Discussing sex with teen patients: Encourage open communication over abstinence

“Just say no.”  This is a phrase I grew up with — mostly referring to drugs but also alcohol, smoking, and of course sex.  What I always wanted to know as a teenager was — other than the risk for pregnancy and disease — why say no? This is a question that remains in the minds of many teens today.

I see a large number of adolescent women in my practice. I inquire about sexual activity at each visit, and we discuss contraception and the importance of condom use.  Many teenagers shy away from this subject at first, but some are more comfortable discussing sex and asking questions.

Mothers often bring their daughters and stay in the room during the visit at their daughter's request. Most interesting are the moms who accompany their daughters and ask me to talk frankly about sex, but only after they've left the room. Many parents express dissatisfaction about what their children are learning about sex at school.

Curious about sex education I've begun to ask my adolescent patients what they are learning, and more importantly, what they would like to know.

Most teens are learning basic sex education — anatomy, physiology, birth control and sexually transmitted infections (STI), with a high emphasis on abstinence. Some teens are receiving abstinence-only education.

What many of these young women want to know from their parents or other trusted adults is, “Why choose abstinence?” They want to know about how sex will affect their relationships, their self-esteem and their friendships. 

Most adolescents acknowledge that conversations about sex with parents are awkward, but most long for honesty and open discussion. One young woman told me she wanted to make “informed sexual decisions,” but she wanted more detailed guidance from her parents other than, “Don't do it.”

As a midwife, I am an important resource for any questions that my teen patients have about women's health and sexual health. At every visit, I try to cover topics ranging from safe sex situations to “sexting,” and the importance of trust and communication between partners. I always remind patients that our conversations are confidential, but I also encourage them to ask questions of their parents and other trusted adults. 

Most of my patients have reported that open and honest communication with their parents has had more of an influence on their sexual decisions compared with school and religion-based education. Despite the statistics that STI rates are rising among younger patients, I have noticed that a fair number of the young women I see choose to remain abstinent. These patients may not wait to have sex until marriage, but at least until they are more mature.

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