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Two recent studies provide insight into patient-doctor communication about sexual matters. The first study describes 150 boys and girls interviewed by telephone. They were asked about their most trusted source of information about sex.1
The results were based on a telephone interview with a representative sample of more than 150 U.S. teens aged 12-18 who included both sexually experienced and inexperienced youth. While biased somewhat, as only those teens whose parents gave consent were allowed to participate, more than half (55%) of the teens stated that their parents were the most trusted source of such sensitive information. However, they also stated that they "receive more information" from other important adults such as teachers, school nurses, and health classes at school than from their parents.
The teens described information about sexual risks coming "too late" and being "too general" in nature to help. Often they felt that adults give information that has little to do with the real-life risky situations that youth face and that it does not contain enough specific detail, (e.g., exactly how to use birth control). Regarding why teens initiate sex, 61% (especially girls) stated that they felt "ready," more than half of them stated that teens start to have sex to be popular, and more than 40% stated that they felt pressured (especially girls by boys). Other reasons for having sex included not wanting to be teased as a "virgin," curiosity, and a desire to be loved. These same adolescents stated that teens often become pregnant because they think they will not become pregnant (62%), have sex while under the influence of alcohol or other drugs (55%), don’t have birth control with them (46%), or because boys don’t like using birth control (42%).
This second study was designed to identify factors associated with young adolescents’ sense of comfort about discussing sexual problems with their pediatrician.2 It was conducted with 212 young adolescent patients attending five primary care pediatric practices at a health maintenance organization in Washington, DC, who received parental permission to participate. Most of these young adolescents valued their physician’s opinion about sexual matters (85% for boys; 95% for girls). Although about 90% felt comfortable talking with their physician, only about half would feel comfortable discussing a problem about sex including an STD. Pediatricians clearly felt comfortable in discussing puberty with their young adolescent patients, as more than two-thirds did so. However, pediatricians rarely discussed a number of topics identified as important by teens. For example, only one-third of teens stated they discussed delaying the initiation of sex, less than one-fifth discussed the correct use of condoms, and only 7% discussed masturbation or nonpenetrative sexual activity with their pediatrician. Compared to the younger teens, the older teens in this study continued to place a high value on their physicians’ opinions on sexual matters (95%) while their parents’ influence generally declined (except for girls and their mothers).
Young adolescents are engaging in risk behaviors that were thought to be reserved for older adolescents and young adults only a decade ago. Almost 4 in 10 report having experienced sexual intercourse before the 10th grade.3 There are a number of negative health outcomes associated with adolescent sexual activity that have been targeted for prevention by the national health objections slated to be met by the year 2000, such as delaying the initiation of sexual activity, decreasing the number of unwanted pregnancies, and decreasing the acquisition of STDs.4 Decreasing sexual risk is an important role of the primary care pediatrician.5 In order to be effective in changing the sexual behaviors that lead to health risks for our adolescent patients, it is necessary for the primary care pediatrician to have some information about what teens believe and where they obtain information on sex, birth control, and STDs.
Teens and parents need professional guidance regarding learning specific skills as to how to resist the pressures to initiate sex and to use alcohol and other drugs that may impair the teen’s ability to make safe decisions for themselves in sexual matters. In addition, teens tell us that they need appropriate and accurate information regarding how to obtain and how to correctly use birth control (especially condoms). The adolescent is telling us that pediatricians need to address some of these specific issues as a part of anticipatory guidance during the well-adolescent visit. In addition, adolescents are telling us clearly that they value our opinions as their pediatricians about sexual issues. They also tell us that they are sometimes uncomfortable about discussing such sensitive topics with us.
I surmise from the lack of discussion about safe sex topics with the teen during well-care visits, that pediatricians are uncomfortable discussing such issues as wellonly one-third of us discuss delaying initiating sex, less than 1 in 5 discusses the correct use of condoms, and less than 1 in 10 of us discusses "very safe sex" such as masturbation.
Adolescents are already engaging in sexual activity at young ages. It is our job as pediatricians to assist the young person in delaying the initiation of sexual activity and to prevent the negative health consequences of such activity including unwanted teen pregnancy and acquisition of STDs. The adolescents in these studies tell us that they value our opinions regarding sexual matters but that often the information we provide is "too little, too late, and too inappropriate" to help manage "real life" situations that our youth face. It is important for the primary-care pediatrician to include some discussion of sexual risk during well-care visits. This information should address need, how to use birth control correctly, and how to resist pressures to have sex and use drugs. The adolescent expects and needs us to do so.
1. Sex, birth control and sexually transmitted diseases: Teens voice their beliefs. Contraceptive Report 1996;7: 11-14.
2. Boekeloo BO, et al. Young adolescents’ comfort with discussion about sexual problems with their physician. Arch Pediatr Adolesc Med 1996;150:1146-1152.
3. Kann L, et al. Youth risk behavior surveillance: United States, 1995. CDC surveillance summaries. MMWR Morb Mortal Wkly Rep 1996;45(no. SS-4):1-83.
4. Health people 2000: National health promotion and disease prevention objectives. Washington, DC: Government Printing Office, 1990.
5. Task Force on Pediatric AIDS. Adolescents and human immunodeficiency virus infection: The role of the pediatrician in prevention and intervention. Pediatrics 1993;92:626-630.