The Elephant In The Room: How To Talk To Teens About Sex

36 seconds.

That's the average amount of time pediatricians spend talking to teens about sexuality, according to a study published by JAMA Pediatrics (Journal of the American Medical Association).

"Only 10% of sexually experienced adolescents reported health care providers as a source of birth control/STI/HIV information."

Sex Education at the Pediatrician's Office

These days, the topic of healthy sexuality needs to cover a whole lot more than a quick overview of anatomy. According to the AAP statement from July 2016, sexuality education includes discussions around:

• Intimate relationships
• Human sexual anatomy
• Reproduction
• STIs (Sexually Transmitted Infections)
• Sexual activity
• Sexual orientation
• Gender identity
• Abstinence
• Contraception
• Reproductive rights and responsibilities
• Consent
• Body image

Try fitting all that into 36 seconds. There is no way it can happen. That means essential discussions with teens are falling by the wayside.

So why the communication breakdown?

Although it may seem like wanting to avoid an awkward talk could be the reason, that is not typically the case according to Dr. Natahsa Burgert in an article on kevinmd.com. It is primarily a matter of time – lack of time that is:

"... 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."

Along with time constraints, the article suggests that apathy plays a role as well:

"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 why is it important to keep the conversation going, and for longer than 36 seconds? Well, in an ideal world an adolescent would be receiving this type of education from parents and in school, as well as in their pediatrician's office. Sometimes though, the pediatrician may be the primary or only source of information. The long term and routine nature of the pediatrician/patient relationship has great potential to foster ongoing discussions over time. Engaging in age-appropriate talks starting when the patient is young, and continuing to make them a consistent part of well care is a good way to start.

Talking About Sexuality: How to Guide Adolescents

Along with the AAP report, other publications offer helpful hints on good ways to talk with adolescent patients about healthy sexuality. The Western Journal of Medicine and PediatricsConsultantLive have good articles on the subject. Highlights from all three include:

• Emphasize the confidential nature of your talks to create a sense of security and openness.
• Let teens know you are not here to judge, just to listen and help. Don't show shock or surprise at their questions.
• Start with both the child and parent in the room. Follow the parent's lead on how much info should be shared with everyone in the room together. At some point ask the parent to leave the room, or ask your patient if they would like their parent present or not. This may improve the chance for a more candid talk.
• Treat and speak to teens as their age dictates (and not the same way you would speak with your 4 year-old patients)!
• Don't lecture. Teens will withhold communication if they perceive judgement.
• Don't assume sexual orientation. Use open questions to involve the teen in a discussion.
• Encourage adolescents to be empowered in decision-making and strategies for themselves around things like assertiveness, consent, rejection of unwanted advances, and social skills.
• Encourage the positive aspects of healthy sexuality, but emphasize the need for responsibility and good decision-making. Make sure to provide information on different options, such as abstinence or contraception methods.
• Encourage teens to seek out information from multiple sources, and provide them with information and access to confidential service and support resources.
• Work to build rapport as a way to increase good communication:
  • When entering the exam room, greet and shake hands with the teen before greeting the parent.
  • Take a health history while the teen is still dressed and save any disrobing for the exam.
  • Be aware of your body language. Face the teen and use eye contact even while listening to the parent.
  • When listening to a parent's concerns, make sure to ask the teen if they have the same concerns for themselves and if so, offer to talk further in private.

Additionally, the AAP suggests approaching sex education with teens from these three standpoints:

1. Cognitive: Giving out information about healthy sexuality.
2. Affective: Discussing feelings, values, and attitudes around sexuality.
3. Behavioral: Working on strategies for communication and decision-making around sexuality.

And rather than the more generic education a teen may receive at school, having the chance to discuss sexuality with their pediatrician can help teens to:

• Have a more personalized sex education experience.
• Have the chance to ask questions they may be embarrassed to ask in a sex ed class at school.
• Have confidential risk screening.
• Have conversations that will enhance their existing strengths, such as promoting and counseling for healthy boundaries.

The takeaway? Empowering teens to embody healthy sexuality through education and open discussions is well worth more than 36 seconds. While the challenge of finding more time in an appointment to talk about sexuality is a constant battle, with these strategies in play the conversations can happen more frequently and with greater ease.