Sexual Health in the Pediatric Population #1

health carehealth care educationsexual healthnursingmedicinetrauma and violence informed caretrauma informed careparamedic educationsexual assault caresexual abuse prevention
Written By Marita Smith

Note: This blog discusses difficult topics like sexualized violence, including against children. There are no graphic details or stories of assault or abuse, but please engage with the content with attention to your needs.

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“Sexual health is fundamental to the overall health and well-being of individuals, couples and families, and to the social and economic development of communities and countries. Sexual health, when viewed affirmatively, requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.”

- World Health Organization

I work exclusively with children. Why do I need to address sexual health?

A smiling health provider high fives a small child who is sitting on their parent’s lap.

A smiling health provider high fives a small child who is sitting on their parent’s lap.

For some pediatric health providers, it may seem incongruent or irrelevant to discuss sexual health. It may feel uncomfortable to even consider. But there are some key factors to consider: first, healthy sexual development doesn’t start in adulthood or even in puberty. Sexuality is a part of who we are as humans from the very beginning, and therefore must be included as part of a holistic health approach.

Another factor to consider is the distressing reality of sexual abuse and assault in our communities. As difficult as this is to face, even the youngest children experience sexual abuse at much higher rates than most of us know. Access to factual, age appropriate information for children, and knowledgeable, supportive caregivers are crucial factors in supporting healthy development and keeping children safe from abuse. Health providers can be an important source of this information, and for some children and families, we may be their only source.







Healthy sexual development doesn’t start in adulthood or even in puberty. It’s a part of who we are from the very beginning, and therefore must be addressed in a holistic pediatric health approach.






I learned about STI’s and reproductive health in nursing/medical school. What more do I need?

An person in a white coat with crossed arms, holding a stethoscope.

An person in a white coat with crossed arms, holding a stethoscope.

Over the years working with a wide range of health care colleagues, I have encountered doctors, nurses, social workers and other community providers who are knowledgeable about sexual and reproductive health. They know how to talk (and more importantly, listen) to young people using trauma informed, supportive approaches. Unfortunately, many more pediatric providers express discomfort or even resistance to seeing patients impacted by sexual violence or addressing basic sexual health needs. Too often these patients are unaware, unable or even prevented from accessing the care they need because of a lack of services and systemic inequities. Worse, some receive services that cause further harm and re-traumatization. This isn’t necessarily because their providers don’t care - many of them were doing the best they could with what they had. In fact, many providers I’ve encountered have specifically expressed that they lacked the knowledge, training, mentorship, and access to the resources they need to support these patients.

This isn’t just anecdotal experiences. Across the literature, we find that doctors and nurses have many limitations when it comes to providing sexual health information, especially to young people.



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“Research studies in health have reported many nurses are not comfortable speaking with their patients about topics related to sexual health. Many nurses tend to neglect sexual health care because they do not feel they have sufficient education, experience, or confidence to properly engage with patients (Sung et al., 2016; Martel et al., 2017), and this creates a barrier to the patient’s sexual care (Klaeson et al., 2017).”

- Educating to sexuality care: the nurse educator’s experience in a multicenter study

“Many young people won’t bring up sexual health issues at health visits, and if conversations aren’t initiated by providers, sexual health won’t be addressed at all. One-third of all adolescents seeking care at North Carolina Clinics had annual visits without any mention of sexuality issues, and when sexuality was discussed, it was estimated to last a mere 36 seconds (Alexander et al., 2014).”

- Sexuality Talk During Adolescent Health Maintenance Visits

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Clearly we need to do better. But how?

Working in health care in our current climate is… not easy. There are constant and overwhelming demands on all of us, and asking providers to do more is difficult. Not to mention, conversations about sexuality in our practice - let alone sexual violence towards children - can often bring up immense discomfort in ourselves.

But it matters.

Sexual health may seem like an individual, deeply personal issue, and one that is for adults, not children. Yet at the same time our sexual health in any given community is deeply interconnected. We know that our current statistic that 1 in 10 children experience sexual abuse before age 15 is likely a low estimate, and sex trafficking continues to forever change the lives of so many children and young people, starting at younger and younger ages. When we begin listing the myriad physical and mental health, relational, emotional, academic and economic impacts of sexual violence we can see how much this issue truly impacts public health across the population. As we saw in our opening statement from the World Health Organization, sexual health cannot co-exist with sexual violence. And sexual violence thrives in an absence of information, in a culture of silence and shame.




Sexual health is deeply individual, and at the same time deeply interconnected with public health: you only have to look at the rates of sexual violence and it’s impacts in a community to see the reality of this.




So what can we do in our practice to better meet the sexual health needs of our patients? It doesn’t require going back to school or a major investment in specialized sexual health education (although if you’re interested those are great things to do!). What you can do today is take some time to reflect on your own level of knowledge as it relates to your practice, and then consider what areas you might need support with. (You’ll find some easily accessible resources at the end of this blog.)

Here are some questions we can use to reflect on our knowledge and comfort level:

  • In caring for pediatric patients, how often are you initiating conversations with adolescents about their sexual health?

  • Are they typically yes or no questions like “are you sexually active”? Are they limited to discussing STI and pregnancy prevention or do you have a specific approach you use to ensure there is a confidential, non-judgmental space for young people to express their concerns and needs over a wide range of topics?

  • Do you have access to a range of high quality, accessible educational resources to offer young people and families on the topic of sexual and reproductive health?

  • Do you know what to look for in terms of risk factors and red flags for sexual abuse, sex trafficking, or other kinds of abusive relationships? What do you do when you encounter these concerns?

  • How do you/would you handle a disclosure of sexual abuse or assault in a patient? What about trafficking?

  • Does your clinic or unit have clear pathways for supporting these patients?

  • Do you know how to quickly access forensic evidence collection if needed for one of your patients?

  • Do you know the laws & professional obligations around consent and mandatory reporting for sexual abuse and assault?

  • How would you navigate questions around concerns for sexualized behavior in young children?

  • Do you feel competent to navigate sexual health conversations with someone who has a physical, intellectual, or developmental disability?

A blank notebook sits next to a cup of coffee, ready for reflection notes.

A blank notebook sits next to a cup of coffee, ready for reflection notes.


If the answers to any of these questions are “no” or “I’m not sure”, you’re in the right place! This blog series will explore many of the topics touched on above and in this list of questions. You’ll hear real world examples and strategies you can employ in your practice to create safer spaces for your pediatric patients and their families. You’ll get practical tips and access to simple resources that will help you grow your own capacity to provide trauma and violence informed care to your pediatric patients and their families.



Interested in learning more today?

Maybe you are among the providers who express frustration with the lack of access to training and resources to improve your care. Maybe you’ve had an experience that has galvanized you to learn more, but you don’t know where to go next. Or maybe you’re a subject matter expert who is frustrated with the lack of educational resources available to your colleagues or staff.

If so, you may benefit from some of our customized educational offerings. Check out the options below or connect with Marita to discuss a workshop, lunch-and-learn, or more extensive training development for your team.

You can also access some helpful online resources below that you can share with your patients or colleagues.


Available Now:

Critical Levels Logo

Critical Levels Podcast Episode:

Trauma Informed Care for Children and Youth

Also available on Spotify and elsewhere.

Empowering Patient Centered Care for Paramedics

  • Online course developed to increase capacity for trauma and violence informed care for patients impacted by sexual violence.

  • Self-paced online module plus virtual case based discussion

  • Participants receive 4 CME credits from RPPEO

  • Created for medics but beneficial for other health providers


More resources:

Marita Smith https://www.maritasmith.ca