Pediatricians Urged to Cover Sexual, Reproductive Health With Adolescent Boys

By Anne Harding

May 04, 2020

NEW YORK (Reuters Health) - Pediatricians caring for male adolescents should routinely address their sexual and reproductive health, according to new guidance from the American Academy of Pediatrics (AAP).

"Pay attention to the boys," Dr. Laura K. Grubb of Floating Hospital for Children at Tufts Medical Center, in Boston, one of the authors of the article, told Reuters Health by phone. "Just pay attention to them, ask questions, be comfortable in your own skin talking about sexual and reproductive health, because you can provide a safe and healthy environment for them so they can make good choices and stay healthy,"

The guidance, published in Pediatrics, updates a 2011 clinical report from the AAP on male adolescents' sexual and reproductive health, covering several new topics such as social media and pornography, confidentiality, consent and the human papillomavirus (HPV) vaccine.

Pediatricians are much more likely to address sexual and reproductive health with their female adolescent patients than with their male patients, Dr. Grubb and Dr. Makia Powers of Morehouse School of Medicine and Children's Healthcare of Atlanta note in the article. They also rarely ask patients about risky sexual behavior or other "sensitive topics" such as gender identity, sexual identity, violence or abuse, the authors add.

"We talk to the girls and the young women, but they don't get themselves pregnant, they don't give themselves STIs, so we have to talk to both parts of the equation," Dr. Grubb said.

Conversations about sexual and reproductive health can easily begin with the HEADSS interview, a psychosocial instrument that covers home, education, activities, diet and drugs and sexuality and safety, she added.

"You can start with a gentle approach: 'Do you have any questions or concerns about your body especially as you're going through puberty?'" Dr. Grubb suggested.

Discussions don't have to take place at a single visit, she added, and the pediatrician should focus on providing a safe and confidential environment for patients, so they will feel comfortable seeking help if they need it. "You start and you develop a rapport with them and you build up a relationship," Dr. Grubb said.

There is no explicit federal law protecting the confidentiality of adolescents' healthcare information, the authors note. Adolescents and young adults, who can be on their parents' health insurance until they are 26, risk having confidential information revealed through explanations of benefits or claim denials sent to the policyholder, they add.

Pediatricians should also screen for social-media use and pornography viewing, and offer guidance for patients and parents on "safe and sensible Internet and social media use," they write.

Other recommendations include:

- Ask whether they have been exposed to sexual assault or other types of victimization

- Discuss consent and nonconsent, offer anticipatory guidance on consensual sexual activity

- Offer screening for sexually transmitted infections (STIs) as appropriate, and discuss STI prevention

- Consider starting HPV vaccination at age 9, provide routinely by age 11.

- Screen sexually active patients for sexual dysfunction.

SOURCE: Pediatrics, online April 27, 2020.