Adolescent Health: Sex Discussions During Office Visits

Stewart C. Alexander, PhD Department of Medicine Duke University Medical Center Durham, North Interview with:
Stewart C. Alexander, PhD
Department of Medicine
Duke University Medical Center
Durham, North Carolina What are the main findings of the study?

Dr. Alexander: Adolescents are reluctant to talk about sex with their doctors and won’t raise the topic with their doctors. For physicians, there are common and valid barriers to talking about sexuality with adolescents, including time pressures and discomfort with the topic. Two-thirds of adolescents in our study had some sexuality talk during their annual visit, lasting 36 seconds long. Girls, African Americans, and older teens were more likely to receive sexuality talk. Additionally, longer visits and visits where the physician talked confidentially with their adolescent patient were more likely to have sexuality talk. Our study suggest that sexuality conversations in annual visits can be improved. Were any of the findings unexpected?

Dr. Alexander: We expected the rate of sexuality discussions to be higher. We know that physicians have a highly demanding job that often requires them to balance many tasks during a health maintenance visit where they need to address a whole host of issues. There is a lot to accomplish during an annual visit and one issue could easily override the entire visit. For example, it may be easy for sexuality to be squeezed out of a session where the physician is dealing with ADHD medicine adherence or even a severe case of acne. In the end, physicians have to weight what to prioritize due to time constraints. Also, because there is so much to accomplish during these visit, we think what might be happening is that physicians may not even realize these discussions are not occurring for all teens every time. What should clinicians and patients take away from your report?

Dr. Alexander: For physicians, the onus is on you to bring up the topic of sexual behavior and sexuality because adolescents never bring up the topic. Like any skill, It helps to practice having these conversations so you are comfortable discussing it. Practice is also important for learning how to help the adolescent open up because just because you bring up the topic doesn’t mean the adolescent will talk about the topic. Adolescents have many reasons why they won’t discuss sexuality: worrying about being judged, worry about their privacy broken, worry that the physician will talk to them as if they are their parent or teacher, and/or don’t understand why they need to have these conversations.

Also, it may be potential useful for physicians to have advance conversations with parents about confidentiality and age-appropriate discussions with emerging teens. That can help doctors and parents be on the same page, and helps doctors in having these discussions. I think this would be a useful way to encourage teens to talk to their providers.

For parents, it is important that you allow your adolescent to have a confidential conversation with their provider without you present. Your teen will be more comfortable sharing without you there. Remember, doctors are the best sources of sexual health information and without their guidance your teen may learn incorrect sexual information from friends, family, and the media.

For adolescents, it would help to educate them why it is important to have these discussions with their doctor. What recommendations do you have for future research as a result of this study?

Dr. Alexander: Pediatricians and experts should develop specific communication training programs to help doctors become more comfortable discussing sexuality and help them educate parents and adolescents why the topic is important for their physician to talk to teens.


Alexander SC, Fortenberry J, Pollak KI, et al. Sexuality Talk During Adolescent Health Maintenance Visits. JAMA Pediatr. 2013;():. doi:10.1001/jamapediatrics.2013.4338.


Last Updated on March 28, 2014 by Marie Benz MD FAAD