December 12, 2011

Reports cite must-have sexual health services for teen boys

Two newly published reports by investigators at the Johns Hopkins Children’s Center highlight the need for greater recognition of the sexual and reproductive health care needs of teen boys, and enumerate the essential services that this traditionally overlooked group should receive at least once a year.

The first report, published in the December issue of Pediatrics, underscores what experts say is the glaring absence of guidelines on what sexual health tests and screening procedures teenage males should get and how often. The article offers a list of clinical practice recommendations to help fill that gap.

“Many clinicians currently forgo delivering some or many of these services because of limited time during visits, lack of evidence on the benefit of doing so and absence of guidelines on how to go about it,” says lead author Arik Marcell, a teen health expert at Johns Hopkins.

Indeed, Marcell notes, primary-care pediatricians are three times more likely to take a sexual history from girls than from boys, and twice as likely to discuss with girls as with boys the importance of condom use. Yet past research shows that 75 percent of U.S. male teens report having a sexual encounter by the time they are 18, have more sexual partners than girls and have sex at an earlier age than girls, he adds. In addition, Marcell and colleagues note, past research shows that many teen boys engage in high-risk sexual behaviors, including sex while drunk or high on drugs (26 percent), unprotected sex (nearly 30 percent) and having sex with an HIV-infected person or a prostitute (6 percent), according to one study.

The second report, a study published online Dec. 5 in the Journal of Adolescent Health, identifies what clinicians deem core sexual and reproductive services that every male teen should receive during annual physical exams.

The findings, based on interviews with 17 primary-care clinicians who specialize in male teen health, recommend a physical that includes a genital exam to assess pubertal growth and screen for inherited disorders of sexual differentiation, such as Klinefelter syndrome and fragile X syndrome, as well as for nonsexually transmitted diseases that can affect sexual function and reproduction; screening and counseling for sexually transmitted infections that include the offer of HIV testing to those age 13 and older; screening for substance abuse and mental health; screening for physical/sexual abuse; and discussion of the male role in pregnancy prevention, including condom use and abstinence.

The clinicians also agreed that during longer visits and with time permitting, they should assess the teen’s relationship with peers, partners and parents, and discuss transition into adulthood, sexual identity, sexual orientation and relevant risk factors. Gay, bisexual and transgender teens have a well-established risk for depression, substance abuse and suicide, researchers say.

Clinicians in the study failed to agree on a list of core services to be delivered during nonroutine visits, even though puberty—the time when most teens have their first and formative sexual experiences—is also a time marked by increasingly fewer routine visits to the doctor.

“It is critical that we, as clinicians, find ways to reach these patients outside of routine visits and devise ways to deliver some of these services even when they come to us for specific illness or problems unrelated to sexual health,” Marcell says.

The researchers say they hope that their findings will be a catalyst for policymakers and adolescent-health experts to draft and issue national guidelines and recommendations. The researchers say that medical school and residency training programs should expand their curricula on teen males’ sexual and reproductive health to better prepare the next generation of pediatricians to care for these patients.

“Our study indicates that clinicians who specialize in male teen health agree on the services they deem essential for their patients,” Marcell says. “What we need now is a set of uniform guidelines to help all pediatricians do the same.”

One encouraging finding, the authors say, was that services deemed important by clinicians to a large extent mirrored the recommendations issued in the Pediatrics article. Additional services listed in the Pediatrics piece include making hepatitis A and B, and HPV vaccinations, part of the annual exam and urging parents to engage their sons in age-appropriate discussions of sexuality and health.

Jonathan Ellen, of the Johns Hopkins Children’s Center, is co-author on the research study.

Co-authors on the Pediatrics article are Charles Wibbelsman, of Kaiser Permanente in California; and Warren Seigel, of SUNY-Health Center at Brooklyn.