Any parent of a teenager is concerned about whether the teen is sexually active and, if so, is using protection against pregnancy and sexually transmitted diseases. The sexual behaviour of teenagers with TS/TS+ can be more of concern. The concerns can be both about risky sexual behaviour and about problems with sexual intimacy when the teenager or young adult is mature and ready to handle a sexual relationship. The points that follow discuss possible factors in the teenager's behaviour. As with all matters concerning TS/TS+, every individual is different, and so it needs to be emphasized that some of these factors may apply to the teenager or none may apply.
- The social immaturity of many teenagers with TS/TS+ can result in these teens being unprepared to respond appropriately to sexual advances.
- Teenagers who have been socially isolated because of their symptoms can be easily swayed when someone starts to pay attention to them. They can be afraid of losing a relationship if they do not become sexually active.
- Teenagers with low self-esteem can be overwhelmed when someone starts to show an interest in them. They may be more easily influenced or vulnerable to wanting the acceptance of their peers and they may view being sexually active as a way to gain acceptance. The link between self-esteem and sexual behaviour is stronger in girls with low self-esteem. In a study published in April 2002 in the Journal of Pediatrics, forty percent of the girls with low self-esteem had had sex by the ninth grade as compared with eighteen percent of the girls with high self-esteem. Of the boys with low self-esteem, twenty-nine percent had had sex by the ninth grade as compared with fifty percent of boys with high-self esteem.
- Risky sexual behaviour - such as unprotected sex, is also a concern if a teenager has low self-esteem or is socially immature.
- Some teenagers with TS/TS+ and OCD can have intrusive and sexual thoughts. The may be confused about what is real and what is in their heads.
- Some teenagers with TS/TS+ and obsessive-compulsive behaviours can become obsessive about sex. This symptom does not seem to be common, but anecdotal reports show that it can be a concern.
- Teenagers with TS/TS+ and OCD may obsess about contraceptives. The can obsess about the failure rates of contraceptives. Because no contraceptive is one hundred percent effective, they may fear that it will be one hundred percent ineffective if they use it.
- Teenagers with TS/TS+ who are not comfortable with their symptoms may fear that becoming intimate with someone will result in their disorder being recognized. The may be afraid that their partner will think they are weird or crazy, and they will avoid intimate relationships.