While pediatric care spans from birth to 18 years, issues of adolescence, particularly regarding reproductive healthcare, often seem to be overlooked. According to the CDC, among high school students in 2017, 40% had ever had sexual intercourse, 10% had four or more sexual partners, and 46% did not use a condom when they were most recently sexually active¹. Appropriate reproductive healthcare is crucial considering these statistics and their implications on various issues such as teenage pregnancy and sexually transmitted infections (STIs), as well as the mental and emotional well being of adolescents. Therefore, care of an adolescent patient should always include taking a thorough sexual history, as well as providing guidance on sexual health and safe practices.

The AAP recommends that a sexual health history be taken at least once a year. This helps maintain ongoing goals for the adolescent as well as identify sexual behaviors that may lead to pregnancy or STIs². Although teen pregnancy rates in the US have continued to decline and are at an all time low (20.3 per 1,000 females aged 15-19 in 2016), these rates are still higher than those in other developed countries such as Canada and the UK. Further, teen pregnancy and childbirth accounts for greater than $9 billion in healthcare and foster care. In terms of sexually transmitted infections, in 2016 individuals aged 13-24 accounted for about 20% of HIV diagnoses, and nearly half of new STI diagnoses³. This indicates that while improvements have been made in sexual health education and use of safe sex practices by teens, there is still significant room for further progress.

One of the barriers to adolescent reproductive health is education, and pediatricians should be aware that each of their adolescent patients will vary in terms of the type and extent of knowledge they have on sexual health. Many adolescents report that they never received information on birth control options prior to being sexually active for the first time. Currently less than half of the states in the US require sexual education to be taught in public schools, and what is taught is often inconsistent and even inaccurate. States with the highest teen pregnancy rates, including Texas, are among those that do not require sexual education in school. There are still a large proportion of schools teaching “abstinence only” curricula, which many studies have shown are ineffective and do not delay a teen’s choice to be sexually active, and they fail to provide sufficient information on sexual health and contraception⁴. Regardless of the type or extent of education an adolescent receives in school or at home, pediatricians should always remember to address this topic with their patients and provide information they need to stay safe and healthy. The following are a few tips to aid in conducting a sexual history:

• Acknowledge that these questions can be uncomfortable or awkward to answer, and ask them in a nonjudgmental manner.
• Take a sexual history at every visit to foster a relationship of comfort and trust between patient and provider.
• Ask the patient and parent how much information they wish to receive on sexual health topics.
• Remember the 5 P’s of sexual health: Partners, Practices, Protection from STIs, Past history of STIs, Prevention of pregnancy

Reproductive health rights can quickly become a heated, political issue, but regardless of personal views, physicians’ sole purpose should be to assure the health and safety of ther patients. For adolescents, who are at a crucial point in their personal and physical development, reproductive health should be a routine part of medical care. Interested in taking action? The following are examples of organizations and initiatives for sexual health advocacy:

• American Sexual Health Association (AHSA): their website contains information on advocacy work and listings of political officials to write letters to
• Forward Together: social issues relating to sexual health such as sex education in schools, immigration reform, and marriage equality
• Adolescent Reproductive and Sexual Health Education Program (ARSHEP): how physicians can play a role in advocating for their adolescent patients’ reproductive health

Jennifer Szotek, MD

Resources

1. https://www.cdc.gov/healthyyouth/sexualbehaviors/index.htm
2. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/adolescent-sexual-health/Pages/Sexual-History.aspx
3. https://www.hhs.gov/ash/oah/adolescent-development/reproductive-health-and-teen-pregnancy/teen-pregnancy-and-childbearing/trends/index.html
4. Breuner CC, Mattson G, AAP Committee on Adolescence, AAP Committee on Psychosocial Aspects of Child and Family Health. Sexuality Education for Children and Adolescents. Pediatrics. 2016; 138(2).
5. https://www.cdc.gov/std/treatment/sexualhistory.pdf