Teens and sexual health

Transcript

Amanda Wilde: There are so many challenges for today’s teenagers. And a big challenge for parents is when it comes to talking with teens about sex. Definitely stretches our comfort zone, but we want to make sure our kids’ bodies are healthy. So here to talk about teens and sexual health, and maybe give us more ease talking about it is Dr. Mike Guyton, Adolescent Medicine Specialist at Prisma Health.

This is Flourish, a podcast from Prisma Health. I’m Amanda Wilde. Dr. Guyton, thank you for being here.

Dr. Mike Guyton: Absolutely. Always happy to be involved.

Amanda Wilde: When is the right time to start talking about sex with your children? Like how should we even approach that conversation?

Dr. Mike Guyton: Yeah. So, the biggest thing, as with many things in medicine, is trying your best to be proactive and not reactive, right? And I think the conversation with sex is the same thing. You really want to try and talk about it before it happens, right? Because that’s where we can actually have the biggest impact in helping navigate kids to making decisions that are the best for them.

And, because of that, it can be tough narrowing down an exact time. You know, it’s not saying so much that, “Gosh, when you’re 12, you have to have this. When you’re 16, you have to have this.” It really depends on every individual relationship this kid has in their life. So developmentally speaking, most kids don’t even really think about sex or have those thoughts or exposed to it until when puberty really starts, which for most, that’s around 10 years old. So that gives you probably the closest time to say this, “If I haven’t had it yet, I should be talking about sex.” Have that conversation, you know, should be talking about it.

And when you approach the conversation for parents, I think one of the most consistent and most helpful ways to approach it is by trying to not shroud it in mystery, right? Like sometimes sex becomes this taboo thing that people aren’t supposed to talk about, right? But at the end of the day, it truly is just a very normal and very healthy biological function, right? It’s a part of being alive, part of being a person. The part that’s tough about sex is all the emotions and that’s where the conversation is so important because being parents, being people who care about our kids, we can use our adult brains to help them understand and guide emotions because they don’t have that ability yet, their brain hasn’t reached that point yet. So they need some help from us.

Amanda Wilde: Well, how can parents help their teens make good decisions?

Dr. Mike Guyton: Always being a consistent stable foundation in the conversation, so being that person who will always be there for them, whether a kiddo makes a mistake or not, or whether they ask something you do or don’t have an answer to, being consistently there through conversation, through presence, I think that’s the best way that parents can support their kids. And whether it be conversations about sex or about really anything.

Amanda Wilde: And as an adolescent medicine specialist, what do you want teens to know about sexual health or health in general?

Dr. Mike Guyton: Well, conversations about sexual health can be awkward, right? And even though that we’re doctors and we’ve had certain types of training, it can be awkward for us too as doctor, so might as well just be awkward together, right? But seriously, knowing that we do go through this training so we can help anybody, whether it be kids or adults navigate their health, it’s a really important thing. So sexual health is a combination of talking, talking about testing, doing testing, who shouldn’t be testing, who shouldn’t be having sex, how sex can be powerful in both good and bad ways. So there’s so many dynamics to the conversation. But in the end, it’s just like any other health topic. We, as doctors, really want to partner with our patients to see what their goals are and to help them reach their goals in a safe and predictable way. And whether that be an adolescent medicine specialist, a pediatrician, or another type of doctor, I think that’s where we all are in the conversation.

Amanda Wilde: How is an adolescent medicine specialist different from a pediatrician?

Dr. Mike Guyton: So adolescent medicine specialist are medical doctors who have done extra training, which usually is about three extra years of training after the residency to only take care of teenagers and young adults. That extra training is called a fellowship. And so we have gone beyond their traditional medical training to note anything and everything there is about being a teenager and young adult and all the health things that come with that. So pediatricians, conversely, they help take care of babies, well-child checks, sports physicals, general like “I’m sick” type of care, we do that too is adolescent medicine doctors, but again, only specifically for teenagers and young adults, but there are other things that we do that other doctors may or may not have much experience with.

So for example, we do a lot of care around eating disorders. We do a lot of care around LGBTQIA+ health, especially transgender care. We do a lot of care for those who have HIV, navigating mental health concerns, acne. So, basically anything and everything that happens between the ages of 10 and 25, adolescent medicine specialists are really attuned to help.

Amanda Wilde: Yeah. Well, it’s not just puberty. It’s like you said, 10 to 25. It’s almost pre-puberty, through puberty, into young adulthood that you would bring your child to see an adolescent medicine specialist versus a pediatrician.

Dr. Mike Guyton: Yeah, essentially. So, the care that we provide tends to be a little bit more complex, right? So maybe the conversation needs a little bit longer than a typical pediatric office or internal medicine office can provide. And that may be a reason to see that adolescent specialist. Most adolescent medicine docs want to help as many people as possible as quickly and efficiently and as long as possible as we need to. So, if there’s the thought that, “Hey, I could benefit from talking to a doctor like this, look us up.” Do a quick Google search of adolescent medicine docs near us. We’re few and far between sometimes, but we’re still there and happy to be involved in the conversation any time.

Amanda Wilde: You mentioned the complex issues that teens face. I mean, what are the most pressing sexual health issues for teens?

Dr. Mike Guyton: I think the biggest thing here is talking about testing, so testing for STI and testing for any other types of infections that could be obtained through sexual means, right? So testing, testing, testing. With STI, individuals and particularly teenagers, young adults, they think that, “Gosh, I don’t have anything unless something is happening, unless I have certain symptoms.” but I like to tell my patients that the most common symptom of any STI, sexually transmitted infection, is no symptom whatsoever. These things can hide sometimes. And you may not know that there’s something going on that needs to be taken care of. So the way that we can help our patients with that is by encouraging routine testing.

And so in general, what we recommend is, you know, if a kiddo is having sex in any form or fashion, no matter how frequent or how many partners or whatnot to have testing done at least once a year, even if you don’t have any symptoms, just to make sure that there’s nothing hiding out there because this is a way to keep their body healthy, but also a way to keep other bodies healthy.

I think providing conversation about that and why testing is important, it’s not meant to prove you’ve got something or to say you’re dirty or not, or any of those things. There’s so much stigmatizing information that could be around this topic. That’s not the reason why we’re seeing it. We’re seeing it because it’s a way to keep our bodies healthy, just like go into the doctor and get your blood pressure checked once a year or however much, same kind of thing. This is a way that we can keep your body sexually healthy. And at the end of the day, that’s what it’s all about.

Amanda Wilde: So testing is a form of prevention. Are there other forms of prevention we should know about?

Dr. Mike Guyton: Oh, hands down. So, education, educating ourselves, educating others is probably the first step in prevention, whether it be from STI or just from having a bad sexual experience in general. During sex itself, there are ways to protect yourself during the encounter. So things like barrier protection, such as condoms. We always encourage those for anybody having any form of sex. And also there are other medications out there that are relatively newer medications and I’m still amazed at a how far we’ve come as a medical society with this. We now have medicines that can pretty much 99% prevent the acquisition of HIV through sexual encounters, right? We don’t have a cure yet, but gosh, we’re on our way. And so it could be done as little as one pill once a day, sometimes as little as one shot every two months that can prevent and dramatically lower your risk of acquiring HIV. So there are many tools in the toolkit, but it all starts with that conversation and that education.

Amanda Wilde: When parents come in with kids, how do you have a normal conversation about these things?

Dr. Mike Guyton: Yeah. So I think the first thing is kind of setting the tone for the visit, right? Being a teenager doctor, that means I speak teenager, right? So they come to me to speak to their kiddo in a way that can be effective. And that’s my main goal of the encounter and the way to do that is everyone kind of starts at the same page. We have mom and dad in the room with their teenager. I introduce myself and I say, “This is kind of how our visit typically goes. We talk altogether because, mom and dad, you’re here and you’re very important in the conversation, what you have to say is important for me to hear. But also your kiddos here. And I want to provide that space for them to feel comfortable and to learn how to talk to their doctor” and almost universally that’s a whole lot easier to do when mom and dad aren’t sitting right beside them. So at any point in time, I give my patients a chance to talk to me one-on-one and that’s not to cut mom and dad out of the conversation. In fact, it’s quite the opposite, to give a space for their kiddo to talk. So I can see ways that we can help improve communication between their teenager and the parent, to make it even more effective, right? So that way, all the things that we do as doctors to help engage your kiddo, you can actually do at home too.

So really kind of focusing on that, giving that space for that one-on-one conversation is a big part of how I can really help, not only the teenagers, but their parents as well. I also tell the teenager that it never turns into a tattletale situation. Really it’s just if there’s something going on and I, as a doctor, feel like I need a little bit help from your parents, I’m going to let you know I think that before we do it, just so we can come up with a plan together.

Amanda Wilde: So very respectful to all sides. And along with the information you’re giving, you’re also facilitating the conversation and also offering some counseling, it sounds like as well.

Dr. Mike Guyton: Yeah. We try and tackle as much as we possibly can during the conversation and the great thing about being an adolescent medicine doc, we can get at least an hour, usually ends up being a lot more during our first visit, just so we can get it all out there and figure out what directions we need to go. And many times my patients and my families think I’m either a therapist or a psychiatrist. And I just tell them, “I like to talk,” but we’re here just to help figure it out together and then maybe throw in some medical expertise every once in a while.

Amanda Wilde: Well, not all doctors have the reputation for talking, so it’s good to know you speak teenager. What else do you want patients and parents to know before they come and see you?

Dr. Mike Guyton: I think the biggest thing is just that we’re all on an even playing field, right? We’re here because there’s something that, that needs to be figured out or want it to be figured out. And we would love to be a part of that conversation and a voice in that conversation, not to dominate the conversation, not to have it done the Dr. Mike way, I’m a huge fan of partnering. I’m a huge fan of shared decision-making. And I think you’ll find most teenager doctors are like that. We present different options and we decide altogether, which option may be worth exploring. Because at the end of the day, we’re not coming home with our patients, right? That’s parents who are doing that or the patients themselves. We’re just here to provide that guidance and that space where no one’s going to get in trouble. No one is going to feel judged or anything of that nature. We just want to be part of the conversation and do whatever we can to help. I think that’s probably the biggest thing, is we’re not here to tell you what to do. We’re here to help you figure it out.

Amanda Wilde: That’s great. How long has this field of adolescent medicine existed?

Dr. Mike Guyton: Yeah. It’s a relatively younger field compared to some others. So it is a board-certified field. It’s been around, at least as a board-certified field, a few decades. But gosh, we’ve been taking care of teenagers forever and ever and ever. We’ve just been able to hone our skills a little bit and bring it out to the public, right? So, I did my training up in New York for my three years. And gosh, it was the best thing I’ve ever done for myself professionally and personally. And just hearing how the field up there has even grown over the last 50, 60 years into what it is now, it’s amazing. So the short answer is we’re relatively new on the block compared to some others, but gosh, we’re doing whatever we can to make as much of a powerful impact as possible on the medical community.

Amanda Wilde: Well, thank you so much, Dr. Guyton, for your compassion and providing a place for teens and parents to talk about health issues and become more comfortable talking with each.

Dr. Mike Guyton: It is my ultimate honor to be able to provide this for these kiddos. And I’m just happy it’s something I’m able to do.

Amanda Wilde: Thank you. For more information and other podcasts, just like this, head over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I’m Amanda Wilde. Be well,