If your adolescent is sexting, they may be already sexually active and engaging in risky behavior, a new study suggests.

Researchers are trying to better understand if young people are at greater risk for HIV or other sexually transmitted diseases because they are sending sexually explicit photos or text messages via cell phones.

“Sexting” is not an alternative to “real world” sexual behavior among adolescents, according to a new study published Monday in the journal Pediatrics.

“The same teens who are engaging in digital sex risk taking through sexting are also the same teens that are engaging in sex risk with their bodies in terms of being sexually active and not using condoms,” said lead study author Eric Rice, an assistant professor at the University of Southern California’s School of Social Work in Los Angeles.

A 2009 report from the Pew Research Center found that some teens “view sexting as a safer alternative to real life sexual activity.”

While the term “sexting” may also include messages also sent over the Internet, this particular study looked solely at cell phone text messages and images. It was conducted via questionnaire in the Los Angeles Unified School District. Researchers surveyed 1,839 students ages 12 to 18 at random. Most were Latino or African-American. Three-quarters of those surveyed had cell phones.

“Even though a minority of teens sext – we only found 15% – but that 15% are much riskier with their physical sexual behaviors as well as their digital sexual behaviors,” says Rice.

He add that teens who reported sexting were seven times more likely to be sexually active than their peers who did not sext.

The data suggests there are norms about sexting, according to Rice, meaning teens are starting to think that sexting is a normal part of their behaviors. More than half of the teens surveyed reported that they had a friend who sexted.

“A lot of young people think that their friends are sexting, and if you think that your friends are sexting, you’re much more likely to sext yourself,” he said – 17 times more likely, according to study.

“I think that the implications are that teens who are sexting may be at greater risk for sexually transmitted diseases because the teens who sext are about 1.5 times more likely to not use condoms when they’re having sex,” in addition to increasing the risk of teen pregnancy, Rice says.

This study was conducted in only one urban area; the authors realize that some of the results may not accurately represent rural areas. In addition, recent nationwide research found much lower rates of sexting.

However, Rice said this information can be valuable for parents.

“We [parents, clinicians, educators] should be talking about sexting and the fact that it’s part of the risky sex behaviors and it’s not just something that exists in a virtual space, so to speak,” he said.

“Talking about sexting might be easier for [parents] than talking about sex and it could lead into a larger conversation about sex.”

Providing condoms to adolescents has been – and likely will continue to be – a controversial topic. But the American Academy of Pediatrics is asking communities, educators, parents and doctors to step up in making this form of contraception more available to teens.

“Although abstinence of sexual activity is the most effective method for prevention of pregnancy and STIs (sexually transmitted infections), young people should be prepared for the time when they will become sexually active,” several doctors wrote in a policy statement published Monday in the organization’s journal Pediatrics. “When used consistently and correctly, male latex condoms reduce the risk of pregnancy and many STIs, including HIV.”

Teen pregnancy rates are declining in the United States; in 2011, the number of babies born to women aged 15 to 19 was at a record low, according to the Centers for Disease Control and Prevention. But sexually transmitted infections, or STIs, continue to be a problem for this age group. The CDC estimates that people between the ages of 15 and 24 account for half of the 20 million new STI cases that are reported each year.

In the statement, an update from their 2001 position, the pediatricians’ organization recommends removing restrictions and barriers that often prevent teens from accessing condoms. Parents should be talking to their teens about sex, the doctors say, and pediatricians can help. The paper’s authors encourage their colleagues to provide condoms in their offices and support increasing access in the community. They also recommend providing condoms in schools, in addition to comprehensive sexual education.

It’s advice some are already taking to heart. The fairly new Condom Access Projectallows teens in seven California counties to confidentially request a pack of condoms online, up to once a month.

In New York, high schools are required to provide Health Resource Rooms where students can access free condoms and other health information. Boston and other cities are also jumping on board to offer free condoms to teens.

Free condoms for your 12-year-old?

Research has shown that sexual education programs do not increase sexual activity among teens, and may have a significant impact on reducing risky behaviors. One 2007 meta-analysis found that sexual education programs may delay the age at which teens start having sex, reduce the number of partners they have sex with, and increase condom and contraceptive use. The same is true for condom accessibility programs.

Several studies have shown that providing condoms to teens, especially in high schools, encourages them to use condoms “more often and more consistently” without encouraging them to have sex more often, or with more partners, according to Advocates for Youth.

For example, a 2003 study done on Massachusetts high schools’ condom availability programs showed “adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in those schools were twice as likely to use condoms.”

In the 2011 Youth Risk Behavior Survey (the latest data available), 47.4% of students reported having sexual intercourse at least once in their lifetime; 33.7% were sexually active at the time of the survey. Approximately 60% of the sexually active students reported using a condom during their last sexual experience – an increase of 14% since 1991.

Sex-wise, my wife and I have never found pregnancy a problem, and this pregnancy has been no exception. Indeed, approaching the seven-month mark, the sex had actually been nearing some kind of zenith, with regular orgasms for both parties and no hint of my desire waning as the pregnant lady’s waist-line expanded. I am not sure if it’s unusual, but I found all the fecundity – the swollen belly, the enormous boobs – rather arousing.

I suppose I should have known it was too good to last.

Although all the books say it’s totally fine to keep going at it with reckless abandon throughout pregnancy, I don’t think there’s a man out there who doesn’t feel slightly nervous about the prospect of somehow – how can I put this delicately? – bumping his baby’s head during a bout of lovemaking. It becomes particularly prevalent in your mind when you get to the phase of the pregnancy where you are convinced you can actually see arms, legs and a head moving about out under your wife’s skin. Pregnancy certainly lends itself to a certain gingerness when it comes to the more kinetic elements of intercourse.

In fact, the idea that sex should continue unabated during pregnancy is actually a relatively new notion. Historically, having sex during pregnancy was not thought to be a good idea at all. Hilary Mantel in Wolf Hall has Henry VIII sleeping with Mary Boleyn while her sister Anne is pregnant for fear of harming the baby (although maybe that was just his story). Many tribal societies prohibited sex during pregnancy (although in Medieval times, some sex manuals did apparently contain guides on the ‘safer’ positions, allowing that while having sex when pregnant wasn’t ideal, it was important for wives to continue to offer sex to try and stop their menfolk from cheating).

We carried on having sex more or less as normal (just with a minimum of thrusting). One odd and rather pleasant surprise was that my wife actually found that during pregnancy her orgasms became more intense. We blithely assumed this was a good thing, until one particularly mind-blowing orgasm led her to feeling a bit strange. For several minutes, she had to lie on the bed while breathing more deeply than usual and waiting for the baby to stop moving around quite so furiously.

I made the mistake of googling ‘sex during pregnancy’ – which was how I came to discover the terrifying fact that while the presence of a penis in the vagina may not be harmful to pregnant ladies or their unborn children, male sperm and the female orgasm both contain hormones that a woman produces when she is about to give birth. For this reason, some people believe that orgasm and sex can actually trigger premature labour.

They are, it must be said, refuted by the vast majority of professionals and by the medical evidence. One of the largest studies ever undertaken (and published by the Lancet in 1981) quizzed 10,981 low-risk mothers and found that, “Preterm delivery was no more frequent in those having intercourse than in those abstaining.”

But maybe they just weren’t having mind-blowing orgasms?

I spoke to the obstetrician Michel Odent, who is credited with introducing birthing pools into hospitals, and delivered his first baby in a Paris hospital in 1953 and still delivers babies in London today. He is best known in medical circles for being the author of the first articles about the importance of the initiation of breastfeeding during the hour following birth, believes men should be somewhere with a cigar far from the delivery room during childbirth, and is a reliably contrary voice when it comes to medical orthodoxy.

He told me that while it has not been scientifically demonstrated that orgasm – as opposed to sex – can trigger childbirth, it is theoretically ‘certain’ that the female orgasm releases oxytocin (a hormone that is involved in triggering labour) and sperm contains prostoglandins (which are also believed to be instrumental in inducing labour), so female orgasm “might be a risk factor for premature birth.”

That was enough for me. There is now a sex ban in effect until a week or two before the due date. My wife says its like living with Henry VIII.

I replied that, in that case, she’s lucky she doesn’t have a sister.

Robert Brady is a pseudonym

I am a 23 year old lesbian. My partner’s 22, we’ve been dating for five years. For the last two, sex certainly hasn’t been the same. We have sex once ever five months. She’s given up on asking so now we just don’t do it. I seem to never be in the mood and when we finally do it, it doesn’t last long and she says it feels like I’m faking it. It never used to be this way. I want to satisfy her and feel satisfied. She’s cheated on me before because of this. I don’t want her going to any other female for something I’m incapable of giving her. I love her with all my heart, I don’t want to lose her or feel like such a failure because I can’t fulfil my girlfriend duties.

You are not alone. Many people reading your letter will identify with your situation.

While mismatched libidos are a major reason people of all sexualities seek therapy, scientific studies of varying quality have suggested ‘lesbian bed death’ – where sex is infrequent or absent the longer you are together – is a unique and inevitable part of all long-term lesbian relationships.

Before this makes you more anxious, it’s worth noting much of this research used very narrow definitions of ‘sex’ and ‘pleasure’ and focused on older lesbian couples whose relationships were in crisis. It didn’t account for issues like parenthood that might explain a lack of desire. Or focus much on those in non-monogamous relationships, younger women, women who weren’t reporting relationship dissatisfaction, or bi and queer women.

So a more accurate picture is that lesbian relationships vary. In some sex never stops being important. In others loving companionship takes priority. Some lesbians are happily asexual.

A lack of sex doesn’t have to be an unavoidable aspect of long-term lesbian relationships. It only constitutes a problem if it is causing you (and/ or your partner) distress.

Unpicking a tangle

You’re unlikely to feel sexy, desired or cherished if sex is something you do to ‘fulfil my girlfriend duties’. Or if you feel inadequate, are afraid your partner will cheat again, or feel under scrutiny you might be ‘faking it’.

Vaginal dryness (as you say you experience in your longer letter) isn’t unusual and using a lubricant can help regardless of how aroused you feel. But being dry is more likely if you’re feeling anxious or not turned on. And can be another reason why you don’t want sex much.

I appreciate your girlfriend may feel unhappy and frustrated with the situation as it is, but are there things she could do to help you feel more nurtured, secure or sexual? Could any of her actions or behaviours be contributing to your lack of desire? Is it easy to talk about this?

Middle-aged woman who are sexually active are likely to keep on having sex as they grow older, even if they were diagnosed with sexual dysfunction, new research shows.

A team of researchers based at the University of Pittsburgh Medical Center recruited 602 women between the ages of 40 and 65 and asked them to report if they were sexually active, and how important they felt sex was in their lives.

“There’s this popular public perception that as women age, sex becomes unimportant, and that women just stop having sex as they get older,” lead author Dr. Holly Thomas said.

“From our study, it looks like most women continue to have sex during midlife,” she said.

“It may be detrimental to label a woman as sexually dysfunctional,” added Dr Thomas.

Psychologists and doctors have been debating the value of diagnosing women with sexual dysfunction since the release of Viagra triggered a search for a female version of the drug.

Doctors use a test called the Female Sexual Function Index to diagnose women’s sexual problems. The index includes 19 questions about arousal, orgasm, vaginal lubrication and pain during intercourse.

In the current study, 354 middle-aged and older women who reported being sexually active when they first took the test took it again four years later.

More than 85 percent of women reported that they remained sexually active when they took the test the second time between the ages of 48 and 73.

Nevertheless, those women generally scored low on the sexual-function index, with an average score of 22.3 – below the cutoff of 26.55 considered sexually dysfunctional.

The authors were surprised to find that sexual function, as measured by the index, failed to predict whether the women continued to have sex.

They theorized that the instrument “may be labeling women as dysfunctional when women don’t have a problem,” Thomas said.

The index’s “focus on intercourse may not accurately reflect what constitutes satisfying sex in this population, yielding falsely low scores,” she and her colleagues write.

Race, weight, relationship status and how important women deemed sex – rather than their scores on the sexual-function index – were the most important predictors of sexual activity, according to findings published in JAMA Internal Medicine.

Women who rated sex as important were three times as likely to remain sexually active as women who rated it as unimportant, Thomas said.