How physicians should talk to teens about sexual health

October 7, 2019

They may be awkward, but physician-led conversations about sexual health are a must when dealing with teenage patients

Talking to teens about their sexual health can feel like an awkward proposition even for physicians who regularly see teenagers, but it’s very important to their health, says LaTasha S. Perkins, MD, a family physician at Georgetown University Student Health Center in Maryland.

However, Perkins rarely leads a conversation by asking about sex first. She recommends opening the conversation by asking teens about their social history first.

“The social history of a teenager is almost equally as important as a vital sign. You want to know what's going on around them and you want to know who their friends are, things they're interested in,” she says. “Because sexual health is a part of that, it's essential to find out what that child is doing around sex.”

Once you have a sense of their social life, she transitions to deeper questions. “Even if this your first time meeting this person, you want to start it off saying, ‘OK, so now we're going to talk about something sensitive, but it's important because I want to take care of your health and I want to make sure we're not missing anything.’”

If she senses that the teen may not be as forthcoming with their parent in the room, she will recommend the parent leave the room to allow the teen more privacy.

“You always let the parents know, ‘We're going to have a sensitive conversation and I want [your child] to be able to answer honestly. So I want to make sure that you're OK with this conversation. If not, we'll have you leave the room.’”

She also recommends paying attention to the teen’s cues, if they seem to clam up in the presence of their parent or answer all questions negatively, then it might be a good time to ask the parent to leave.

“Most parents are OK with leaving the room because they want their child to have the conversation with someone and they prefer it to be a medical professional,” Perkins says.

She often asks if the teen has a boyfriend or girlfriend first as a segue into sexual activity and reassures them that anything they say in the room remains confidential unless they are hurting themselves, or planning to hurt others.

Even if the teen is not forthcoming with any information, she says that’s OK. “You're trying to establish a relationship, a rapport, and a safe zone where they can ask questions.”

Opening the door to conversations of sexual health not only helps to clarify questions, it lets kids who experience sexual trauma know that they have an ally and a medical professional they can speak to later if they need to, she says.

She recommends that physicians be alert to signs in teens that don’t have an obvious source such as stomachaches, headaches, sudden changes in mood, or a lack of interest in activities they previously enjoyed.

“Pay attention to anything that just seems a little off kilter,” Perkins says. “Then you know to kind of start digging because they're not going to say ‘someone is sexually assaulting me.’”

Additionally, she says physicians need to realize that teens have greater access to information about sex due to the availability of the internet and social media, which often leads to misinformation.

“Kids are very smart, they know how to find information,” Perkins says. “So as a physician, our role has changed a bit. Instead of us being the only ones with the info, the kids have it, so we just want to make sure that we're helping them understand it in a way that makes sense for them.”

She reminds her teen patients that the information they find online about sex may not be accurate or helpful. “So, you might say, ‘If you’ve used Google, you might see something that you don't quite understand. You can always come back and ask me about it.’”

The more comfortable a physician is having these conversations, the more at ease the teens are likely to be, as well.

“[Taking a] sexual history is one of those things that we learned in medical school, but tends to get left off because it is mildly uncomfortable. It’s definitely an area where physicians need to take control and get comfortable asking the question, whether it's to teenagers or adults.”