Blythe M J, Rosenthal S L
Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, USA.
Obstet Gynecol Clin North Am. 2000 Mar;27(1):125-41. doi: 10.1016/s0889-8545(00)80010-8.
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.
医疗保健提供者必须认识到为青少年提供服务所面临的具体挑战和回报。优质护理始于医疗保健提供者与青少年之间建立信任、尊重和保密关系。数据表明，青春期开始的正常年龄正在下降，这具有重要的临床、教育和社会意义。医疗保健提供者应了解涉及青少年的广泛潜在性行为，以及青少年对这些行为的接受程度，这通常由年龄、性别、文化和教育决定。在为青春期女孩提供妇科护理时，医生不仅应提供避孕措施和筛查性传播疾病，还应促进患者性健康的发展。特别是在为年龄较小的青少年提供护理时，医疗保健提供者必须注重让家庭成员或其他重要成年人参与进来，以提供所需的支持和指导。对父母的预期指导应侧重于评估他们的育儿方式并加强监督。尽管父母应努力与青少年保持开放的沟通，但他们可能无法准确估计其十几岁孩子的性活动和性风险。需要鼓励父母考虑自己性行为的影响。提供者应努力营造一个舒适的环境，让年轻人可以在其中寻求适当医疗护理的帮助和支持，同时保留在准备好时披露其性身份的权利。医疗保健专业人员不能因为年轻女性自我认定为同性恋而排除异性性行为。她报告的性行为可能并不表明她的性取向。性取向的自我定义是一个动态过程，包括幻想、欲望和行为等因素。性身份的自我定义受性别、性角色和性取向等个体差异的影响。大多数青少年希望与他们的医疗保健提供者讨论与性相关的问题，并且当以保密且非道德评判的方式提出有关性行为和可能风险的直接问题时，他们会表示欢迎。讨论与青春期相关的身体、情感、家庭和社会变化将促进健康的性发育。
