A 16-year-old male presents to your practice to establish care. During the social history, he tells you he is bisexual and has sex with males and females. What do you do with this revealing and challenging information?
A revised AAP clinical report can guide you in addressing male adolescent sexual health, including taking a sexual history and offering anticipatory guidance.
The report, Emerging Issues in Male Adolescent Sexual and Reproductive Health Care from the AAP Committee on Adolescence, is available at https://pediatrics.aappublications.org/content/early/2020/04/23/peds.2020-0627 and is published in the May issue of Pediatrics.
The report aims to inform and empower pediatricians to feel comfortable asking about and providing guidance for sensitive issues, which can enhance the provider-patient relationship and improve overall care for adolescent males.
Several transitions occur for adolescent boys, including the physical, psychological and social changes associated with puberty. Pediatricians and other physicians who care for male adolescents have unique opportunities to incorporate anticipatory guidance around issues such as puberty and sexuality not only at health maintenance visits but also at sick and/or injury visits.
Although pediatricians have long been advocates of providing appropriate sexual and reproductive health services to female teen patients, the needs of many male teens are not addressed in the primary care setting. The 2011 report (https://bit.ly/39ix9hZ) aimed to correct this imbalance and since its publication, resources and delivery of male adolescent sexual and reproductive health care have improved significantly (see resources).
Updated and expanded topics in the revised report include information on male adolescent sexual behavior; emerging issues in health confidentiality; discussion of consent for sexual acts among adolescents; counseling males on their roles in contraception decision-making; sexually transmitted infections (STIs); human papillomavirus (HPV) vaccine; and sexual dysfunction.
Pediatricians are in an ideal position to deliver high-quality sexual and reproductive health care services to male adolescents and can address these health issues at routine, follow-up, acute care and immunization visits.
Although time constraints at most visits may preclude a full exploration of many issues surrounding sexuality, additional visits can be scheduled to address identified issues. Pediatricians also can use “clinical hooks,” such as preparticipation physical evaluations or acne follow-ups, to keep male adolescents engaged in care and to deliver sexual and reproductive health care services.
Guidance for pediatricians
- Discuss sex and sexuality with male teens during routine visits and screen for sexual activity, including high-risk activity, as appropriate.
- Screen adolescents for social media use, especially sexually explicit material.
- Screen for and discuss principles of sexual consent and nonconsent.
- Coach on how to talk with partners about sex and family planning. Encourage use of both contraception and barrier methods as appropriate.
- Provide routine STI risk assessment screening and appropriate testing and treatment.
- Aim for complete HPV immunization for all males. Consider starting vaccination at age 9, and provide routine vaccination for all males at age 11. Emphasize the importance of HPV immunization for those who participate in high-risk behaviors.
- Screen for sexual problems with all sexually active males at well visits and as needed. Consider standardized screening tools for sexual dysfunction. Investigate further for health or mental health issues. Follow up with those who report problems and consider therapies such as counseling or pharmacotherapy as appropriate.
Dr. Grubb is a lead author of the clinical report and a member of the AAP Committee on Adolescence. She is the liaison from the Society for Adolescent Health and Medicine to the AAP Committee on Federal Government Affairs.
