Sexuality not always discussed at adolescent annual health visits

One-third of adolescents who visit their physicians annually do not discuss sexual behavior, dating or other sexuality issues with them, according to recent study findings published in JAMA Pediatrics.

Stewart C. Alexander, PhD, of Duke University Medical Center in Chapel Hill, N.C., and colleagues evaluated conversations between 253 adolescents (mean age, 14.3 years; 53% female) and 49 physicians (82% pediatricians) to determine the time spent discussing sexuality issues, level of adolescent participation, and patient characteristics associated with sexuality discussions during the visits. Talk about sexuality was defined as any comment, question or discussion related to sexual activity, sexuality, dating, or sexual identity.

Stewart C. Alexander

Sixty-five percent of visits included sexuality talk; 30% of talks were 1 to 35 seconds and 35% were 36 seconds or longer. The physician initiated the discussion in all cases. Among 2% of visits, physicians did not attempt to engage the adolescent in the discussion.

In the multivariate logistic regression analyses, researchers found that blacks were 60% more likely to talk about sexuality and twice as likely to talk for 36 seconds or longer. Females were more likely than males to spend more time discussing sexuality issues. Discussion also occurred more often when the visit was longer and the conversations were explicitly confidential.

“The best way for physicians to improve their attention and comfort discussing sexual behavior and sexuality would be for physicians to practice talking about it,” Alexander told Infectious Diseases in Children. “Research indicates that learning how to communicate is similar to learning any other procedure. With more practice, physicians will get more comfortable and will talk about it more. They also should realize that the onus is on them to bring up the topic as our work indicates that adolescents don’t initiate discussions of sexuality. By initiating the topic of sexuality during visits, it opens the door for teens to talk about the topic later down the line. Another point to remember is that bringing up the topic doesn't ensure that the teenager will participate/disclose during the discussion. Often these discussions require the teenager to trust the doctor. This is where ensuring confidentiality helps because teens are less likely to seek health care and more likely to withhold information about sexuality without an explicit assurance of confidentiality.”

In an accompanying editorial, Bradley O. Boekeloo, ScM, PhD, of the University of Maryland School of Public Health wrote that physicians may not initiate discussion due to lack of time, skill and adolescent avoidance of the topic.

. “Prepare parents and adolescents for sexuality discussion before their health assessments,” Boekeloo told Infectious Diseases in Children. “Then, after rapport and trust is established, make inquiries in a non-judegmental and unassuming way (don’t assume heterosexuality, sexual experience, knowledge about sexuality). Be sensitive to adolescents’ need for confidentiality with (the) parent.” — by Amber Cox

Stewart C. Alexander, PhD, can be reached at alexa045@mc.duke.edu.

Bradley O. Boekeloo, ScM, PhD, can be reached at boekeloo@umd.edu.

For more information:

Alexander SC. JAMA Pediatr.2013;doi:10.1001/jamapediatrics.2013.4338.

Boekeloo BO. JAMA Pediatr.2013;doi:10.1001/jamapediatrics.2013.4605.

Disclosure: The study was funded in part by the National Heart, Lung, and Blood Institute. The editorial was funded in part by the Prevention Research Centers Program, CDC, and the National Institute for Child Health and Human Development.