Male Adolescent Reproductive Health

1. Male Adolescent Reproductive Health

2. Outline • Adolescent Male Demographics • Sexuality and Contraceptive Use • Healthcare Access for Males • Male Adolescent-Friendly Health Services • The Male Adolescent Sexual History and Physical Exam

3. Objectives • By the end of this presentation, participants will be able to: • Identify sexual activity and contraceptive use patterns of adolescent males • Discuss factors affecting utilization of health services by adolescent males • Perform a basic male adolescent clinical interview and genital exam

4. Why Focus on Young Men?

5. Focus on Young Men to Improve: • Awareness and responsibility for disease prevention • Awareness and support of their partners’ reproductive health choices • Knowledge of efficacious methods for preventing pregnancy and STIs • Access to comprehensive reproductive health services

6. Adolescent Male Population

7. Adolescent Development

8. Adolescence Is a Time of Major Changes • Characterized by: • Physical, emotional, and developmental changes • Emerging sexuality • Awareness of gender identification and sexual orientation • Shaped by race, ethnicity, religion, SES, family/peers, and other factors

9. Male and Female Development During Adolescence • Males and females progress through the same stages • For the most part, males stages are 1-2 years later

10. Stages of Male Adolescence • Start to think abstractly • Early adolescence: • A spurt of growth • Beginnings of sexual maturation • Mid-adolescence • Develops a stronger sense of identity • Relates more strongly to peer group • Thinking becomes more reflective • Late adolescence • The body fills out and takes its adult form • Distinct identity and more settled ideas and opinions

11. Gender Identity and Adolescence • Increased focus on gender normative roles • What does it mean to be a man? • What are the cultural expectations? • Gender identification may not = biological sex or cultural expectations

12. Adolescent Male Sexuality

13. Male Adolescent Sexuality • Healthy sexual development key component of adolescence • Even if not sexually active, teens are still developing a sexual identity

14. Sexual Activity Includes Spectrum of Behaviors • Sexual behavior is a spectrum • Includes coital and non-coital activities: • Kissing • Self and partner masturbation • Oral, anal, and vaginal sex

15. Sexuality Development in Male Adolescence • Early: • Increased interest in sexual anatomy • Anxieties and questions about size of genitals • Penis, nocturnal emission • Self-exploration and evaluation normal • Normal to compare to others of the same sex and age • Limited dating and intimacy

16. Middle and Late Male Sexual Development • Middle: • Tests ability to attract opposite sex • Initiation of sexual activity • Late: • Focus on intimacy and formation of stable relationships • Plans for future and commitments (marriage, etc.)

17. Most Men Begin Sexual Intercourse During Their Teenage Years2002National Survey of Family Growth Percent of Men Aged 15-19 Who Have Had Intercourse Ages

18. Racial and Ethnic Disparities in Sexual Activity are Narrowing Males Ages 15-17 Sexual Activity by Race, NSFG 2002

19. Contrary to Media Reports, Oral Sex DOES NOT Supplement Vaginal Sex

20. Healthy Sexuality vs. Sexual Risk Behaviors • Sexual development and growth is a natural part of human development • Healthy sexual expression different than sexual risk • Risk characterized by: • Coercion • Sexual activity while drunk or high • Sexual activity to fill an emotional void

21. Recognizing Sexual Minority Young Men • Actual prevalence of gay, lesbian, bisexual (GLB), transgender, and questioning is unknown • The 2005 Vermont YRBS: • 4% students described themselves as GLB • 3% not sure • 2% reported same-sex sexual encounters These numbers likely to be underestimates

22. Sexual Identity in Adolescent Males • Many question sexual feelings and experience same-sex attraction • Sexual Identification: • Does not always = behavior • Can change throughout adolescence

23. GBTQ Youth Are at Increased Risk Of: • Suicide • Substance use • Homelessness • Survival sex and/or coerced sex • Dropping out of school • Early sexual intercourse and more partners • Sexually transmitted infections • Body image dissatisfaction/disordered eating behaviors

24. Contraceptive Use

25. 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

26. Many Young Men Rely on Condoms Male Contraceptive Use at Last Intercourse, NSFG 2002

27. Why Do Some Young Men Choose Not to Use Contraception? • Reliance on female methods increases with age • Condom use = partner trust? • Discomfort Female Method

28. Health Care Access and Services

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

30. Few Young Men Discuss Sexuality or Receive Sexual Health Services • > 1/3 report discussing reproductive health with healthcare provider • Of sexually experienced young men: • 1/6 have had an STI test • ¼ have had an HIV test

31. External Obstacles to Providing Optimal Care for Young Men • No consensus on standards for male reproductive healthcare • Provider reluctance to offer services for men • Services tend to focus on women’s health • Lack of information about men’s needs • Inadequate medical training • Gaps in financing

32. 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

33. Internal Obstacles That Can Affect Healthcare Utilization • Lack routine channel for obtaining sexual and reproductive health services • Less informed about where and how to access health services • Gendered differences in health beliefs and perceptions of symptom severity

34. Ways to Reduce Office Barriers to Healthcare Use • Staff values and attitudes about men • Staff skills and/or training needs • Health facility environment • Outreach and marketing to men

35. Services That Young Men Routinely Receive • Information • Skills • Counseling • Preventive healthcare • Clinical diagnosis and treatment

36. Information Should Include: • Basic sexuality and reproductive health education • Genital health and hygiene • Healthy relationships • Pregnancy prevention • Sexually transmitted infections • Fatherhood • Where and how to obtain other services

37. Skills Development Should Include: • Pregnancy and STI prevention and sexual health skills: • Risk assessment and avoidance • Resisting peer pressure • Communicating with partners • Using contraceptives properly • Fatherhood skills (as appropriate)

38. Counseling Services Should Include: • Self-concept • Life events and decision-making • Values and motivation

39. Preventive Healthcare Should Include: • Sexual and reproductive health history • Cancer evaluation screening • Substance abuse screening • Mental health assessment • Routine physical • Links to additional services or referral, as appropriate

40. Clinical Diagnosis and Treatment Should Include: • STI diagnosis, treatment, and counseling • Partner follow-up • Sexual dysfunction diagnosis and treatment • Fertility evaluation • Contraceptive services, including vasectomy • Urologic disease, vasectomy reversal

41. Taking the Adolescent Male Reproductive History

42. Transitioning from Non-Sensitive to Sensitive Topics: HEADDSS • Model developed to provide healthcare providers with a comprehensive assessment structure • Designed to begin with the least sensitive and lowest risk factors and finish with those that require more time and counseling

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

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

45. Sexual History: Information Gathering and Information Giving • Opportunity to incorporate health education and promotion • Educate and empower to facilitate behavior change • Harm reduction: Meet him where he is “at” and empower him to make the changes he wants.

46. Sexual History: Information Gathering and Information Giving • Avoid lecturing • Be clear; ask if he understands or quiz him on what you just counseled • Help him set “goals” for change

47. Age at first sexual act If he has not had intercourse: Other sexual behaviors? Readiness for intercourse? # partners past 3 months # partners past year Pressure to have sex? Components of the Sexual History:Gathering Information

48. Components of the Sexual History:Gathering Information • Gender of partners (F, M, both, or other) • History of sexual assault/abuse, risky sex • Gender identity • Sexual orientation

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

50. Components of the HistoryGathering Information • 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? • Type of Sexual Activity • Oral Sex? • Vaginal Sex? • Anal Sex?