Patient Provider Communication and Reproductive Health

Abstract

The prevalence among youth aged 15–19 ever having sexual intercourse has decreased from 1991–2007. However, the 2007 Youth Risk Behavior Surveillance Survey (YRBS) of AYA in the United States reports 48% of this population has had sexual intercourse [1]. Along with these rates of sexual activity, 28% of adolescents who have requested pregnancy tests at local health departments had already used a home pregnancy test [2]. Considering these high rates of sexual activity in teens in conjunction with the public health risk of adolescent pregnancies [3] and sexually transmitted infections (STIs) [4], the American Academy of Pediatrics (AAP) and the American Congress of Obstetricians and Gynecologists (ACOG) provide professional guidelines stressing the responsibility of health professionals to offer comprehensive reproductive health services such as sex education, counseling, and contraceptive awareness [5, 6]. These guidelines are consistent with research that sex education results in lower rates of sexual activity, increased contraceptive use, and fewer adolescent pregnancies [7, 8].

It’s difficult to talk about sex with my patients. I wasn’t trained to have these discussions; I was trained to treat cancer. It’s even more difficult when the patient has his or her parents in the room. The shock of the cancer diagnosis is still hanging in the air and everyone is focused on survival. Parents often don’t want to think about their child as a sexually active person. I’ve had plenty of mothers assure me their son or daughter is a virgin, even when the kid is twenty-five years old. I usually catch a glimpse of the patient with a sly smile. It may be the only time anyone smiles during the whole conversation.

Dr. K, Pediatric Oncologist

I was afraid to ask about having a child in the future. I was afraid it was too much to ask for to survive cancer and have a child too. My doctor didn’t mention it except to tell me I would likely be sterile after my treatment. I regret not asking about it. I don’t know if I would have done anything but at least I would have explored my options. I am a five year survivor now and grateful for every day, but every time I hear about a friend having a baby or see a pregnant woman I wish I could go back in time and ask my doctor if there was something I could have done to preserve my options. I have a great guy in my life, he would have made a great dad, but now he won’t have that chance, at least not with me.

Janice, 35 year old Non- Hodgkin’s Lymphoma Survivor

I know it’s important to talk about fertility with my patients but it makes me uncomfortable. Some patients can’t afford the bus fare to get to clinic and I’m going to talk to them about an expensive procedure that is not imperative to their survival? And some patients are getting really bad news… . their chance of survival is low; so I’m going to tell them they have a less than 10% chance of long-term survival and then say have you ever thought about having kids? It seems insensitive and like a double slap in the face.

Dr. C, Oncologist