September 25, 2019
What is sexual health awareness?
The World Health Organization defines it as a state of physical, emotional, mental and social well-being in relation to sexuality. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. I think sexual health awareness covers everything from sexual identity to how people think about their sexual selves and in relationship with other people.
You have studied the issue for some time.
Yes, almost all of my research is on sexual health. I have spent my career trying to convince pediatricians that sexual health and sexually transmitted infections is really an area for us to focus on. The burden of sexually transmitted infections (STIs) in the United States weighs heavily on young people 15 to 25, the population we see in our adolescent and young adult clinic. It is a national problem but we have some local issues here in Baltimore. Our young people bear a disproportionate burden of STIs when you look at us compared to other places around the United States.
How do you approach sexual health for patients?
That sexual health is definitely something we should be thinking and talking about and working on for both prevention and intervention. I am also interested in helping young people develop their own sexual healthy selves. Oftentimes I talk to young people who are engaging in sexual experiences and find they are not necessarily fulfilled in any way. For me, there are three things I want for them as their health provider: 1) not to acquire any sexually transmitted infections, 2) that their experiences are not coerced, and 3) that they are safe. My research focuses on the health safety part of it – how to keep young people from acquiring sexually transmitted infections; and how do we do our best to take care of them when they do have one.
Do parents discuss sexual health awareness with their teens?
Often parents hide from it, or push it away rather than engage their teen. One of the things sexual health awareness month does is encourage discussions around healthy relationships, healthy sexual experiences, and ways to keep yourself healthy. In the United States, many people are having sex but very few people are talking about it. Even fewer people talk about STIs. Sadly, people really do not care about STIs until they have one.
What do pediatricians need to think about?
As providers, we have to think about preventive services and how to optimize our one-on-one time with patients. Research suggests that both parents and teens want doctors to have that confidential time with adolescents and to talk about sexual issues. However, providers spend on average just 36 seconds on sexual health issues. That is not long enough for you to have a meaningful conversation. It may not even be enough time for you to get the information you need to decide about screening for STIs or to answer questions young people may have about their bodies and development.
How can parents address the issue?
Parents should ensure their adolescent has a preventive health services visit with their primary care physician or provider at least once a year. When the parent is gently asked to step out of the room to give the child some confidential time, the parent can say, “I would love you to talk to my child about puberty, sexual development and relationships.” However, the parents have to bring them to the visit for that to happen. We have learned that adolescents, of all groups, are least likely to have those preventive services visits. Parents can also read up, see what young people are looking at online. There are great resources to help parents talk to children and adolescents about sex. They have to do their homework early – there is nothing worse than being caught off guard. They could say, “Let’s look it up together and talk about it.”
What kind of questions will teens ask?
At a young age, they may ask about the way their body is changing. That conversation becomes more developmentally complex as the child moves into adolescence. Teens may have alone time with the physician, which affords an opportunity to ask any question. Parents need to support that alone time – the adolescent also has a right to confidentiality. Parents need to know that does not mean we are keeping secrets that could harm them; it means the adolescent has a safe place to open up. Our job is to really help their adolescent reconnect with the parents as a key component of their safety net. We want young people to engage parents around these and other issues as often as they can.
Are parents’ reactions important?
They have to work on monitoring their feelings about questions, even before the young person needs the information. When young people ask their parents questions, they are concerned about being judged. Is my mother or father going to be a safe person to talk to in a way that does not pass judgment? Will they make me feel uncomfortable? Dishonesty or rebuff has the potential to push adolescents away because the parent may not be seen as a safe person to talk about that issue.
What can parents do?
We still see sexual activity starting around age 15, but about half of young people have not had sex when they graduate from high school. Many parents are caught off guard when they learn of sexual behavior. Open communication and parental monitoring are important strategies for creating structure and making sure young people are making healthy decisions. Having these conversations with your child very early on and slowly adding to the content is another. Talking to your kindergartener about “safe touch” and “boundaries” with adults and other children is a great way to start.
What if they feel their child is too young to engage in sexual relations?
Parents can say, “Honestly, I think young people your age are too young to be having sex. If you wait a bit, you may be able to better manage it and keep yourself healthy. If you start moving in that direction, I am here to help you get the resources you need to keep yourself healthy and safe.” Research supports that young people who clearly understand parental perspectives and have good information, delay initiation of sex and are more likely to engage in behaviors that prevent STIs and pregnancy when they do decide to have sex.
Therefore, parents would rather know their child is having sexual relations. That is a tricky one. Ultimately, I think parents would rather know. If we do not offer any message or information, young people are left to fend for themselves. It is like jumping from one ledge to the next with no safety net. Parents are a critical piece of the safety net, and young people take cues from them.
What kind of resources are available for teens?
The Johns Hopkins Center for Adolescent and Young Adult Health at the Harriet Lane Clinic currently runs a Title X supported reproductive health services program. This allows us to offer sexual and reproductive health services to young people. Adolescents and young adults can receive free or low cost confidential services for family planning, STI screening and HIV testing, and counseling. The Baltimore City Health Department also offers a number of STI/HIV prevention services and clinics, including school-based health centers. The American Sexual Health Association, Yes Means Test campaign and Y2Connect, designed by a Johns Hopkins adolescent/young adult specialist on our team, Arik Marcell, also steer young people to local resources regarding sexual health. Advocates for Youth’s AMAZE website offers animated videos on topics ranging from sexual orientation and gender identity to sexual abuse and personal safety for tweens 11 to 14 years of age. The website fills a gap for youth access to such information and can be an integral tool for anticipatory guidance in the office.