CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care Emerging Issues in Male Adolescent Sexual and Reproductive Health Care Laura K. Grubb, MD, MPH, FAAP,a Makia Powers, MD, MPH, MSc, FAAP,b COMMITTEE ON ADOLESCENCE Pediatricians are encouraged to address male adolescent sexual and abstract reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health. Departments of aAdolescent Medicine, Pediatrics, and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and bDepartments of Pediatrics and Public Health and Community Medicine, Morehouse INTRODUCTION School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia During adolescence, several transitions occur for boys, including the Clinical reports from the American Academy of Pediatrics benefit from physical, psychological, and social changes associated with puberty, with expertise and resources of liaisons and internal (AAP) and external 1,2 reviewers. However, clinical reports from the American Academy of most male adolescents reporting the initiation of sexual behavior. Many Pediatrics may not reflect the views of the liaisons or the emerging behaviors, including sexual initiation, are associated with organizations or government agencies that they represent. preventable negative health consequences such as sexually transmitted All clinical reports from the American Academy of Pediatrics infections (STIs), unintended pregnancies, and nonconsensual sexual automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. activity.2 During this developmental period, the number of health encounters typically declines, particularly among older male adolescents, The guidance in this report does not indicate an exclusive course of 3 treatment or serve as a standard of medical care. Variations, taking and there is a shift from routine to more time-limited acute visits. into account individual circumstances, may be appropriate. Pediatricians and other physicians who care for natal male adolescents DOI: https://doi.org/10.1542/peds.2020-0627 (cisgender or transgender female adolescents) or those who identify as Address correspondence to Laura K. Grubb, MD, MPH, FAAP. E-mail: male (transgender male adolescents or gender nonconforming) have unique [email protected] opportunities to incorporate anticipatory guidance around issues such as PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). puberty and sexuality not only at any health maintenance visits but also at sick and/or injury visits with adolescents and their families. For the Copyright © 2020 by the American Academy of Pediatrics purposes of this report, the term “male” refers to cisgender adolescents and FINANCIAL DISCLOSURE: The authors have indicated they have no young adults, unless otherwise specified.4 financial relationships relevant to this article to disclose. FUNDING: No external funding. Even after the release of the American Medical Association’s Guidelines for Adolescent Preventive Services (GAPS)5 and the American Academy of Pediatrics (AAP) Bright Futures: Guidelines for Health Supervision of Infants, To cite: Grubb LK, Powers M, AAP COMMITTEE ON ADOLESCENCE. Children, and Adolescents,6 which recommend preventive health services for Emerging Issues in Male Adolescent Sexual and Reproductive Health Care. Pediatrics. 2020;145(5):e20200627 adolescents, there have been few improvements in the counseling of male Downloaded from www.aappublications.org/news by guest on October 2, 2021 PEDIATRICS Volume 145, number 5, May 2020:e20200627 FROM THE AMERICAN ACADEMY OF PEDIATRICS teenagers regarding the prevention • emerging issues in health lifetime partners, 39% did not use of STIs or HIV infection.7,8 confidentiality; a condom at last sexual intercourse, Furthermore, data from outpatient • data on the patterns of social media and 5% reported initiating sex at 2 medical records reveal that use in male sexual health; 13 years or younger. pediatricians are 3 times more likely • discussion of consent for sexual Adolescents with intellectual to take sexual health histories from acts among adolescents; disabilities (IDs) and physical female than male patients and twice • disabilities are an overlooked group as likely to counsel female patients recommendations for counseling of in terms of sexual behavior, but they on the use of barrier methods.7,9 male adolescents on their roles in contraception decision-making; have similar rates of sexual behaviors Thus, it is important for when compared with their peers • updated data on STIs and pediatricians to have an without disabilities.15 These youth treatment among male patients understanding of what sexual and receive limited sexual education aged 15 to 24 years with updates reproductive health care means for from their parents and pediatricians, on STI screening and treatment; the male adolescent. Although who may assume they will not boys and young men comprise • recommendations on human engage in sexual behaviors.15 Much approximately half of the adolescent papillomavirus (HPV) vaccine for of the research on IDs and sexuality population in the United States, boys; among adolescents and young adults standards for addressing their • information on sexual dysfunction is focused on contraception choices reproductive and sexual health needs among adolescent and young adult and pregnancy prevention among lag behind those for adolescent males and recommendations for females, with little focus on male girls and young women, and addressing in practice; and adolescents. Jahoda and Pownall16 male adolescents continue to be • updated sexual and reproductive evaluated sexual knowledge and a particularly vulnerable patient health resources (Supplemental social networks among adolescents population.7,8 Pediatricians are Table 2) for pediatricians with IDs compared with adolescents encouraged to address male adolescent specifically for male adolescent without IDs. Results revealed that sexual and reproductive health on patients. male adolescents with IDs scored a routine basis, including boys and higher in knowledge of sexual topics young men with developmental or compared with female adolescents physical disabilities,10,11 by taking ADOLESCENT MALE SEXUAL BEHAVIOR with IDs and discussed sexual a sexual history, discussing healthy topics more frequently in their According to the 2017 Youth Risk sexuality, performing an appropriate social networks compared with Behavioral Surveillance System examination, providing patient- female adolescents; however, (YRBSS), 41% of male teenagers of centered and age-appropriate male adolescents with IDs were high school age reported they had anticipatory guidance, performing less likely to have received sexual intercourse, defined as appropriate screening, and information about sex from their opposite-sex vaginal-penile contact, administering vaccinations.12 pediatricians when compared with by the 12th grade.2 In another study, their peers without IDs.16 Current male adolescents were significantly The 2011 AAP clinical report on male research is now being focused more likely to engage in oral sex adolescent sexual and reproductive on the importance of sexuality compared with sexual intercourse health care discusses specific issues counseling with these adolescents and more likely to have significantly related to male adolescents’ sexual and young adults so that they greater numbers of oral sex partners and reproductive health care in the develop healthy sexual behaviors.10 than sexual intercourse partners and context of primary care, including The AAP clinical report “Sexuality indicated that during oral sex, they pubertal and sexual development, of Children and Adolescents had never used STI protection.14 A sexual behavior, masturbation, With Developmental Disabilities” substantial number of young men consequences of sexual behavior, provides additional guidance and report engaging in concerning sexual and methods of preventing STIs information.11 behaviors, including an earlier age of (including HIV) and pregnancy.13 sexual debut and having more sexual As the national dialogue shifts toward This revision provides updated partners than female adolescents.2 openness and acceptance of lesbian, information and recommendations YRBSS data from 2017 indicated that gay, bisexual, transgender, and since the 2011 clinical report, among surveyed male high school questioning (LGBTQ) individuals, including the following: students, 22% reported using adolescents are increasingly • updated information concerning alcohol or drugs before last sexual expressing sexual fluidity and male adolescent sexual behavior; intercourse, 12% reported $4 flexibility. Discordance between Downloaded from www.aappublications.org/news by guest on October 2, 2021 2 FROM THE AMERICAN ACADEMY OF PEDIATRICS sexual attraction and orientation Pediatricians rarely discuss high-risk Association, AAP, Society for and behavior is also possible because sexual behaviors during routine Adolescent Health and Medicine,