Sexual and Reproductive Health Care Services in the Pediatric Setting

Abstract

Pediatricians are an important source of health care for adolescents and young adults and can play a significant role in addressing their patients' sexual and reproductive health needs, including preventing unintended pregnancies and sexually transmitted infections (STIs), including HIV, and promoting healthy relationships. STIs, HIV, and unintended pregnancy are all preventable health outcomes with potentially serious permanent sequelae; the highest rates of STIs, HIV, and unintended pregnancy are reported among adolescents and young adults. Office visits present opportunities to provide comprehensive education and health care services to adolescents and young adults to prevent STIs, HIV, and unintended pregnancies. The American Academy of Pediatrics, other professional medical organizations, and the government have guidelines and recommendations regarding the provision of sexual and reproductive health information and services. However, despite these recommendations, recent studies have revealed that there is substantial room for improvement in actually delivering the recommended services. The purpose of this clinical report is to assist pediatricians to operationalize the provision of various aspects of sexual and reproductive health care into their practices and to provide guidance on overcoming barriers to providing this care routinely while maximizing opportunities for confidential health services delivery in their offices.

Barriers and facilitators to sexual and reproductive health communication between pediatric oncology clinicians and adolescent and young adult patients: The clinician perspective

“…They acknowledged that cancer treatment incurs new risks to patients both during and after treatment that primary care providers may not be aware of. These sentiments fall in line with recommendations set forth by the American Academy of Pediatrics (AAP) that states that pediatricians should provide SRH information and services for male and female AYAs, including discussion of sexuality, sexual health promotion, and risk reduction . Both the AAP and the Society for Adolescent Health and Medicine support adolescents’ universal access to receipt of SRH care, which may be compromised during cancer treatment if the oncology team fails to take this on .…”

A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients

“…The presence of parents may be effectively addressed by clearly communicating that the structure of AYA visits includes time alone with the clinician. This is consistent with AAP recommendations that pediatricians should provide confidential time during health maintenance visits . As the oncologist often assumes the role of the PCP during treatment, this responsibility does fall to the oncology clinician.…”

“…Clinicians also emphasized their responsibility because of the concern that PCPs may simply not be aware of the risks and unique health concerns incurred both during and after cancer treatment, and how these must be factored into SRH counseling. These observations are supported by the American Academy of Pediatrics (AAP), which states that pediatricians should provide SRH‐related information and services for male and female AYAs, including discussion of sexuality, sexual health promotion, and risk reduction . The National Comprehensive Cancer Network states that “fertility preservation as well as sexual health and function should be an essential part in the management of AYAs with cancer,” highlighting the need for routine conversations .…”

Pediatric hematology and oncology fellow education in sexual and reproductive health: A survey of fellowship program directors in the United States

“…Clinical guidelines from the American Academy of Pediatrics (AAP) and the NCCN highlight sexual health conversations as essential to AYA patient care 9,29 . Less than half of the programs surveyed in this study include structured education on safe sex practices during cancer therapy or general sexual health, which may lead to significant health and quality‐of‐life issues for AYA patients and survivors.…”

“…The diverse SRH care needs of AYAs cannot be adequately met unless the provider workforce is sufficiently educated and prepared. Although national guidelines support the need for patient‐clinician communication about SRH across the cancer care continuum, no data are currently available regarding the current state of SRH training during pediatric hematology and oncology fellowship 9,29,30 . As the mandate to address AYA‐centered patient and survivorship care continues to take hold in oncology care, there is a growing need to ensure that clinicians receive appropriate training to address SRH.…”