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Doctors don’t talk to adolescents about sex
December 31st, 2013
08:48 AM ET

Doctors don’t talk to adolescents about sex

Thirty-six seconds is the average time a physician spends speaking with adolescent patients about sexuality, according to research published online Monday in JAMA Pediatrics.

About one-third of adolescent patient-doctor interactions result in no talk at all about sexuality - which includes things like sexual activity, dating and sexual orientation.

"A lot of these are one-way conversations," said Stewart C. Alexander, associate professor of medicine at Duke University Medical Center and lead author of the study. "The adolescent barely talks or responds (when issues of sexuality are raised).

"Doctors just lob it up there and when there isn't participation, they stop going there."

About 30% of the time, the conversations lasted between one and 35 seconds (out of an average 22-minute appointment), while 35% of conversations went a bit longer, according to the study.  On the high end of the spectrum, the sex-talk lasted just under two minutes - hardly enough time to delve deeply into a topic.

Researchers listened to audio recordings of annual doctors' visits with 12 to 17 year olds (with their parents' consent) in the North Carolina area from 2009-2012; study participants included 253 adolescents and 49 physicians.

They analyzed the conversations according things like how often sexuality was raised, how engaged the adolescent was during those conversations, and who brought up issues of sexuality.

Questions ranged from "Are you having sex?" and "How many partners do you have?" to more innocuous-seeming fare, like "Are you dating?"  Not surprisingly, the usual response from the adolescents tended toward one-word answers.

What should be happening, according to organizations like the American Academy of Pediatrics, is for children and adolescents to "discuss potentially embarrassing experiences, or reveal highly personal information to their pediatricians," according to a policy statement on the AAP website.

In fact, the conversation should go much further than simple Q and A, and cover "questions, worries, or misunderstandings...regarding anatomy, masturbation, menstruation, erections, nocturnal emissions ('wet dreams'), sexual fantasies, sexual orientation, and orgasms."

Clearly, that's not happening in 36 seconds.

Part of problem is cultural. Another part of the problem may involve parents, Alexander said.  When they left the room during the appointment, adolescents seemed to feel safer and tended to be more open.  When parents stayed in the room, he said, there was less chance for meaningful conversation.

And it is not just an issue of adolescents being tight-lipped around parents. The reluctance to talk sex also came from doctors.  Study authors cite discomfort and a lack of confidence among physicians when speaking about these issues.

An editorial responding to the study suggests the issue is more complicated than that.

"Physicians may also be hesitant to discuss sexuality because of factors related to their comfort and confidence; concern about adolescents' or parents' comfort; beliefs about their role," according to an editorial by Bradley O. Boekeloo of the University of Maryland School Of Public Health.

Their hesitation, according to Boekeloo, may also stem from "judgments based on patient stereotyping; complexity of sexual issues; concern about legal and ethical issues; concern about adolescents' stage of cognitive development; and concern about the availability of follow-up services."

Alexander says that doctors are missing a window of opportunity to provide credible and accurate information about sexually transmitted diseases, pregnancy and screening to a vulnerable group.  (Their other sources of information - peers, the Internet, the media, even parents - don't necessarily provide accurate information.)

"We need to start training doctors to teach them how to start these conversations and how to keep them going," Alexander said.


soundoff (12 Responses)
  1. Shelia

    Its none of the doctors Business..The business of the doctor is health of the human body not parenting or therapy. A doctor may ask are u sexual active and anything going on in the private area but sex therapy is for the professional therapist..

    January 2, 2014 at 17:48 | Report abuse | Reply
    • nunovyerbizness

      Clearly you didn't bother to read the end of the article. "doctors are missing a window of opportunity to provide credible and accurate information about sexually transmitted diseases, pregnancy and screening to a vulnerable group."

      January 4, 2014 at 10:25 | Report abuse |
    • Kate

      Shelia...you didn't seem to bother to read the article, did you? You said, and I quote "The business of the doctor is health of the human body not parenting or therapy." Sexual health is still health, even though it is often an uncomfortable topic to discuss. Pediatricians need to know about the general health of their patients, whether it be stomach aches, vision problems, headaches or even sexual problems...they need to know this because they are the doctor children and adolescents go to for yearly check-ups. They do this so that they can refer the child, if needed, to a specialist if complex health issues occur.

      Shelia, you missed the point entirely. Sexual health might seem rather uncomfortable to talk about...but ultimately it is sheer ignorance to dismiss it entirely from regular check ups. ALSO the article states "Alexander says that doctors are missing a window of opportunity to provide credible and accurate information about sexually transmitted diseases, pregnancy and screening to a vulnerable group. (Their other sources of information – peers, the Internet, the media, even parents – don't necessarily provide accurate information.)"

      But again...it really seems like you didn't bother to read the article.

      January 4, 2014 at 18:58 | Report abuse |
    • BoB

      If the doctor is familiar with the patient, they will ask more detailed information. HSV2Dating org posted a poll and support my idea. Patient may take the initiative during the conversations.

      January 10, 2014 at 21:35 | Report abuse |
  2. Shelia

    "We need to start training doctors to teach them how to start these conversations and how to keep them going," Alexander said.

    Actually no we don't no one needs a busy body doctor and if i get one i will walk out of the room..

    January 2, 2014 at 17:50 | Report abuse | Reply
    • Nobody you know

      …and the doctor will do a happy dance.

      January 8, 2014 at 09:52 | Report abuse |
  3. Jeb

    Doctors don't have time to talk to patients about much of anything.

    January 4, 2014 at 00:12 | Report abuse | Reply
  4. Captain Wolff

    The solution to this one is easy:
    'Alright, I'm not gonna lie, sex is pretty freaking awesome. However, and accidental pregnancy or STD would be inconvenient for all of us, so I'm buying you a World of Warcraft account. That should keep you a virgin well into your thirties."

    January 5, 2014 at 19:07 | Report abuse | Reply
    • maggie

      hysterical, smiles

      January 6, 2014 at 15:00 | Report abuse |
  5. Snow

    I'm not afraid to talk to my doctor about anything, mostly because my family has been seeing the same doctor since I was born. It can be uncomfortable, but I feel like they know a whole lot more than I do about stuff like that.

    January 8, 2014 at 11:10 | Report abuse | Reply
  6. Real Talk with Dr. Offutt

    Important topic. I make sure my teenage son has alone time with his Dr (they take the time for this). And I make sure to tell him that there is no question that is off limits for him to ask his Dr. Maybe encouraging parents to spread this message, along with getting doctors to ask these questions of their teen patients will help improve this situation. As for teens and their health, given that they live on social media, and given that health classes in school are so widely variable, I have spent the past year building an online teen health content community called Real Talk with Dr. Offutt. No ads, not monetized, no bias. Just straight information and encouragement for teens to discuss health topics and take ownership of their bodies, their health and their decisions. Nothing replaces a live conversation with a respected adult, but I am trying at a minimum to get teens thinking and talking about health in a place that they are often more comfortable than face to face, and in a place that is rife with inaccurate information. Here is where I am:
    http://drlauraoffutt.blogspot.com/
    @RTwithDrOffutt
    http://realtalkwithdroffutt.tumblr.com
    https://www.pheed.com/realtalkwithdroffutt

    January 16, 2014 at 21:06 | Report abuse | Reply
  7. GOP Prayer

    The GOP Prayer/Mantra/Solution: Dear God...With your loving kindness, help us to turn all the Old, Sick, Poor, Non-white, Non-christian, Female, and Gay people into slaves. Then, with your guidance and compassion, we will whip them until they are Young, Healthy, Rich, White, Christian, Male, and Straight. Or until they are dead. God...Grant us the knowledge to then turn them into Soylent Green to feed the military during the next "unfunded/off-the-books" war. God...Give us the strength during our speeches to repeatedly yell........TAX CUTS FOR THE RICH!!!..........and........GET RID OF SS AND MEDICARE!!!
    In your name we prey (purposely misspelled, or is it?)........Amen

    April 16, 2014 at 21:57 | Report abuse | Reply

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