An interview with a CHOC doctor on how to have "the talk" with our kids

This post is sponsored by Children's Hospital of Orange County


I've talked quite a bit about how important I think it is for parents to talk openly with their kids about sex. (I even did a facebook live series on it.) Last week I had a chance to chat with a doctor and adolescent specialist from CHOC (Children's Hospital of Orange County) to hear an expert opinion on how to talk with our kids about hard topics. Dr. Terez Yonan shared her expertise on talking to our kids about sex and sexuality and answered several questions I had about how to best manage this aspect of our children's lives.



Kristen: Having the sex talk seems to be an area of a lot of anxiety for parents. What advice would you give to parents around that? I'm assuming that you're probably of the camp that it's more of an ongoing conversation than a one-off talk.

Dr. Yonan: Yes.

Kristen: When should that start?

Dr. Yonan: I think there are opportunities to talk about our bodies and body parts as early as toddlerhood. It's developmentally appropriate for toddlers to touch and explore their bodies and ask questions. Instead of being embarrassed by questions that come out of a toddler's mouth, it might be good to use that as an opportunity to talk about what is going on and why things happen the way that they happen.

For younger kids, you don't have to get very detailed. I think one of the important things is naming things as they are, so not using little playful names or nicknames for genitalia. I think calling a penis a penis and a vagina a vagina is helpful for young people. I know it's embarrassing to think that they might say these words at school or in public, but this can be helpful in maintaining their safety. Studies have shown that when kids know the right names for genitalia, they're more likely to talk about and report sexual abuse.

Kristen: Yeah, absolutely, knowing the right words so that there's a common language so that if something, God forbid, were to happen, they can verbalize exactly what's going on. It seems like in the maybe elementary years, it's more about learning the body parts, body boundaries and stranger safety. How about for kids that are approaching puberty? What are the conversations we want to be having there?

Dr. Yonan: I think that's very important as well. It's scary to go through puberty and realize things are changing. A lot of kids or young children become confused and may kind of isolate themselves because of fears that they are different, for example, "Oh, now I have armpit hair.” or  “There are changes in my underwear." Talking about these physical changes before they start to happen for the young person is really helpful. It prepares them for the things that are going to happen, and it normalizes it. That's part of being an early adolescent, too, is one of the major developmental tasks in early adolescence is trying to figure out who they are and whether they are normal and if they fit into their age group with the other kids.

Kristen: Absolutely. I know you specialize in caring for LGBT youth. How do we open up the lines of communication so that if our child has issues around sexual identity, or if they feel like maybe they're gay, they'll come to us and talk about that?

Dr. Yonan: That's really important. You want them to be safe in talking to you so that they can come to you for these discussions instead of finding information on the internet where things that aren't so safe. I think that discussions on sexuality are ones that you can have early on, even in toddlerhood. One playful way to do it is if you have friends who are hitting those different milestones in life, say you have friends in a heterosexual relationship who just got married, you can talk about what marriage is and how that relationship is different than just dating. If you have a friend who is dating a same-sex partner, you can talk about why that's normal, too.   "Matt and John are in a relationship, and they love each other, and it's good and normal." Normalizing that early on in life makes it less of a stigma as your child grows up. This will allow you to introduce other identities, like that there are transgender people, which actually comes up more frequently than we think in the younger, elementary school population. I've seen patients as young as ages three to seven who come in with their parents to discuss gender identity. Transgender or gender non-conforming children will have questions or comments about whether their bodies match their gender identity (being a boy or a girl). These discussions may come up early on. It's okay to talk about it early on because that is the time in a child's life, between age three to five or so, when their gender identity solidifies. As they are exploring their gender,  they may play with toys from the opposite gender or want to wear clothes that the opposite gender wears. That doesn't necessarily mean that they'll be transgender when they get older. It just means that they're exploring these, and that's okay to do. It's a normal part of development and shouldn't be stigmatized for children.

Kristen: Absolutely. How do we help prepare our girls for menstruation and some of the stress that goes around girls being scared of that starting?

Dr. Yonan: It's really a hard first milestone for some young women. It's great to have those discussions about menstruation with girls as they're growing up, definitely. I recommend talking about puberty in general with both girls and boys between ages eight and 11 as some kids start puberty as early as age nine. This includes just things like changes in body hair, breast bud development in females, and enlargement of the penis and the testicles for males.

They may notice those. They may not. For girls, they're kind of pushed to notice changes in their bodies because of societal pressure to use training bras, the need for sports bras and things like that. That would be a great time to talk about menstruation because typically for female development, they have breast bud development, and then about two years later, they'll have their first period.

Kristen: Right.

Dr. Yonan: You can discuss what periods are, why they happen, what the ovaries, uterus and vagina are, and so on, so that they know their anatomy and why things happen the way that they do. I think you can also talk to other women in the young person's life to talk about how periods can be different for each person, and you can include the doctor in the discussion. I can recall a few visits where moms have come in with their daughters asking, "Can you talk to her about periods?" We pull out diagrams, and we draw pictures, talk about body parts, etc. I think it is a great way to normalize puberty to a young teen.  

Kristen: Yeah, that's great.

Dr. Yonan: Talking about pads and tampons and hygiene is important, too.  Many parents have little packets prepared when they're children are nearing the age. One thing to remember as a parent is that usually, young women have periods around the same age that their mothers, sisters, etc did. Parents can use this as a guide on when to expect the first period.

Kristen: Yeah. That's been helpful for reducing my own daughter's anxiety. She has a little packet in the bottom of her school backpack and one in her room so that whenever that starts, she knows where to go and what to get and how to use it. As they're transitioning into puberty and kind of exploring their sexuality, how do we talk to kids about sex? How do we educate them on what it is? Then how do we help them develop a healthy ethic around it?

Dr. Yonan: That's a good question. I think the second part of the question is probably the more important part, right? As parents, the aim is to have them be happy with their bodies, find healthy relationships, and maintain their values. Even early on in those discussions about the talk, as a family, it's important to talk about what characteristics are valued in your young person, like, "I want you to be strong and respectful and caring," and then also what they should look for in a partner.

Kristen: Yeah.

Dr. Yonan: These are things that you can talk about early on. Again, like we talked about when you illustrate couples in your life to your kids, you can show the strength in those couples, like, "Matt and John are in a relationship, they respect each other and care about each other very much, and this is what's really nice about their relationship."

That can be helpful for kids to see, too, growing up, what a good relationship looks like so that when they start to form crushes and/or to date, they can form more age-appropriate interests and safe interests, they’re more likely to choose a person who is caring and respectful and trustworthy. This lowers their risk of engaging in relationships that lead to bullying, online harassment, or violence.

The other benefit of discussing your family’s expectations is that their values are reinforced early on and throughout elementary school into middle school and to high school, and they're able to resist some of those peer pressures that parents worry about as teens start to date. Even though they form relationships, they can bond and be together and do more age-appropriate activities without jumping into having sex.

Kristen: Right. Yeah, that's good.

Dr. Yonan: It's really important to talk about sex, too. You’ve talked about the body parts. You’ve talked about development. What about sex itself? Reproduction is something that will eventually happen for most people, so talking about how someone gets pregnant, what it's like to be pregnant, and what having babies is like is important information. These are things that kids and teens have questions about, too.

There are a lot of toddlers who ask where babies come from also, but that doesn't have to be as detailed in terms of what happens with sexual intercourse. It can be more uncomfortable to talk about intercourse with older children and teens. But talking about the ways that people have sex is important. Parents of LGBT youth should educate themselves on how non-heterosexual couples have sex to help their youth learn about safe sex. Parents can always ask for advice from their doctor! This helps to prevent misinformation because most sexual education is focused on the heterosexual experience and can exclude our LGBT youth, putting their sexual health at risk.

Kristen: Right. How do we prepare our kids if they do become sexually active to be empowered with safe sex choices and birth control?

Dr. Yonan: These are things that you can talk about together. If there are things that parents are not sure of, it probably would be worthwhile preparing before “the talk”. Do some research. Learn more about how condoms are used or what their efficacy is compared to things like birth control pills or IUDs for preventing pregnancy. It's okay to take time to do the research and anticipate some questions your teen might have before your talk. But it's also, I think, important to check in with your teens, for example, "What have you heard at school?", or "What are your friends talking about?" You can help bust some myths and rumors youth hear about sex and pregnancy. Or "What questions do you have?"

Kristen: Right. Right.

Dr. Yonan: Bringing everything to the table in a relaxed manner with openness and a nonjudgmental tone helps to keep the teen at ease so that they're more likely to come back to you when they do have questions.

Kristen: Yeah, that's really good, having an open line of communication so that when things do start happening in that arena they'll come talk to you.

Dr. Yonan: Yeah. One thing that I learned in my training is that to maintain a curiosity helps to make these more difficult discussions flow easily, so coming from a place of curiosity will make it less ... you're forced to be nonjudgmental.

Kristen: Right. You're just wanting information, but you're not coming to it from a place of judgment. That's good. What about teaching our kids about consent? Any advice on that?

Dr. Yonan: Yes, that's one of my favorite topics, especially with everything that's been happening in the media and on the news.

Kristen: Right.

Dr. Yonan: I think it's very important. So just to step back for a minute, I think there is a question about, “Should we talk to girls about boy development and boys about girl development?” Absolutely, because intercourse takes two partners, one of each, generally. Then not knowing what the other partner looks like or what their development was like can make person A uncomfortable and maybe feel like they have to do something they didn't necessarily want to do.

Coming to the relationship with as much information as possible is helpful. Even talking to boys about periods is really helpful.

Kristen: Yeah.

Dr. Yonan: Consent, I think, is one of the most important parts of any relationship. I think this goes back to starting with those discussions about values, in your family, culture and your community. We have consent for all kinds of things, consent for medical care, consent to pay for things when you go shopping, contracts, etc. You should still talk about consent when it comes to your body.

How do I approach it in a medical visit? The way I talk about is by discussing what it’s like if you're dating somebody: having a crush, becoming more interested in them, dating and becoming more emotionally invested. These are all good things, but we also discuss what to expect from your partner. Again, the things I emphasize for adolescent relationships are trust and respect. Discussing respect leads into a discussion about consent.  What does respect look like? It is actually really hard to define if you’ve never had to think about it before. Respect looks like someone who likes you for who you are, who doesn’t ask to change how you look or act, and who shares in decision-making. Having a partner that respects you prevents teens from ending up in situations of intimate partner violence. A partner can also show respect by not forcing you to do something that you don't want to do.

Kristen: Right.

Dr. Yonan: Even if it's kissing or holding hands. These are things that a partner should ask about before they touch your body. If that's okay and you're ready for that, let them know, "I'm ready for that," and go for it. But the reverse should happen, too. You should ask your partner if they're okay with what you're about to do. This becomes most important when you’re ready to have sex. I encourage young couples as well as single young people to think about what's important for them in a relationship and encourage them to talk to their partners about this.

Then if they do find someone that they start to date, to talk about, "These are the things I expect in a relationship from early on." This includes sex. A lot of young people think, and parents, think that girls want to wait to have sex, and boys want to have sex as soon as possible, but that's not the truth. Really, young men also want to take their time, invest in a relationship, get to know their partner before things get sexual.

Kristen: Right.

Dr. Yonan: I find that a lot of young people are surprised to hear that. I encourage them to talk about their expectations around sex, if they want to wait, and how long they would wait to have sex. Then if they are having sex or they're interested in having sex, we talk about how important it is to come in and talk about condoms and birth control and STD testing. These are best to discuss before becoming sexually active, but are still important if they've already had sex.


Kristen: Right.

Dr. Yonan: It's important.

Kristen: The door is always open. It's not like a missed window.

Dr. Yonan: I know as parents we can get really upset if we hear that our teenager has already had sex. It's hard not to reprimand them, but it's probably better not to shame them so that they can still come to talk to you about it.

Kristen: Right. Absolutely, because as soon as you shame them, that line of conversation is over.

Dr. Yonan: Yeah, and then they may go to friends or other people for information, and it may not be the most accurate or safe information.

Kristen: Right. Absolutely. I mean at the end of the day, we want our kids learning all about all of this from us and not from their friends on the bus.

Dr. Yonan: Yeah, a trusted source.

Kristen: Yes. Yeah, or a doctor. I mean if a parent finds themselves completely uncomfortable with this topic maybe due to their own life experiences, how do we outsource? What kind of resources are available if this is a difficult conversation for parents?

Dr. Yonan: Yeah, some people talk to other parents and see how they had the talk with their children. Some people reach out to trusted community members or clergy, just to talk about the values and how to have those discussions with young people. You can definitely talk to your medical providers about that. . And there are websites from different trusted organizations that the Adolescent Medicine Society has compiled for parent resources on how to have the talk.

Kristen: Is there anything that you would really want to impart to parents about these conversations with their kids?

Dr. Yonan: Yeah, I think that, again, being honest with your young person about what you know and what your limitations are makes these conversations more natural.  "Yeah, I know about birth control. This is what I know..," It's also okay to be open about the gaps:, "Oh, I don't know about Nexplanon. I'm going to write it down and look it up,” or “We can go talk with the doctor about that." I think that's okay to show them that we don't know everything.

Kristen: That's good.

Dr. Yonan: I mean honestly, as a doctor, I do that sometimes.

Kristen: Yeah. That's really good, to just say, "Let me get back to you on that," or "Wait," or "Let me wait."

Dr. Yonan: Yeah, and you can use life’s little moments. You don't have to make it feel like a proper meeting. You can take advantage of your daily routine like when driving together and it's going to take half an hour.  “Hey. Let's check in about that one thing you had a question about periods (or whatever topic you needed to look into)."

Kristen: Oh, that's good.

Dr. Yonan: One other thing that can be helpful is to talk about  what they’re seeing on tv. I think that the same with those real-life teaching moments, you can outline there are types of relationships. In some of those shows, we see there are positive relationships and negative relationships, and you can use that to outline what is good about this relationship versus what is bad in another. Or what's acceptable and what's not acceptable by using the little vignettes on TV. It's also good to talk about how a person in a movie reacted to a difficult situation like bullying, body shaming, an abusive relationship, etc. "What would you do in that situation?" Or "This is how I would have done it. What would you have done?"

Kristen: That's really good, using it as a conversation starter.

Dr. Yonan: Yeah, I know some TV shows get really dramatic, but parents can use TV as leading points for discussions about difficult topics. It's hard to talk about what to do if someone is raped or abused. Or what happens if you have sex and the condom breaks? What are your resources? What is emergency contraception? This can lead to other difficult but relevant topics of discussion, like what really is abortion? These are little things that you can look up and talk about together.



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