NEA HEALTH INFORMATION NETWORK: HIV/AIDS & Sexual Health

is, by definition, a period of growth and change. With the anxiety,

confusion, and risks the changes create, physicians are in a unique

position to answer the questions young people have about sensitive

topics related to sexual health. Physicians have the opportunities

to provide adolescents with the information and skills needed to

reduce their risks for sexually transmitted diseases (STD’s) and

unplanned pregnancies. However, two recent surveys indicate that

many adolescents are too embarrassed to raise sensitive issues with

their physicians, and that many physicians similarly shy away from

High school students in an urban Los Angeles County school district

were asked a series of questions related to their experiences and

feelings surrounding patient-provider communication about sexual

health. The findings, published in the Archive of Pediatric Adolescent

Medicine, reveal that the majority of students have not discussed

sexual matters with a health care provider, but do feel it would

be helpful. Thirty-nine percent of the adolescents interviewed reported

discussions with their provider about how to avoid contracting AIDS

through sex. Thirty-seven percent reported discussions about using

condoms, 13% about how to use condoms, 15% about the adolescent’s

sex life, 13% about how to say no to unwanted sex, and 8% about

sexual orientation. Eight percent reported having been given condoms

by a provider. In contrast to the apparently low number of patient-provider

discussions taking place around sexuality, an overwhelming 80-90%

of students said they believe that such conversations would be beneficial.

The Commonwealth Fund’s 1997 Survey of the Health of Adolescent

Girls reported similar discordance between what adolescent girls

would like to discuss with their physicians and the topics that

are actually covered. The majority of girls surveyed think that

their physicians “should” provide information on topics such as

STD’s, taking drugs, drinking alcohol, and eating disorders. However,

less than one-third of adolescents reported a provider ever discussing

one of these issues with them. Physicians seem to be more comfortable

discussing “safer” issues such as eating habits and the importance

The survey found that much of the reason for the lack of communication

between young people and their doctors might be the adolescents’

embarrassment about discussing sensitive health issues. Thirty-five

percent of girls reported a time when they were too embarrassed

to discuss a problem with their provider. Embarrassment was a particular

problem for younger girls. Sexuality, menstruation or cramps, body

changes, physical or sexual abuse, birth control, pregnancy, and

STD’s topped the list of topics too embarrassing to discuss with

Adolescents also appear to prefer the opportunity to confer privately

with a physician, and for the provider to be of the same gender.

In the Commonwealth Fund Survey, 41% of older girls and 52% of older

boys expressed a desire to see the doctor without their parents

in the room. However, one-third of the girls and one-fourth of boys

preferring privacy were not given this option. Fifty-one percent

of girls reported a preference for a female physician, although

only 23% were actually seeing a provider of their gender choice.

Furthermore, due to anxiety about confidentiality, over 40% of girls

in grades nine through twelve did not get needed health care to

avoid telling their parents about their concern. Not wanting to

discuss health problems with one’s family was the leading reason

given as a barrier to accessing needed care. It was cited more than

cost, lack of adequate insurance coverage, time constraints, and

The results of these two surveys seem to suggest that adolescents

would like to have conversations with their doctors about sexual

health, but a number of barriers often prevent this process. It

would be useful to examine, from the physician’s point of view,

the obstacles blocking the incorporation of sexual health matters

into routine health services for adolescents. Patient-provider communication

could be facilitated further by increasing privacy during visits

and matching young people with health providers of their gender

choice. With improved communication comes the hope of improved health