In a review of health maintenance visits, 1 of 3 adolescent patients did not receive any information on sexuality from their pediatrician, and if they did, the conversation lasted less than 40 seconds. Information about sexuality can be taught and shared in schools, communities, homes, and medical offices using evidence-based interventions. Children and adolescents should be shown how to develop a safe and positive view of sexuality through age-appropriate education about their sexual health.
Sexuality education can be disseminated through the 3 learning domains: It covers healthy sexual development, gender identity, interpersonal relationships, affection, sexual development, intimacy, and body image for all adolescents, including adolescents with disabilities, chronic health conditions, and other special needs.
The various dimensions of healthy sexuality comprise the anatomy, physiology, and biochemistry of the sexual response system; identity, orientation, roles, and personality; and thoughts, feelings, and relationships. Unhealthy, exploitive, or risky sexual activity may lead to health and social problems, such as unintended pregnancy and sexually transmitted infections STIs , including gonorrhea, Chlamydia, syphilis, hepatitis, herpes, human papilloma virus HPV ; HIV infection; and AIDS.
The decrease in adolescent birth rates in the United States reflects an increased use of contraception at first intercourse and in the use of dual methods of condoms and hormonal contraception in already sexually active teenagers. Pediatricians can introduce issues of physical, cognitive, and psychosexual development to parents and their children in early childhood and continue discussions at ongoing health maintenance visits throughout school age, adolescence, and young adulthood.
Sharing this information can help overcome barriers to discussing the sexual development of all children and adolescents and to improve screening rates for STIs, pregnancy, and partner violence. It is also important to provide access to current accurate sexuality education and to provide access to confidential relevant information, services, and support over the course of a lifetime.
For example, by recognizing that masturbation is typical toddler behavior, parents can better understand and discuss self-stimulatory behaviors of their teenager.
The problem is often the inability to distinguish between behaviors that are publicly and privately appropriate as children grow older. The dynamics of the sexuality education conversation can then change as the child becomes a young adolescent by asking the parent or caregiver to leave the room after the initial introductions and history taking has occurred with the parent in the room.
Parents and adolescents benefit from being prepared for these changes in adolescent interactions when there will be time alone for the adolescent to engage with the pediatrician to discuss sexuality, as well as personal and mental health, drug and tobacco use, and other psychosocial issues. The importance of confidentiality and its role in adolescent health care autonomy should be discussed with both adolescents and their parents.
Unlike school-based instruction, a conversation about sexuality with pediatricians can provide an opportunity for personalized information, for confidential screening of risks, and for addressing risks and enhancing existing strengths through health promotion and counseling.
Children and adolescents may ask questions, discuss potentially embarrassing experiences, or reveal highly personal information to their pediatricians. Families and children may obtain education together or in a separate but coordinated manner.
Prevention and counseling can be targeted to the needs of youth who are and those who are not yet sexually active and to groups at high risk of early or unsafe sexual activity, which includes children with and without chronic health conditions and disabilities. Use of a psychosocial behavior screening tool or the Bright Futures Previsit Questionnaire available at https: The AAP policy statement on providing care for lesbian, gay, bisexual, transgender, and questioning youth, as well as other resources, offer suggestions on how to incorporate important conversations about sexual and gender identity in the health supervision visit.
Information regarding availability and access to confidential sexual and reproductive health services and emergency contraception is important to discuss with adolescents and with parents. During these discussions, pediatricians also can address homosexual or bisexual experiences or orientation, including topics related to gender identity.
It is also important to acknowledge the influence of media imagery on sexuality as it is portrayed in music and music videos, movies, pornography, and television, print, and Internet content and to address the effects of social media and sexting. According to the US Preventive Services Task Force, intensive behavioral counseling is important for all sexually active adolescents and for adults who are at increased risk of STIs. In addition, more information and resources can be shared with adolescents, many of which are easily accessible and listed at the end of this report.
Most adolescents have the opportunity to explore intimacy and sexuality in a safe context, but some others experience coercion, abuse, and violence. Screening for sexual violence and nonconsensual sexual encounters is important when evaluating all sexually active adolescents, especially for adolescents with chronic health conditions and disabilities, because they may be more likely to be victims of sexual abuse.
Adolescents and most parents agree that school-based programs need to be an important source of formal education for adolescent sexual health. Ideally, this education happens conjointly in the home and in the school. Fewer than half of states require public schools to teach sexuality education, and even fewer states require that, if offered, sexuality education must be medically, factually, or technically accurate. Fewer than half of states and the District of Columbia require parents to be notified that sexuality education will be provided.
There is little to no information available from parochial or private scholastic institutions on the provisions of sexuality education. Although policies exist requiring sexuality education, it may not be occurring in an unbiased and systematic manner.
The FoSE Initiative has released the National Teacher Preparation Standards for Sexuality Education to provide guidance to institutions of higher education to better prepare future teachers. According to these standards, teachers may benefit from receiving specialized training on human sexuality, which includes accurate and current knowledge about biological, social, and emotional stages of child and adolescent sexual development including sexual orientation and legal aspects of sexuality ie, age of consent.
Professionals responsible for sexuality education may benefit from receiving training in several learning and behavior theories and how to provide age- and developmentally appropriate instruction as part of sexuality education lesson planning. Ongoing professional development and participation in continuing education classes or intensive seminars is advised. Teachers can benefit from access to updated and current sexuality information, curricula, policies, laws, standards, and other materials.
The FoSE standards advise that teachers are aware of and take into account their own biases about sexuality, understand guidelines for discussion of sensitive subjects in the classroom and addressing confidentiality, and know how to address disclosure by students of sexual abuse, incest, dating violence, pregnancy, and other associated sexual health issues.
The goal is for teachers to feel comfortable and committed to discussing human sexuality and to know how to conduct themselves appropriately with students as professionals both inside and outside of the classroom and school. In the United States, It is important for teachers to develop skills in creating a safe, respectful, and inclusive classroom.
Health care providers, schools, faith-based institutions, the media, and professional sexuality educators are resources that guide and advise parents by providing training, resources, understanding, and encouragement. These include intentions to talk about sex, to monitor and stay involved, and to understand environmental barriers and facilitators that influence talking about sexuality eg, community norms that discourage or encourage such communication.
Conversely, parents who are engaged and comfortable talking about sexual health have teenagers who are more knowledgeable and may even be more proactive in seeking reproductive health medical services. Discussions of sexuality do not occur equally among mothers and fathers.
One review found that overall, the number of discussions parents have with teenagers about sex has decreased from to Although mothers can also effectively teach their sons about sexuality, 51 the relationship boys have with their fathers or other male role models plays a crucial role in their sexual health, including reducing sexual risk taking and delaying initiation of sexual intercourse, especially in those boys with a connection to their fathers, whether they live in the same home or not.
In that review, most comprehensive sexuality education programs showed efficacy in delaying initiation of intercourse in addition to promoting other protective behaviors, such as condom use. There was no evidence that abstinence-only programs effectively delayed initiation of sexual intercourse. The Community-Based Abstinence Education program received the most federal funds and made direct grants to community-based organizations, including faith-based organizations.
Federal guidance required all programs to adhere to an 8-point definition of abstinence-only education and prohibited programs from disseminating information on contraceptive services, sexual orientation and gender identity, and other aspects of human sexuality.
Programs promoted exclusive abstinence outside of heterosexual marriage and required that contraceptive use, contraceptive methods, and specifically condoms must not be discussed except to demonstrate failure rates. However, most public funding now supports evidence-informed interventions that have been proven to delay onset of sexual activity, reduce numbers of partners, increase condom and contraceptive use, and decrease incidence of teen pregnancy and STIs, including HIV.
They also found that teenagers who took the pledge were less likely to use contraception after they did initiate sexual intercourse and not to seek STI screening.
At 6-year follow-up, the prevalence of STIs Chlamydia, gonorrhea, trichomoniasis, and HPV infection was comparable among those who took the abstinence pledge and those who did not. Diverse family circumstances, such as families with same-sex parents or children who identify as lesbian, gay, bisexual, transgender, or questioning, create unique guidance needs regarding sexuality education. Modeling ways to initiate talks about sexuality with children at pertinent opportunities, such as the birth of a sibling can encourage parents to answer children's questions fully and accurately.
Parents and adolescents are encouraged to receive information from multiple sources, including health care providers and sexuality educators, about circumstances that are associated with earlier sexual activity.
Adolescents are encouraged to feel empowered through discussing strategies that allow for practicing social skills, assertiveness, control, and rejection of unwanted sexual advances and cessation of sexual activity when the partner does not consent. Discussions regarding healthy relationships and intimate partner violence can be effectively included in health care visits.
Pediatricians are encouraged to acknowledge that sexual activity may be pleasurable but also must be engaged in responsibly. Specific components of sexuality education offered in schools, religious institutions, parent organizations, and other community agencies vary based on many factors. The pediatrician can serve as a resource to each. School-based comprehensive sexuality education that emphasizes prevention of unintended pregnancy and STIs should be encouraged.
It is also important to discuss consistent use of safer sex precautions with sexually active teens. Bright Futures recommendations can be used. Abstinence is the most effective strategy for preventing HIV infection and other STIs, as well as for prevention of pregnancy. Preparation for college entry is an excellent opportunity for pediatricians to address issues such as the effects of alcohol, marijuana, and other drug consumption on decisions about safe, consensual sexual practices.
Children and adolescents with special issues and disabilities may benefit from additional counseling, referrals, and sharing of online resources listed at the end of this report. Advocates for and supports promotion of comprehensive sexuality education, provides programming guidance for both school and community settings, and advocates for wider educational opportunities for all young people and partners with civil society organizations. Uses resources, advocacy, collaboration, and research to improve and increase access to integrated physical, behavioral, and sexual health care for adolescents.
Developed the National Sexuality Education Standards for teachers to standardize and improve the quality of sexuality education provided in schools. A resource for educators, counselors, administrators, and health professionals about human sexuality research, lesson plans, and professional development.
The SexEd Library is a comprehensive online collection of lesson plans relate to sexuality education. Comprehensive Sex Education is a unique curriculum designed for implementation in both middle and high schools. Information provided is medically accurate and age-appropriate and can reinforce family communication and improve communication skills for healthy relationships.
The Health Education Curriculum Analysis Tool can help schools select or develop appropriate and effective health education curricula and can be customized to meet local community needs and conform to the curriculum requirements of the state or school district. Health Care Providers Bright Futures: Preventive health information and recommendations about promoting healthy sexual development and sexuality to help health care providers during health supervision visits from early childhood through adolescence.
Recommendations about interventions to promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other STIs in adolescents. American Congress of Obstetricians and Gynecologists: Information and resources about adolescent sexuality and sex education.
Scarleteen is an independent, grassroots sexuality education and support organization and Web site. Founded in , Scarleteen. It is the highest-ranked Web site for sex education and sexuality advice online and has held that rank through most of its tenure. Stories written by teen staff writers and national contributors. Opportunities to get involved and make a difference on sexual health issues. Forums where teens can participate in moderated discussions with other teens.
Videos about sexual health. A sex terms glossary of almost terms. By combining our resources and capacity, we are reaching more people, building more healthy relationships, and saving more lives. Parent training and information center for families of children and youth with all disabilities from birth through 21 years old.
Parents can find publications, workshops, and other resources about a number of topics, including sexuality and disabilities. Your Child Development and Behavioral Resources: A program at the University of Michigan that houses a resource list of materials and Web sites about sexuality education for youth with disabilities for families as well as for teachers, and providers.
Center for Parent Information and Resources: