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  • Writer's pictureJames T. Martin, MD

Ob-Gyns Can Play Critical Role in Adolescent Sexuality Education

Youth increasingly looking to inaccurate content online

Washington, DC—Obstetrician-gynecologists have a unique role to play in sexuality education by helping to evaluate adolescents’ level of engagement in risky behaviors including those occurring online or via social media, according to new recommendations in a Committee Opinion released by The American College of Obstetricians and Gynecologists (ACOG).

While nearly 70 percent of high schools across the country have a class devoted to health topics based on the latest data from the Centers for Disease Control and Prevention (CDC), sexuality education varies widely in terms of the accuracy of the content, emphasis and effectiveness. Therefore, it’s not uncommon for adolescents to use a variety of media sources to fill in the gaps. As many as three quarters use social networking sites, including platforms such as Twitter, Facebook and YouTube.

“When we as a community of educators, clinicians, and parents fail to provide teenagers with much-needed information regarding sex and sexuality in a way that’s easy to comprehend, they will look for it elsewhere,” said Joanna H. Stacey, M.D., a lead author of the Committee Opinion. “There has been a rise in popularity for sexual health information online that is relatable and presented in a way that is entertaining and interactive. While there are reputable sexual education websites, teenagers can also unintentionally be exposed to misinformation or even pornography. That’s why it’s important that we reach them first to teach them not only about sexual health but media literacy.”

ACOG recommends that sexuality education start in early childhood and that it be comprehensive, medically-accurate and age-appropriate. In addition to information about reproductive health, contraception and prevention of sexually transmitted infections and diseases, sexuality education should teach adolescents about gender identity and sexual orientation. It should also include information about various forms of sexual expression, communication, consent, healthy sexual and nonsexual relationships and sexual violence.

Among U.S. high schools with required courses in health education, 41.4 percent used curricula developed by the teacher to instruct students on topics regarding human sexuality, according to CDC data, and 26.8 percent used curricula from “some other source.” This presents an opportunity for ob-gyns to provide evidence-based curricula for sexuality education in schools and community programs that focus on clear health goals. According to the Committee Opinion, evidence has shown that this type of education reduces rates of sexual activity, risky sexual behaviors, sexually transmitted infections and adolescent pregnancy.

“Over the past two decades, we’ve seen a dramatic decline in the teen birth rate,” said Stacey. “In large part, this is due to increased use of contraception, specifically more effective methods, such as IUDs or implants. Ob-gyns are in a great position to educate adolescent patients and their parents or guardians about everything from dangerous online behavior to the benefits of long acting reversible contraception. We also have the opportunity to ask mothers about their daughters’ reproductive development and HPV vaccination status. The good news is it’s clear that we’re making progress. However, there is always more work to be done.”

The Committee Opinion, “Comprehensive Sexuality Education,” #678, will be available in the November 2016 issue of Obstetrics and Gynecology.

Other recommendations issued in the November Obstetrics & Gynecology:

Immersion in water during labor or delivery has been popularized over the past several decades. The prevalence of this practice in the United States is uncertain because it has not been studied in births outside of the home and birth centers, and the data are not recorded on birth certificates. Among randomized controlled trials included in a 2009 Cochrane systematic review that addressed immersion in the first stage of labor, results were inconsistent with regard to maternal benefits. Neither the Cochrane systematic review nor any individual trials included in that review reported any benefit to the newborn from maternal immersion during labor or delivery. Immersion in water during the first stage of labor may be associated with shorter labor and decreased use of spinal and epidural analgesia and may be offered to healthy women with uncomplicated pregnancies between 37 0/7 weeks and 41 6/7 weeks of gestation. There are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery. Therefore, until such data are available, it is the recommendation of the American College of Obstetricians and Gynecologists that birth occur on land, not in water. A woman who requests to give birth while submerged in water should be informed that the maternal and perinatal benefits and risks of this choice have not been studied sufficiently to either support or discourage her request. Facilities that plan to offer immersion during labor and delivery need to establish rigorous protocols for candidate selection; maintenance and cleaning of tubs and pools; infection control procedures, including standard precautions and personal protective equipment for health care personnel; monitoring of women and fetuses at appropriate intervals while immersed; and moving women from tubs if urgent maternal or fetal concerns or complications develop.

Checklists are used in medical and nonmedical settings as cognitive aids to ensure that users complete all the items associated with a particular task. They are ideal for tasks with many steps, for tasks performed under stressful circumstances, or for reminding people to perform tasks that they are not routinely accustomed to doing. In medicine, they are ideal for promoting standardized processes of care in situations in which variation in practice may increase patient risk and the chance of medical errors. Checklists also can be used to enhance teamwork and communication. It is a good idea to include frontline individuals who are involved in completing the procedure in the selection and development of the checklist. To be optimally effective, those who create checklists need to carefully plan for their design, implementation, evaluation, and revision. Checklists are valuable cognitive aids to help health care teams provide complete and timely care to patients, but checklists should be only one tool in the armamentarium to ensure that practitioners do the right thing for the right patient at the right time.

Practice Bulletin #173, Fetal Macrosomia

Suspected fetal macrosomia is encountered commonly in obstetric practice. As birth weight increases, the likelihood of labor abnormalities, shoulder dystocia, birth trauma, and permanent injury to the neonate increases. The purpose of this document is to quantify those risks, address the accuracy and limitations of methods for estimating fetal weight, and suggest clinical management for a pregnancy with suspected fetal macrosomia.

Adnexal masses (ie, masses of the ovary, fallopian tube, or surrounding tissues) commonly are encountered by obstetrician–gynecologists and often present diagnostic and management dilemmas. Most adnexal masses are detected incidentally on physical examination or at the time of pelvic imaging. Less commonly, a mass may present with symptoms of acute or intermittent pain. Management decisions often are influenced by the age and family history of the patient. Although most adnexal masses are benign, the main goal of the diagnostic evaluation is to exclude malignancy The purpose of this document is to provide guidelines for the evaluation and management of adnexal masses in adolescents, pregnant women, and nonpregnant women and to outline criteria for the identification of adnexal masses that are likely to be malignant and may warrant referral to or consultation with a gynecologic oncologist.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.

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