Ample scientific evidence suggests that youth who suffer from psychiatric disorders are more likely to experience difficulties during their sexual and gender identity development. Several factors may contribute to these difficulties, including feelings of low self-worth, trouble finding romantic partners, the sexual side effects of many psychotropic medications, and the higher-than-average prevalence of sexual trauma among individuals with mental health conditions. Nevertheless, sexuality remains an infrequently discussed topic between mental health care providers, adolescent patients, and patients’ parents.

A representative sample of 242 mental health care providers (psychiatrists, psychologists, group counselors, and parent counselors) from seven institutions and five solo practices in the Netherlands completed a survey regarding the frequency at which they discuss sexuality and gender identity with their patients. In particular, they were asked about how often they communicated about these topics (in an age-appropriate manner) with patients between the ages of 12-21 years and/or with the patients’ parents.

For the purposes of this study, “sexuality” was defined as “a broad term that covers all topics of sexuality, such as: being in love, romantic relationships, (age-appropriate) sexual behavior, sexual experiences, sexual orientation, risk behavior, trauma, and so on.”

Almost all of the mental health providers surveyed (99.5%) considered sexuality to be an important topic to discuss with adolescent patients. However, just 19.9% stated that they talk about sexuality with the majority (at least 75%) of their adolescent patients, and 14.0% reported that they discuss sexuality with the majority of their patients’ parents. Furthermore, while 72% of the providers felt sufficiently knowledgeable about the sexual side effects of medications like antidepressants, antipsychotics, benzodiazepines, and stimulants, less than a quarter (20.3%) relayed this information to most of their patients when prescribing medications.  

At times when an aspect of sexuality was talked about during a mental health visit, the most commonly covered topics were (in order of frequency): love, relationships, sexual trauma, sexual experiences, sexual risk behavior, sexual orientation, sexual harassment, sexual development phases, sex and social media, gender diversity, deviant sexual behavior, and sexual dysfunctions.

The top reasons the mental health care providers gave for not engaging in conversations about sexuality with patients were “not thinking about it,” assuming the patient would feel ashamed, thinking the patient could not handle such a conversation, lacking time, and their personal feelings of shame.

A patient’s feelings and level of readiness to have a conversation about sexuality with a medical provider are important considerations, especially for younger patients in their teens and early twenties. Still, mental health care providers may be able to help young patients navigate the sometimes difficult path of sexual and gender identity development by providing a safe space for respectful, age-appropriate discussions about these topics.

Resources:

• Bungener, S. L., Post, L., Berends, I., Steensma, T. D., de Vries, A. L., & Popma, A. (2022). Talking About Sexuality With Youth: A Taboo in Psychiatry? The Journal of Sexual Medicine, 19(3), 421-429. DOI: https://doi.org/10.1016/j.jsxm.2022.01.001