and Brody S. Anxious and avoidant attachment, vibrator use, anal sex, and impaired vaginal orgasm. J Sex Med 2011;8:2493–2500.     

Couple, ways of couples coping, and erectile dysfunction

Erectile Dysfunction (ED) is extremely common in men. Erection problems will usually produce a significant psychological and emotional reaction in most men, and their partners. Both are likely to face a drop in sexual quality of life and challenges to their intimate relationship as couples' sexual activities are curtailed by the loss of erectile function. If successful and effective management is to occur, any discussion of treatment should include the couple. ED is a couple's problem and therefore it requires a couple's solution. The quality of relationship is to be improved by couple-centred understanding and solutions.     

Racial/Ethnic Disparities in Female Sexual Health from Adolescence to Young Adulthood: How Adolescent Characteristics Matter?

Study ObjectiveTo describe sexual initiation patterns in female adolescents and examine their association with adolescent characteristics and racial disparities in adverse sexual health across adolescence into early adulthood.DesignA prospective, longitudinal, observational study from adolescence to adulthood.SettingNationally representative, the National Longitudinal Study of Adolescent to Adult Health data, in the range of 24-32 years old at final assessment.ParticipantsData from 43,577 US women from 1994 to 2008.Interventions and Main Outcome MeasuresAdolescent sex-related characteristics at the individual-, family-, and school peer-level were assessed, and multiple sex partners, sexually transmitted infections (STIs)/HIV, and intimate partner violence (IPV) were longitudinally tracked. The sexual initiation pattern and its longitudinal association with sexual health were analyzed using latent class analysis and mixed effects Poisson regression models.ResultsOf the 43,577 subjects, the sexual initiation patterns were determined as normative (n = 28,712, 65.9%), late (n = 10,799, 24.8%), and early but unempowered (n = 4,066, 9.3%). The highest rate of the early-unempowered group was shown in Hispanic individuals (1,054/7,307 = 14.4%); they were more likely to be depressed, unsatisfied with their bodies, receiving welfare, and have less educated/permissive parents to their sexual initiation than others. The late group had a higher body mass index and greater satisfaction with their bodies. The highest number of STIs/HIV and IPV victimization was shown in non-Hispanic Black (NHB) and Hispanic individuals, respectively. However, NHB females’ higher number of STIs/HIV was shown in the late/normative groups, not in the early-unempowered group. Among Hispanic females, adolescent sexual initiation patterns were not directly associated with their frequent IPV victimization.ConclusionNHB females' higher STI/HIV in late/normative groups and Hispanic females’ frequent IPV victimization regardless of their sexual initiation patterns might indicate that racial/ethnic disparities in female sexual health was not directly determined by adolescent risk behaviors.     

Adolescent sexual assault: an update of the literature

PURPOSE OF REVIEW: In this review, we examine the most recent literature on adolescent sexual assault, and summarize new findings regarding prevalence, risk factors, sequelae, cultural factors, genital injury, legal issues and practice implications. RECENT FINDINGS: Child and adolescent sexual-assault victims are at risk for a range of negative outcomes, including comorbid post-traumatic stress disorder and major depressive episode, comorbid post-traumatic stress disorder and substance abuse, eating disorders, delinquency, and revictimization. Cultural factors and severity levels of trauma may serve as risk factors to such outcomes in adolescent sexual-assault victims. Compared with adults, adolescent sexual-assault victims have a greater frequency of rape-related anogenital injuries, but data on healing of injuries in this population are lacking. Factors related to a child sexual-assault victim's demeanor and intelligence can influence the perceived credibility of the child as a witness to the abuse. SUMMARY: Recent studies investigating prevalence, risk factors, and sequelae of child and adolescent sexual assault highlight the need for educational programs and primary prevention interventions to educate pre-pubescent children and adolescents about sexuality, including sexual assault. In addition, further research is warranted in the area of statutory rape reporting to determine its effects on adolescent health-service-seeking behaviors and outcomes. Although most adolescent sexual assault victims do not seek acute post-rape medical care, forensic nurse examiners are often the first clinicians to encounter the adolescent sexual assault victim. Nursing protocols that standardize evidence collection as well as psychological support are important in the comprehensive care of these traumatized teens.