Pediatricians advised to talk to teenage boys about sexual health

Physicians routinely talk about sexual and reproductive health with adolescent girls. Now it's time they do the same with adolescent boys, says a report in the December Pediatrics.

These young males are going through physical, psychological and social changes during puberty, but those issues are not routinely addressed during office visits. Research has shown that physicians are three times more likely to take sexual health histories from girls and twice as likely to counsel female patients on condom use, the report said (link).

Consequently, the report encourages pediatricians and others caring for teenage boys to take a sexual history, examine the genitals, provide age-appropriate discussions about sexuality, talk about hygiene and sexually transmitted diseases and administer vaccinations.

The discussions are particularly important as the number of doctor visits usually declines for this age group, especially for older male teens.

"We need to get away from the locker room physicals," said pediatrician Charles Wibbelsman, MD, a co-author of the report and chair of the adolescent medicine subspecialists at Kaiser Permanente, Northern California. "When adolescent males come in, it's not just listening to the heart and lungs. It's a matter of talking to them about things such as sexuality and depression. ... We should be sitting down with them and asking them personal questions."

Dr. Wibbelsman, who serves on the American Academy of Pediatrics' committee of adolescence, said physicians need to be comfortable discussing the genital exam and be ready to discuss why a boy might refuse the exam.

The clinical report offers doctors guidance on what they should address during an office visit and provides resources on these topics for physicians and their patients.

A second report on male adolescent sexual health was published online Dec. 5 in the Journal of Adolescent Health. It outlines the core sexual and reproductive services that teenage boys should receive during their annual physical exam (link).

Among the items that made the list based on interviews with 17 primary care physicians who specialize in male teen health:

• Examine genitals to assess pubertal growth.
• Screen for inherited disorders such as Klinefelter syndrome and fragile X syndrome, as well as nonsexually transmitted diseases that can affect sexual function and reproduction.
• Test and counsel for sexually transmitted infections, including offering HIV screening, to boys 13 and older.
• Screen for substance abuse and mental health.
• Look for signs of physical and sexual abuse.
• Discuss the male role in pregnancy prevention.

"Our [research] indicates that clinicians who specialize in male teen health agree on the services they deem essential for their patients," said pediatrician Arik Marcell, MD, MPH, a teen health expert at Johns Hopkins Children's Center and the lead author of both studies. "What we need now is a set of uniform guidelines to help all pediatricians do the same."

Researchers said they hope both reports will lead to national guidelines and recommendations. They also would like to see medical school and residency programs expand their teaching on adolescent males' sexual and reproductive health.