Adolescent sexuality and sexual behavior are best viewed within the context of overall adolescent development. Sexuality is a multidimensional construct and includes ethical, psychological, biological, and cultural dimensions. The overt expression of sexuality depends on the biopsychosocial environment in which the individual exists.[1] Biological changes at puberty prime the adolescent brain and body for reproduction, and individual and family psychodynamics influence sexual behavior. The larger sociocultural environment sets the norms for sexual behaviors and controls them through its institutions, including churches, schools, government, and the media. As adolescents experiment with sexual expression, they inevitably make errors of judgment. Most such errors are minor, but many have significant health consequences.

Pediatricians and other primary care physicians are in an ideal position to provide longitudinal sexual health care to children and adolescents as part of preventive care and to help adolescent patients maintain their sexual health (BOX 154-1).[2] Traditionally, monitoring pubertal changes and providing anticipatory guidance to adolescents and their parents regarding timing of the growth spurt or onset of menstruation have been viewed as appropriate tasks for pediatricians. However, with initiation of sexual intercourse at younger ages, clinicians caring for teens should also be able to provide preventive care related to sexual behavior, including contraceptive counseling and prescription, screening for sexually transmitted infections (STIs), and counseling related to issues of sexual orientation and abuse. In addition, because of a high prevalence of health problems stemming from sexual behavior in the adolescent age group, clinicians must be able to diagnose and manage conditions such as pregnancy, STIs, sexual dysfunction, and sexual victimization. The physician's role is not limited to providing direct care—schools and other community organizations can often benefit from the expertise of health care providers who may help design sexuality education classes, pregnancy prevention programs, or HIV-AIDS prevention initiatives. This expanded societal role gives clinicians a broader influence on adolescent sexuality than is possible within the patient-physician-family relationship.