“I just think that doctors need to ask more questions”: Sexual minority and majority adolescents’ experiences talking about sexuality with healthcare providers

• We explore adolescent sexuality communication with physicians by interviewing sexual minority and majority adolescents and young adults.
• Participants reported that discussions with physicians about puberty, romantic and sexual attractions, orientation, and sexual behaviors occurred with low frequency and quality, and when conducted, often occurred in front of parents.
• Sexual minority adolescents reported concerns about comfort and inclusivity during healthcare encounters, emphasizing that physicians often appeared uncomfortable discussing sexuality with them and that they felt isolated by non-inclusive language and office environments.
• Physicians may need to be creative when addressing sexuality with adolescents. They may find it beneficial to use indirect questioning techniques and utilize adolescent interest in social media and technology to assist with engagement around sexuality education, collection of sexual histories, and maintenance of electronic health records.
• Clinic staff can participate in inclusiveness trainings (e.g. Safe Zone) and display visual signage that promotes a safe and inclusive environment for sexual minorities.

ObjectiveTo examine adolescent and young adults’ experiences of sexuality communication with physicians, and gain advice for improving interactions.MethodsSemi-structured interviews were conducted with questions focusing on: puberty, romantic attractions, sexual orientation, dating, sexual behavior, clinical environment, and role of parents. Interviews were transcribed and analyzed using thematic analysis with both open and axial coding.ResultsFive themes emerged from interviews: 1) need for increased quantity of sexual communication, 2) issues of confidentiality/privacy, 3) comfort (physician discomfort, physical space), 4) inclusivity (language use, gender-fluid patients, office environment), 5) need for increased quality of sexual communication.ConclusionsSexual minority and majority adolescents and young adults indicate sexuality discussions with physicians are infrequent and need improvement. They indicate language use and clinical physical environment are important places where physicians can show inclusiveness and increase comfort.Practice implicationsPhysicians should make an effort to include sexual communication at every visit. They should consider using indirect questions to assess sexual topics, provide other outlets for sexual health information, and ask parents to leave the exam room to improve confidentiality. Clinic staff should participate in Safe Zone trainings, and practices can promote inclusion with signs that indicate safe and accepting environments.