Talking to children about their sexual activity and how to protect themselves is something that many parents dread. Or more unfortunately, just flat out avoid. As providers it is important that we know how to navigate these conversations with both parents and their children. According to the Centers for Disease Control (CDC) there are approximately 20 million people with new sexually transmitted infections (STIs) every year and 110 million infections annually. Additionally, the CDC reports that while teen pregnancy is the lowest in the United States that it has been in decades, it is still one of the highest in developed nations. In a society where access to contraception is continuously being threatened, it is more important than ever that we work to educate child and adolescent patients and their parents about safe sex. It is important that these conversations begin long before the patient becomes sexually active. Prevention is key.
The initial consult with adolescents and their parents:
As of 2010 the American Congress of Obstetricians and Gynecologists (ACOG) recommends that children have their first reproductive health visit between the ages of 13 and 15. The CDC recommends starting earlier at age 11. Given that this is an extremely sensitive topic it is important to make sure that the environment is welcoming, judgment free, safe, and supportive. This is an opportunity to build mutual trust in the provider and patient relationship.
ACOG emphasizes the importance of discussing with both the patient and the parent how confidentiality works in the state where you practice. This is important in building trust and providing patient centered care. As always it is important that we use our judgment and assess each situation individually, but ideally this first visit should start with a discussion with both the parent and patient present. After that a private consultation with the patient should occur, and teaching materials such as pamphlets and models should be used as necessary. As younger patients may feel embarrassed talking about sex, utilizing the teach-back method can help ensure that he or she understands what has been discussed. After the consultation with the patient, a third conversation between the provider, patient, and parent should take place. ACOG recommends that if the parent desires a conversation alone with the provider, this should take place prior to the patient provider consultation and should be discussed with the patient first. Part of building a lasting trusting relationship with adolescents that will ensure that they receive the best possible healthcare is reminding them that confidentiality is of utmost importance.
When talking with parents giving them facts and statistics may help them understand that having these conversations does not mean that we are encouraging sexual activity at their child’s age, or that their child definitely is having sex. It is all about prevention and making sure that their child is afforded the best opportunities in life. It is important that parents feel included in this conversation about their child’s health. Parents are often the primary source of information for their children and as providers it is part of our job to help facilitate a trusting relationship between the child and parent.
What should be discussed?
This conversation should be detailed and combine not only education, but also assessment of the patient’s physiology. The topics should cover menstruation with an evaluation of the patient’s cycle to assess any abnormalities. Puberty and what changes to expect should also be discussed. This is the perfect opportunity to dispel the many myths about reproductive health that is floating around in schools and on the internet.
During the private discussion with the patient, sex, STIs, contraception, pregnancy, healthy relationships, and consent. While an 11-year-old may seem young to have these conversations, each patient is unique. Tailor the conversation to the individual patient. We should never assume that someone is not sexually active just because of his/her age. ACOG reports that 47 percent of females aged 15 to 19 have engaged in intercourse and it is essential that oral, vaginal, and anal sex, as well as manual stimulation be discussed.
This is also an opportune time to talk about other habits and experimentation such as tobacco, alcohol, marijuana, and other drugs. For many people sexual activity often occurs while the patient is under the influence. The safety discussion should include negative health effects of these activities, driving while under the influence, and consent. Below are some resources for both adolescents and parents.
Resources for Adolescents:
Resources for Parents: