Doctors are missing a prime opportunity to share information about sex with their teenage patients by failing to broach the subject during checkups, according to researchers at Duke Medicine.

The study, published Dec. 30, 2013, in JAMA Pediatrics, found that less than two thirds of doctors and teenage patients talk about sex, sexuality or dating during annual visits, and the conversations that occur last less than a minute on average.

"It's hard for physicians to treat adolescents and help them make healthy choices about sex if they don't have these conversations," said lead author Stewart Alexander, Ph.D., associate professor of medicine at Duke. "For teens who are trying to understand sex and sexuality, not talking about sex could have huge implications."

During annual visits, doctors can promote a range of healthy behaviors to teenage patients by talking about issues such as smoking, drinking and wearing seatbelts.

Sex is another topic that the American Academy of Pediatrics recommends physicians address with teens. While these conversations may be uncomfortable for the patient and provider alike, they are important opportunities to discuss sexual development, sexually transmitted infections and pregnancy prevention.

One-on-one confidential time during annual visits is recommended to allow for these sensitive conversations. Confidential discussions help establish trusting relationships between doctors and patients and foster candid disclosures from adolescents.

Past studies on discussions of sex during doctors' visits were based on information teens or physicians repftalk talk orted after visits. To capture naturally occurring conversations, Duke researchers gathered audio recordings of annual visits, including camp and sports physicals, for 253 adolescents. The teens, ages 12 to 17, visited pediatricians and family medicine physicians at 11 clinics in North Carolina.

The researchers listened to the recordings for any mention of sexual activity, sexuality or dating. They found that physicians brought up sex in 65 percent of visits, with conversations lasting an average of 36 seconds. The other 35 percent of visits included no mention of sex. None of the adolescents initiated discussions on sex, reinforcing the need for physicians to start the conversation.

"We saw that physicians spent an average of 22.4 minutes in the exam room with their patients. Even when discussions about sex occurred, less than 3 percent of the visit was devoted to topics related to sex," Alexander said. "This limited exchange is likely inadequate to meet the sexual health prevention needs of teens."

Adolescents' engagement in these discussions varied. When physicians asked them questions about sex, about half of the teens responded to yes or no questions with limited discussion, and a meager 4 percent of teens had prolonged conversations with their doctors.

Female adolescents were more than twice as likely to spend more time talking about sex than their male counterparts. While females may have more to discuss when it comes to birth control and pregnancy prevention, the finding raises the concern that males could be missing out on benefits of annual visits.