“One of the most important roles played by a primary care provider—perhaps the most important—is as a source of objective information,” says pediatrician Cara Natterson, MD, co-founder of puberty resource OOMLA. “This information may reflect back on something that has happened in the past or that’s going on in the moment, but it often points forward in the form of anticipatory guidance.”
The Study in Detail
The researchers from University of Minnesota analyzed data from a nationally representative survey of U.S. adolescents ages 11-to-17 years old and their parents. They found that 14% of younger adolescents (ages 11–14 years old) and 38.7% of older adolescents (ages 15–17 years) reported that providers asked about their sexual activity at their most recent checkup. And less than one-third of adolescents reported a provider discussing any sexual and reproductive health topic besides puberty. Additionally, conversations about confidentiality and time alone between providers and adolescents were infrequent, with 20% of younger adolescents and 44% of older adolescents reporting time alone with their provider at their most recent check-up. “Our findings suggest clear gaps between parent and adolescent perceived importance of discussing sexual and reproductive health topics with primary care providers and adolescents’ experiences during preventive visits,” says lead author Renee E. Sieving, PhD, RN, a professor in the School of Nursing at the University of Minnesota. Sieving adds that while most parents and many youths that were surveyed noted the importance of providers discussing these topics, these discussions do not routinely occur during preventive visits.
The Importance of Sexual Health Guidance
“A great primary care provider will help a patient think ahead to the health and safety issues that will arise, and in doing so will help arm that patient with the tools to make smart choices,” says Dr. Natterson. “The conversation with a health care provider often kicks open a door.” At the same time, it’s not a surprise that these conversations often don’t take place, Dr. Natterson says—they’re tricky, they require time (which many doctors don’t have), and they also require a depth of relationship that’s not always present between a provider and their patient. “It takes a very skilled conversationalist to meet a kid (or a parent) for the first time and then go deep into highly personal territory,” Dr. Natterson explains. Also, the doctor’s office or clinic may not be the most conducive setting for an intense conversation—there are often other people around, the walls can be thin, and the light is brassy, all of which creates an environment that is the opposite of intimate. While the study suggests that a large percentage of parents and kids report having no sexual health conversations with their primary care provider, Dr. Natterson says it’s possible that the doctor tried to go there but felt shut down, rerouted, or simply not heard. “It happens,” she says. “Think about the last time you went to a doctor’s office or a clinic. Do you remember absolutely everything that was said? It’s human to filter, which is precisely why providers need to repeat this content over and over. One conversation about anything is rarely enough.”
Parents Want These Conversations to Take Place
The study findings dispel the notion that parents object to providers having discussions about sexual and reproductive health topics with their young adolescent children. In fact, most of the young patients—and their parents—supported such conversations. So what can parents do to help facilitate them? A lot, says Sieving. First of all, parents can let their teens know that what they share with their PCP is confidential. They can also make it clear to their teens that they support this confidentiality practice and emphasize that their PCP is a good person to ask about questions concerning sexual and reproductive health (e.g., questions about things like puberty, dating relationships, sexual decision making, preventing pregnancy, and STI prevention). Equally important is to ask questions, says Dr. Natterson. By the time kids reach their teens, most primary care visits will have at least some component that involves having the parent step out of the room, which is appropriate. “If the sexual health content hasn’t come up before leaving, you can ask the provider to cover it,” says Dr. Natterson. “Just remember to be sensitive about how you do so.” One simple way is to say something like, “Before I step out of the room, I just wanted to make sure you knew I am very comfortable with the two of you talking about sexual health.” And if you have a specific question, go ahead and ask it. “Then—and this is really important—follow up with your child later on,” says Dr. Natterson. “Ask what was covered, or take a different tack and ask what your kid knows about sexual health. Ask if they have any related questions or if there’s any new information they are grappling with? Make it clear that you want to be a resource for them.” If that scares you or it’s not within your comfort zone, let your child know that the health care provider is someone they can always call for advice. As well as taking an active role in these conversations, ask your health care provider to make sexual health guidance a priority during check-ups.
