Identifying types of sex conversations in adolescent health maintenance visits

Abstract

Background Physician–adolescent sexuality discussions are a recommended element in health maintenance visits, but such discussions – if they occur at all – probably vary by adolescents’ characteristics and situations, and physicians’ personal beliefs and training. However, little is known about the form and content of physician–adolescent sexuality discussions during health maintenance visits. Methods: We evaluated 245 physician–adolescent sexuality conversations. Using latent class analysis, we identified conversation types based on 13 sexually related topics, which occurred in at least 10% of all conversations. Results: We found four discrete types of sexuality conversations, which differed in terms of emphasis, topics addressed as part of the sexual history and risk assessment, and topics addressed in anticipatory guidance. Inquiry about partnered sexual experience was typical across all conversation types, as well as over half including discussions about body development and protective behaviours. In all four types of conversation, sexuality discussions were typically embedded in a sequence of psychosocial and behavioural topics recommended for health maintenance visits. Conclusions: The presence of sexuality conversations in the majority of these visits suggests that physicians consider sexuality to be an important issue and part of their responsibility in caring for their adolescent patients. However, the substantial variability in the types of sexuality conversations, particularly the notable omissions of many key topics, supports the importance of teaching sexual health interview skills in medical school and residency, and as part of continuing medical education and quality improvement.