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.