The beginning of sexual (coital) behavior is in adolescence for most people in the world (13). The American 2005 Youth Risk Behavior Survey (YRBS) noted that 46.8% of all high school students (ages 13-18 years) are coitally sexually experienced, with a range of 67.6% for African-American youth, 51% for Hispanic youth, and 43% for Caucasians(14). This survey also comments that over 6.2% are sexually active before age 13 (4% in females and 9% in males) while over 14% have at least four sex partners—11% of the females and 17% of the males. Though parents and some clinicians assume that youth with chronic illness are not engaging in coital behavior, research has noted that chronic illness increases the risk for sexual behavior
Table 1 Prevalence of Chronic Illness in American Youth Aged 10 to 17 Years per 1000
Overall: 315/1000 adolescents, aged 10-17 years
Table 2 Selected Adolescent Health Topics
Motor vehicle accidents Homicide and suicide in some youth who use sexual experimentation as a way of proving their normalcy (15).
Individuals who are sexually active early (i.e., during their adolescent years) tend to have multiple partners and often do not use condoms correctly or consistently; thus, they are at increased risk for unplanned (unwanted) pregnancy and sexually transmitted diseases (STDs). Having a chronic illness, such as a rheumatoid disorder, is not a situation that can be relied on to help avoid unplanned pregnancy or STDs. Most coital activity among adolescents in the world is unprotected by condoms (3). Sexually active adolescents tend to practice serial monogamy—that is, having one partner at a time. These youth with increased sexual behavior often have other high-risk behaviors as well, such as increased substance use and abuse, sometimes leading to involvement in survival sex as prostitutes living on the streets of the world.
Thus, the clinician caring for youth with or without rheumatic disorders, must inquire about each youth's sexual behavior. Such inquiry is imperative when prescribing teratogenic drugs such as mexthotrexate and with certain diseases, such as SLE, that have particular implications for reproductive health. It is always important to recommend sexual abstinence; however, the youth who is sexually active should be provided with appropriate contraception to allow them effective control over their fertility and prevention of unwanted pregnancy and abortion (15-18). Youth who wish to become mothers should learn how to space their children correctly so they can become better caretakers (19-25).
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