Adolescent Health Care, Sexuality and Contraception

The American Academy of Family Physicians (AAFP) values the sexual health of adolescents in the United States.  The AAFP particularly recognizes the importance of comprehensive sex education in reducing the incidence of unintended teenage pregnancies; preventing sexual assault; increasing awareness of the risks and signs in adolescents regarding sex trafficking; and increasing awareness of the legal ramifications of sexuality and technology. The AAFP believes that an evidence-based approach to sexual health education will effectively address these issues, and recognizes the need for more comprehensive and effective sex education programs in the community.  The AAFP endorses opt-out comprehensive sexual education in all states and does not support abstinence-only sexual education.  The AAFP recommends that:

1. All sexual education programs (including school-based programs within elementary, middle, and high schools) include comprehensive, medically accurate, evidence-based information that is age-appropriate and culturally relevant.
2. Comprehensive sex education includes discussions about consent, intimate relationships, human sexual anatomy, sexual reproduction, sexually transmitted infection (STI) prevention, sexual activity, sexual orientation, gender identity, abstinence, contraception, and reproductive rights and responsibilities. Comprehensive education and counseling regarding sexual practices of adolescents should include discussion about genital, anal, oral, and other types of sexual contact.
3. Family physicians should provide appropriate guidance and counseling to educate patients about responsible sexual behaviors that decrease the risk of unplanned pregnancy and transmission of STIs. Patient education should address signs and symptoms of STIs and the need for testing even when patients are asymptomatic.
4. Family physicians should be aware that adolescents may be exploring sexual orientation and/or gender identity, which can impact their psychosocial and physical health.  Asking open-ended questions about sexual orientation and gender identity can open a dialogue about family relationships, safe sexual practices, mental health, and other issues confronting lesbian, gay, bisexual, transgender, queer, questioning, and intersex adolescents in a sensitive and accepting atmosphere.
5. Family physicians should discuss with and educate their adolescent patients on the concept of consent to sexual activity and what to do if sexual contact takes place against one’s consent.
6. A medical evaluation that addresses an adolescent's sexual and reproductive health should include a careful assessment for abusive or unwanted sexual encounters.
7. Family physicians must know their state laws and report cases of suspected sexual abuse to the proper authority in accordance with those laws.
   
8. Family physicians should also be knowledgeable about their state laws in regard to technology and sexuality and should educate adolescents about the risks of sexting and using social media in a sexual manner.
9. Adolescents receiving family planning services deserve confidential care.  Family physicians should be aware of any state laws that may impact the reproductive rights of their patients.  Updated state laws can be found through the Guttmacher Institute at https://www.guttmacher.org.
10. Family physicians are in an ideal position to encourage family members and other trusted adults to be involved in adolescent sex education efforts.  Encouraging dialogue with parents or other trusted adults has been shown to positively impact outcomes of sexuality, increase adolescent use of condoms and contraception, and lead to delayed initiation of sexual activity.
11. Family physicians and other health professionals who care for children and adolescents should be actively involved in community efforts that initiate and implement comprehensive, effective sex education and prevention programs.
12. If a family physician is uncomfortable providing these services, the patient should be referred to another clinician who is willing to provide the education and/or services.

(1987) (2020 COD)