Alcohol and attitudes are two of the key factors that health professionals need to be aware of when they are dealing with sexually active teenagers.
Researchers from the University of Sheffield, UK, found considerable differences between the way that boys and girls aged 14 to 16 viewed a series of sexual scenarios.
"The girls who took part in our focus groups were more likely to see their partner's point of view and were more aware of the complex nature of relationships than the boys" says nurse researcher Dr Mark Hayter.
Ten focus groups were held with 35 teenagers who had accessed nurse-led sexual health outreach clinics for contraception. These clinics are often held in conjunction with youth clubs in areas where teenage pregnancy rates are high.
The participants were presented with a series of scenarios – a girl and a boy both reluctant to have sex, a girl who had had a numbers of partners and a girl who felt pressured to have sex because her friends had paired off with two boys leaving her with a third.
"The objective of this study was to explore the broad gender-based attitudes and opinions towards all of the case studies, not just to explore any differences between attitudes towards any one particular case study" explains Dr Hayter, who carried out the research with Christina Harrison, a sexual health specialist nurse from Doncaster Primary Care Trust.
"Male and female attitudes clearly differed. The girls' responses were more empathic and complex because they face more complex social pressures when it comes to having sex. The young men on the other hand appeared to follow behaviour patterns that included pressuring girls to have sex, often with the use of alcohol.
"We also noticed that the boys often used aggressive language about relationships - an element that was missing from the girls' focus groups. For example they suggested that a girlfriend who slept around would probably pay a physical price and that using tactics like getting a girl drunk were acceptable.
"In one of the boys' focus groups there was even a suggestion that it was OK for a boy to force his girlfriend to have sex and the group started trying to differentiate between 'just a bit of pressure' and 'proper rape'."
The researchers concede that the focus group format could have encouraged stereotypical male and female behaviour, but point out that in the real world teenagers' behaviour is shaped by the sort of peer pressure displayed during the sessions.
Sexual health is a major issue in all cultures, with increasing numbers of young people between 13 and 18 being affected by sexually transmitted infections (STIs), unplanned pregnancies and abortions.
"Studies from the USA, Europe and Asia all indicate that adolescence is a time of sexual vulnerability" says Dr Hayter. "The UK certainly reflects this trend and has one of the highest rates of teenage pregnancies and STIs in Europe. In some areas it is common to see pregnancy rates of up to 19 per 1000 in the 13-16 age group."
Distinct trends can also be seen from the international literature, including sexual activity at a younger age and increased risk taking, such as unprotected sex with new or casual partners. This behaviour is strong influenced by social and contextual factors closely related to peer pressure, alcohol use and gender power.
"Nurses working in sexual health clinics used by young people should be aware of the ways in which their clients think about sex and relationships" concludes Dr Hayter.
"Providing information and contraception is only one element of promoting sexual health.
"When it comes to female clients, nurses should develop interventions that can strengthen self-esteem and teach young girls how to respond positively to the social pressures they face around sex.
"It would also be helpful to encourage young male clients to empathise with their female partners.
"Last, but definitely not least, clinics need to treat alcohol use by their clients as a higher priority, integrating advice and help about harmful drinking into their sexual health promotion work."
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