A new national report indicates many at-risk teens are missing needed reproductive health services.

During the 12 months prior to participating in a survey interview, approximately 30% of sexually experienced females ages 15-19 did not receive contraceptive services, with nearly 70% not receiving recommended sexually transmitted infection (STI) services. In sexually active males in the same age range, 74% did not receive STI services.¹ Adolescents ages 15-19 without insurance coverage, younger females ages 15-17, and adolescents ages 15-19 with a previous pregnancy also had a lower prevalence of receiving reproductive health services.¹

The report, issued by the Centers for Disease Control and Prevention, focuses on 11 clinical preventive services for infants, children, and adolescents. Three of the services are of particular interest to reproductive health clinicians: human papillomavirus (HPV) vaccination, chlamydia screening, and reproductive health services.² All 11 services prevent and detect conditions and diseases in their earlier, more treatable stages, which significantly reduces the risk of illness, disability, early death, and expensive medical care.

Through implementation of the Affordable Care Act, new opportunities exist to promote and increase use of such clinical preventive services, states the CDC. "The Affordable Care Act requires new health insurance plans to provide certain clinical preventive services at no additional cost, with no copays or deductibles," said Lorraine Yeung, MD, MPH, medical epidemiologist with CDC’s National Center on Birth Defects and Developmental Disabilities, in a statement accompanying the report. "Parents need to know that many clinical preventive services for their children, such as screening and vaccination, are available for free with many health plans."

Male adolescents’ sexual and reproductive health needs often go unmet. Look to a new report developed jointly by Johns Hopkins experts and the federally funded Male Training Center for Family Planning and Reproductive Health, which enumerates the reproductive and sexual health screening tests, exams, and interventions that all men should receive regularly. Guidance also is offered to help clinicians discuss reproductive and sexual health issues, such as how to prevent unplanned pregnancies and STIs.³ (Access the report at http://bit.ly/1vzTJcF.)

Male adolescents and young adults have substantial sexual and reproductive healthcare needs in their own right, but few report receiving related preventive services by their healthcare providers, says Arik Marcell, MD, MPH, an adolescent medicine expert at the Johns Hopkins Children’s Center. 

"It is our hope that this guidance can help providers start thinking about their male adolescent and young adult patients’ sexual and reproductive healthcare needs, be more effective and efficient in their clinical practice by organizing and bundling relevant services to deliver to this population, use it as a tool to educate their male patients inclusive of parents, and serve as foundation for standards of care to deliver this population in the U.S."

The report recommends that clinicians provide the following services at least annually to reproductive-age adolescent males:

• a comprehensive clinical history and exam that include screening for mental disorders, depression, and alcohol and drug use;
• discussion of a patient’s desire to have a family and development of an individualized plan reflecting any relevant preconception health needs;
• a thorough sexual health assessment, including conversations about sexual practices and partners;
• screening for STIs;
• discussion of intimate partner violence and any problems related to sexual function, which might signal other underlying disorders such as heart disease;
• a detailed vaccination history, including checking for HPV vaccination;
• a panel of lab tests for certain STIs;
• counseling on safer sex practices, including condom use, pregnancy prevention, and preconception health;
• counseling on sexuality, sexual identity, relationships, and sexual dysfunction.³

The report states it is not recommended to routinely counsel about testicular self-exam for cancer for male adolescents and adults. There is no evidence that teaching young men how to examine themselves for testicular cancer will improve health outcomes, even among men at high risk, including men with a history of undescended testes or testicular atrophy, the report states.³

What other tests should be no longer offered or recommended to patients due to lack of evidence of benefit? They include:

• prostate-specific antigen (PSA) testing to screen for prostate cancer,
• routine urinalysis,
• physical exams for hernia,
• routine testing for anemia.³

REFERENCES

1. Tyler CP, Warner L, Gavin L, et al. Receipt of reproductive health services among sexually experienced persons aged 15-19 years — National Survey of Family Growth, United States, 2006-2010. MMWR Surveill Summ 2014; 63:89-98
2. Centers for Disease Control and Prevention. Use of selected clinical preventive services to improve the health of infants, children, and adolescents — United States, 1999-2011. MMWR Surveill Summ 2014; 63:1-107.
3. Marcell AV. Male Training Center for Family Planning and Reproductive Health. Preventive Male Sexual and Reproductive Health Care: Recommendations for Clinical Practice. Philadelphia, PA: Male Training Center for Family Planning and Reproductive Health and Rockville, MD: Office of Population Affairs; 2014. Accessed at http://bit.ly/1vzTJcF.