The XX Factor

Doctors Need to Have the Sex Talk

Fewer than two thirds of physicians discuss STDs, birth control, or other sexual health issues with their patients

In the doctor’s office, a shroud of bashful silence too often hangs over teenagers’ sex lives, according to a study published in December in JAMA Pediatrics. Though almost half of high-schoolers have had sex, fewer than two-thirds of physicians discuss STDs, birth control, or other sexual health issues with their patients. Those who do spend an average of 36 seconds on the topic, which amounts to about 3 percent of the typical 22-minute checkup.

Researchers from Duke University Medical Center took audio recordings of 253 routine annual exams for adolescents aged 13 to 17 in the Raleigh/Durham, N.C., area. They found, maybe unsurprisingly, that the teenagers never brought up intercourse during their visits—the onus fell on the physicians to start the conversation. And physicians were inconsistent: They were more likely to broach the theme with female patients, especially black ones. Does this reflect a double standard by which girls bear most of the responsibility for promoting safe sex? Probably. But of course even if boys needn’t worry about becoming pregnant themselves, they stand to suffer if their girlfriends conceive unexpectedly or if they contract an STD. As for the racial disparity, though surveys suggest that black teens, on average, engage in riskier sex than white teens, that gulf is steadily narrowing. Doctors also proved more likely to bring up sex with older patients, despite recommendations from the American Academy of Pediatrics that these dialogues happen early: Though physicians may fear that they are inciting tender youths to debauchery by mentioning birth control and protection, studies don’t bear this anxiety out.  

The Duke team’s findings would seem less urgent if teenagers could count on comprehensive sex education at home or at school—but, as ThinkProgress notes, many states fail to enforce meaningful sex-ed classes for adolescents. Meanwhile, a 2011 poll from Planned Parenthood revealed that only 60 percent of parents dare to raise the conversational specter of birth control with their kids (which makes the physicians’ 36 seconds of awkwardness appear downright heroic). Researchers were able to identify a few factors that increased the likelihood that doctors would dive into the birds-and-bees talk. Across the 31 percent of cases in which parents were instructed to leave the room, reproductive health came up four times as often (shocker). Longer visits also yielded more sex-themed conversations, possibly because physicians had more time to run through the checklist of recommended topics created by the AAP.

It is hard to imagine doctors, familiar with all of our intimate human nooks, blushing to discuss reproductive health with their teen patients. (It is easier to imagine teenagers declining to bring up sex because they know scientists are recording their annual checkup.) I wonder whether they are more concerned about outraging conservative parents—or perhaps they truly are just busy and rushed. In any case, the physician’s office is one of the few spaces in which kids can get helpful answers to embarrassing sexual queries. We can’t hold teenagers accountable for making dumb decisions in bed if we don’t educate them first (especially if we’re sending boys the message that reproductive health isn’t their concern). Maybe time-crunched doctors should resolve to discuss sex for no less time, say, than it takes for an adolescent to complete his first-ever erotic experience. Actually, longer.