According to the World Health Organization's definition, sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality. It is not merely the absence of disease or disability, but entails much more.

Sexual health requires a positive and respectful approach to sexuality and sexual relationships. Everyone, regardless of gender, age or sexual orientation, has the right to pleasurable and safe sexual experiences free from violence and discrimination.

Things moving in the right direction

Many indicators of young people's sexual health in Estonia have improved markedly over the past 20 years. Over roughly the last decade, the number of new HIV cases has been on a downward trend. The level of HIV testing has increased and the results indicate that HIV prevalence in the general population is low. A positive development is the decline in HIV cases among children and young people: whereas in the early 2000s, two-thirds of new cases were detected among those under 20, in recent years there have been only isolated cases.

The incidence of other nationally registered sexually transmitted infections has also decreased over the past decade. Chlamydia remains the most common sexually transmitted infection, but compared with ten years ago, its incidence has nearly tripled downward. Another positive development is the ratio of births and abortions among teenagers (ages 15–19), which has declined significantly and reached the level of the Nordic countries.

According to data from a sexual health survey conducted among Estonian youth in 2021, 22 percent of young people aged 14–18 have had sexual intercourse. More than half of young people have experienced masturbation in their lifetime, about half have experienced kissing on the mouth, more than a third have engaged in petting over clothing and fewer than a third in petting under clothing or while naked. Within this age group, the share of young people with experience of sexual intercourse rises rapidly: while fewer than one in ten 14-year-olds have had intercourse, by age 18 slightly more than half have.

Most young people behave responsibly in sexual relationships and several indicators show positive trends: the share of young people with experience of sexual intercourse has declined, as has the number of young people who have had multiple partners within a year and the prevalence of casual relationships.

These trends apply broadly to all young people, but it is particularly encouraging to see a decline in sexual experiences at a very young age. Between 2003 and 2007, one in five 14–15-year-olds had had sexual intercourse; according to the most recent data, this figure is more than halved, at under 10 percent.

Whereas in 2003 those in this age group who had had intercourse reported an average of 2.3 partners per year, by 2021 this figure had fallen to 1.8. In 2005, 45 percent of 14–15-year-olds who had been sexually active in the previous 12 months reported casual relationships; 15 years later, that figure stands at 27 percent.

Condom use declining

A condom is the only method that both helps prevent pregnancy and protects against most sexually transmitted infections. However, much depends on how well it is used. Among Estonian youth aged 14–18, 71 percent used a condom during their first sexual intercourse.

At the same time, a key concern is that only half of young people who had casual sexual encounters reported always using a condom during such encounters in the year preceding the survey. In addition, several indicators suggest that condom use is declining.

This is most clearly reflected in data on first sexual intercourse. Until 2015, condom use during first intercourse was on the rise, but comparing the two most recent survey periods, the indicator has declined. A statistically significant negative change has occurred among 14–15-year-olds, dropping from 83 percent to 65 percent.

Of young people who had sexual intercourse in the past 12 months, 39 percent did not use a condom the last time. The most common reason was having a steady partner and mutual trust. At the same time, young people who had sex without a condom tend to use more substances, with the strongest association seen with drug use.

Their attitudes toward condoms are also more negative: they are more likely to consider condoms uncomfortable, their use inconvenient and believe they reduce sexual pleasure. They place less importance on friends' and partners' opinions about condom use and find it more difficult to discuss condom use with a partner.

The data also indicate insufficient condom-use skills among young people — among those who used a condom during their most recent casual encounter, one in ten reported that the condom slipped off or broke during intercourse.

In an international comparison, however, Estonian youth stand out positively in terms of condom use, with rates higher than in several neighboring countries.

According to a 2022 health behavior in school-aged children study, 69 percent of 15-year-old girls and 71 percent of boys in Estonia used a condom during their last sexual intercourse. The averages across the 43 reporting countries were 57 percent and 61 percent, respectively. In Latvia, the figures were 65 percent for girls and 61 percent for boys; in Lithuania, 66 percent and 49 percent; in Poland, 66 percent and 53 percent; in Finland, 57 percent and 60 percent; and in Sweden, 28 percent and 43 percent.

An important issue that must also be addressed is sexual abuse, which is widespread among young people. Among 16–18-year-olds, 45 percent have experienced at least one form of sexual abuse in their lifetime. The most common experience is sexual harassment (43 percent), primarily unwanted touching (30 percent). Between 2 and 8 percent of young people have experienced various forms of sexual violence and fewer than one in ten have experienced sexual abuse online.

According to a study commissioned by the Ministry of Justice, sexual harassment was also the most common form of abuse in 2015: 30 percent of 16–18-year-olds had experienced at least one incident of sexual harassment, mainly unwanted touching (25 percent).

Between 1 and 5 percent of young people had experienced various forms of sexual violence. Differences between the 2015 and 2021 data do not necessarily indicate an increase in the prevalence of sexual abuse but may instead reflect improved awareness. This may point to the impact of sexual education: young people are better able to recognize and identify abuse. More broadly, societal understandings of what constitutes sexual abuse have also evolved.

More diverse sexual education needed

The rapid and diverse accumulation of experiences during adolescence makes young people one of the most important target groups for preventive efforts, while at the same time rendering them highly vulnerable and susceptible to external influences. In Estonia, important steps have been taken to support the well-being of young people in matters related to sexuality.

The most impactful of these has been the provision of sexual education in schools. Sexual education helps young people make healthy and safe choices and enables them to feel a sense of satisfaction and enjoyment in themselves, their bodies and their lives, including their sexual lives.

It is positive that schools address a range of topics related to relationships, sexuality and sexual life, though the extent to which these are covered varies considerably.

Greater emphasis has tended to be placed on issues related to physical health (such as changes during puberty, sexual development and behavior, pregnancy and childbirth, HIV and other sexually transmitted infections) than on those related to social health (such as discussing sex and contraception with a partner or forming relationships), as well as topics related to pleasure and enjoyment.

Passive teaching methods (lectures, information-sharing and independent work) are used most frequently, while interactive methods (discussions, practical exercises, role-playing) are used less often. Considering that young people often lack skills in condom use or find it difficult to talk with a partner, interactive methods — such as practicing how to put on a condom using a model or role-playing conversations about wanting to use one — could be highly beneficial.

The more comprehensive and diverse sexual education is, the better young people's knowledge, the more positive their attitudes toward condom use and the more their sexual behavior reflects values of safety and equality. Systematic sexual education in schools must therefore continue in the future, as it is the most widely accessible means of supporting young people's health and well-being.

According to data from the sexual health survey, young people themselves also consider this important. They would like to see more diverse topic coverage in school-based sexual education, more time devoted to it, more real-life examples, a more serious yet positive approach and fewer teaching methods that cause discomfort.

A young person's well-being is shaped by their entire environment, not just school. For this reason, sexual education is inherently community-based. In addition to schools, all those around children and young people contribute to sexual education: parents, friends and adults who work with youth.

In today's world, there is more information about sexuality than ever before. Questions often arise long before young people feel able to voice them aloud. There may also be a fear of excessive closeness, which can make it difficult to ask such questions of one's parents. This is where people who work with young people — whether in hobby groups, sports or youth centers — play an important role.

At a recent youth data seminar, one idea stood out: if a young person has even one trusted individual who will listen to them, that is already enough. The ability to listen without judgment is crucial. It is also important to notice problems before young people feel able to speak about them. Issues related to sexuality are often deeply personal and complex and require courage from adults as well. This is where self-education can provide valuable support for youth workers.

Resources and help

• https://seksuaaltervis.ee/
• https://www.hiv.ee/en

This commentary was originally published in the March issue of the youth sector digital magazine MIHUS, published by the Education and Youth Board's Erasmus+ and European Solidarity Corps Agency.

--

Follow ERR News on Facebook and X and never miss an update!