Adolescent sexuality.

ABSTRACT

PIP: Responsible teenage sexual behavior can be promoted by the pediatric practitioner through contact with adolescent patients, parents, and community outreach. In order to achieve this end, a review of the epidemiology of adolescent sexual behavior (sexual activity, contraceptive use, abortion, sexually transmitted diseases (STDs), pregnancy and outcomes for adolescents, parents, and children) and determinants of sexual risk-taking behavior are provided. Such determinants include developmental characteristics, puberty, identity, intimacy, cognitive development, biologic characteristics, and individual characteristics (religiosity, race, socioeconomic status, and media influences). Concrete guidelines for the pediatric practitioner which instruct in the prevention of pregnancy and STDs are included. The practitioner needs to be comfortable with his/her own sexuality; trained in basic adolescent care; knowledgeable about community norms and expectations; and needs to take a sexual history of each patient, including questions about incest, homosexuality, the specific numbers of sexual partners, age at 1st intercourse, and practice of oral or anal sex. Information provided must be nonjudgmental and supportive. A table provides 17 possible questions to prompt history taking. Well-child visits from the beginning should address issues of sexuality. Communication channels prepuberty need to be open between the practitioner and adolescent and parent, so that a confidential discussion between practitioner and adolescent can occur. Parents need to be encouraged to discuss sexual issues. A table provides recommended books. Adolescent needs depend upon the developmental stage, i.e., a teen who has not reached operational thinking does not understand cause and effects of sexual behavior. Sexuality involves feelings and relationships, not just intercourse; it is only 1 aspect of one's personal life. The practitioner can be an important source of accurate information and can promote effective se education and use of clinics. National advocacy can effectively change, for instance, restoring Reagan-style budget cuts for maternal-child health block grants.