This qualitative study highlights the complexity of addressing adolescent sexual health in pediatric subspecialty settings, identifying multi-faceted barriers among practitioners, adolescents, and logistics, and underscores the need for in situ training and dedicated adolescent consultations.
Key Findings
Results
Pediatricians reported uncertainty and discomfort regarding their role in addressing sexual health as part of both routine care and chronic condition management.
Seven pediatricians from various subspecialties at Montpellier University Hospital were interviewed.
Physicians described discomfort, perceived illegitimacy, and lack of training as personal barriers.
The intimate nature of the topic was specifically identified as a practitioner-related challenge.
Study period ran from November 2023 to March 2024 using semi-structured interviews.
Results
Multiple physician-related barriers were identified that hinder involvement in adolescent sexual health care.
Barriers included discomfort, perceived illegitimacy, and lack of formal training.
The intimate nature of the topic was cited as a specific challenge for practitioners.
These barriers were identified through inductive, open, step-by-step coding with double reading and triangulation after each interview.
Literature was noted to reveal 'significant gaps between scientific recommendations and actual pediatric practices.'
Results
Adolescent-related obstacles, including taboo and fear of causing embarrassment, were identified as barriers to sexual health discussions.
Adolescents' perception of the topic as taboo was specifically reported by pediatricians.
Fear of causing embarrassment to adolescents was cited as a deterrent for practitioners raising sexual health topics.
Gender dynamics between practitioners and adolescent patients were also noted as a complicating factor.
Results
Parental presence during consultations and the nature of the care relationship were identified as contextual barriers to addressing sexual health.
Parental presence in the consultation room was cited as a specific obstacle.
Both 'fragile' and 'overly close' care relationships were described as hindering sexual health discussions.
These relational dynamics were particularly relevant in the context of specialized pediatric follow-up for chronic conditions.
Results
Logistical and structural constraints at the institutional level were found to impede sexual health care for adolescents.
Time limitations during consultations were identified as a logistical barrier.
Overly specialized consultation formats were cited as structurally limiting.
The absence of a local adolescent health policy was specifically noted as an institutional gap.
Study was conducted in a single university hospital (Montpellier University Hospital), which may limit generalizability.
Results
Pediatricians proposed several concrete strategies for improving sexual health care for adolescents in the hospital setting.
Proposed improvements included dedicated adolescent-focused consultations.
Targeted training for pediatricians was recommended.
Access to educational materials for both practitioners and adolescents was suggested.
Anchoring sexual health approaches into routine care was identified as a key strategy.
Methods
The study used a qualitative methodology with semi-structured interviews and a rigorous coding process involving seven pediatric subspecialists.
Seven pediatricians from various subspecialties participated.
Interviews were transcribed and analyzed using an inductive, open, step-by-step coding approach.
Double reading and triangulation were performed after each interview to strengthen validity.
The study was conducted over approximately five months (November 2023 to March 2024).
What This Means
This research suggests that pediatric subspecialists—doctors who care for children and teenagers with chronic or complex medical conditions—often struggle to address sexual health with their adolescent patients, even though sexual health is an important part of overall well-being. Researchers interviewed seven specialized pediatricians at a French university hospital and found a wide range of obstacles, including doctors feeling uncomfortable or undertrained, perceiving sexual health as outside their expertise, and worrying about embarrassing their patients. The presence of parents in the room and the close or sometimes complicated relationships that develop during long-term care for chronic illness also made these conversations harder to initiate.
Beyond individual practitioner and patient dynamics, the study identified broader structural problems: consultations that are too short and too narrowly focused on specific medical conditions, and the absence of any hospital-wide policy specifically addressing adolescent health needs. These findings align with existing literature showing a gap between what guidelines recommend and what actually happens in clinical practice.
This research suggests that improving adolescent sexual health care in pediatric settings would require action on multiple levels simultaneously—including specialized training for pediatricians, dedicated consultation time focused on adolescent health broadly (rather than just the specific chronic condition), better access to educational resources, and institutional policies that normalize sexual health as part of routine pediatric care. The study's findings come from a single hospital with a small number of participants, which means the specific details may not apply everywhere, but the types of barriers identified are likely relevant across similar settings.
Laurent-Lacroix C, Jeziorski E, Stheneur C, Perrollaz C. (2025). Tackling sexual health in specialized pediatric consultations with adolescents: challenges, barriers, and local perspectives.. European journal of pediatrics. https://doi.org/10.1007/s00431-025-06294-3