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Original article

A cross-sectional study of factors associated with adolescent sexual activity

R. Shashikumar, R. C. Das, H. R. A. Prabhu, K. Srivastava, P. S. Bhat, J. Prakash, P. Seema
Department of Psychiatry, AFMC, Command Hospital (SC), Pune, Maharashtra, India

Abstract

Context: Adolescents constitute about 20% of our population and increasingly more of them are initiating sexual activity
at an early age. Several behaviors associated with adolescence like masturbation, expression of masculinity/femininity,
lifestyle habits like attending late night parties, and consumption of alcohol have been variously implicated in initiating
sexual activities. Sexual abuse can also lead to premature sexualization. In view of few worthwhile studies from India
that have dealt with these issues this study was undertaken.
Aims: To elicit information from two co-education schools adolescent boys and girls on matters related to pubescence,
sexual experiences, and sexual health.
Settings and Design: Study subjects involved students from class IX to XII in two co-education schools. Consent of
parents was taken to administer the questionnaire to their wards.
Materials and Methods: A total of 586 out of 1580 students completed a self-reporting questionnaire on matters related
to sexuality. Statistical Analysis EpiInfo6 Software was used.
Results: Significant association was found among those holding the view that having sex proves their masculinity,
being sexually abused, masturbation among boys, and sexual activity. A significantly large number of boys and girls are
unaware of role of alcohol on sexual activity and that pregnancy can be caused by single intercourse.
Conclusions: This was probably the first such comparative study from India. Mechanisms need to be evaluated to help
adolescents understand their sexual attitudes and situations that are likely to provoke sexual activity. Therefore, not
only more detailed and longitudinal studies are needed to understand these relations in a better perspective, but also a
well‑planned educational program for adolescents is a need of the hour.

Key words: Adolescent sexuality, masculinity, masturbation, sexual abuse

INTRODUCTION abuse put adolescents at risk of early initiation of sexual

Adolescents constitute about 20% of our population and
their number is only going to increase further. They are
growing up in an environment that is dramatically different
from that in which their parents grew up. Increasingly more
adolescents are initiating sexual activity at an early age.[1]
Adolescence is a period when an individual’s personality
develops which includes his/her masculinity/femininity
ideas also. This could have overbearing influence on
his sexual attitudes and behaviors.[2] Exposure to sexual
Address for correspondence: Dr. R. Shashikumar,
Department of Psychiatry, AFMC,
Pune – 411 040, Maharashtra, India
E-mail: sribuj@rediff.com
activity.[3]
Masturbation is a unique human behavior, often regarded
as an appropriate sexual outlet, but it has also been related
variously to early onset of sexual activity.[4-6] Masturbation
in India is known to be associated with positive feelings
when outlook toward it is positive.[7]
With growing urbanization, liberal attitudes and mingling
of both genders in school and social contexts, there is an
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How to cite this article: Shashikumar R, Das RC, Prabhu H,

Srivastava K, Bhat PS, Prakash J, et al. A cross-sectional study DOI:
of factors associated with adolescent sexual activity. Indian J
10.4103/0019-5545.99532
Psychiatry 2012;54:138-43.

138 Indian Journal of Psychiatry 54(2), Apr-Jun 2012

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Shashikumar et al.: Factors associated with adolescent sexual activity
increasing opportunity for boys and girls to party together
and also consume alcohol.[8-10] Such occasions are known
to increase the likelihood of their indulgence in sexual
activity.[11]
Many children are prone to be sexually abused.[12,13] It
is known that such children grow up and initiate sexual
activity at an early age.[14] Since early age of initiation of
sexual activity puts adolescents at risk of pregnancy,
HIV infection/STDs, and a myriad of social and health
consequences, it is essential that they need to be educated
on these aspects. In a study from Kolkata of adolescent girls,
Das et al. found that many of them had poor knowledge on
matters related to sexuality, sexually transmitted diseases.
They also suggested that regular surveys on sexual attitudes,
knowledge, and behaviors are essential in understanding
the epidemic of sexually transmitted diseases.[15] TSS Rao
in an editorial had emphasized the need for assessment of
attitudes and beliefs in regard to sexuality.[16] In view of the
above, this study was undertaken to ascertain what kind
of attitudes and behaviors are likely to be associated with
increased chances of sexual activity.
MATERIALS AND METHODS
This study was conducted in two co-education schools of
Pune. After having taken permission of principals of both
schools and due consent from the parents of students of
class IX to XII was taken as the study sample.
They were administered a self-report questionnaire
which contained four sections. First one dealt with socio-
demographic data, second one pubescence, the third
sexual experience, and fourth attitudes, knowledge with
regard to sexual health including HIV infection. The
demographic data collected included questions regarding
duration of television/ unsupervised internet use, the type
of channels usually seen on television. Questions like
whether they thought that attending late night parties
and consuming alcohol increases chances of indulging in
sexual activities. Sexual abuse was described as anyone
having touched their private parts, shown pornographic
material, unsolicited exposure to private parts of others or
non-consensual sexual activity. They were asked to report
if anyone had experienced such abuse. They were also
asked about masturbation and ideas about masculinity
and femininity.
Only those girls and boys who volunteered were separately
presented the questionnaire. The questionnaire was given
on separate days in two schools. The lady worker clarified
the questionnaire to girls and principal worker clarified for
the boys. The identity of the students was kept confidential.
Sexual contact was described as having kissed sensuously,
touched/fondled private parts of opposite sex, and having
had engaged in sexual intercourse.
Indian Journal of Psychiatry 54(2), Apr-Jun 2012
This study restricted itself to evaluating the relation of
masturbation, masculinity/femininity ideas, views on
attending late night parties/drinking alcohol, and sexual
abuse to sexual activity of the students.
Questionnaires that were not complete or had not given
demographic data were excluded from the analyses.
Analyses were done using EpiInfo6 software.
RESULTS
The combined strength of students from class IX to XII in
both schools was 1580 of which 822 (52.25%) parents had
given consent. A total of 642 (40.63%) students filled up
the Proforma. Others were absent on the days of study, of
these only 586 were taken up for further analysis. As those
that were incomplete were not taken up for the study. It
comprised of 357 (61.93%) boys and 229 (39.07%) girls.
Sexual contact was described as having touched private parts,
kissing, or sexual intercourse. About 30.08 % of boys and
17.18 % of girls reported having had sexual contact. About
37 (6.31%) boys and 03 (1.31%) girls had reported having had
experienced sexual intercourse. Average age at first sexual
contact for boys was 13.72 yrs and for girls was 14.09 yrs,
while average age at first intercourse in those who had it was
15.25 yrs for boys and 16.66 yrs for girls. Masturbation was
more common among boys (45.9%) than girls (12.7%).
It is evident here that a highly significant number of boys
who had sexual contact think that having sex proves
masculinity.
Here it is evident that a significantly larger percentage of
sexually abused boys are likely to have sexual contact than
those who have not been abused, while there is no such
difference among girls.
The practice of masturbation is only 21.9% among girls while
it is 55.7% among boys. Although this table shows significant
difference, it is significantly only among boys with a larger
proportion of boys practicing masturbation also having had
sexual contact, while there is no such difference in the two
groups of girls.
Here we do not see any significant difference in knowledge
levels regarding pregnancy after one sexual intercourse
among those having sexual contact and those not having.
Overall, 41.9% of girls and 53.0% of boys have the knowledge
in this regard.
Here we see that while only 40.8% girls accept the concept
that attending late night party is likely to increase indulgence
in sex, up to 50.45% of boys think so. However, there is no
significant difference between those who have had sexual
contact and those who have had not.
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Shashikumar et al.: Factors associated with adolescent sexual activity
This table shows that 28.3% girls and 37.2% boys consider
consumption of alcohol to increase indulgence in sex.
However, there is no significant difference between those
who have had sexual contact and those who have had not.
DISCUSSION
Fifty-two percent of parents had given consent for their
children to fill up the questionnaire. It could be because
either they were not shown the consent form by their
children or that they were apprehensive of it. However, it
was heartening to note that 78.10% children of consenting
parents completed the questionnaire, implying that
adolescent students per se were not much averse to it.
Others could not as they were absent on the day of survey.
Femininity and masculinity or one’s gender identity refers
to the degree to which persons see themselves as masculine
or feminine given what it means to be a man or woman in
society. Femininity and masculinity are rooted in the social
(one’s gender) rather than the biological (one’s sex). Societal
members decide as to what being male or female means e.g.
dominant or passive, brave or emotional. Males will generally
respond by defining themselves as masculine while females
will generally define themselves as feminine.[17] The concept
of masculinity in India usually implies having good physical
looks and penis size. It is usually is associated with sexuality
that often involves coercive sexual behaviors.[18] It was thus
not surprising to find in our study that a large number of boys
agreeing to the fact that sexual act proves their masculinity
(∼29% of boys) [Table 1]. Barker & Lowenstein reported in a
study from Brazil that becoming sexually active is perceived
as an easier way of ascertaining masculinity rather than by
proving their productivity and ability to financially support
family.[2] Verma et al reported that many young men indulged
in unwarranted, unsolicited verbal comments, whistling,
jostling, touching, and harassing girls as a form of proving
their masculinity.[18]
The concept of femininity generally inculcated into girls
in India is that of being submissive, being coy about their
sexuality, and being obedient.[3] In the present study
therefore, it is not very surprising to find that only 17.64%
of girls agreed that having sex proves their femininity and
of those who have had sexual contact only 13.5% agreed
Table 1: Gender-wise relation of sexual contact with
concept of femininity and masculinity
Sexual Girls Boys
contact Do you think having sex Do you think having sex
proves femininity proves masculinity
No Yes Total No Yes Total
No 122 28 150 142 43 185
Yes 32 5 37 54 37 91
Total 154 33 187 196 80 276
χ2=0.25, P=0.620 χ2= 8.96, P=0.004
140
to such a view, whereas among boys the percentage
was significantly higher on both accounts (46.25% and
27.55%, P=0.004) [Table 1].
Impett et al had reported that increasing femininity is
associated with less sexual self-efficacy. Sexual self-
efficacy is a girl’s conviction that she can act upon her own
sexual needs in a relationship. Diminished self-sufficiency
in turn predicted less sexual experience and less use of
protection.[19] However, in our study we had not asked
for their ability to use protection during sexual acts.
Tolman reported a significant association between early
adolescent girl’s espousals of more conventional beliefs
about femininity and diminished positive sexual health. It
is not quite common for women to assert their femininity
by indulging in sexual activity. When they have poor social
skills, they may offer sex for social support or staying in
marriage.[20] Such behaviors put both boys and girls at risk
of HIV infection/STDs/pregnancy. Therefore, they should
be encouraged to assert their masculinity/femininity by
engaging in pursuance of good social skills, improving their
intellectual assertiveness rather than sexual assertiveness.
Further studies are warranted to understand the construct
of femininity among our adolescents.
Sexual abuse of a child is defined as involvement of a child
in a sexual activity that he/she does not fully comprehend,
is unable to give informed consent, or to those acts that
violate the laws or social taboos of society.[12] While we
had found that 7.84% boys and 13.53% girls having had
experienced sexual abuse, it is not surprising as Patel et al
also had reported sexual abuse from educated high school
students.[21] Stewart et al had in a study found that such
children are likely to indulge in risky sexual behavior, be
unable to use contraception correctly, and are prone to
various STDs/HIV infections.[14] In our study we found a
significant association of sexual abuse with sexual contact
but only among boys (P=0.0017) [Table 2]. We had not asked
for the time of abuse so cannot say if the sexual activity
preceded or followed sexual abuse. More comprehensive
longitudinal studies are hence needed as the number of
those reporting abuse is not small. This is especially so as
Sobtia et al in a cross-sectional study found that one fourth
of the students surveyed had been sexually abused and had
long-term psychological impact on the victim but they had
not looked for any increased sexual activity among them.[13]
Risky sexual behavior could often be a manifestation of
the abuse victims’ inability to cope up with the shame and
guilt and to distinguish sexual behavior from affectionate
behavior.[14]
The human species is probably the only one to practice
masturbation and often is regarded as an appropriate
sexual outlet for them.[4] Masturbation is universally
practiced ranging from 10% to 33% among girls and 39.7%
to 63% among boys.[3,5] However, masturbation has also
Indian Journal of Psychiatry 54(2), Apr-Jun 2012
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Shashikumar et al.: Factors associated with adolescent sexual activity

Table 2: Relation of sexual abuse to having sexual contact

Sexual contact Sexual abuse
Girls Boys
No Yes Don’t know Total No Yes Don’t know Total
No 139 21 11 171 178 8 14 200
Row % 81.3 12.3 6.4 100.0 89.0 4.0 7.0 100.0
Col % 85.8 72.4 84.6 83.8 72.1 36.4 77.8 69.7
Yes 23 8 2 33 69 14 4 87
Row % 69.7 24.2 6.1 100.0 79.3 16.1 4.6 100.0
Col % 14.2 27.6 15.4 16.2 27.9 63.6 22.2 30.3
Total 162 29 13 204 247 22 18 287
Row % 79.4 14.2 6.4 100.0 86.1 7.7 6.3 100.0
Col % 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
χ2 3.2581 12.7836
P= 0.196 0.001

Table 3: Relation of sexual contact with masturbation among girls. This probably is due to the fact that only small
Sexual contact Masturbation number of them actually reporting masturbation (12.7%)
No Yes Total and much smaller number of sexual activities (17.18%). It
No 184 103 287
therefore becomes imperative that educational programs
Row % 64.1 35.9 100.0 on sexuality should also deal with issues related to
Col % 78.6 53.9 67.5 masturbation.
Yes 50 88 138
Row % 36.2 63.8 100.0 Adolescent pregnancy can lead to cascading health and
Col % 21.4 46.1 32.5
Total 234 191 425
psychosocial consequences in the girl. In our study we
Row % 55.1 44.9 100.0 found that up to 40.2% of students (41.9% girls and 53% boys)
Col % 100.0 100.0 100.0 had no knowledge that a single intercourse can lead to
χ2 28.1576 P=0.000 pregnancy [Table 4]. But this awareness was much better
Boys P=0.000 that that reported by Shittu et al, who found that 80% of
Girls P=0.129
students from urban schools did not know about it.[23]

Table 4: Relation of sexual contact with knowledge Partying together for fun or to celebrate an occasion is not
that single intercourse can cause pregnancy quite uncommon among school going adolescents. When
Sexual contact Knowledge that single intercourse can girls do attend parties they do so in a group and stay as a
cause pregnancy group. This helps them in keeping boys at bay and prevents
No Yes Total them from making sexual advances. However, as the party
No 145 194 339 prolongs the group tends to break up and leads to a let up in
Row % 42.8 57.2 100.0 such defense.[24] In this context we wanted to know if these
Col % 78.4 70.5 73.7 adolescents believed that partying late into the night would
Yes 40 81 121
lead to increased indulgence in sexual activity. We found
Row % 33.1 66.9 100.0
Col % 21.6 29.5 26.3 that 40.8% girls and 50.45% boys agreed that such parties do
Total 185 275 460 lead to increased chances of indulging in sexual activities. On
Row % 40.2 59.8 100.0 further analysis we found a significantly larger percentage
Col % 100.0 100.0 100.0 (P=0.001) of those having sexual contact agreeing to such a
χ2=3.1081 P=0.077
view (58.6%). Further among those having such a view point
Boys P=0.332
Girls P=0.1785
31.9% had sexual contact, while among those who did not
hold such a view only 19.7% has sexual contact [Table 5].

been associated with sexual activity in that earlier the age
of initiation more the sexual activity.[22] Sathe & Sathe had
reported that 44.6% of males felt that masturbation made
them feel more masculine, so it is not surprising that we
also found a significant association between masturbation
and having sexual contact among boys (P=0.00) [Table 3].[7]
Yeong et al had also found diminished sexual activity
(coital rate) among non-masturbators when compared to
masturbators.[22] However, there was no such association
Indian Journal of Psychiatry 54(2), Apr-Jun 2012
Late night parties are often associated with use of alcohol by
students. Alcohol has been varyingly related to indulgence
in sexual activity among adolescent boys and girls, but
many do agree that alcohol increases indulgence in sexual
activity.[8,25,26] We studied the view of the students in regard
to role of alcohol in increasing the chances of indulgence in
sexual activities. We did not find any significant association
between having sexual contact and professing the view
that consumption of alcohol increases the chances of
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