[Medical aspects of adolescent sexuality]

The increase of sexual activity among the adolescents has become a danger to their reproductive health. The goal of this study was to explore sexual behaviour of young people, to establish risks that endanger their reproductive health, and to find out the ways to reduce the consequences of adolescent sexuality. The study was conducted in the Mother and Child Health Care Institute of Serbia over a 2-year period. The sexual and reproductive behaviour, attitudes toward sexuality and contraception, as well as the prevalence rates of unintended pregnancy and Chlamydia trachomatis genital infections were analyzed in 300 sexually active adolescent females, aged 19 years. The first sexual intercourse was in 16.9 years, in average. Less than one-third of the total number (31.3%) of these persons had contraceptive protection at the first intercourse; condom was most frequently used (28.3%). Motives for the initiation of sexual activity were: love (45.7%), curiosity (35.7%), physical attraction and passion (8.3%), peer pressure (5.0%), on the boyfriend's insistence (4.7%), need for love (0.3%) and without answer (0.3%). Two-thirds of adolescent females (63.7%) reported more than one partner, 21.7% more than three and 10.2% more than five sexual partners. Almost half of girls (40.7%) experienced sexual intercourse in casual acquaintance, and 10.3% with a 10 or more years older partner. Use of contraceptive methods during each sexual encounter was inconsistent and sporadic. More than half of adolescent females (54.3%) relied on traditional forms of contraception, like withdrawal of the phallus. Condom was the method of contraceptive choice in one-third (34.3%) of girls, "birth-control pill" in 10.7% and spermicides in 0.7% of subjects. With a new sexual partner condom was used regularly by 55.6% of adolescents; and the remaining percentage of girls used condom irregularly (24.7%), or never (19.7%). The time interval between the initiation of sexual activity and the first gynaecological examination was more than 6 months in 56.7% of cases, and from one to three years in 31.0% of tested adolescent females. The reasons for the first gynaecological visit were as follows: fear of getting pregnant (22.0%), suspicion of contracting a sexually transmitted disease (22.0%) and symptoms indicating a pelvic inflammatory disease (18.3%). Only one-third of girls (37.7%) had their first gynaecological examination as a regular control examination or to get some contraceptive advice. During the adolescence unwanted pregnancy was noted in 16.0% of examined girls. One legal abortion had 14.4% of girls, two 1.3% and three 0.3% of adolescent females. Chlamydia trachomatis genital infection was found in 30.3% of girls. In the girls' opinion the improved knowledge about sexuality, reproduction and contraception is the best way of popularizing contraception among youth. This could be done by introduction of sexual education in school programmes (51.0%) or through mass media (33.3%). A successful health care service for young people should include: a gynaecologist who will have enough time and patience for an adolescent patient (91.3%); a female gynaecologist (36.7%); and a kind other health care workers (21.3%). In order to increase the number of adolescents who will use a condom, the following measures are necessary: a better quality of condoms (54.0%), installation of condom machines (15.6%), mass media education programmes on the significance of the condom role in the prevention of sexually transmitted diseases (10.0%), attractive design of condoms (7.0%), free condoms (6.7%), and universal accessibility of condoms (1.0%). The reproductive health of adolescent girls in Belgrade has been endangered by: their sexual behaviour, poor acceptance of healthy life styles, lack of responsibility in sexual relationships and high prevalence rates of unintended pregnancy and sexually transmitted diseases. Improvement of adolescent reproductive health could be achieved by: educational programmes for adolescents about sexuality, reproduction and contraception; appropriate adolescent advisory health care services; and a better condom quality.