Adolescent contraceptive counseling and gynecology: a deficiency in pediatric office-based care

With the large and increasing numbers of sexually active adolescents, pediatricians must learn to deal with the issues of adolescent pregnancy and sexually transmitted diseases (STD). This is particularly true at a time when health care reform will encourage primary care physicians to assume a greater role in general medical management of their patients. One hundred Connecticut general practice pediatricians were randomly selected to examine the frequency, level of comfort, and rationale for involvement regarding sexual history taking, contraceptive counseling, and performance of pelvic examinations. This represents 9% of all Connecticut pediatricians. The response rate was 54%. The results were as follows: Seventy-nine percent of responding pediatricians counseled on STDs, 39% counseled on family planning, and only 62% almost always took a sexual history from the their adolescent patients, ages 10 and up. Thirty-one percent of respondents stated they would refer a male inquiring about contraception to a family planning clinic. Thirty-eight percent never do pelvic examinations on their sexually active adolescent patients. Connecticut pediatricians are providing adolescents with counseling on other high-risk behaviors such as drug and alcohol use, but provide inadequate care related to adolescent sexual activity.