Tips for talking to teens about STDs

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Applied Evidence

Tips for talking to teens about STDs

J Fam Pract. 2009 February;58(2):76-81a

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References

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Consider introducing the general topic of sexual health—physical anatomy, physiology, risks of STIs, myths—with the teen and parent together.

Meet with patients alone when questions relate directly to their sexual habits, activity, or preferences. You may want to start with an open invitation designed to engage the adolescent in a dialogue: “At your age, I was very confused and misinformed. I am here to answer any of your questions. I also want to remind you that everything we discuss stays here. I know you have some information about this, but I am here to help you understand what is true and what is not.”

Legality. With a few exceptions, adolescents in the United States can legally consent to the confidential diagnosis and treatment of STIs, and medical care for STIs can be provided without parental consent or knowledge. In addition, in the majority of states, adolescents can consent to HIV counseling and testing.³

Plan for follow-up visits. Rather than overwhelm a teen at the initial visit, answer pressing questions and provide an overview. Have the teen make a follow-up appointment for 1 to 2 weeks after the initial visit. Provide print or online resources and phone numbers to call for additional information, and say you’ll be happy to address any questions or concerns at the next visit. (For reimbursement, these sessions can be coded as time-based counseling visits. When done in conjunction with other problem visits, your counseling can be coded with modifiers for prolonged services.¹¹)

How important is it to raise this topic?

Adolescents and teens are prone to receiving and accepting misinformation from a variety of sources, such as peers, the general media, and the Internet. Not providing them with sound, accurate information about risks puts their health in jeopardy.

Most parents want to discuss this issue with their children, but they are often afraid or ill prepared to do so. Based on the literature^2-4,6 and our conversations with therapists, it seems most parents don’t object to physicians giving their children sound information as much as they object to being left out of the process. One technique to encourage parental cooperation is to offer choices about the way information will be delivered.

How should I advise parents?

Parents who really want to talk with their teens about sexual behaviors will likely find it easier to ask questions of their child in the doctor’s office, and to accept in that setting the answers they receive. Parents and physicians can collaborate ( TABLE 2 ) to create a 3-way conversation with the child in which any topic can be discussed safely and objectively. Such discourse in your office will hopefully translate to the home, as well.

In addition to answering parents’ questions and giving them medical information and counseling suggestions, offer them handouts and a list of online resources. Many groups have used MySpace to deliver counseling and support group information to children and teens.^12-15 These include Congress (health promotion, safety); Rape, Abuse, & Incest National Network; National Suicide Prevention Hotline (20,000 hits/month on MySpace); and gay/lesbian counseling forums. We suggest parents get texting capabilities on their phones and set up MySpace accounts to augment communication with their teens.

TABLE 2
Gaining parental buy-in before the teen talk: A conversation starter

DR: Mr. Jones, I wanted to take this opportunity to discuss an important matter with you. As you know, Eva is now a teenager. There are a lot of issues that teenagers are faced with, have questions about, and are misinformed about. One of these is sex. First, I would like to know your thoughts on the matter and what kind of discussions—if any—you have had with your daughter.
Mr. Jones: She is only 13, and she is not having sex. I want to keep it that way. I don’t want to talk about it and thus encourage her to have sex.
DR: I can appreciate what you’re saying. I want you to know that I respect your views and how you would like to raise your child. I have some concerns because teens nowadays have many questions and get a lot of misinformation from their peers and the media.
Mr. Jones: What do you want to do?
DR: Well, I would suggest we ask her about what she knows about sex, what she has heard, and what questions she may have. I would like to do that with both of us in the room. Then, I would like to go over some of the terminology along with issues such as STDs and pregnancy/complications.
Mr. Jones: As long as I’m there and as long as you are not encouraging it. I don’t want her to think it’s OK to have sex at 13. But I’m also scared about what she sees on TV and at school and what she thinks she should be doing.
DR: I understand. Before the 3 of us talk, I would like to speak to her privately and see if there are any specific issues she may want addressed. I want to ensure that she feels comfortable enough to ask anything. I also want to assure you that if there is anything of concern, I will address it and let you know. What do you think?
Mr. Jones: That’s fine.
DR: One more thing: If you would like any information regarding how to continue this discussion at home, or even medical information for your own reference, I would be happy to provide that for you.
Mr. Jones: Yes, that would be great.