Although most teenagers in the United States receive some form of sex education in school, teens have no guarantee of receiving comprehensive or reliable information about contraception, safe sex, or STIs from their teachers. For example, it is well documented that many abstinence-only programs not only teach outright falsehoods about condoms and birth control, but they completely fail to address the sexual health needs of LGBT youth [1]. Compounding this problem is the fact that many parents are reluctant to talk to their kids about anything related to sex at all. So if teens can’t get the information they need about sex at home or at school, surely they can at least get it from their physicians, right? Not necessarily. A new study finds that sexual communication is compromised even inside the confines of the doctor’s office.

In this study, researchers listened to audio recordings of the interactions between 253 adolescents (age 14.3 on average) who were visiting their doctors. Each office visit occurred at one of 11 clinics in the state of North Carolina. Researchers took note of whether sex was discussed during each visit and for how long, as well as who brought up the topic.

Overall, sex was discussed in about two-thirds (65%) of visits, meaning that one-third contained no mention of sex whatsoever. Every time the topic of sex was brought up, it was the doctor who did so—no adolescent initiated sex talk (although there were 4 cases where a parent brought it up). However, when sex was discussed, it was not talked about for very long. In fact, the average length of sexuality discussions was just 36 seconds in total. This amounted to less than 3% of the average office visit length time of 22.4 minutes.

Researchers found that sex was 60% more likely to be discussed with African American adolescents. In addition, female adolescents spent more than twice the time talking about sex that male adolescents did. Sex talk was also more likely to occur among older adolescents and when the office visit was longer; however, sex talk was less likely to occur when patients had an Asian physician.

These findings tell us a few important things. First, there appears to be a reluctance to talk about sex in the doctor’s office on both sides of the table. No adolescents brought up the topic of sex, and one-third of doctors never brought it up either, despite the fact that the American Academy of Pediatrics gives pediatricians a list of suggested questions about sexuality and sexual decision making that should be discussed with all adolescents. Even when sex is discussed, it is unlikely that doctors are asking all of the questions they’re supposed to because they can barely read through all of the recommended questions in 36 seconds, let alone listen to any answers. Second, there appear to be important cultural and gender issues at play in determining when sexuality discussions are most likely to occur. Sex is more likely to be discussed with African American and female patients, and Asian doctors are the least likely to bring up the topic.

Although it is easy to place all of the blame here on doctors, it is important to keep in mind that doctors get only a limited amount of time with each patient and they have a ton of ground to cover, not to mention the fact that many adolescents come in with other, nonsexual health concerns that can take a lot of time to address. In addition, parents are often in the room during these visits, which can make doctors and kids feel uneasy talking about things like sex and birth control (e.g., kids may not want to reveal to their parents that they have been sexually active, and doctors may not want to talk about sex out of fear of offending the parents).

Any way you look at this, it is clear that many doctor’s appointments represent missed opportunities for adolescents to have their questions about sex asked and answered. In light of the inadequate state of sex education combined with societal attitudes toward sex that limit parental discussions, the lack of sex talk in the doctor’s office is an important deficit we must find a way to address.

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[1] Committee on Government Reform (2004). The content of federally funded abstinence-only education programs. Retrieved from: http://spot.colorado.edu/~tooley/HenryWaxman.pdf

[2] Alexander, S.C., Fortenberry, J.D., Pollak, K.I., … & Shields, C.G. (in press) Sexuality talk during adolescent health maintenance visits. JAMA Pediatrics.

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