Male Adolescent Reproductive Health

1. Male Adolescent Reproductive Health

2. Objectives By the end of this presentation participants will be able to:

3. Male Sexual and Reproductive Healthcare

4. Adolescence Is a Time of Major Changes Physical, emotional, and developmental changes Emerging sexuality Awareness of gender identification and sexual orientation Challenging parents and caretakers

5. Adolescence in Context What else?

6. Stages of Adolescence • Young men and women go through the same stages • Male stages are generally 1-2 years later

7. Stages of Adolescence Early Middle Late

8. Stages of Adolescence • Growth spurt • Begin thinking abstractly • Begin sexual maturation Early Middle Late

9. Early Adolescence: Sexual Development Increased interest in sexual anatomy Anxieties and questions about size of genitals begins Self-exploration and evaluation Comparison of self to others of the same sex and age Limited dating and intimacy

10. Stages of Adolescence • Stronger sense of identity • Relates more strongly to to peer group • More reflective thought • Transitioning between dependence & independence Early Middle Late

11. Middle Adolescence: Sexual Development Awareness of sexuality Testing ability to attract partners Initiation of sexual activity

12. Stages of Adolescence • The body fills out and takes its adult form • Distinct identity, ideas and opinions become more settled Early Middle Late

13. Late Adolescence: Sexual Development Focus on intimacy and formation of stable relationships Plans for future and commitments

14. Providing Reproductive Healthcare to Adolescent Males

15. ALL Youth Need Reproductive Health Care • But young men are less likely to receive it.

16. Few Men Make Reproductive Health Visits Annual visits per 100 men 15-19 20-24 25-29 30-34 35-39 40-44 45-49

17. Few Young Men Receive Sexual Health Services

18. Structural Barriers to Care for Young Men

19. Health Insurance and Adolescent Males • 1 in 5 have no health insurance • Groups more likely to be uninsured: • Older adolescent males • Young adult Black and Hispanic males

20. Internal Barriers to Healthcare Utilization • Less informed about where and how to access health services • Gender differences in health beliefs and perceptions of symptom severity • Discomfort with providers of the same or opposite genders

21. Opportunities to Provide Reproductive Healthcare

22. Preparing to Provide Reproductive Health Services to Young Men

23. Assessing Readiness for Caring for Young Men Staff values and attitudes about young men: Myth busting Establishing a male-friendly environment Offering comprehensive services

24. Myths About Young Males What are some common myths about young men? How do these affect healthcare delivery?

25. Age at First Intercourse MYTH: Young men start having sex much earlier than young women. FACT: In 2007, median age for BOTH men and women at first intercourse is 17.

26. Most Men Begin Sexual Activity As Teenagers Percent of Men Aged 15-19 Who Have Had Intercourse 2002 National Survey of Family Growth

27. Sexual Behavior MYTH: More young men are sexually active than females. FACT: According to the 2007 YRBS, 34% percent of high school males reported being currently sexually active compared to 36% of females.

28. Oral Sex MYTH: Young men engage in oral sex in place of vaginal sex to avoid the risk of pregnancy. FACT: Young people who are already engaging in vaginal intercourse are more likely to have engaged in oral sex. The initiations of vaginal and oral sex appear to occur closely together.

29. Oral Sex DOES NOT Replace Vaginal Sex

30. Condom Use MYTH: The majority of teenage men did not use a condom at last sex. FACT: According to the 2007 Youth Risk Behavior Survey, 68.5% of sexually active high school men reported condom use at last intercourse, an INCREASE from 54.5% in 1991.

31. Young Men are Increasingly More Likely to Use Contraceptives at First Sex Male Contraceptive Use at First Intercourse by Year of First Premarital Intercourse, NSFG, 2002

32. Myths About Young Males Myths about the sexual and reproductive health behaviors of young men can contribute to provider and staff bias.

33. Assessing Readiness for Caring for Young Men Staff values and attitudes about young men: Myth busting Establishing a male-friendly environment Offering comprehensive services

34. Young Men’s Needs Assessment

35. Training Needs for Staff Caring for Young Men • Exploration of preconceived opinions about young males • Male clinical issues • Medicaid eligibility and billing • Respectful communication • Cultural competence

36. The Values and Attitudes of Staff Around Men

37. Assessing Readiness for Caring for Young Men Staff values and attitudes about young men: Myth busting Establishing a male-friendly environment Offering comprehensive services

38. Case: Eric Eric is a 17-year-old male who has made an appointment for a sports physical. How do you begin the visit?

39. Sexual History Tips Reassure confidentiality Take history when the patient is still dressed Assess development and structure questions accordingly Watch for concrete vs. abstract answers

40. HEADDSS H: Home E: Education A: Activities D: Drugs D: Depression S: Sexuality S: Safety

41. Components of a Sexual History: • Age at first sexual act • If he has not had intercourse: • Other sexual behaviors? • Readiness for intercourse? • # of partners in past 3 months? 6 months? • Types of sex: oral, anal, vaginal

42. Components of a Sexual History: Gender of partners History of sexual assault/abuse, risky sex Gender identity Sexual orientation

43. Assessing Sexual Orientation: • Are you romantically interested in men, women, or both? • Are you comfortable with your feelings? • Have you ever had any sexual contact with someone of your same gender? • For younger teens: when you imagine yourself in a relationship in the future is it with a man, a woman, or both?

44. Components of the History • Physiology • Any pain on ejaculation? • Any difficulty getting or maintaining an erection? • Any issues relating to premature or delayed ejaculation? • Any concerns about sexual functioning? • Any other concerns or questions?

45. Components of the History

46. Components of the History • Birth Control • Does partner (if female) use hormonal birth control? • Other methods? • Pregnancy History • Have you ever gotten a woman pregnant? • If so, how many? • What was/were the outcome(s)?

47. Components of the History • STI History • Ever had an STI? • Ever been exposed to an STI? • Current symptoms of an STI? • Discharge? • Dysuria? • Sores or bumps?

48. How can a provider address the role of masculinity in male health outcomes?

49. Gender-Specific Questions • What does “becoming a man” mean to you? • Personally? In your community? • Are you “becoming the man” you’d like to be? • Do you have thoughts about fatherhood? • How do you expect the role of fatherhood to be part of your life?

50. Case: Eric • During the sexual history, you discover that Eric has had two female partners and is currently in a monogamous relationship with his girlfriend. • He reports that his girlfriend is “on the pill” and that he uses condoms “half the time.” • What follow-up counseling do you give?