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Doctors should use annual check-up to talk to teens about sex

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Doctors are missing an opportunity to educate their teenage patients about sex by not having “the talk” during annual visits, according to a study published in the Dec. 30 online edition of JAMA Pediatrics.

The study, conducted by researchers at Duke University, found that less than two-thirds of doctors and teenage patients talk about sex, sexuality or dating during annual visits, and that those conversations last less than a minute on average.

“It’s hard for physicians to treat adolescents and help them make healthy choices about sex if they don’t have these conversations,” lead author Stewart Alexander, PhD, an associate professor of medicine at Duke University, said in a news release.

“For teens who are trying to understand sex and sexuality, not talking about sex could have huge implications,” added Alexander.

Duke researchers analyzed audio recordings of annual check-ups for 253 adolescents who visited pediatricians and family doctors at 11 clinics in North Carolina. The teens ranged in age from 12 to 17.

Listening for any mention of sexual activity, sexuality or dating, the investigators found that physicians brought up sex in 65 percent of visits, with conversations lasting an average of 36 seconds. None of the teens initiated discussions about sex.

“We saw that physicians spent an average of 22.4 minutes in the exam room with their patients. Even when discussion about sex occurred, less than 3 percent of the visit was devoted to topics related to sex,” said Alexander.

Of concern was that this “limited exchange is unlikely to meet the sexual prevention needs of teens,” said Alexander.

Study results also showed that girls are more than twice as likely as boys to talk about sex. While girls may have more to discuss when it comes to birth control, noted the research team, the finding points to the fact that teenage boys could be missing out on the benefits of annual visits.

“The implications for boys,” said Alexander, “are troublesome because as they get older, they become less likely to routinely see physicians outside of check-ups or sports physicals. Thus, the annual visits become essential and are perhaps the only opportunity for physicians to address the sexual behaviors of adolescent boys."

In a not-so-surprising finding, the investigators learned that older teens are more likely to talk about sex than younger patients. Current guidelines, however, recommend that doctors start these conversations in early adolescence, before teens become sexually active.

Analysis of the audio recordings also showed that longer visits and confidentiality – discussions when parents were not present in the exam room – increased the chances that sex was mentioned. However, only 31 percent of the study visits included confidential conversations between doctor and patient, and sex was discussed 4 percent of the time.

In an editorial accompanying the study, adolescent health expert Bradley Boekeloo, PhD, a professor at the University of Maryland School of Public Health, called on doctors to increase their efforts to engage their teenage patients in conversations about sex.

“While parents, family members, teachers, coaches, faith leaders and peers are important sources of sexual information, primary care physicians have access to objective, science-based sexual information that adolescents need,” wrote Boekeloo.

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