Tuesday, April 30, 2013

Seven Questions Your Health Care Provider Should Ask Your Teen

Although the average doctor face-time is somewhere around 6-7 minutes with a pediatrician these days, it might actually be possible for the most dedicated among them to squeeze in a few potentially life-saving questions.  Here are seven such queries that help educate and elucidate around issues of relationships, risk, romance and sexuality.

ONE: Who do you hang out with? Tell me about your friend group. (gently opening with relationships and friends...)

TWO: On the spectrum of gay to straight or somewhere between, where would you say you are now?(...recognizing that this is a spectrum and a fluid status....)

THREE: Have you ever had an unwanted sexual experience? Have you ever had a sexual experience you regretted?(.....letting the teen know that the doctor cares and that this is a safe place if and when he/she is ready to talk about it....)

FOUR: Have you had skin-to-skin contact below the waist with another person? That's skin-to-skin contact below the waist with any body parts.  Think about that. (...avoiding altogether the concept of "sex" and getting at risky behaviours and a "spectrum" of sexual activity....)

FIVE: Would you say that your romantic relationships or dates have been respectful? How about safe from STD and pregnancy worries?(...allowing for some evaluation of relationships and permission to discuss concerns about STDs,  contraception,  power imbalances, abusive situations or unhappiness....)

SIX: How do you really feel about condoms? Do you know how to use them?(...recognizing that almost no one prefers them but hey! let's be real...what are the alternatives?)

SEVEN: (for boys): Do you know how to do a testicular self exam?(...healthy bodies are sexy and testicular cancer is a young man's disease)

On a given day I can imagine re-prioritizing these questions or adding others.  But these seven are openers to many dialogues.  It should go without saying that these conversations with teens need to happen in a private setting, without parents present, with the reassurance of confidentiality made explicit and with clothes on.  For all parties, including parents in the waiting room, the benefit of these conversations is enormous and gratifying: healthier, savvier kids; reassured parents; and practitioners who know they have done their job well.
image from blog.timesunion.com via Googleimages.com

Monday, April 8, 2013

Parents Reluctant to Vaccinate Kids against HPV?

As one of the medical providers at Barnard College, I am asked every day by students to be tested for STD's.  When I ask them what tests in particular they have in mind, they often answer "all of them."

We, like most clinicians in this kind of clinic only screen for HIV, chlamydia and gonorrhea. And that is not "all" of the STDs. As a followup question I often inquire whether the student has had the three HPV, often called by its brand name, Gardisil, vaccine.  I have been shocked in the year I have been working there by how often students are not aware if they got the vaccine; do not know what HPV is or say that their parents "didn't want them" to get it. Then I launch into my little speech about how they can make their own decisions now and we have a tutorial on HPV.

Now a new study just released in the prestigious journal Pediatrics sheds some light on this situation.  It shows that over half of parents of teens are not vaccinating their teens against Human Papillomavirus or HPV. And the share of unvaccinated teens has increased even though they are making this decision against the medical advice from their own medical providers.

The three most common reasons for not vaccinating against HPV were:
  • my child is not sexually active
  • the vaccine is not needed or not necessary
  • safety concerns/side effects

These reasons linger and in fact increased over the study period from 2008 to 2010 in spite of scientific, medical and public health advice to the contrary.

So what is HPV vaccine and what do most clinicians who see teens and young adults say about it?
  • HPV is the most common sexually transmitted disease.
  • HPV is ubiquitous and easily transmitted even with non-intercourse sexual activities (read "oral sex")
  • By age 18 over 70% of sexually active adolescents have already acquired HPV
  • Their are over 100 sub types of HPV
  • Most healthy people will clear HPV from their system through natural immune mechanisms
  • BUT, four of the 100 subtypes do not clear spontaneously.
  • These four subtypes cause cervical cancer, head and neck cancers, and genital warts
  • Men and women, young men and women, and girls and boys are all equally susceptible to infection with HPV
  • The HPV vaccine was designed to protect agains the four nasty subtypes of the virus that cause most of the lasting and disfiguring diseases (warts and cancers)
  • The vaccine is recommended for boys and girls ages 12 and up
  • Finally, the vaccine is exceptionally safe and effective
  • PS: it requires a series of three shots and it hurts a bit more than the average immunization.
It is my belief that the marketers from Merck should have called this vaccine "the first shot we have to protect against cancer. " The mistake was in connecting the vaccine with sex, teens and heaven forbid, teen sexuality. This was the cue for Michelle Bachman to get on board with those who talk about the "ravages" of HPV vaccine.  

The denial mechanisms that parents need to stay sane as they dare to think about their teens becoming sexually active in a dangerous world have held them back from making smart decisions about this shot.    We don't' wait until our kids step on a rusty nail to get a tetanus shot.  We shouldn't wait until they are infected or have abnormal Pap smears to give them the HPV shot. Besides it would be too late by then.

Call for an appointment today if your children have not had the vaccine.  At least listen to what experts have to say.  And remember when the eighteen year old comes in to see me in college and is ready to make her own decision--having done some reading, research and chatting with friends, it is often too late for the vaccine to work.

image from news.emory.edu