For adolescents and young adults, sexual development and health is an especially important area of growth that can have far-reaching impacts into adulthood.
For example, according to the Centers for Disease Control and Prevention (CDC) HIV Surveillance Report 2016, young people ages 15-24 accounted for 21 percent of all new HIV infections, with the majority of those occurring in men who have sex with men (MSM). African-Americans and Latinos are disproportionately affected, accounting for 78 percent of new infections in this age group.
In addition to rising rates of sexually transmitted infections (STIs), the CDC reports that Texas ranks fifth in the country in births to teens ages 15-19 and has the highest rates of repeat teen pregnancy.
As physicians, what can we do about this?
We can start by having open, honest, and confidential conversations with our patients about their sexual activity. This includes asking about the number of sexual partners, the gender of their partners, and what sites they use for intercourse (oral, vaginal, anal).
For patients who are sexually active, we can provide confidential screening for STIs and ask about the use of contraceptives, both barrier and hormonal. For patients who have not yet become sexually active (and for those that have), we can provide counseling on healthy sexual relationships and/or give an appropriate handout.
It is important for physicians to make themselves available for questions whenever an adolescent patient has any, in addition to encouraging the adolescent to call your office directly.
Besides being an effective clinical advocate for healthy sexual development, physicians have the opportunity to advocate for state policies that promote access to sexual and reproductive services for minors. Currently in Texas, minors cannot confidentially access prescription contraceptives without parental consent unless they are on Medicaid or access care at a Title X clinic.
In addition, Texas is one of two states in the country that does not allow any state funds to be used to provide confidential contraceptive services to minors.
Also, under Texas law you are required to report to Child Protective Services any minor who discloses to you that they are sexually active with someone of the same gender. This places physicians in an ethical dilemma in seeking to provide comprehensive care to our patients.
These state policies hinder a physician’s ability to provide sexual and reproductive health care for adolescents.
Physicians who take care of adolescents are in a unique position to provide accurate sexual and reproductive health information to our patients.
Because only 16.6 percent of Texas schools provide comprehensive sex education, physicians may be the only source of medically accurate information for adolescents. It is therefore imperative that we continue to advocate for, and provide, our adolescent patients access to confidential STI testing and contraceptive services.
M. Brett Cooper, MD, is a pediatrician in Houston who serves as the Resident & Fellow Section Representative on TMA’s Child and Adolescent Health Committee.