Teens want their physicians to discuss sexuality: but most physicians do not routinely bring up the topic, several studies show.

NEWPORT BEACH, CALIF. -- Adolescents want their doctors to bring up the topic of sexuality but few physicians do, a survey of 388 teenagers revealed.

The findings support previous data that showed that a minority of pediatricians address sex when questioning adolescent patients or taking histories, mainly because they don't know what to ask, they fear offending patients. or they feel unqualified to counsel patients who are bisexual or homosexual.

In the current survey, the majority of adolescents said they'd be comfortable being asked any of 11 questions about sexuality, and gave top ratings to three questions that physicians could use to broach the topic, Dr. Natacha Hebert and Dr. Sophie Laflamme reported in a poster presentation at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

The survey of students at four high schools revealed that physicians had brought up the subject of sex with only 27% of the adolescents. Even fewer of the teenagers--17%--had raised the subject of sex with their physicians, reported the investigators, both of University of Sherbrooke (Que.).

Fully 72% of the teenagers said that they think physicians should discuss sexuality with them, and 80% of the cohort said the doctor should be the one to raise the topic. Those opinions did not vary by the age or sex of the adolescents, Dr. Hebert reported.

Half of respondents were younger than 15 years of age, and half were aged 15 or older. Females accounted for 65% of the cohort. Sixty percent of the students attended private schools, and forty percent were in public schools.

Girls were more likely to report being questioned by physicians about sex (35%) or raising the topic themselves (21%), compared with boys (17% and 11%, respectively).

Older teens were more likely to report being questioned by their physicians about sex (33%) or raising the topic themselves (23%), compared with younger adolescents (20% and 10%, respectively).

Physicians who are at a loss for words to initiate a discussion of sex could use these three questions, which were rated most highly by the teens:

* "Do you have a boyfriend or girlfriend?"

* "Have you ever been sexually involved with a boy or a gift?"

* "Do you have any questions or concerns about your sexual attractions?"

Survey participants were asked to imagine being asked 11 different questions by their physician and to rate their comfort with each question on a 10-point scale, with 1 being "not at all at ease" and 10 indicating "totally at ease" (see box).

If asked, "Do you have a boyfriend?" 90% of the adolescents rated their comfort level at 6-10, indicating they'd be moderately to totally at ease, Dr. Hebert said.

While 95% of females were moderately to totally comfortable with the question, 78% of males were. Similarly, 86% of respondents were moderately to totally at ease with the question, "Do you have a girlfriend?," including 81% of females and 94% of males.

A separate, previous survey of 60 pediatricians in Washington found that 41 (68%) did not question adolescent patients about sexuality (orientation, identity, or behaviors) mainly because they didn't know how to raise the topic and didn't feel knowledgeable about the needs of bisexual or homosexual patients (J. Adol. Health 1998;23:191-3).

Another previous survey of 61 Canadian pediatricians found that 43 (70%) did not include sexual orientation in taking a history for the same reasons, and because they feared offending patients (Annals RCPSC 2002;35:406-10), Dr. Hebert said.

BY SHERRY BOSCHERT

San Francisco Bureau Percentage of Teenagers Comfortable Answering Questions About Sex Do you consider yourself gay, lesbian, bisexual, or 86% heterosexual? Have you ever been sexually involved with a boy? 87% Have you ever been sexually involved with a girl? 70% Some of my patients your age date boys, girls, or both. Are you attracted to boys? 87% Are you attracted to girls? 92% There are many ways of being sexual with another person-kissing, having sexual intercourse. Have you ever been sexual with a girl? 75% Have you ever been sexual with a boy? 71% Do you have any questions or concerns about sexual things you have been doing? 75% Do you have any questions or concerns about your 84% sexual attractions? Note: Data from a survey of 388 male and female adolescents who rated their comfort level as moderately to totally at ease. Source: Dr. Hebert and Dr. Aflame