With teens, even some doctors avoid sex talk

The doctor's office should be a natural place for teens to talk about sex, sexual development and sexual health, but new research shows that doctors spend an average of 36 seconds talking about it during annual physical exams — if the topic is brought up at all.

"Sexuality and sexual development are critical topics that physicians should be addressing with teenagers," said Cleveland Shields, a Purdue University associate professor in the Department of Human Development and Family Studies and the study's senior author. "The brevity of many discussions is not enough to cover the risk of teen pregnancy, sexually transmitted infections or overall wellness."

Shields and Laurence Steinberg, professor of psychology at Temple University, joined The Daily Circuit the issue. Highlights from that conversation:

Shields on the doctor-teenager talks he studied:
"There was very little back-and-forth. When it did happen at all — and it didn't happen at all in 30 percent of the cases — when it did happen at all, the kids mostly said 'yes' or 'no.' There were only a few cases where there was a little bit of back and forth. But for many of them it was just, 'Are you having sex?' 'No.' Or, 'Here's some information about condoms.' Or, 'Are you using condoms?' There was very little actual discussion. ... There were a few physicians who made statements like, 'This isn't my job. Talk to your parents.' I think that it is part of physicians' job, partly because even though I talk to my kids about sex — and, bless my parents, they did too talk to me about sex ... many parents unfortunately are not able to do it, for a gazillion reasons."

Steinberg on why doctors may be nervous:
"I think that [doctors] perhaps are thinking erroneously that if the teenager wants information about it, the teenager will ask. But I think that doctors who are trained in adolescent medicine, particularly, know better than that. Let's face it: This is a sensitive and difficult topic for people to talk about. It's difficult for teenagers to ask their parents questions about sex, and it's difficult for lots of parents to start the conversation, and unfortunately I think a lot of these same difficulties pervade the doctor-patient relationship. Perhaps some physicians are nervous that by bringing this up with a teenager they're going to somehow irritate the teenager's parents. ... It seems almost inconceivable that you wouldn't talk about sex with a teenage patient, but it doesn't come up that often."

Steinberg on the role of parents:
"I think parents and physicians can play different roles in this conversation. ... I think that it's a parent's obligation not only right but obligation to discuss sexuality with a teenage child, and talk about the values part of it and not just the plumbing. But I think that physicians can play a very important role in talking about the plumbing and talking about contraception and protecting oneself and so on. It's not either/or; it should be both."

Shields on how his mother told him about sex:
"I was in the fifth grade and my mom gave us these small booklets, which I recently found, and they explained the whole act of sex and everything — now look at me, I'm acting uncomfortable talking about it — and the very middle of the book had two paragraphs that explained the act of sexual intercourse. So, the next day, my mother's in my room and she's cleaning up something and she said, 'Cleveland, do you have any questions?' And I said, 'Well yes, I do.' And she said, 'What's your question?' So I opened it to the page where the two paragraphs were that talked about sexual intercourse. ... And I said, 'Is this really what happens?' And she said, 'Yes, it is.' And I said, 'That's disgusting!' I think she was very relieved that was my response at that time."