Teens and Sex: A difficult conversation for everyone – Including doctors

I vividly remember the first time my son’s pediatrician asked me to leave the examining room during his annual check-up. He said that as his patients approached adolescence, it was his practice to spend a few minutes with them privately. It would allow them to ask any questions or voice concerns that they might not be willing to discuss in front of their parents.

At first, I was fuming.  I thought, “Who does this doctor think he is?” After all, my husband and I have been in charge of our son’s health from the moment of his conception. We’re his parents, the ones who know him best. We have a good relationship, we openly and often talk about difficult issues and the challenges he may be facing. We only want what’s best for him.

Once I got over my misplaced anger, I realized that the doctor also wanted what was best for our son.  That day turned out to be a learning milestone for all of us. Our son had the chance to take another step away from childhood and toward independence and manhood.  He also had the chance to share his thoughts, worries, and personal questions with someone other than his Mom and Dad, someone especially skilled at asking and answering difficult questions.

In this particular case, the doctor was the perfect choice to help reinforce the discussions about sex my husband and I were already having with our son. He had the skill and expertise to fully listen and respond without any of the emotional baggage and anxiety a parent might justifiably bring to the discussion. It taught me that no matter how much my husband and I love and care about our children, it’s not only good, but essential that they expand their support network and reach out to other knowledgeable adults as they grow older who can provide sound advice including, grandparents, aunts, uncles, teachers, and most definitely doctors and other health professionals.

But a recent study by Duke University shows that our family pediatrician may have been the exception and not the rule when it comes to broaching these difficult subjects. Far too often, doctors aren’t taking the necessary time to talk about sex and other issues with their pre-adolescent patients. This is especially alarming at a time when more and more teens – and in some cases even younger children - are having sexual relations earlier and earlier. Add the constant bombardment of a hyper-sexualized media, the increase in STDs, the rise in the numbers of teens binge drinking, an increase in smoking, and the reduction or total elimination of health education in the schools and we’re facing a national public health crisis.    

The study, published in JAMA Pediatrics found that less than two-thirds of doctors and teenage patients talk about sex, sexuality or dating during annual visits.

Other key findings included:

  • Doctors are missing a prime opportunity to share information about sex with their teenage patients by failing to broach the subject during checkups.
  • Physicians spent an average of 22.4 minutes in the exam room with their patients. When discussions about sex occurred, less than 3 percent of the visit was devoted to topics related to sex.
  • Physicians initiated discussions about sex in 65 percent of visits, with conversations lasting an average of 36 seconds. The other 35 percent of visits included no mention of sex. None of the adolescents initiated discussions on sex, reinforcing the need for physicians to start the conversation.
  • Female adolescents were more than twice as likely to spend more time talking about sex than their male counterparts. While females may have more to discuss when it comes to birth control and pregnancy prevention, the finding raises the concern that males could be missing out on benefits of annual visits.
  • The implication for males is especially troublesome because as they get older, they become less likely to routinely see physicians outside of checkups or sports physicals. Annual visits become essential and are perhaps the only opportunity for physicians to address the sexual behaviors of adolescent boys
  • Doctors are more likely to bring up sex with older patients, despite recommendations from the American Academy of Pediatrics that these dialogues happen early
  • These limited discussions are inadequate to meet the sexual health prevention needs of teens. 

Lead author of the study, Stewart Alexander, PhD, associate professor of medicine at Duke stated, “For teens who are trying to understand sex and sexuality, not talking about sex could have huge implications and although adolescents have access to information on sex from a variety of sources, physicians could do more in support of teens’ healthy sexual development.”

Perhaps the most important thing for parents to learn from this study is that when it comes to talking about sex and all those other difficult but necessary topics, they can’t and shouldn’t depend on someone else to do it for them. It is their responsibility.

Need a little help? Welcome to the club! The following websites are a good place to begin:

While challenging, not to mention awkward for everyone involved, these conversations are even more important than just science and facts; they’re the perfect time to talk about family values, relationships, making healthy choices, and feelings – and that’s what being a parent all is about.  

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