July 09, 2004
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Publication Date: Friday, July 09, 2004
Teens talk about sex
Teens talk about sex
(July 09, 2004) Local doctors' group caters to young women
By Diana Reynolds Roome
"What's on your mind? Is sex an issue? Let's talk (and we won't tell)," runs the new brochure for teenage girls from the Women Physicians Ob-Gyn Medical Group in Mountain View.
Though information seems readily available through school programs and organizations like Planned Parenthood, more insistent messages about sex are coming through pop culture and peers. Through it all, there are few places where teens between 13 and 18 can go to discuss the wide spectrum of challenges that beset the turbulent years between childhood and adulthood.
Traditionally, a pediatrician takes care of a girl's health until she is 18 years old, when most first see a gynecologist (or women's health specialist). Though some pediatricians are good with teens, many girls do not feel comfortable talking to their "baby" doctor or a male doctor about the issues that can arise, especially if they become sexually active. Even when they're not, they need a safe place where their questions and concerns are kept confidential and they can get straight answers from someone who is qualified and at the same time offers an understanding ear.
"My daughter has a pediatrician who we really like, but he's male, and every time we go she says, 'He's so nice -- I don't want to switch,'" said Julia (who is not using her real name). At the same time, mother and daughter both realized that at some point they needed to find a female doctor with whom Kris, 13, could "discuss female things." When someone at school gave Kris incorrect information about toxic shock syndrome, her mother decided it was time.
As it turned out, the timing was perfect. When the American College of Obstetricians and Gynecologists (ACOG) recently recommended that gynecologists start seeing girls between the ages of 13 and 15, the Women's Physicians Group -- where Julia was already a patient -- decided to take up the challenge. Their teen program was just underway. It was a major departure from its usual realm, which is primary care and reproductive health for women, contraception, and delivering babies.
Julia's own physician, Dr. Christine Litwin-Sanguinetti, seemed to be just the right match, she said. "Knowing her makes a big difference -- I wouldn't sign [my daughter] up to go to just any doctor."
As an obstetrician as well as a gynecologist, Litwin-Sanguinetti had delivered Kris, but for Kris she was someone new.
"It's nice to know I can talk to someone who won't judge me, and if I have any questions I can just ask" said Kris, who was especially impressed that Litwin gave her a 24-hour telephone number to call if she ever needed to talk without delay to someone who was qualified to answer her questions.
On her first visit, she and her mother each received an information packet, filled with fact sheets, articles, useful phone numbers, Internet resources, and a reading list. A pelvic exam is not usually necessary until age 18, except when the patient is sexually active or has a problem, for example, with periods. Mostly, the one-hour appointment is used to talk, and for the physician to get to know the patient and her concerns.
These conversations aren't just about sex and physical development. Alcohol and drug use, cigarette smoking, depression, date rape, body image, Internet safety, sexual identity, as well as more obvious health issues such as menstruation problems, stress, weight and acne, are all major potential roadblocks in the brave new world of adolescence.
When mothers and daughters see Litwin-Sanguinetti and her colleague Dr. Katherine Sutherland, they each fill out a questionnaire, which provide the basis for the discussions. The questions for teens are open-ended, but cover schoolwork, home life, friendships, and experiments with alcohol, tobacco and drugs as well as emotions and moods. A mother's questionnaire may reveal things to the doctor that the daughter's doesn't, such as sudden weight-loss.
At the end of the session, the doctor brings all three together. This is not always easy, and Sutherland has found herself in the middle of mother-daughter arguments. Her job is then to try and close the gap, to help each understand where the other is coming from, especially remembering that everyone is really on the same side -- aiming for the daughter's optimal health and safety.
"Most of the time, these girls have great values, they want guidance and they want to do the right thing. They're girls their mothers should be proud of." It's true, she says, that many go through stages when they experiment with drugs and sex, get tattoos and piercings. "But I've watched many make that circuit and [eventually] come right back to the mainstream," said Sutherland.
The freedom to talk
When problems go beyond the expertise of the practice, especially when they involve eating disorders, serious depression, suicidal tendencies, or a suspicion of conditions such as bipolar disorder, they are quick to refer to a psychiatrist or other specialist. "We want to be a sorting mechanism," said Sutherland.
Confidentiality agreements, signed by parent and daughter, are critical to the success of the teen program. They state that the daughter can come in at any time for health care and can make independent health care decisions under the guidance of the physician. "Confidentiality is inviolate, for everyone," said Sutherland. "The only way we can expect to have a full, open and honest relationship with the daughter is if we promise to keep the information she gives us confidential." Even so, Sutherland and her colleagues try to bring the mother into decisions whenever possible -- but only with the daughter's agreement. For many mothers, this is a reasonable option.
"Confidentiality is a doctor-patient privilege. There are some things a teen might not want to talk about with her parents," said Julia, who said she tries to be open to conversations with her daughter when subjects come up. "I think for the most part we have a pretty open communication. But for a parent, it's hard to say, 'Today we're going to talk about ... [this issue]. Meanwhile, I wanted my daughter to meet [Dr. Litwin] before she had a problem."
Younger patients who have not yet encountered many problems might wonder why they're there, said Sutherland. "But our feeling is that if they come to know and trust us, to know that we're non-judgmental, that we're here for them 24/7, then if they're on the verge of getting into trouble they'll come back."
Patients receive phone numbers for the Crisis Hot Line, Safe Rides, and the Rape Crisis Center, as well as the hotline for Women Physicians Ob-Gyn. They're assured that they can phone not just for themselves but also for a friend.
"What if one of the friends [of the 14-year-old girl who recently died from an overdose of the drug ecstasy] had seen one of us and had that card in her wallet?" wondered Sutherland. "When kids get into a crisis situation, they need to have somebody they can trust. Many teens are afraid to call the police or tell their parents. But might they have called us?"
E-mail Diana Reynolds Roome at email@example.com
Women Physicians Ob-Gyn 2485 Hospital Drive, Suite 221 Mountain View,
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