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AAP Clinical Report: Pediatricians Should Provide Sexuality Education

​Sexuality education is effective in helping to prevent and reduce the risks of teen pregnancy, HIV and sexually transmitted diseases among children and adolescents, and should be part of a pediatrician’s ongoing discussions with patient and parent, according to a clinical report by the American Academy of Pediatrics (AAP).

The clinical report, “Sexuality Education for Children and Adolescents,” marks the first update by the AAP on the subject since 2001, and will be in the August 2016 Pediatrics (published online July 18).

Children and adolescents should receive developmentally appropriate and evidence-based information about human sexuality and reproductive health over time from parents, caregivers and a variety of professional resources, including the pediatrician’s office and schools, according to lead author Cora Collette Breuner, MD, MPH and chairperson of the AAP Committee on Adolescence.

“Research has conclusively demonstrated that programs promoting abstinence only until heterosexual marriage occurs are ineffective,” Dr. Breuner said. “Sex education is about more than when to have sex. Conversations with kids cover healthy sexual development, interpersonal and consensual relationships, affection, intimacy and body image.”

The report finds that school-based programs offering sexuality education can vary widely, and that parents would benefit from support to improve communication with their adolescents about sex.

One review of 12 studies showed that parents who were trained on how to talk with their adolescents about sex had better communication with their teens on the subject compared with those who did not. Such conversations between parent and adolescent are correlated with a delay in sexual debut and increased use of contraception and condoms.

Pediatricians are in a good position to complement the sexuality education provided at home and in school. The report suggests that pediatricians introduce issues of physical, cognitive and psychosexual development with parents of young children, and continue discussions at ongoing health maintenance visits.

“The longitudinal relationship and annual well visit present several opportunities for discussion,” according to the report, which also speaks to the needs of adolescents with disabilities, chronic health conditions and other special needs.

However, many pediatricians do not address sexuality during patient visits, according to the report.

“One of three adolescent patients did not receive any information on sexuality from their pediatrician, and if they did, the conversation lasted less than 40 seconds,” said Dr. Breuner, who cited a review of health maintenance visits.

Adolescent sexual activity and teen births and pregnancies have been decreasing since 1991, with the exception of 2005 to 2007, when there was 5-percent increase in birthrates. The report attributes the overall decline in teen birth rates to increased use of contraception.

“Nevertheless, the United States continues to lead industrialized countries with the highest rates of adolescent pregnancy,” according to the report. About 88 percent of births to adolescents age 15 to 17 are unintended, research shows.

The AAP report calls for pediatricians to introduce early parental discussion with children and adolescents at home about sexuality, contraception, the Internet and social media use that is consistent with the family’s attitudes, values, beliefs and circumstances.

As an adolescent approaches college-entry age, a pediatrician may address issues such as the effects of alcohol, marijuana and other drug consumption on decisions about safe, consensual sexual practices.

In the office setting, adolescents have been shown to prefer a pediatrician who is open and nonjudgmental in responding to worries or concerns about sexuality.

Pediatricians can acknowledge that sexual activity may be pleasurable but also must be engaged in responsibly, the report concludes.

“Children and teens should be encouraged to ask questions or share concerns about their bodies or sexuality,” Dr. Breuner said. “The pediatrician can provide personalized, accurate information in a safe setting.”

Published
7/18/2016 12:45 AM
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