Q&A: Preteen Sexuality
By Joanne Cox, MD, and Phaedra Thomas, RN, BSN

When should I start discussing sexuality with my young patients?
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 is needed.

45.6% of high school students have reported having sexual intercourse.

Are there any strategies to answering preteens’ questions?
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.

Approximately 20% of adolescents have engaged in sexual intercourse before their 15th birthday.

What medical screening should I complete on sexually active teens?
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.

Resources for Parents, Teens and Tweens For Parents The Everything Tween Book: A Parent’s guide to Surviving the Turbulent Pre-Teen Years by Linda Sonna (part of the Everything Series) Get a Clue!: What’s Really Going On with Pre-Teens and How Parents Can Help by Ellen Rosenberg The Rollercoaster Years by Margaret Sagarese, Charlene Giannetti Not Much Just Chillin’: The Hidden Lives of Middle Schoolers by Linda Perlstein Families are Talking www.familiesaretalking.org/resources National Campaign to Prevent Teen Pregnancy www.teenpregnancy.org National Network for Health www.nnh.org/products/sexualsub2.htm Resource Center for Adolescent Pregnancy Prevention www.etr.org/recapp Not Me, Not Now www.notmenotnow.org For Teens Center for Young Women’s Health, Children’s Hospital Boston www.youngwomenshealth.org Youth Shakers–Sexual Health www.youthshakers.org/sexualhealth Kids Health–Sexual Health www.kidshealth.org/teen/sexual_health