Male Adolescent Reproductive and Sexual Health

1. Male Adolescent Reproductive and Sexual Health

2. Objectives By the end of this presentation participants will be able to: Identify Elements of male friendly health services Take A comprehensive, male-focused sexual health history Perform A male genital exam

3. Male Sexual and Reproductive Healthcare Sexual and reproductive healthcare should be: • Part of an effort toward overall youth development and helping young men achieve lifetime goals • Viewed within a context of overall health • Part of every visit

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 • Changes during adolescence are shaped by • Race/Ethnicity • Religion • Socioeconomic Status • Family • Peers 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 • Early • Middle • Late • Growth spurt • Begin thinking abstractly • Begin sexual maturation

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

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

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

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 • > 1/3 report discussing reproductive health with provider • Of sexually experienced young men: • 1/6 have had an STI test • 1/4 have had an HIV test

18. Structural Barriers to Care for Young Men • No consensus on standards • Lack of routine channel for obtaining care • Inadequate medical training • Gaps in financing • Provider/staff bias toward providing male reproductive healthcare

19. Health Insurance and Adolescent Males • One in five 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 • Sports physicals • School physicals and immunization visits • When young men accompany partners, friends, or other family members to medical visits • ANY VISIT

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: The median age for BOTH men and women at first intercourse is 17.

26. Most Men Begin Sexual Activity As Teenagers Percentage of Men Aged 15-19 Who Have Had Intercourse 2006–2008 National Survey of Family Growth

27. Sexual Behavior MYTH: More young men are sexually active than females. FACT: According to the 2009 YRBS, 33% percent of high school males reported being currently sexually active in the last three months 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 2009 Youth Risk Behavior Survey, 68.6% 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. Community Needs Assessment • Are there young men in the area who need services? • Where are they? • What are their health care needs? • How can they be reached? • Are there other organizations offering young men’s care in the community? • What services will you offer that will differentiate yourself from others in the area?

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 • Staff exercise • How is serving young men different than serving adult males or young females? • What does making your clinic “male adolescent-friendly” mean to you? • What are some of your reservations about serving young 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. HEADDSSS • H: Home • E: Education • A: Activities • D: Drugs • D: Depression • S: Sexuality • S: Safety • S: Spirituality* • Strengths*

41. Components of a Sexual History • Age at first sexual act • If he has not had intercourse: • Other sexual behaviors? • Readiness for intercourse? • Numbe of partners in past three months? Six months? Lifetime? • 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 • Condom Use • Condom use in last sexual act? • Has condom ever broken? Last time? What did you do? • Frequency of condom use? • Withdrawal • Use as method of birth control? • Use as a method of STI prevention?

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. Addressing 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?