Foreword

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Recently, in our pediatric clinic, I saw a teen I will call Susan, who was brought in by her mother for headaches and a checkup. A junior in high school, she had a steady boyfriend and disclosed confidentially that she had recently initiated sexual activity, but her free time was so closely monitored by her parents that she had not been able to obtain hormonal contraception or testing for infections. Wondering, as I often do, how teens who are this carefully watched manage to have a sexual relationship, I sent her off to collect a urine specimen, along with an application for publicly funded pregnancy prevention services. She left the clinic with a laboratory slip in her hand for anemia and cholesterol screens, a confidential screen for Chlamydia waiting for pickup, condoms and emergency contraception in her purse, and an appointment for follow-up for her headaches (plus).

Susan is one of the many young women who cannot easily access Planned Parenthood or another freestanding teen clinic for confidential care and does not feel that she can tell her parents she is seeking these services. If we had not had the opportunity to weave confidential services into our regular care, Susan might not have received them. Having a relationship with both Susan and her parents, we also have the opportunity to facilitate parent–teen communication.

These opportunities can present challenges for pediatric clinicians. When do we screen for sexually transmitted infections (STIs)? Can we just prescribe birth control without an examination? How do we know what is really confidential in our state? And how do we even start to ask the right questions?

Fortunately, Monasterio, Hwang, and Shafer have given us the answers to all these questions and more, in a timely and highly readable update of Adolescent Sexual Health. They cover current research about the prevalence and trends in adolescent sexual activity, modifiable risk factors for early onset of activity, legal issues in providing care, and recommendations for STI screening, contraception, and counseling about safer sex.

Last week, in a rare moment of nostalgia, my college-bound daughter asked her parents to take her to see the popular animated film Ratatouille, about a rat who dreams of being a chef. The movie has a message: not everyone will be a chef, but anyone can learn to cook. Coming home to edit, I realized that this article was written in the same spirit: not everyone wants to be an adolescent medicine specialist, but, with the help of this excellent overview, any pediatric clinician can provide confident and competent adolescent health care.