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The idea of setting the tone for the years to come is very important," Stewart C. Alexander says. "This may not be the big conversation for the 12-year-olds—that may take place in four years—but the tone needs to be set at age 12 so that when the time comes the child is comfortable and knows the doctor is a safe contact." (Credit: iStockphoto)

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How doctors can get LGBT teens to open up

When doctors talk to teens about sex, only about three percent of them do so in a way that encourages LGBT teens to discuss their sexuality, a new study reports.

“Physicians are making their best efforts, but they are missing opportunities to create safe environments for teenagers to discuss sexuality and their health,” says lead investigator Stewart C. Alexander, an associate professor of consumer science at Purdue University who focuses on health communication.

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“What the doctor asks or brings up about sexuality sets the tone, and gay and lesbian youth are very good about reading adults to determine who is safe to confide in. They ask themselves, ‘Can I disclose this information to this adult?'”

Physicians are encouraged to discuss teenage sexuality during wellness visits per the American Academy of Pediatrics recommendations.

But researchers say these conversations need to be more than a simple phrase and doctors should consider the whole conversation. Physicians can undo any good if they aren’t inclusive.

“Open, inclusive conversations can help youths realize there is no threat, and this can be a great start for building trust with the physician who is someone they are likely to see year after year,” says co-investigator Cleveland Shields, associate professor of human development and family studies.

“These adolescents, especially the younger ones, may not have established a sexual identity, their sexuality is in flux, or they may be romantically involved with someone of the same gender but not identify themselves as gay or lesbian.”

Inclusive conversations

For the study, published in LGBT Health, researchers looked at patterns in physicians’ conversations about sex when speaking to patients ages 12-17. The data was collected at 11 clinics in the Raleigh/Durham, North Carolina, area as part of the Duke Teen CHAT project.

The analysis is based on recorded conversations between 49 physicians and 293 adolescents during annual wellness checks. Of all the visits that contained sexuality talk, physicians were able to maintain open and inclusive talk only 3 percent of the time.

“The physicians I know want to do a good job, so we’re trying to identify best practices, and hopefully these examples will provide them additional context for strengthening these conversations,” Shields says.

The study offers suggestions for inclusive conversation tactics, which have not been tested clinically:

  • Focus on attraction: “I know some teenagers who are attracted to girls. I know some teenagers who are attracted to boys, and I know some who are attracted to both. Have you started to think about these things?” or “Usually girls your age start to become interested in boys or other girls or both. Have you started to become interested in others?”
  • Ask about friends: “Have any of your friends started dating? Any boyfriends or girlfriends or both?” or “Do you know if your friends started to have sex yet?” Physicians can use this approach to then turn to the teenager’s dating and sexual behavior by always suggesting gender-neutral terms such as “anybody,” “someone,” or “partners.”

While maintaining an inclusive conversation can be challenging at first, it allows doctors to reinforce the notion of multiple attractions and identities and emphasize non-judgment, the researchers say.

Leave the door open

Another technique to maintain inclusive conversations is leaving the door open for future conversations, such as, “If things change, or if along the way you decide something else is right for you, I want you to let me know.”

The idea of setting the tone for the years to come is very important,” Alexander says. “This may not be the big conversation for the 12-year-olds—that may take place in four years—but the tone needs to be set at age 12 so that when the time comes the child is comfortable and knows the doctor is a safe contact.

This approach also reinforces the adolescent as an emerging adult. We want to provide them with autonomy so they can be a consumer of their own health.”

The National Heart, Lung, and Blood Institute funded the research. Researchers from Indiana University School of Medicine, Duke University, and University of Michigan collaborated on the study.

Source: Purdue University

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