CLINICAL REPORT Male Adolescent Sexual and Reproductive Health Care

Male adolescents’ sexual and reproductive health needs often go unmet in the primary care setting. This report discusses specific issues related tomale adolescents’ sexual and reproductive health care in the context of primary care, including pubertal and sexual development, sexual behavior, consequences of sexual behavior, and methods of preventing sexually transmitted infections (including HIV) and pregnancy. Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, performing an appropriate examination, providing patient-centered and age-appropriate anticipatory guidance, and delivering appropriate vaccinations. Pediatricians should provide these services to male adolescent patients in a confidential and culturally appropriate manner, promote healthy sexual relationships and responsibility, and involve parents in age-appropriate discussions about sexual health with their sons. Pediatrics 2011;128:e1658–e1676 INTRODUCTION During adolescence, a number of changes occur for boys, including the physical, psychological, and social changes associated with puberty, and the majority of male adolescents report the initiation of sexual behavior.1 Many of these events, including sexual initiation, are associated with preventable consequences that can lead to significant morbidity and mortality.2 During this same time period, the number of health visits typically declines, particularly among older male adolescents, and there is a shift from routine to more time-limited acute visits.3 For health care providers, including primary care providers and pediatricians, who care for male adolescents, issues of puberty and sexuality are areas that should be commonly addressed with the male patient and his family.4 Evenafter the releaseof theAmericanMedical Association’sGuidelines for Adolescent Preventive Services (GAPS)5 and Bright Futures,6 which recommend preventive health services for adolescents, few improvements have been observed in the counseling of male teenagers regarding the prevention of sexually transmitted infections (STIs) or HIV infection.7,8 Furthermore, data from outpatient ambulatory medical records show that primary care providers are 3 times more likely to take sexual health histories from female thanmale patients and twice as likely to counsel female patients on the use of condoms.9,10 Thus, it is important for primary care providers to have an understanding of what sexual/reproductive health care means for the male adolescent. Addressingmale teenagers’ sexual/reproductive health includes but is not limited to preventing STIs and HIV. The 1994 Cairo United Nations Arik V. Marcell, MD, MPH, Charles Wibbelsman, MD, Warren M. Seigel, MD, and the Committee on Adolescence