September 2000
ATLANTA - Sexual history taking is an important but difficult part of adolescent care.
"Sexuality is part of us all from birth to the grave," said Linda M. Kollar, MSN, RN, CPNP, associate director of clinical services, division of adolescent medicine, at the Children's Hospital Medical Center, Cincinnati. "But it is also something that we keep very private in our culture. Therefore, we're not very comfortable talking about it."
However, overcoming this difficulty is important to prevent pregnancies and sexually transmitted diseases and to help facilitate communication between adolescents and their parents. Making adolescents better informed is also important.
"Knowledge is part of what they need," Kollar said. "Part of what we can do is give them the information. They don't know that sexually transmitted infections are often asymptomatic among adolescent males and females."
Only 17% of girls and 25% of boys actually plan their first sexual experience, said Kollar, who spoke here at the 21st Annual Nursing Conference on Pediatric Primary Care. "And if you're not planning your sexual intercourse, you're probably not planning on having some kind of contraceptive method available either," she said. "You're not planning on having a condom, not planning on really knowing that partner or risk factors. There's a lot of stuff that didn't go into that lack of planning."
And there are consequences of that lack of planning. Teen pregnancies are still prevalent. Twenty percent of teens who have sex will become pregnant within the first month, and 50% will become pregnant within six months. At the same time, it generally takes six months before teens will ask for contraception, Kollar said. "And it's usually a pregnancy scare that will bring them in for that."
In general, screening should be done early, because 25% of teens begin having sex by the time they are 15, according to Kollar. By age 17, 50% of teens have had sex, and about one-third are sexually active.
Asking questions may help teens at least plan for their sexual activity if not prevent it. Kollar cited a recent study in which children were asked at the beginning of sixth grade if they thought they would have sex that year. Fifty percent of children who reported that they thought they would have sex actually did.
"It's a question we ought to be asking them," she said. "Kids who tell me [they] think [they are] going to have sex this year whether they're in a relationship or not, I'm going to spend a little more time and energy and help them look at strategies to maybe make different decisions or at least plan their decision if that's the decision they want to make."
Adequate time is necessary when speaking to teens about sexuality issues. "Teenagers take more time if you're really going to discuss these really private issues," Kollar said. An initial screening should take about an hour, and follow-up discussions should last about 30 minutes.
Confidentiality is important as well. "Kids do want to tell their parents about the hard issues that are going on," Kollar said. "They would like to tell their parents if they have a sexually transmitted infection, and in my experience, most of them do tell their parents. They want to be able to tell their parents that they're using contraception and having sex. What they want from us is to give them the chance to say it and talk about it and to know that anything that comes out of their mouth is not a direct line back to their parents."
Once teens are ready, care providers should help them talk to their parents about sexual issues, Kollar said. "I think that's really an important role, and it eases the minds of the parents that we're dealing with. The person who should have an impact on [a teenager's life] is the parent or guardian. And until we involve [parents] and help the teenager be able to access [them], it's just not going to work."
Teens will not usually bring up sexual issues on their own, Kollar said. They want to be asked, and asked directly.
Ask about sexual abuse when taking a sexual history screening, and resources should be available when a patient mentions this.
"When you're dealing with sexuality issues in high-risk adolescents, you need to know who your resources in the community are, so that you don't feel like you're opening a can of worms that you have to handle on your own," she said.
Sexual orientation should also be discussed. "When we look at the rates of running away, substance abuse, high-risk opposite sex experimentation among kids who are homosexual, transgender or bisexual, we really do need to have a place where kids can talk about these issues with us," Kollar said. "They [need] a safe place to wonder about their same sex attractions. "
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Fear of alienating parents can be a barrier to obtaining sexual history from teens, however it should not be, Kollar said. "When we ask parents, they say [they] want someone to be asking [their children] about this. They want care providers to take a proactive role in talking to their kids. They're having a hard time with this."
For more information:
- Kollar LM. Sexual history taking with adolescents: finding the comfort zone. Session 207. Presented at the 21st Annual Nursing Conference on Pediatric Primary Care. March 29-April 1, 2000. Atlanta.
- Ammerman S, Perelli E, Adler N, et al. Do adolescents understand what physicians say about sexuality and health? Clin Pediatr. 1992;31:590-95.
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