Cox, MD, and Phaedra
Thomas, RN, BSN
When should I start discussing sexuality with my young
It is important to introduce the topic of sexuality early in the
preteen years. According to the CDC, 46 percent of high school
students are sexually active and a full one-third do not use contraception
at first intercourse. Introduce the subject by discussing the
body changes of puberty. Let the preteen know that it is normal
for teens to have romantic or sexual feelings. Ask if their friends
are sexually active. Help them identify an adult who can provide
them with information and advice. Ask if they have questions.
Preteens often have many misconceptions, so let them know that
they can talk to you or a trusted adult if they are concerned
or confused about their sexual feelings. Encourage young teens
to delay intercourse until they are mature enough to handle the
responsibilities. Reinforce that abstinence is the best way to
avoid pregnancy or sexually transmitted infections. Stress that
you are available to discuss contraception and safe sex when needed.
How should the Well Child Care visit be modified during
the preteen years?
By age 10 or 11 you should introduce the concept of confidential
time when children can talk alone with you or another clinician.
Parents or children may resist this depending on pubertal level,
but by age 12, time for conversation alone with the child should
be part of the physical exam. Parents and children should understand
that confidentially enhances communication about difficult or
embarrassing issues, but clearly define the limits of that confidentiality
in case a dangerous situation arises where parental involvement
Are there any strategies to answering preteens’ questions?
|45.6% of high school students
have reported having sexual intercourse.
Understanding the developmental stage of preteens as well as appreciating
what’s on their minds will help you prepare responses to frequently
asked questions. Generally, preteens are more inquisitive and less
embarrassed to ask questions than older teens. They are extremely
curious and interested in their bodies and how they work, and often
have misconceptions about sex and relationships. If preteens have
a trusting relationship with you, they may ask very direct questions.
You might start a conversation by acknowledging that their bodies
are changing and ask the question: “Is there anything that you are
worried about?” Depending on the patient, you may need to be more
direct and ask if they are sexually active. If they are, asking
about safety in terms of protection against STDs and violence (date
rape, domestic violence) is very important.
Your responses to a preteen’s questions should be honest, concrete
and free of medical jargon. Be aware of your nonverbal communication
as you answer sensitive questions so you are perceived as nonjudgmental.
Since time management is a factor in counseling patients, you
may wish to offer resources that teens can access on their own.
For example, www.youngwomenshealth.org, which is the Web site
for Children’s Center for Young Women’s Health, has guides and
interactive quizzes designed for 12 to 15 year old girls on topics
such as Healthy Relationships, Safety in Relationships, Safety
on the Street and Safety on the Internet. This site also has educational
materials for health professionals on these topics.
What medical screening should I complete on sexually active
20% of adolescents have engaged in sexual intercourse before
their 15th birthday.
Sexually active teens should be screened for chlamydia and gonorrhea
at least yearly. There are now highly sensitive urine screening
tests such as the APTIMA that do not require cervical specimens.
Human Papilloma Virus infections are common in young teens but frequently
resolve without treatment. Therefore, to avoid over-treatment of
cervical abnormalities, the PAP test should be delayed until a teen
has been sexually active for three years (or by age 21). Although
syphilis is uncommon, an RPR or VDRL should be obtained yearly.
There are many good resources such as Web sites
and books that provide educational materials for parents. The
resources listed on the previous page address adolescent and preteen
issues. They offer fact sheets, research articles and tips on
how to answer preteens’ questions about sexuality.