For adolescent patients, routinely take a sexual history, discuss the use of barrier methods, and perform relevant examinations, screenings, and vaccinations, according to a new policy statement on barrier protection use from the American Academy of Pediatrics’ Committee on Adolescence.
The policy statement has been expanded to cover multiple types of sexual activity and methods of barrier protection. These include not only traditional condoms, but also internal condoms (available in the United States only by prescription) and dental dams (for use during oral sex) or a latex sheet. “Pediatricians and other clinicians are encouraged to provide barrier methods within their offices and support availability within their communities,” said Laura K. Grubb, MD, MPH, of Tufts Medical Center in Boston, who authored both the policy statement and the technical report.
Counsel adolescents that abstaining from sexual intercourse is the best way to prevent genital sexually transmitted infections (STIs), HIV infection, and unplanned pregnancy. Also encourage and support consistent, correct barrier method use – in addition to other reliable contraception, if patients are sexually active or are thinking about becoming sexually active – the policy statement notes. Emphasize that all partners share responsibility to prevent STIs and unplanned pregnancies. “Adolescents with intellectual and physical disabilities are an overlooked group when it comes to sexual behavior, but they have similar rates of sexual behaviors when compared with their peers without disabilities,” Dr. Grubb and colleagues emphasized in the policy statement.
This is key because Centers for Disease Control and Prevention 2017 data showed that in the United States, “456,000 adolescent and young women younger than 20 years became pregnant; 448,000 of those pregnancies were among 15- to 19-year-olds, and 7,400 were among those 14 years of age and younger,” according to the technical report accompanying the policy statement. Also, “new cases of STIs increased 31% in the United States from 2013 to 2017, with half of the 2.3 million new STIs reported each year among young people 15 to 24 years of age.”
Parents may need support and encouragement to talk with their children about sex, sexuality, and the use of barrier methods to prevent STIs. Dr. Grubb and colleagues recommend via the policy statement: “Actively communicate to parents and communities that making barrier methods available to adolescents does not increase the onset or frequency of adolescent sexual activity, and that use of barrier methods can help decrease rates of unintended pregnancy and acquisition of STIs.”
Use Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Fourth Edition, for guidance on supporting parents and adolescents in promoting healthy sexual development and sexuality, including discussions of barrier methods.
Some groups of adolescents may use barrier methods less consistently because they perceive themselves to be lower risk. These include adolescents who use preexposure prophylaxis or nonbarrier contraception, who identify as bisexual or lesbian, or who are in established relationships. Monitor these patients to assess their risk and need for additional counseling. In the technical report, studies are cited finding that barrier methods are used less consistently during oral sex and that condom use is lower among cisgender and transgender females, and among adolescents who self-identify as gay, lesbian, or bisexual, compared with other groups.
In the policy statement, Dr. Grubb and colleagues call on pediatricians to advocate for more research and better access to barrier methods, especially for higher-risk adolescents and those living in underserved areas. In particular, school education programs on barrier methods can reach large adolescent groups and provide a “comprehensive array of educational and health care resources.”
Katie Brigham, MD, a pediatrician at MassGeneral Hospital for Children in Boston, affirmed the recommendations in the new policy statement (which she did not help write or research). “Even though the pregnancy rate is dropping in the United States, STI rates are increasing, so it is vital that pediatricians and other providers of adolescents and young adults counsel all their patients, regardless of gender and sexual orientation, of the importance of barrier methods when having oral, vaginal, or anal sex,” she said in an interview.
Dr. Brigham praised the technical report, adding that she found no major weaknesses in its methodology. “For future research, it would be interesting to see if there are different rates of pregnancy and STIs in pediatric practices that provide condoms and other barrier methods free to their patients, compared to those that do not.”
No external funding sources were reported. Dr. Grubb and Dr. Brigham reported having no relevant financial disclosures.
SOURCE: Grubb LK et al. Pediatrics. 2020 Jul 20. doi: 10.1542/peds.2020-007237.