A recent study conducted in New Jersey and Pennsylvania looked at electronic documentation and notes from pediatric visits and showed pediatricians had only documented a sexual history for one out of five teenagers. The authors of the study also found very low rates of recommended testing for sexually transmitted infections in teenage patients, a finding concerning given that half of all chlamydia and gonorrhea cases occur in people between the ages of 15 and 24.
So why aren’t some pediatricians talking about sex?
There several reasons to consider. Time constraints on visits make in-depth history taking difficult and put pressure on providers to limit the questions that they are able to ask. Some also believe that some pediatricians just are not that comfortable asking or assume that they’ll know what kids are at risk, though studies show that 47 percent of U.S. high school students have ever had sexual intercourse. Lastly, because there are laws and ethics that protect the conversation between adolescents and their providers (except when there are reports of abuse or concern for imminent self-harm to the patient’s self or to others), some providers may chose not to document fully the conversations that they have with adolescents, even if they are asking the questions.
Many might wonder how important it is for a pediatrician to ask an adolescent about their relationships and sexual activity, but this is a critical part of providing the appropriate counseling, testing, and education to support health. Here’s the deal:
Let’s talk about… much more than sex. Though it’s often labeled a “sexual history,” the conversations between a provider and an adolescent encompass much more than that, ranging from safety and relationships at home and at school or work to diet, body image, drug and alcohol use, and mood. The “sexual history” is just part of the interaction, and even that conversation covers a number of different topics. Often, providers will start by talking about attraction, puberty, and healthy relationships at younger ages. As teens get older, discussions are guided by the patient’s experiences and include anticipatory guidance and education to help teens be as safe and healthy in their relationships as possible, including delaying sex if they’re not ready. We also screen for violence or abuse in relationships and open up a safe space for victims of sexual assault.
Families play an enormous role in education around all of these topics, and an open relationship that encourages straightforward discussion with lots of room for questions can be a teen’s best resource. A pediatrician that asks these important questions can add to that by being another trusted adult with access to the latest up-to-date information and tools for screening and prevention of sexually transmitted infections and pregnancy.