Pediatricians have great opportunities to provide sexual healthcare and educational resources for adolescents under their care. While the American Academy of Pediatrics, the North American Society for Pediatric and Adolescent Gynecology, and other medical bodies encourage and provide guidelines for sexual healthcare for children and adolescents, studies show that there is room for pediatricians to expand access to this critical care. Here are some ways to get a sexual healthcare program started at your practice.
Why Adopt Pediatric Ob-Gyn Care?
The primary goals of pediatric ob-gyn care for children and adolescents are to prevent unwanted outcomes such as STIs, HIV, dating violence, and unintentional pregnancies, and to promote positive outcomes, such as healthy relationships and confidence in sexual healthcare for cisgender and transgender young women and men.
According to the Centers for Disease Control and Prevention (CDC), half of all new STDs reported each year are among young people 15 to 24, and nearly 46% of sexually active high school students did not use a condom the last time they had sex. These risk behaviors display the clear need for pediatricians and adolescent healthcare providers to engage young adults in conversation about their safety, sexual health, and offer resources for healthier behaviors.
The American Academy of Pediatrics (AAP) has clinical resources for pediatricians who wish to expand or start a sexual healthcare focus at their practice. There are many facets to sexual healthcare, but in this post, we’ll cover some of the top-level concerns for pediatricians, including how to protect patient privacy, engage with patients on sensitive topics like privacy and contraception, and when to refer patients to an adolescent gynecologist or other specialist.
Protecting Patient Privacy
Patient privacy for adolescents is a tricky aspect for every pediatric practice. Depending on your state’s laws, a patient’s state of emancipation, and your practice’s policies, a patient can consent to certain services such as STI or HIV testing, while still requiring parental consent for other healthcare services. Besides accommodating federal regulations such as HIPAA and the CURES Act, which apply to all healthcare providers, the first step to protecting patient privacy is to understand the laws in your state and how they apply to each of your patients.
Clinically, privacy should be maintained at all times. A 2011 policy statement from the AAP recommends the presence of a chaperone during gynecological exams, regardless of patent or physician gender. The presence of a chaperone such as a medical assistant or nurse can help patients feel more comfortable. They can act as witnesses in cases of misunderstanding. The patient should have the final say over the genders of the providers with whom they are most comfortable
Your EHR vendor can help you configure your patient data to protect adolescents’ healthcare information at the age your state or policies dictate. For example, patient portal access to healthcare information can be restricted to only the patient after they reach the age of majority (age 18 in most states). Learn how PCC EHR protects patient privacy in the patient portal in this video.
Should You Offer Pelvic Exams? and Other Clinical Questions
Pelvic exams are an important part of gynecological care for adolescents and young adults. The most common recommendation is for young women to have their first gynecologist visit from age 13 to 15. The level of comfort for gynecologists and pediatricians offering gynecological care for adolescents varies, so depending on your community, your pediatric practice and the local OB-GYN practices should come to an understanding on who will treat whom that best benefits these patients.
Adolescents between the ages of 13 and 15 are not likely to need a pelvic exam unless one is medically called for to diagnose or treat a complaint, such as bleeding, lack of bleeding, or pain.
Adolescent girls aged 13 to 15 who can access women’s healthcare at their pediatrician stand to benefit from the relationships built with their pediatrician and medical staff, familiar surroundings, and the knowledge that sexual healthcare is an ordinary part of their overall healthcare. According to the AAP:
“At a minimum, examination of the external genitalia should be included as part of the annual comprehensive physical examination of children and adolescents of all ages. Routinely explaining and including this examination normalizes the experience rather than setting it apart as something that is only performed as an exception.”
When to Refer Adolescents to Specialist Care
Pediatricians may often refer to their own judgment in referring adolescents and children to gynecological or specialist care. A patient may wish to receive an examination by a physician they haven’t seen before to protect their anonymity or relationship with their pediatrician, or specialist care for conditions such as endometriosis could require ongoing consultation with both the patient’s pediatrician and ob-gyn. Clinical tools such as Tanner stages can help pediatricians identify a patient’s stage in puberty, identify potential delays or abnormalities and enable access to a specialist as early as possible.
Engaging Patients with Empathy
Adolescence is a period of intense change for young people, and it’s very typical for teens to be shy, embarrassed, frightened, or uncertain about the changes happening in their bodies and with their social relationships. All teens benefit from positive rapport with their pediatrician, who can offer them access to resources that can prevent adverse outcomes such as STIs and pregnancy while promoting the positive outcomes of sexual healthcare.
Confidentiality and privacy, as previously mentioned, are essential pillars to a successful exam. Interviewing techniques can help pediatricians navigate sensitive subjects while maintaining the patient’s rapport and comfort. According to a 2017 clinical report, pediatricians can try:
- Open-ended questions like “How often do you use a condom/protection?” or “Do you know what symptoms of an STI look like?”
- Empathetic and reflective responses to a patient's feelings, such as “It sounds like you’re uncomfortable being the first person you know to enter puberty. Tell me more.”
- Reassuring statements: “You’ve said you want to have protected sex with your partner, even if they get angry with you. It sounds like you’ve made the right choice for you.”
- Gender-neutral language to support LGBTQ+ patients and identity exploration: “What kind of sexual experiences have you had?”
For a more comprehensive list of questions to ask during sexual health interviews, be sure to visit the full clinical report from the AAP. For more information about supporting LGBTQ+ patients, check out our previous post.
A Note on Unintended Health Outcomes
The AAP, CDC, and other experts emphasize that it’s not only rapport and easy access to sexual healthcare for adolescents who need treatment that matters. Consistent and regular visits to the pediatrician for reproductive and sexual healthcare normalize the experience for patients, making it easy as adults to access such care. Consistency can also open doors for communication about complex topics like dating violence, pregnancy, or sexual identity.Your practice can support adolescents and entire families and help prevent domestic and dating violence, unintended pregnancy, and STIs by providing adult and adolescent resources for these subjects. Posters, links on your practice website, and even social media posts can help access intervention, treatment, and care for families in your community.
Your practice can help stop domestic and dating violence by establishing connections with your local women’s shelters and similar resources. The National Domestic Violence Hotline is 800-799-7233.
If you’d like to learn more about girls’ health in your pediatric practice, we recommend a visit to Girlology, founded by a pediatrician and Ob-Gyn, for resources and programs for parents and girls to learn about girls’ health, puberty, sexual health, and much more.
Early and consistent access to ob-gyn and sexual health care, including routine examinations and testing for STIs, is a critical part of overall healthcare and promotes risk-averse behaviors and positive, healthy relationships for a lifetime.
So, how do you set prices for services like sexual healthcare? Are you making the revenue you should from these and all of your visits? Learn how to set your practice's prices and make sure you're not leaving money on the table with this webinar with PCC's Chip Hart.