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Let’s Talk About Sex: Empowering Families in Sexual and Reproductive Health Conversations

Talking with patients and their families about sexual and reproductive health conversations

by Mari Lowe, NP-C

published 10/17/19

Engaging young people and their families in conversations about sexual and reproductive health can feel awkward, but primary care providers, like pediatricians, family medicine doctors, and family nurse practitioners, are well-suited to discuss sexual and reproductive health, as their age-based expertise and ongoing relationships with families provides support for everyone involved. By talking about physical, mental, and social well-being in relationships and sexual development in the exam room, we model a safe way to have these discussions that can be continued at home.

Setting the Stage for Conversation

Families often want to have sexual and reproductive conversations with their young people, but sometimes don’t know where to begin. As a provider, you can reassure family members that they do not have to have one big “talk” about sexual and reproductive health, as this can be overwhelming for everyone involved. Instead, recommend that they start with smaller, more frequent conversations from an early age to make it easier for kids and teens to take in new information.

At the start of each health visit, introduce yourself and your role, and ask each person present to introduce themselves and their relationship to each other. During the visit, you should use anatomically correct terms when describing the human body to people of all ages. This sets the stage to encourage families to do the same.

Listen Before Talking

Young people love asking questions, and by listening carefully, families and providers can look for themes in the questions that lay the groundwork for deeper conversations. Listening also shows young people that their questions and concerns are valid and important. If the family is unsure of the answer to a question or uncomfortable with the question being asked, assure them that they are always welcome to call your office or schedule a visit to talk. As providers, we may not always know the answer to every question, but we can help families by researching the answers with them. Collaborating directly with families to uncover answers empowers everyone involved.

It’s important for health care providers to recognize that the cultural and religious norms of families vary and affect how families talk about sex and relationships. If you’re unsure of a family’s views around sexual and reproductive health, ask them! They likely have questions, concerns, and wisdom to share that will enrich discussions.

Confidentiality

State laws vary in what services, including sexual and reproductive health care, substance abuse, and mental health services, people under age 18 can receive from their health care providers without the knowledge of a legal guardian. As a health care provider, take the time to review your state’s laws and share that information with young people and their families so they all know what services minors can access without their guardian’s consent.

You can also share with families that young people are more likely to be open about their sexual and reproductive questions and experiences if they trust that their conversations will be kept in confidence. For example, frame conversations by saying, “the things you tell me in private will be kept private. If there is something going on, and I am concerned about your safety, we can’t keep that a secret. If that happens, we will go together to get you the help you need.”

Understanding Consent

Families and providers can begin discussing consent as soon as kids can communicate. For younger children, caregivers can model consent by asking permission before giving physical affection and teaching children to do the same with others. As they become older, examples from the media can serve as relevant conversation starters for discussions about why it’s important to get affirmative consent before any physical touching, every time. Families and providers can review Bedsider content for ideas and questions to start conversations about enthusiastic consent, sexual assault, and more.

Families and health care providers should also encourage young people to trust their gut feelings and speak out if they are uncomfortable with how someone is treating them or touching them. You can ask young people to think about who they can talk about their relationships without fear of judgment and to consider that it may not be someone in their family. Young people may not feel comfortable, or safe, talking to family members about sex, love, and relationships. You can ask more about their experiences and listen to them without recommending or requiring that they talk to family members. Providers and families can also share resources, like RAINN’s confidential 24/7 online chat and hotline services, if young people have questions or want to know more about relationships and consent.

Health care providers should use the principles of explicit consent during every physical exam, beginning with the first well-child check.

Bottom Line

Health care providers are in a position to empower families to have thoughtful and intentional conversations about sexual and reproductive health. Conversations should start early and occur frequently. Begin by engaging families about their beliefs and values around sexual and reproductive health and encouraging them to listen to their young people without judgement. Both families and providers play an important role in discussing sexual and reproductive health including teaching about consent and respecting confidentiality.

Mari Lowe, NP-C, works as a family nurse practitioner in Washington, D.C., serving in respite care and medical outreach for people experiencing homelessness. She previously spent several years incorporating sexual and reproductive health into primary care at Unity Health Care. In her free time, you’ll find her reading the latest non-fiction book or practicing yoga.
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