Reaching teens on sexual health through telehealth

The onset of the adolescent years also means the need to discuss a variety of topics on sexual health such as sexually transmitted infections (STIs), pregnancy, and contraceptives. At a session at the virtual 2021 American Academy of Pediatrics National Conference & Exhibition, Maria Trent, MD, MPH, FAAP, FSAHM, chief of the division of adolescent and young adult medicine at Johns Hopkins School of Medicine and Public Health in Baltimore, Maryland, discussed the importance of discussing sexual health with teenagers, how the pandemic changed the landscape, and what telehealth can bring to the plate.

For teenagers, the development of healthy sexuality is an important milestone on the path to being an adult. Parents are an important part of this and should be a part of the discussion. Research has found that high-quality discussions between parent and teenager about sexual health can lead to delays the first sexual experience; make the teenager more likely to discuss STIs and pregnancy with partners; use contraceptives; and have used condoms during his or her last sexual experience. Such discussions are becoming more common, but both parents and teenagers express feelings of discomfort and many adolescents feel embarrassed discussing the topic with their parents. Many parents and teenagers rely on their pediatrician to have discussions and most visits do have some type of sexual health content, but the average time spent is 36 seconds and only half of teenagers get time to speak to their provider alone.

The COVID-19 pandemic led to another wrinkle. Social distancing may have been a key way to prevent spread of the disease, but information indicates that many teenagers and young adults still engaged in sexual activity. Many medical offices were closed to in-person visits in the beginning months and public health departments that would’ve worked with sexual health were often shifted over to perform COVID-19 testing. Reduced access to care introduced new barriers to accessing contraceptives; preventive visits, which reduced the chance to provide anticipatory guidance; providing pregnancy options and counseling; counseling on risk reduction; and STI/HIV screening and treatment.

Telehealth is an important way to give vital sexual health care to adolescents. Some of the key parts of care that can be provided through it include anticipatory guidance, contraception counseling, family planning, coordinating follow-up care, and connecting teenagers to other resources. It also offers clinicians and teenagers a chance to have a private and confidential conversation about a variety of topics on sexual health. When visiting with an adolescent patient in the office, clinicians should be sure to tell them that telehealth is an option to discuss topics of a sexual nature. When in a Telehealth visit, health care professionals should ensure that the “tone” of the visit is the same as it would be in the office. Due to the sensitive nature of the topics discussed, clinicians should take a variety of steps to ensure that the adolescent patient’s confidentiality is maintained:

• Inform the patient what confidentiality means and the limits that may exist for that confidentiality
• Be aware of who is in the room with the patient
• Help the teenager find a space that’s as private as possible, which may take some creativity
• Encourage the teenager to use headphone during the visit

During telehealth visits, clinicians should be sure to discuss sexual health with all patients, not just female patients. Motivational interviewing can be a good way to encourage proactive and protective behaviors. If a hybrid visit requiring the patient to come into the office for other elements such as testing, clinicians should offer support as needed and ensure that the patient can get to the office for it.

Reference

1. Trent M. Meeting teens where they are: using telemedicine to improve sexual health. American Academy of Pediatrics 2021 National Conference & Exhibition; virtual. Accessed October 11, 2021.