A third of adolescents have annual visits with their physicians without any mention of sex or sexuality issues, and if talks do occur they tend to be brief, according to a study published by JAMA Pediatrics, a JAMA Network publication. 1
Physicians can help promote healthy sexuality in their adolescent patients by providing education and counseling about sexual development and by discussing sexually transmitted infections and pregnancy prevention, according to the study background.
Stewart C. Alexander, Ph.D., of the Duke University Medical Center, Chapel Hill, N.C., and colleagues examined the time spent discussing sexuality issues, the level of adolescent participation in the discussion, and physician and patient characteristics associated with sexuality discussions during medical visits. Sexuality talk was defined as any comment, question or discussion related to sexual activity, sexuality, dating or sexual identity.
The study was conducted at 11 clinics throughout the Raleigh/Durham, N.C., area and included 253 adolescents and 49 physicians. Conversations between patients and physicians were recorded and analyzed for sex and sexuality content and the duration of time the issues were discussed.
The results indicate 65 percent of all visits had some discussion of sexual content and the average time of sexuality discussions was 36 seconds. More talk of sexuality happened with female patients, older patients and African American adolescents, as well as when physician office visits were longer and conversations were explicitly confidential. Asian physicians were associated with less sexuality talk.
“The findings suggest that physicians are missing opportunities to educate and counsel adolescent patients on healthy sexual behaviors and prevention of sexually transmitted infections and unplanned pregnancy” the study concludes.
In a related editorial2, Bradley O. Boekeloo, Sc.M., Ph.D., of the University of Maryland School Of Public Health, College Park, writes: “Unfortunately, physicians may be unable to initiate discussion about sexuality owing to factors related to their lack of time and skill as well as adolescent avoidance and other health priorities. Physicians may also be hesitant to discuss sexuality because of factors related to their comfort and confidence; concern about adolescents’ or parents’ comfort; beliefs about their role; judgments based on patient stereotyping; complexity of sexual issues; concern about legal and ethical issues; concern about adolescents’ stage of cognitive development; and concern about the availability of follow-up services.”
“Overcoming barriers to physician-adolescent discussion about sexual health may require multitiered infrastructure supports. … A new primary care vision is needed to accommodate a range of sexual health topics, effective patient risk assessment and education practices, and multiple levels of primary care supports,” Boekeloo concludes.
1. JAMA Pediatr. Published online December 30, 2013. doi:10.1001/jamapediatrics.2013.4338.
2. JAMA Pediatr. Published online December 30, 2013. doi:10.1001/jamapediatrics.2013.4605.