For most parents, finding the right time to have The Sex Talk with their tween or teen can be tricky. Well, you are not alone Mom and Dad. Many doctors with adolescent patients are also reluctant to broach the subject.
It is a lost opportunity. A few carefully chosen words from a doctor might help lower the risk of sexually transmitted diseases and perhaps even reduce the number of teenage pregnancies.
Unfortunately, fewer than two-thirds of doctors talk about sex, sexuality, or dating with their adolescent patients during the teens’ annual checkups, according to a study published recently in JAMA Pediatrics. And any discussion that does occur is very brief, averaging a minute or less.
Though there are probably many reasons for this, physicians may be missing a chance to talk about sexual development, the prevention of pregnancy and sexually transmitted diseases with teens who may soon become sexually active, if they are not already.
Researchers recorded the conversations that occurred between doctors and adolescents during the teens’ annual visits. Conversations about sex lasted, on average, 36 seconds.
“It's hard for physicians to treat adolescents and help them make healthy choices about sex if they don't have these conversations,” Stewart Alexander, lead author of the study, said in a statement. “For teens who are trying to understand sex and sexuality, not talking about sex could have huge implications.”
Alexander, an associate professor of medicine at Duke University, and his colleagues recorded the conversations that occurred between doctors and adolescents during the teens’ annual visits. When the investigators listened to these recordings for any mention of sex or sexual health, they found it was physicians who brought up sex in 65 percent of visits, and the conversation lasted, on average, 36 seconds.
Because adolescents tend not to initiate discussions about sex, physicians need to start the conversation, according to the authors. Even when physicians asked teens questions about sex, about 50 percent of the teens responded in a yes or no manner, limiting meaningful discussion.
Only four percent of teens had an extended talk with their doctors about sex, with girls more likely to talk with their doctors than boys.
The annual visit may be the only chance healthcare providers have to address the sexual health needs of adolescents.
“The implication for males is troublesome because, as they get older, they become less likely to routinely see physicians aside from checkups or sports physicals,” said Alexander. The annual visit may be the only chance healthcare providers have to address the sexual health needs of adolescent boys.
Sex was four times more likely to come up when teens had a clear sense that a conversation was confidential.
“We expected the rate of sexuality discussions to be higher,” Alexander tells TheDoctor in an e-mail. But physicians, Alexander adds, must juggle many tasks during a health maintenance visit, and they may need to address other issues.
“Because there is so much to accomplish during these visits, we think what might be happening is that physicians may not even realize these discussions are not occurring for all teens every time,” says Alexander.
It's also true that when doctors initiate sex discussions, it can be the starting point for a longer, more personal conversation. It is important, however, according to Bradley Boekeloo, one of the authors of a related editorial, that teens know that such talks are a normal part of a checkup and central to their physician's understanding of their health, and that they are not being singled out for discussion about sexuality.
Two circumstances made it more likely that doctors and teens would talk about sexual issues: confidentiality and time. When teens knew their discussions with their doctor would be confidential, they were more likely to open up. But the visit also needed to be long enough for the opportunity to do so to happen.
“It may be useful for physicians to have advance conversations with parents about confidentiality and age-appropriate discussions with emerging teens,” Alexander said. For doctors, knowing that parents are on board about the value of a discussion of sexual issues can help them feel more comfortable about having these discussions with their young patients.
At the same time, adolescents also need to understand the limits of confidentiality in their physician visit, says Boekeloo, a professor of behavioral and community health at the University of Maryland.
When teens knew their discussions with their doctor would be confidential, they were more likely to open up.
Alexander and his team plan to continue looking for patterns in the sexuality discussions doctors have with their patients. They are particularly interested to see if, when it comes to sexual orientation, physicians use language that acknowledges gay, lesbian, and transsexual identities, since sexual identity development is often fluid and dynamic during adolescence.