REVIEW ARTICLES

Promiscuity in adolescence and its relationship with sexually transmitted infections

La promiscuidad en la adolescencia y su relación con las infecciones de transmisión sexual

Lázaro Alejandro Sánchez Blanco ^1*, https://orcid.org/0009-0006-5074-4640

Miguel Enrique Barroso Fontanals ¹, https://orcid.org/0000-0003-3291-7457

Yilian Brossard de Armas ², https://orcid.org/0009-0003-2668-6071

Octavio Alisdan Paz Ricardo ¹, https://orcid.org/0009-0005-8983-0493

¹ University of Medical Sciences of Santiago de Cuba. Faculty No. 1 of Medicine. Santiago de Cuba, Cuba.

² University of Medical Sciences of Santiago de Cuba. Faculty of Nursing – Health Technology. Santiago de Cuba, Cuba.

* Corresponding author: mbarrosof9@gmail.com

Received: 23/03/2024

Accepted: 05/07/2024

How to cite this article: Sánchez Blanco LA, Barroso Fontanals ME, Brossard de Armas Y, Paz Ricardo OA. Promiscuity in adolescence and its relationship with sexually transmitted infections. Med. Es. [Internet]. 2024 [cited access date]; 4(3):e222. Available in:  https://revmedest.sld.cu/index.php/medest/article/view/222

ABSTRACT

Introduction: a promiscuous person is defined as someone who engages in sexual relationships with multiple partners, as well as exhibiting unstable behavior due to frequent changes in partners within a short period of time.

Objective: describe the relationship between promiscuity in adolescence and STIs.

Methodological Design: the information was obtained through Scielo, PubMed, and Google Scholar. 37 articles in Spanish and English were selected.

Development: adolescence is a stage of openness to sexuality, in which the tendency towards sexually active behavior is increasing, with greater access to full sexual relationships and an increase in the number of sexual partners, exposing them to risks.

Conclusions: promiscuity as a risky sexual behavior in adolescence is closely related to sexually transmitted infections, as it is a primary risk factor for their occurrence.

Keywords: Adolescent; Sexually Transmitted Infections; Health; Sexuality

RESUMEN

Introducción: una persona promiscua se define como aquella que mantiene relaciones sexuales con varias personas, así como un comportamiento inestable, debido al constante cambio de pareja en un corto tiempo.

Objetivo: describir la relación existente entre la promiscuidad en la adolescencia y las ITS.

Diseño Metodológico: se obtuvo la información a través de Scielo, PubMed y Google Académico. Se seleccionaron 37 artículos en idioma español e inglés.

Desarrollo: la adolescencia es una etapa de apertura a la sexualidad, en la cual la tendencia a una conducta sexualmente activa es creciente, con un mayor acceso a las relaciones sexuales completas y al aumento del número de compañeros sexuales, por lo que se exponen a riesgos.

Conclusiones: la promiscuidad como conducta sexual de riesgo en la adolescencia guarda una estrecha relación con las infecciones de transmisión sexual pues constituye un factor de riesgo primordial para la aparición de las mismas.

Palabras Clave: Adolescente; Infecciones de Transmisión Sexual; Salud; Sexualidad

INTRODUCTION

Adolescence is a stage in which biological, psychological and social changes occur. During this period, a process of building identity, autonomy, sexuality, vocation and life projects deepens. Adolescents begin to explore themselves due to new physical changes and begin to have their first sexual impulses with contact with the opposite sex. Between the ages of 14 and 17, their development is almost complete, their organs are ready for reproduction and sexual desire increases. ⁽¹⁾ They also generally enjoy good health, but face the risk of suffering from sexually transmitted infections and/or unwanted pregnancies when they begin a sexual life without responsibility. ⁽²⁾

A promiscuous person is defined as someone who has sexual relations with several people, as well as unstable behavior, due to the constant change of partner in a short time, thus presenting a difference from monogamous people who have only one partner and even remain abstinent. ^(3,4)

Promiscuity has historical antecedents that date back to ancient times when social and cultural norms regarding sexuality were different from those of today. For example, in some ancient societies such as the Greek or Roman, sexual promiscuity could be more accepted or even associated with religious practices or festivals. ⁽⁵⁾

Today, promiscuity remains a debated and taboo topic in many cultures. The evolution of moral and social norms has influenced how this practice is perceived in different societies. There are divergent opinions: while some defend individual freedom and the right to live sexuality openly and without ties, others question promiscuity for ethical, health and even religious reasons. ⁽⁶⁾

From a health point of view, according to data from the World Health Organization (WHO), every day more than one million promiscuous people contract a sexually transmitted infection (STI); it is estimated that of that million people, one third are adolescents. ^(7,8)

The limited information provided to adolescents and young people on aspects related to sexuality and in particular on STIs such as HIV/AIDS is in contrast to the existing increase in this exposed population, which, seen from a preventive perspective, are those who open the doors to infection in their highest percentages. For this reason, the objective is to describe the relationship between promiscuity in adolescence and STIs.

METHODOLOGICAL DESIGN

In order to describe the relationship between promiscuity in adolescence and STIs, a bibliographic review was conducted where the main technique for collecting information was the online search in Scielo, Google Scholar and open access journals. The descriptors used were: adolescent; sexually transmitted infections; health; sexuality, both in Spanish and English. A total of 37 articles were selected based on their fit and focus on the topic. For the preparation of the article, the methods of documentary review, analysis-synthesis and inductive-deductive were used.

DEVELOPMENT

Adolescence is a stage of sexual openness, in which the tendency towards sexually active behaviour is increasing, with greater access to full sexual relations and an increase in the number of sexual partners, which exposes them to risks. The increasingly early initiation of sexual relations, the inexperience typical of their age and the lack of information bring with them the possibility of acquiring sexually transmitted infections and early pregnancies. ^(9,10)

It is necessary to mention in a special way the existence of promiscuity, as an element of great importance. This is a sexual behavior that has accompanied human beings throughout their history, since in ancient times greater freedom was accepted for these expressions, together with the wide development of prostitution and the "relaxed" customs prevailing at that time. Sometimes they occur in a covert manner, but every day they are defended more openly by people who do not consider themselves as "transgressors" of the established, although in practice they demonstrate the opposite. This way of facing sexuality does not create any moral or psychological problem for such individuals, because they are consistent with their actions and enjoy these crazy and thoughtless relationships. ⁽¹¹⁾

According to Pimiento Idiarte et al., ⁽¹²⁾ promiscuity is the practice of sexual relations with several partners or sexual groups, while Almenares Isaac et al., ⁽¹³⁾ define promiscuity as cohabitation with people of the opposite sex or mixing and confusion.

According to the review carried out by the authors of this article, promiscuity and promiscuous have been used, sometimes in a derogatory sense to qualify as negative (disqualify) the sexual behavior of some people, which is why it is usually used to clearly define this type of sexual activity.

There are two types of promiscuity: Passive promiscuity is defined as the psychological sexual condition of people whose actions are not always in accordance with their voluntary sexuality and may be conditioned or repressed by cultural, social, religious factors, responsibilities of any kind or by modesty. They are generally more responsible and controlled with their sexuality, they organize themselves by having passionate and emotional relationships and sometimes they can be unfaithful, even combining several partners at the same time, without them knowing it. On the other hand, active promiscuity is defined as that in which those who practice it continually enjoy sporadic sexual encounters, without any kind of sentimental attachment. Such is the way in which they live their sexual condition that they can be regular clients of brothels or participate in dates with high sexual content such as "threesomes". ^(14,15)

Paredes López et al., ⁽¹⁶⁾ define as causal factors of sexual promiscuity the education of people, the lack of guidance in the stage of adolescence, the family environment and the environment in which the individual develops, as well as the culture. When treating patients, the age at which they began their sexual practice must be taken into account, since the earlier they have started, the greater the chances of contagion. Immaturity and the number of people with whom they have had sexual relations also influence.

Medical and psychological professionals warn about the risks derived from sexual promiscuity, because in addition to sexual diseases, there are pregnancies that can arise, mainly in adolescents. Sexually transmitted diseases and other urinary diseases are some of the consequences on the health of men who are sexually promiscuous. The exercise of this sexual activity without any protection will make them vulnerable to the contagion and spread of numerous sexual diseases and in turn bring with it unwanted pregnancies. ⁽¹⁶⁾

With the so-called sexual liberation, promiscuity became more tolerated and lost its scandalous streak. The daily life of certain people includes promiscuity as a normal thing. In large Western cities, it is common for young people to have casual sexual relations when they go out dancing or having fun at night. However, this behaviour is not usually socially condemned nor does it lead to accusations of promiscuity. ⁽¹⁵⁾

Nowadays, although society has changed and promiscuity is more tolerated, this attitude is still not equally well regarded by both sexes. If it is a man who carries it out, he is considered a “flirt”, but in many areas if it is a woman, she is accused of being “a slut”. ⁽¹⁵⁾

The authors determine that it is important to keep in mind that, beyond any moral condemnation of this type of behavior, promiscuity requires the practice of safe sex to avoid sexually transmitted diseases and unwanted pregnancies.

Relationship between promiscuity and STIs

STIs are diseases whose main mode of transmission is sexual relations, whether between homosexual or heterosexual couples, where incorrect partner selection and frequent partner changes are risk factors. ⁽¹⁷⁾

Adolescents represent a very sensitive group of individuals, exposed to multiple changes and risk factors. During this period of their life, young people begin to become aware of their sexuality, and frequently initiate these activities without adults noticing. Many are unaware of the functions of their own body and have little knowledge about intimate relationships and their consequences. ^(18,19)

Studies such as that by Long JR et al., ⁽²⁰⁾ refer to the fact that the reason for initiating sexual activity is multifactorial: whether for love, spontaneously, out of curiosity or by a planned and discussed decision, but among those that frequently prevail are: spontaneously and out of curiosity.

Many adolescents begin to have sexual relations without having received accurate information about sexuality, health and reproduction. This lack of information is responsible for the high incidence of unplanned pregnancies and sexually transmitted infections that are currently reported at this age. ⁽²¹⁾

The authors comment that this is why sexuality in adolescence is one of the issues to which special attention is paid at national and global levels.

STIs are the greatest threat to adolescent health, representing the most widespread and devastating disease facing young people today. Therefore, there is no greater approach to the development and formation of responsible sexuality that can determine protection, which is an indispensable factor to avoid them. It has been shown that adolescents are interested in expanding their knowledge about STIs and other topics that have a significant impact on the development of their sexuality, such as abortion, family planning, human physiology and reproductive health. ^{(22, 23)}

During adolescence, the care and improvement of sexual health has been one of the goals of governments and health organizations, since the way in which they live their sexuality delimits practices and behaviors that will define their sexual identity. However, the cardinal health problems during adolescence are related to inappropriate behaviors and unhealthy lifestyles, so most can be prevented in a timely manner. ⁽²⁴⁾

This epidemic of STIs includes a group of risks, among which are: infertility, fetal malformations, cervical cancer and death. It can be said that there is no approach to the development and formation of a responsible sexuality with protection, since an indispensable factor to not acquire sexually transmitted infections is to assume sexuality not only as intercourse or as an impulse or instinct, but always keeping in mind that to procreate one must do it at the right time. ^(1,24)

The age of initiation of sexual relations seems to be the most important, because it is related to the biological changes that occur in the cervix during puberty, revealing the physiological immaturity of the transformation zone. ⁽²⁵⁾ The risk of early initiation of sexual relations is due to the fact that in adolescents there is active metaplasia, or in other words, a cellular transformation of the columnar epithelium into metaplastic, and of this into squamous, increasing the potential for interaction between the carcinogen (semen and trauma from intercourse) and the cervix. ⁽²⁶⁾

Among the most lethal are the Human Immunodeficiency Virus and its development in Acquired Immunodeficiency Syndrome (HIV/AIDS), Hepatitis B and C, the Human Papillomavirus (HPV) and candidiasis in women. The precocity of sexual relations is associated with a higher incidence of cervicitis and associated inflammatory gynecological diseases, which favors the existence of a grouping of risk factors that increase the possibility of oncogenicity, associated with an immune system that is not completely mature. ⁽²⁷⁾

HPV infection affects the health of women and men. However, it is young people and adolescents in late stages who are the most vulnerable group. In Spain, a study indicated that the prevalence of HPV was found mostly in women aged 18 to 25 years, in Chile it revealed a higher prevalence in women aged 15 to 19 years, while in Cuba it was found that around one in three adolescents diagnosed with HPV was between 15 and 17 years old. ⁽²⁸⁾

The high incidence of HPV infection is associated with the early onset of sexual activity in the adolescent and young adult stage and a greater number of sexual partners. The importance of HPV infection lies in the fact that it is the main etiological factor of cervical cancer. In Cuba, as in the world, there is evidence of a change in the age of appearance of this type of tumor, possibly related to the precocity of the first sexual relations, promiscuity and the concomitance of other risk factors. ⁽¹⁰⁾

When referring to the number of sexual partners, in most Public Health research, the high number of sexual partners is associated with the appearance of cervical cancer. ⁽²⁹⁾ Epidemiological studies carried out in the last 30 years have established a strong association between cervical cancer and sexual behavior, among which can be identified the early age of initiation of sexual relations and a high number of sexual partners. Other associated factors are multiparity and tobacco consumption. ⁽³⁰⁾

The diagnosis of cervical neoplasia is not synonymous with female promiscuity, although it is no less true that promiscuous women have a greater chance of suffering from it. Many women who only report one sexual partner also develop the disease, so it is worth considering the role of men in the genesis of cervical cancer, especially high-risk or promiscuous men who have unprotected sex, since they have a higher probability of developing an HPV infection and therefore contamination of their seminal plasma, which plays an important role in transmitting the infection to their sexual partner. ⁽³¹⁾

The Human Papillomavirus is also a growing cause of certain types of mouth and throat cancer that affect not only men but also women, although the risk is greater in men due to lack of protection. It is important to note that when men contract the virus, they do not develop any symptoms that affect their health and push them to go to the doctor, but they are the ones who can cause the death of their partner. In the most extreme cases, they present outbreaks of warts around the glans or at the end of the rectum. The age at which sexual relations begin and the number of sexual partners, with or without a history of promiscuity, are important because they represent an approximate indicator of the number of exposures to the virus. ⁽³²⁾

Therefore, the authors comment that it can be determined that the sexual behavior of men and women constitutes a significant risk factor between high and low incidence populations.

Some other STIs such as syphilis and gonorrhea were more widely known in the 1950s, whereas in the 1990s we have chlamydia, soft chancroid, hepatitis A and B, trichomoniasis, molluscum contagiosum, salmonella, venereal granuloma, HIV, among others. ⁽³⁰⁾

HIV/AIDS is one of those chronic diseases that has had epidemic manifestations and currently constitutes one of the most serious public health problems worldwide. It was discovered in 1981 and is produced by a virus that attacks and destroys CD4 T lymphocytes, also called T helpers, which defend us from infections by germs and the proliferation of certain cancer cells. During the period 2013 - 2016 in Santiago de Cuba, 90 patients were diagnosed late, with 30 deaths. The epidemic in the province prevails in 3 municipalities: Contramaestre, Palma Soriano and Santiago. According to the criteria of experts in the territory, the province of Santiago de Cuba is the second largest population cluster with HIV-positive people in the country. ⁽³³⁾ The authors state that currently the virus is still deadly, however, there are treatments to improve the quality of life of the infected.

Gonorrhea is a very common venereal disease caused by the bacteria Neisseria gonorrheae, which can easily grow and multiply in warm, moist areas of the reproductive tract, including the cervix, uterus and fallopian tubes in women, and in the urethra of women and men. It is easy to detect in men, since a purulent discharge is produced by the urethra with considerable pain and burning when urinating. However, in women it is much more difficult to detect, because it generally does not cause discomfort, and if it does, it is not very specific and can be confused with other genital infections. If not treated, this bacteria will infect and destroy the internal genital organs of women, resulting in sterility in many. ⁽³⁴⁾

Syphilis is a venereal disease that can be easily detected if, several days after having had sexual relations, a painless ulcer with defined edges appears on the genitals, accompanied by inflammation in the lymph nodes of the groin. You should go to the doctor quickly for treatment, otherwise the ulcer will disappear and the infection will spread throughout the body, damaging it irreversibly and possibly causing death. ⁽³⁵⁾

The herpes simplex virus (HSV) is an infection characterized by a localized primary lesion, a latency period and a tendency to reappear in a localized form. There are two known types of HSV: 1 and 2, which generally produce different clinical syndromes depending on the route of entry, although taking into account the types of sexual practices, both can infect the genital tract. ⁽³⁶⁾

Nowadays it is difficult to control the sexual relations of our young people. Young couples maintain these relations without having to be married and without having to reach the age that was previously normal. Understanding the changes in sexual practices and experiences in young people of both sexes can improve intervention programs designed to reduce early pregnancy, STIs and HIV/AIDS. ⁽³⁷⁾ The authors state that programs must be designed for sexually active adolescents of both sexes, without a fixed partner, if we want to aspire to prevent unwanted pregnancies and reduce the transmission of diseases through sexual means.

They also state that for responsible sexual education it is very important to talk about the subject from an early age with children, in simple, clear and manageable terms according to their age. In addition, one should know about contraceptive methods for the prevention of unwanted pregnancy and the prevention of STIs.

CONCLUSIONS

The debate on promiscuity is still ongoing and is addressed from different perspectives, including sexual education, respect for the diversity of sexual choices and the importance of open communication to establish healthy and safe relationships. Promiscuity as a risky sexual behavior in adolescence is closely related to sexually transmitted infections, as it is a primary risk factor for the appearance of these infections.

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STATEMENT OF AUTHORSHIP

LASB: Conceptualization, Data curation, Formal analysis, Investigation, Project administration, Resources, Validation, Writing the original draft.

MEBF: Conceptualization, Investigation, Methodology, Project administration, Resources, Validation and Writing, review and editing.

YBA: Conceptualization, Research, Validation and Writing of the original draft.

OAPR: Conceptualization, Research, Validation and Writing of the original draft.

CONFLICT OF INTEREST

The authors declare that there are no conflicts of interest.

SOURCES OF FINANCING

The authors did not receive funding for the development of this article.