Female adolescent sexuality. Promoting healthy sexual development

Health care providers must recognize the specific challenges and rewards of providing services for adolescents. Quality care begins with the establishment of trust, respect, and confidentiality between the health care provider and the adolescent. Data suggest that the normal age for beginning puberty is decreasing, which has important clinical, educational, and social implications. The health care provider should be aware of the broad range of potential sexual behaviors involving adolescents, as well as the teen's acceptance of such behaviors, often dictated by age, gender, culture, and education. When providing gynecologic care to adolescent girls, the physician should not only provide contraception and screen for sexually transmitted diseases but should contribute to the development of the patient's sexual health. Especially when providing care for the younger teen, the health care provider must focus on involving a member of the family or another significant adult to provide needed support and guidance. Anticipatory guidance for parents should focus on assessing their parenting styles and promoting supervision. Although parents should strive to maintain open communication with their adolescents, they may not accurately estimate the sexual activity of and the sexual risk for their teenage children. Parents need to be encouraged to consider the implications of their own sexual behaviors. The provider should attempt to foster a comfortable environment in which youth may seek help and support for appropriate medical care while reserving the right to disclose their sexual identity when ready. Health care professionals cannot exclude heterosexual behavior on the basis that a young woman self-identifies as homosexual. Her reported sexual behaviors may not indicate her sexual orientation. Self-definition of sexual orientation is a dynamic process including factors such as fantasies, desires, and behaviors. Self-definition of sexual identity is affected by individual variations in sex, gender, sexual roles, and sexual orientation. Most adolescents want to discuss sexual-related issues with their health care providers and will welcome direct questions about sexual behaviors and possible risks when posed in a confidential and nonmoralistic manner. Discussion of the physical, emotional, familial, and social changes related to adolescence will encourage healthy sexual development.