Many doctors aren't asking teenagers about sex or sexuality, and those who do are spending just 36 seconds on the topic, on average. That's not much time to get into sexually transmitted diseases or birth control, let alone sexual orientation, dating or other big topics.
And teenagers are so bashful when it comes to asking questions about sex and health that they won't bring it up if the doctor doesn't, researchers say.
"They're so reluctant to interact," says Stewart Alexander, an associate professor of medicine at Duke University Medical Center who led the study, which was published Monday in JAMA Pediatrics. "No teen brought up the topic themselves, even if they wanted birth control."
Almost half of high-schoolers have had sexual intercourse, according to the Centers for Disease Control and Prevention, so clearly these are conversations that need to happen. But there are lots of reasons that they don't, the researchers say, beyond the obvious desire to avoid sensitive topics.
One is that teenagers don't go to the doctor very often. In the study, researchers taped conversations during 253 annual visits in North Carolina's Raleigh-Durham area, then analyzed them for content and how much time was devoted to various topics.
Teenagers were more likely to talk about sexuality if they were female, older and African-American, the researchers found. "For boys, you only get them for health maintenance visits for sports or camps," Alexander says. "If a boy comes in and has a problem with acne or ADHD medicine, that may override the preventive health stuff. There are other topics that are getting in the way."
Having a longer office visit helps, too. The teenagers spent nine minutes with the doctor, on average. In that time, doctors are supposed to go down a long checklist of topics from the American Academy of Pediatrics. Alexander timed how long it took to read the suggested questions on sexuality and sexual decision-making. There is no way a doctor can get through them in 36 seconds, Alexander told Shots, let alone hear the answers. "It's easy for things to get lost in the shuffle," Alexander says. "I don't want to bash doctors. They're required to do so much. They should do this. But it's hard."
Having a confidential conversation with just doctor and teen helps, too, the researchers found. But in these visits, that happened just one-third of the time. Mom and Dad are often to blame, Alexander says.
"It's hard to get the parent out of the room," Alexander says. But some doctors are good at explaining at the beginning of the visit that there's going to be time set aside for a confidential one-on-one, he says. "So when it's time to kick the parent out, it's not a surprise."
Parents can make it easier for their children to get the information they need by talking with their children about sexual development early on, says Bradley Boekeloo, a professor of behavioral and community health at the University of Maryland School of Public Health who wrote an editorial accompanying the study.
"Answer the questions when they come up, and start answering those questions early," Boekeloo told Shots. And parents can encourage both teenagers and doctors to discuss sex and health during office visits. "The physicians probably need as much support as the youth in a visit, in terms of logistics."
The good news, Boekeloo says, is that other studies have shown that teenagers really do feel comfortable with their doctors, and when they have actually had these conversations, they're glad they did. The same goes for talking about sex and sexuality with their parents.
"It's ultimately important to the adolescent," Boekeloo says. "And sometimes the conversations that occur in the car in the back seat on the way to the game or to school can be the best conversations."