Sexual and Reproductive Health
Key Points
- Data from outpatient ambulatory medical records show that primary care providers are 3 times more likely to take sexual health histories from female than male patients and twice as likely to counsel female patients on the use of condoms.
- Among adolescent males in 2011, 49.2% had had sexual intercourse by the 12th grade.
- The use of language in the adolescent patient encounter is important; for example, adolescent males may not consider oral or anal intercourse as “having sex” and the meaning of that term may vary depending on the sexual orientation of the patient. It is therefore important to be quite explicit when interviewing adolescent males about their sexual behaviors.
- Among male adolescents STIs are more likely to be asymptomatic .
Overview
Even after the release of the American Medical Association’s Guidelines for Adolescent Preventive Services and The American Academy of Pediatrics’ Bright Futures program, which recommend preventive health services for adolescents, few improvements have been observed in the sexual and reproductive health care of male teenagers.
Data from outpatient ambulatory medical records show that primary care providers are 3 times more likely to take sexual health histories from female than male patients and twice as likely to counsel female patients on the use of condoms1, despite the fact that condoms are the only option that prevents both pregnancy and STIs for both genders. Thus, it is important for primary care providers to have a much better understanding of what sexual/reproductive health care means for the male adolescent.2
Adolescent sexual behavior is common. Among adolescent males in 2011, 49.2% had had sexual intercourse by the 12th grade.3
Risky sexual behaviors among adolescent males put them at risk for sexually transmitted diseases, HIV/AIDS, and unplanned fatherhood, yet few facilities in the United States provide focused sexual and reproductive health services to these young men. A general acknowledgement exists that the development of such services is needed, yet there is little research to guide providers in making existing services more attractive to young males and in developing new sexual health services for this population.”4
No single primary data source exists to capture all dimensions of adolescent sexual behavior. Key data sources include the National Vital Statistics System, the Youth Risk Behavior Surveillance System (YRBSS), the National Survey of Family Growth (NSFG), the National Longitudinal Study of Adolescent Health (known as Add Health), the Youth Internet Safety Survey, the National Longitudinal Study of Youth, the National Health and Nutrition Examination Survey (NHANES), and the National Survey of Sexual Health and Behavior NSSHB).5
With that said, risky sexual behaviors are not limited to vaginal intercourse and may include oral or anal intercourse. The use of language in the adolescent patient encounter is therefore important; for example, adolescent males may not consider oral or anal intercourse as “having sex” and the meaning of that term may vary depending on the sexual orientation of the patient. It is therefore important to be quite explicit when interviewing adolescent males about their sexual behaviors (Rafferty).
Male adolescents’ use of sexual/reproductive health care services remains low for a variety of reasons. For many, the onset of sexual behavior during adolescence serves as a rite of passage into manhood but does not trigger thinking about preventive behaviors related to the consequences of sexual behavior. Young men might also hold more traditional masculine beliefs that preclude them from seeking care despite having symptoms. In addition, the components of young men’s sexual/reproductive health care have been poorly defined and have historically received little attention.6 Among male adolescents STIs are also more likely to be asymptomatic. (Rafferty)
Sexual media is commonly used by adolescent boys as a source of information about sex. A middle school study found that 53% of adolescent boys in middle school reported exposure to sexually explicit (pornographic magazines, internet porn, X-rated movies) media.7
The relationship between media exposure, attitudes, and sexual behaviors is complex. Multiple studies have shown associations between consumption of different types of sexual media, gender stereotypes, and increased frequency or earlier onset of sexual behaviors.8 ,9,10 However, these studies also demonstrate complex interactions with gender, income, and type of media. For example, for boys, sexually explicit media was longitudinally associated with permissive sexual norms, but not gender roles; the opposite was true for girls.11 For young men, sexual behavior has been associated with sexually explicit media, and to a high proportion of sexual programming in the young man’s media diet.12,13(as cited in14)
Models of health care focused on men in general, and young men in particular, are beginning to emerge which recognize the need for prevention of early morbidity, and the need to attend to the sexual health of men. Clinics in schools and in the public health sector have emerged in the past 20 years in North America, Australia and Europe. Many university health services offer male-focused clinical care.15,16 Young men’s health has become a focus for several broad-based, multi-disciplinary health organizations such as the World Health Organization, the Centers for Disease Control and Prevention, the International Society for Men’s Health, the American College Health Association, and the Society for Adolescent Medicine, to name a few. Virtual men’s sexual health programs can be found on the internet.17
Methods, Tools and Resources
The health care provider should know how to:
- take a complete sexual history;
- perform a complete sexual/reproductive health examination that includes examination of the skin, breasts, genitals, hair, and, if relevant, the perianal area and documentation of the SMR;
- perform and interpret STI/HIV tests and know how to treat STIs;
- administer vaccinations, as recommended by the AAP, to protect against infections that are transmitted sexually, such hepatitis B and A vaccines and HPV vaccine;
- provide anticipatory guidance/ counseling on sexual/reproductive health matters (Table 2), including the use of messages about dual methods (eg, “not having sex is the best way to avoid pregnancy and STIs/HIV, but if you choose to have sex, use condoms consistently and use a reliable contraceptive method for the partner”); and
- use resources (Table 3) in varying formats (ie, clinic handouts, books, Web-based resources, community resources) to share and/or refer patients and parents as needed. From Examining the Development and Sexual Behavior of Adolescent Males.
Five clinical, counseling, and intervention recommendations for delivering care to adolescent males (Table 2)
- GUIDANCE FOR HEALTH CARE PROVIDERS, Male Adolescent Sexual and Reproductive Health Care,SECTION II.G.2011
References
American Academy of Pediatrics. Policy Statement: Condom Use by Adolescents. COMMITTEE ON ADOLESCENCE. 2013.
Bell, David L., Breland, David J. and Ott , Mary A. Adolescent and Young Adult Male Health: A Review. Pediatrics. originally published online August 12, 2013
Lawrence S. Neinstein, MD, The New Adolescents: An Analysis of Health Conditions, Behaviors, Risks and Access to Services Among Emerging Young Adults. University of Southern California. 2013.
Marcell, Arik V.,M.D., M.P.H. and M. Ellen, Jonathan, M.D, Core Sexual/Reproductive Health Care to Deliver to Male Adolescents: Perceptions of Clinicians Focused on Male Health. Journal of Adolescent Health. 2012.
Marcell, Arik V. M.D., M.P.H., Matson, Pam , Ph.D., Ellen, Jonathan M.M.D. Ford ,Carol A. , M.D.
Annual Physical Examination Reports Vary by Gender Once Teenagers Become Sexually Active . Journal of Adolescent Health. October 2012.
Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System: Selected 2011 National Health Risk Behaviors and Health Outcomes by Sex. 2012
Physicians for Reproductive Health.Male Adolescent Reproductive Health (UPDATED: March 2012).(Power Point)
New York City Young Men’s Initiative Best Practices in Sexual and Reproductive Health Care for Adolescents For Health Care Providers in Primary Care, Family Medicine, Pediatrics, Adolescent Health, Family Planning, and Obstetrics and Gynecology.
Mary A. Ott, MD.Examining the Development and Sexual Behavior of Adolescent Males.
Journal of Adolescent Health. 2010.
James A. Farrow, MW, Male sexual health during adolescence and young adulthood: contemporary issues. Journal of Men’s Health. September 2009
Region II Male Involvement Advisory Committee. Guidelines for Male Sexual and Reproductive Health Services . 2005.
9 Ward LM. Understanding the role of entertainment media in the sexual socialization of American youth: a review of empirical research. Developmental Rev. 2003;23:347–88.
13 Ward LM. Understanding the role of entertainment media in the sexual socialization of American youth: a review of empirical research. Developmental Rev. 2003;23:347–88.
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Health History and Screening
Physical Examination and Labs
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