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Physicians balk at airing sex issues with teens.


Primary care physicians avoid discussing sexual issues with adolescents at their annual visits.

In a study analyzing audio-recorded yearly checkups between 49 pediatricians or family physicians and 253 of their adolescent patients, fully one-third of these visits included no mention at all of any topic touching on sexuality including physical development, emotional development, sexually transmitted diseases, pregnancy, sexual orientation, intercourse behaviors, other sexual behaviors, sexual abuse, or dating.

And even when such "discussions" did take place, they lasted an average of 36 seconds and rarely involved much input from the patients, according to Stewart C. Alexander, Ph.D., of the department of medicine, Duke University Medical Center, Durham, N.C., and his associates.

These findings, taken together with other revealing results of what may be the first study to observe discussions of sexuality between physicians and adolescents, indicate that "physicians are missing opportunities to educate and counsel adolescent patients on healthy sexual behaviors and prevention of STDs and unplanned pregnancy."

The investigators assessed the frequency and duration of talk regarding sexual issues using data from Teen CHAT, a randomized trial that examined how health care providers talked to overweight adolescents about attaining a healthy weight. That trial began with audio recordings of annual health visits in 2009, and it is ongoing.

For their analysis, Dr. Alexander and his colleagues assessed 253 recordings collected from annual visits at three academic and eight community-based primary care practices during a 4-year period.

Participating physicians included 40 pediatricians and 9 family physicians. All the patients were aged 12-17 years, and the mean age was 14.3 years. Just over half were girls; 47% were black, and 40% were white.

The physicians spent a mean of 22.4 minutes in the examination room with the adolescents. Talk regarding sexuality occurred in only 65% of visits and was initiated by the physician in every case; no patient ever brought up the topic, and many were reluctant to engage other than to answer specific questions with a "yes" or a "no."

When sexual issues were discussed, in 2% of visits, the physician spoke about sexual issues without attempting to engage the adolescent, and in another 2%, the physician spoke and the adolescent responded nonverbally. In 17%, adolescents made a mean of two yes or no responses. These "'discussions" tended to last no more than 30 seconds.

To put this time frame in context, it takes more than 35 seconds just to read aloud the questions regarding sexual health that are suggested in American Academy of Pediatrics guidelines for adolescent health visits, without allowing any time for answers, the investigators noted (JAMA Ped. 2013 [doi: 10.1001/jamapediatrics. 2013.4338]).

Something approaching conversation about sexual issues occurred in only 35% of visits. In these cases, the adolescents made a mean of 7 statements to the physicians" 14 statements over the course of 68 seconds.

Somewhat more comprehensive conversations occurred in the remaining 8% of visits: The adolescents made a mean of 9 statements to the physicians' 17 statements during interactions that averaged 103 seconds in 4% of visits, and the most talkative adolescents made a mean of 20 statements to the physicians' 26 statements during 114-second interactions in 4% of visits, according to Dr. Alexander and his colleagues.

This study was supported by the National Heart, Lung, and Blood Institute. No relevant financial conflicts of interest were reported.
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Author:Moon, Mary Ann
Publication:Family Practice News
Date:Jan 1, 2014
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