American Academy of Pediatrics Policy Offers Guidance for Counseling Teenage Boys About Puberty, Sexual and Reproductive Care

Pediatricians should use any opportunity they can during visits to help boys navigate sensitive issues.

As boys enter adolescence, they are less likely to see their doctor for routine wellness visits, yet this is the time when they need expert guidance on puberty, sexual behavior, contraception, and sexually transmitted diseases.

For that reason, the American Academy of Pediatrics encourages physicians to address puberty and sexuality with teen patients not only during regular health maintenance visits but also when they are being seen for illness or injuries.

In a clinical report, “Emerging Issues in Male Adolescent Sexual and Reproductive Health Care,” the AAP updates information on sexual behavior; emerging issues in health confidentiality; discussion of consent for sexual acts among adolescents; counseling males on their roles in contraception decision-making; sexually transmitted infections (STIs); consent; media use; human papillomavirus (HPV) vaccine; and sexual dysfunction.

The clinical report, which is a revision of 2011 guidance, will be published in the May 2020 Pediatrics (published online April 27).

“We know that it is easier to build relationships over time, rather than during one or two routine doctor appointments,” said Laura K. Grubb, MD, MPH, FAAP, Director of Adolescent Medicine at Floating Hospital for Children at Tufts Medical Center and lead author of the report, written by the Committee on Adolescence.

“This report builds on the ways physicians can broach sensitive topics, establish trust and provide young men with a safe place to bring their questions.”

Pediatricians are in an ideal position to deliver high-quality sexual and reproductive health care services during various medical visits with all adolescent boys -- including those with developmental or physical disabilities, the report states.

According to the 2017 Youth Risk Behavioral Surveillance System, 41% of male teenagers

reported they had sexual intercourse with a member of the opposite sex by the 12th grade. Among male high school students, 22% reported using alcohol or drugs before last sex, 12% reported 4 or more lifetime partners, 39% did not use a condom with last intercourse, and 5% reported initiating sex at 13 years or younger.

“Teens may have questions over sexual orientation, sexual identity or gender identity,” said Makia Powers, MD, MPH, MSc, FAAP, co-author of the clinical report and pediatrician at Children’s Healthcare of Atlanta. “It’s important to have these conversations within a nonjudgmental and confidential environment.”

AAP recommends that pediatricians:

• Discuss sex and sexuality with male teens during routine visits and screen for sexual activity, including high-risk activity, as appropriate.
• Screen adolescents for social media use, especially sexually explicit material.
• Screen for and discuss principles of sexual consent and nonconsent.
• Coach on how to talk with partners about sex and family planning. Encourage use of both contraception and barrier methods as appropriate.
• Provide routine STI risk assessment screening and appropriate testing and treatment.
• Aim for complete HPV immunization for all males. Consider starting vaccination at age 9 and provide routine vaccination for all males at age 11. Emphasize the importance of HPV immunization for those who participate in high-risk behaviors.
• Screen for sexual problems with all sexually active males at well visits and as needed. Consider standardized screening tools for sexual dysfunction. Investigate further for health or mental health issues. Follow up with those who report problems and consider therapies such as counseling or pharmacotherapy as appropriate.

“Teens today are bombarded with information and ideas through social media,” Dr. Grubb said. “We hope to start these conversations early to help them develop healthy habits that reap lifelong benefits.”

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.