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Talking about sex: AAP recommends evidence-based education, with pediatricians’ help :

July 18, 2016

Pediatricians are in an excellent position to educate their patients about sexuality, but do they? In a review of health maintenance visits, one in three adolescent patients did not receive any information on sexuality from the pediatrician, and if he or she did, the conversation lasted less than 40 seconds.

Some clinicians say they lack the time, are uncomfortable with the topic or are concerned about offending patients or parents.

A revised clinical report can help bridge the gaps. Sexuality Education for Children and Adolescents offers many solutions to the busy pediatrician and summarizes updated research on evidence-based sexual and reproductive health education since the original report in 2001. Available at, the report from the Committee on Adolescence and Committee on Psychosocial Aspects of Child and Family Health is published in the August issue of Pediatrics.

Comprehensive approach  

Sexuality education involves teaching about human sexuality, including intimate relationships, human sexual anatomy, sexual reproduction, sexually transmitted infections (STIs), sexual activity, consent, sexual orientation, abstinence, contraception, and reproductive rights and responsibilities. Developmentally appropriate and evidence-based education about human sexuality and sexual reproduction provided over time by pediatricians, schools, other professionals and parents is important to help children and adolescents make informed, positive and safe choices about healthy relationships, responsible sexual activity and their reproductive health.

Sexuality education can prevent and reduce the risks of pregnancy, HIV and STIs for U.S. children and adolescents with and without chronic health conditions and disabilities.

Why not teach abstinence?

We know that abstinence is 100% effective at preventing pregnancy and STIs; however, research has conclusively demonstrated that programs promoting abstinence only until heterosexual marriage occurs are ineffective.

A recent systematic review examined the evidence supporting both abstinence-only and comprehensive sexuality education programs designed to promote abstinence from sexual intercourse. In that review, most comprehensive sexuality education programs showed efficacy in delaying initiation of intercourse in addition to promoting other protective behaviors, such as condom use. There was no evidence that abstinence-only programs effectively delayed initiation of sexual intercourse.

The American College of Obstetricians and Gynecologists, the Society for Adolescent Health and Medicine, the Academy, the American Medical Association, the American Public Health Association, National Education Association and National School Boards Association oppose abstinence-only education and endorse comprehensive sexuality education that includes both abstinence promotion and accurate information about contraception, human sexuality and STIs.

Suggestions for the pediatrician 

  • Education about sexuality that is provided by pediatricians can complement the education children obtain at school or at home.
  • Discussions regarding healthy relationships and intimate partner violence can be effectively included in health care visits.
  • Preparation for college entry is an excellent opportunity for pediatricians to address issues such as the effects of alcohol, marijuana and other drug consumption on decisions about safe, consensual sexual practices.
  • Diverse family circumstances, such as families with same-sex parents or children who identify as lesbian, gay, bisexual, transgender or questioning, create unique guidance needs regarding sexuality education.
  • Specific components of sexuality education offered in schools, religious institutions, parent organizations and other community agencies vary based on many factors. The pediatrician can serve as a resource to each.

Dr. Breuner is a lead author of the clinical report and chair of the AAP Committee on Adolescence.

See related College Parent Plus, "Talk with students about alcohol, sex before they go to college."  

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