A new study suggests that many doctors are not talking to their teenage patients about sexuality, and those who are spend an average of just 36 seconds on this important topic.
The study, published in JAMA Pediatric, found that teens—even those who want birth control—will not bring up the topic, and that
physicians often fail to do so as well. Apart from school-based sex education, regular checkups with physicians may be one of the best opportunities for young people to have their sexuality questions answered by experts. Unfortunately, this study suggests that more often than not the opportunity is being wasted.
As part of the study, researchers audio-taped the visits of 253 teens at 11 clinics in North Carolina and then analyzed the recordings for “sexuality talk,” which was defined as any discussion, comment, or question linked to sexual activity, sexuality, dating, or sexual identity. They found that only 65 percent of the visits included any sexuality content. This means not only that one-third of teens are leaving their health-care visit having received no information about sexuality, but that physicians often have no idea of the sexual health risks their patients might be taking.
Perhaps more disturbing, however, is the finding that even when these topics were brought up, the average conversation lasted just over half a minute. Stewart Alexander, lead author on the study, told NPR that he ran through the American Academy of Pediatrics’ checklist of questions that providers should ask adolescents about sex, and there is no way to even ask all the questions in such a short period of time, let alone wait for them to be answered. In truth, it is hard to imagine what can be thoroughly (or even minimally) discussed in 36 seconds. As J. Dennis Fortenberry, co-author on the study, pointed out to RH Reality Check, “Asking a young woman about her menstrual periods does not constitute ‘sex talk.’”
Part of the problem is the short amount of time doctors spend with adolescents in total. The average length of a visit in the study was just nine minutes, and a lot of things need to get covered in that time. Alexander told NPR, “For boys, you only get them for health maintenance visits for sports or camps. If a boy comes in and has a problem with acne or ADHD medicine, that may override the preventive health stuff. There are other topics that are getting in the way.” Still, physicians need to make time to engage in in-depth discussions about sexuality with their teenage patients. Alexander noted, “It’s easy for things to get lost in the shuffle. I don’t want to bash doctors. They’re required to do so much. They should do this. But it’s hard.”
One reason it is so difficult may be that teenage patients are too reluctant to bring up any sexuality topics themselves. In fact, all of the conversations about sex that did occur between physicians and adolescent patients in the study were initiated by the physician. Fortenberry, however, reminds us that “just because young people don’t initiate conversations with physicians about sex, doesn’t mean that they aren’t interested in being asked.” Proof of this may be in the study’s finding that even some of the young people included in the study who wanted birth control didn’t start a conversation on the topic. This suggests that if their physicians hadn’t brought it up, they would have left their appointment
without a prescription and may have gone on to have (or continued to have) unprotected sex. It also suggests that there were likely adolescents among the one-third that didn’t discuss sexuality with their physician who also wanted birth control but were afraid to ask. Again, they left the visit unprotected.
Both Alexander and Fortenberry believe that one of the key issues stopping youth from asking questions about sexuality is confidentiality. Their research found that having a time for confidential conversations without the patient’s parents in the room made discussions of sexuality more likely, but only one-third of the visits in the study included such one-on-one time. As Alexander told NPR, “It’s hard to get the parent out of the room.” He added that some doctors explain the need for confidential time with the teenager up front, which can make it easier to ask parents to leave later in the visit. Fortenberry also noted that many teenagers are not aware of their right to physician-patient confidentiality. He told RH Reality Check, “This matters to young people and should be addressed near the beginning of every visit. Not all young people fully understand physicians’ legal and ethical commitments to confidentiality and these have to be explained.” Knowing that what they say when they are alone with their provider cannot be repeated to their parents may go a long way in getting young people to talk about sex.
Parents also have a role to play in fostering a confidential relationship between their teens and a trusted health-care provider. Understandably, it can be hard for a parent who has been in charge of their child’s health
since their first well-baby appointment at two weeks to step away, both literally and figuratively, but it is important to give young people the opportunity to ask their own questions.
At the same time, parents can help in a number of different ways, explained Bradley Boekeloo, a professor of behavioral and community health at the University of Maryland School of Public Health, who wrote an editorial accompanying the study. He told NPR that parents can make it easier for their children to get the information they need by talking with them about sexual development early on and answering questions as they come up. It makes sense that kids who have become more comfortable discussing sex with their parents will also be more comfortable discussing it with a health-care provider. Boekeloo says parents also can play a direct role during the visit by encouraging both their teen and the doctor to tackle sexuality. “The physicians probably need as much support as the youth in a visit, in terms of logistics,” he said. Of course, the next and possibly most important step is for parents to get up and leave the room.
Fortenberry says that the conversation that happens next “does not have to be embarrassing, time consuming, or especially detailed. Many young people have fairly clear ideas about their sexual boundaries and are quite willing to discuss these if asked.” Still, these conversations have to happen so that young people can have their questions answered and physicians can assess threats to their patients’ health. Only then can we make sure that young people leave their health-care visits armed with the information and tools, such as birth control, they need to protect their sexual heath now and in the future.