A recent study in JAMA Pediatrics discovered that conversations about sexual health between a health provider and a teen patient are shockingly short (less than 40 seconds), full of bland yes/no answers, and more likely to occur if the patient is older. The research has put a glaring light on the need for better sex education opportunities during routine teen health visits.
I believe all teenagers deserve a safe place to ask questions about sexual health, and pediatricians should rise to that need. But as much as all docs would like to extensively support our teens by sharing accurate information and resources about sex and sexuality, there are very real reasons that I believe we fall short.
And, no, Dr. Boekeloo. It’s not because we’re “uncomfortable.” We are doctors, for goodness sake.
Practically, I only have a few minutes with a teenager each year. In order to make that time effective, initiating any discussion with a teen can make me feel like a quarterback calling an audible. During our visit, I will listen, ask a few questions, and then the conversation-play-call is driven by the risks I know my patient is taking. I turn to the topics of discussion I think are going to be the most heard, understood, and relevant to my patient at that moment.
So during a teen’s visit, I may find myself talking about a lots of important stuff. Drug use, smoking, sexuality, mean girls, family relationships, eating habits... Any one of those sensitive subjects could get the lion’s share of our conversation. If sexual health is only getting 40 seconds, I assure you that another important topic is getting more.
If we were all being truthful, however, I think a bigger reason some docs don’t invest the 40 seconds is simply because we have gained apathy towards the sex talks. It only takes seeing a few patients deal with the difficult repercussions of poor sexual choices - after you have counseled otherwise - to lose faith that our sex talks even matter. We start to believe that our limited time could be better spent on marijuana abuse, drinking and driving, or depression risks; subjects that can equally lead to life-long consequences, and where our words may have more influence.
So, how can we improve?
When I reflect on the most effective sexual health conversations I have experienced with teenagers, one thing has remained consistently true. My effectiveness is improved when I am pro-active support to existing family teachings and conversations that have already begun in the home.
*In other words, I believe parents and pediatricians need to be sex education partners. We need to support each other to ensure that every teen has the opportunity to ask questions when needed, be provided education for clarity, and have a safe place to turn for honest conversation.
Here are 3 ways parents can partner with their pediatricians’ sex talks:
1. Let me know what you believe.
We want to partner in your family’s sex-ed efforts by extending the values, teaching, and expectations of sexual health that you have begun in your home. So share with us what you are teaching so can we can reinforce these lessons in the clinic. You could do this in a letter, email, or private conversation with your doc at anytime. These lessons will change over time as your teen grows, so we expect different issues to be raised and shared as we grow together.
2. Understand our mutual responsibilities.
When docs talk with teens about sex, we focus on the physical and mental health of sexual behaviors. We talk mechanics, safety, boundaries, and protection - basic biology sorts of stuff. However, foundational learning about the emotional aspects and long-term consequences of sexual activity, including religious and personal values your family may believe, takes place at home. Respecting these different roles allows a teen to be supported in different dimensions.
3. Let your teen know that they have a voice, and it is OK to use it.
Empower your teen to speak up in the office. Allow them to share their stories, explain their symptoms, and ask their questions for all sorts of clinic visits - well and sick. When they lead the conversation, they are building confidence in communicating about their health. This confidence will be critical when it comes to having honest discussions about their own sexuality and other sensitive issues when they are teens. And when it comes time to begin private conversations between a doc and your teen, let them know that it’s OK to talk to the doc. Your approval and encouragement goes a long way behind our closed door.
Teenagers deserve answers to all aspects of health, including their developing sexuality. When doctors provide a supporting role to foundational teaching in the home, the challenge to ensure this to all teens becomes a more manageable goal.
Need some tips when talking about sex with your teen? Healthychildren.org has some easy suggestions. In addition, to begin the conversation even sooner, I recommend The Care and Keeping of Youseries for girls.
