Teen sex and LGBT issues: It's what doctors say and how they say it

September 18, 2014  

WEST LAFAYETTE, Ind. — When doctors speak to teens about sex and LGBT issues, only about 3 percent of them are doing so in a way that encourages LGBT teens to discuss their sexuality, and Purdue University researchers say other doctors can learn from these conversations.

 "Physicians are making their best efforts, but they are missing opportunities to create safe environments for teenagers to discuss sexuality and their health," said lead investigator Stewart C. Alexander, an associate professor of consumer science who focuses on health communication. What the doctor asks or brings up about sexuality sets the tone, and gay and lesbian youth are very good about reading adults to determine who is safe to confide in. They ask themselves, 'Can I disclose this information to this adult?'"

Physicians are encouraged to discus teenage sexuality during wellness visits per the American Academy of Pediatrics recommendations. But the researchers said these conversations are more than a simple phrase and they need to consider the whole conversation - thus physicians can undo any good they do if they don't remain inclusive.

"Open, inclusive conversations can help youths realize there is no threat, and this can be a great start for building trust with the physician who is someone they are likely to see year after year," said Cleveland Shields, an associate professor of human development and family studies and co-investigator. "These adolescents, especially the younger ones, may not have established a sexual identity, their sexuality is in flux, or they may be romantically involved with someone of the same gender but not identify themselves as gay or lesbian."

The researchers looked at patterns in physicians' conversations about sex when speaking to patients ages 12-17. The findings are published in LGBT Health. The research was funded by the National Heart, Lung, and Blood Institute, and the data was collected at 11 clinics in the Raleigh/Durham, North Carolina, area as part of the Duke Teen CHAT project. The analysis is based on recorded conversations between 49 physicians and 293 adolescents during annual wellness checks. Of all the visits that contained sexuality talk, physicians were able to maintain open and inclusive talk only 3 percent of the time.

"The physicians I know want to do a good job, so we're trying to identify best practices, and hopefully these examples will provide them additional context for strengthening these conversations," said Shields, who used to train family doctors in communication methods.

These conversation methods have not been tested clinically, but here are examples of inclusive conversation tactics from the study:

* To start an inclusive conversation, focus on attraction: "I know some teenagers who are attracted to girls. I know some teenagers who are attracted to boys, and I know some who are attracted to both. Have you started to think about these things?" or "Usually girls your age start to become interested in boys or other girls or both, have you started to become interested in others?"

* To start an inclusive conversation, ask about friends: "Have any of your friends started dating? Any boyfriends or girlfriends or both?" or "Do you know if your friends started to have sex yet?" Physicians used this approach to then turn to the teenager's dating and sexual behavior by always suggesting gender-neutral terms such as "anybody," "someone" or "partners."

The researchers say that maintaining an inclusive conversation can be challenging at first, but when done inclusively doctors can reinforce the notion of multiple attractions and identities and emphasize non-judgment. For example, "People like different people" or "I see teens of all types and I tell them the same thing 'be yourself.'" One physician stated, "I want you to know that I am here for you and regardless of who you are or become interested in, I want to be sure I can provide you the proper care."

Another technique to maintain inclusive conversations is leaving the door open for future conversations, such as, "If things change, or if along the way you decide something else is right for you, I want you to let me know."

"The idea of setting the tone for the years to come is very important," Alexander said. "This may not be the big conversation for the 12-year-olds - that may take place in four years - but the tone needs to be set at age 12 so that when the time comes the child is comfortable and knows the doctor is a safe contact. This approach also reinforces the adolescent as an emerging adult. We want to provide them with autonomy so they can be a consumer of their own health."

Shields and Alexander collaborated with J. Dennis Fortenberry from the Indiana University School of Medicine and Kathryn I. Pollak and Truls Ostbye from Duke University and Terrill Bravender from University of Michigan. 

Writer: Amy Patterson Neubert, 765-494-9723, apatterson@purdue.edu

Sources: Alexander C. Stewart, alexan90@purdue.edu

Cleveland G. Shields, cgshields@purdue.edu 

Related website:

College of Health and Human Sciences

Related news release:

Doctors missing opportunity to talk with teens about sex

Note to Journalists: Journalists interested in a copy of the LGBT Health article please contact Amy Patterson Neubert, Purdue News Service, 765-494-9723, apatterson@purdue.edu


Physicians Use of Inclusive Sexual Orientation Language During Teenage Annual Visits

Stewart C. Alexander, J. Dennis Fortenberry, Kathryn L. Pollak, Terrill Bravender, Truls Ostbye and Cleveland G. Shields

Purpose: Physicians are encouraged to use inclusive language regarding sexuality in order to help all adolescent patients feel accepted. Non-inclusive language by physicians may influence relationships with adolescent patients, especially those with still-developing sexual identities. The aim of this study was to identify patterns of physicians' use of inclusive and non-inclusive language when discussing sexuality.

Method: A total of 393 conversations between 393 adolescents and 49 physicians from 11 clinics located throughout the Raleigh/Durham, North Carolina, area were audio recorded. Conversations were coded for the use of inclusive talk (language use that avoids the use of specific gender, sex or sexual orientation language), direct non-inclusive talk (language use that assumes the teenager is heterosexual or exclusively engages in heterosexual sexual activity) and indirect non-inclusive talk (language use that frames talk heterosexually but does not pre-identify the adolescent as heterosexual).

Results: Nearly two-thirds (63 percent, 245) of the visits contained some sexuality talk. Inclusive talk rarely occurred (3.3 percent) while non-inclusive language was predominant (48.1 percent direct and 48.6 percent indirect). There were no significant differences in language use by gender, age, adolescent race or visit length. These non-significant findings suggest that all adolescents regardless of race, gender, or age are receiving non-inclusive sexuality talk from their providers.

Conclusion: Physicians are missing opportunities to create safe environments for teenagers to discuss sexuality. The examples of inclusive talk from this study may provide potentially useful ways to teach providers how to begin sexuality discussions (focusing on sexual attraction or asking about friends' sexual behavior) and maintain these discussions). 

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