updated 11/1/2010 4:49:21 PM ET 2010-11-01T20:49:21

A "birds and the bees" talk with your kids isn't complete without a discussion of oral sex, according to a new study that found a connection between oral sex and old-fashioned intercourse.

The three-year survey found that teens who had oral sex by the end of ninth grade were at the highest risk of having sexual intercourse during high school. These teens had a 25-percent chance of having intercourse by the end of ninth grade and a 50-percent chance by the end of 11th grade.

Meanwhile, teenagers who did not have oral sex until the end of 11th grade had only a 16-percent chance of having intercourse by the end of that school year.

The survey also found that most sexually active teenagers will start having oral sex and intercourse within the same six-month period.

Health care providers, parents and educators should directly address oral sex and its risks with teens, according to study researcher Bonnie Halpern-Felsher, a professor of pediatrics at University of California, San Francisco.

"I see most of the health policies out there and guidelines for preventive services talking about sex generally, but they do not specify oral sex. That is an important distinction because teens don't consider oral sex to be sex, and many are not aware of the risks involved," Halpern-Felsher said.

"Our study demonstrates that through its relationship with intercourse, oral sex contributes to the total risk associated with sexual activity among teens, including sexually transmitted diseases and pregnancy ," said Anna Song, also a study researcher and an assistant professor of psychological sciences at the University of California, Merced.

The researchers followed more than 600 students at two northern California high schools from the ninth grade through the end of 11th grade. The study is published online by the journal, Archives of Pediatrics and Adolescent Medicine, and it will also appear in the March 2011 print issue.

About 4 in 10 never–married U.S. teenagers ages 15–19 have had sexual intercourse at least once, according to a Centers for Disease Control and Prevention report released in June. [ 42% of U.S. Teens Have Had Sex ]

Risky sexual behavior among teens was also reported in a study of more than 7,000 New York City adolescents published online Oct. 25 in the Journal of Pediatrics. Nearly 9 percent of females and nearly 4 percent of males had both male and female sex partners, the research found. And these teens with both-sex partners indicated a marked prevalence of dating violence and forced sex, along with sexual behaviors that could put them at risk for sexually transmitted diseases, including HIV, the researchers reported.


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