Adolescent Sexuality

The shaping of sexual beliefs, attitudes, and behavior begins at birth, continues throughout childhood, and is dramatically influenced by puberty. At this time, teenagers must incorporate their changing physical appearance into their self-image, ideally including knowledge and acceptance of their bodies. In addition, they must explore and learn ways of interacting with their peers, sexually and otherwise. When thinking about how a pediatrician can best serve the needs of an adolescent, especially with regard to sexuality, it becomes clear that there is very little requirement for "treatment" in the traditional medical sense, ie, prescriptions, surgery, physical therapy, etc. Instead, the greatest contribution comes from eliciting and answering questions, providing information about the teenager's current physical and social environment, and bringing to his or her awareness changes and issues that might come to the fore in the near future. The process of taking the history and performing the physical examination provides numerous opportunities to gather and dispense information, as will be illustrated below. Practice experience as well as research data indicate that issues of importance to the prepubertal or early pubertal child differ from those of the mid or late adolescent. This natural separation will form the framework for the following discussion, although it must be realized that some adolescents cannot be so neatly categorized.