Dr. Laurie Freeman: Could you help us talk about when is the right time to talk about sexuality, sexual health/consent, gender identity with our daughters?

Caitlin Fiss: Early, before it’s an issue. Talk about it to make it normative and casual and non-confrontational. Ideal time to do this is when you are driving but that is hard in Manhattan, so do it when walking down the street. Pick a time when you’re not across the table. Have a casual conversation with your child in 3rd or 4th grade – explain how babies are made when a man and woman come together and egg and sperm meet. And talk about other ways families are made. It’s important to be very nonchalant. Kids absorb information differently and you’ll be surprised what questions they come back with. A great book is The Care and Keeping of You (American Girl series)  that talks about anatomy. And It’s NOT the Stork – a childhood book that is illustrated with male/female anatomy and sexual positions. It may sit on the bookshelf for years but kids will eventually look through it.

Angelish Kumar: They start having discussions in health class- and learn sex ed in 5th grade. Kids will drop hints about what they learned in class or heard from a friend. That is a good opportunity to talk to them and ask what they heard, and open the conversation that way. It’s important to take advantage of small moments.

Natalie Geary:  Always ask the child what they know before you answer. If they ask you a question you should say “what do you understand?” You need to respond based on what their magical thinking is. Kids have versions of what they understand. It’s amazing what kids have misheard and mis-processed, they hear things from TikTok, friends, social media, etc. I recommend if the child asks you a question, you ask them what they think is going on.

LF: Many here have adolescent daughters, but how do we find out what is going on with them if they aren’t really forthcoming about their dating? How do we provide them with info if they aren’t talking to us?

AK: If they are experiencing any physical symptoms – pain/running to the bathroom/they seem upset/change in personality or behavior – that is an introduction to say “hey I noticed this” or,  “are you ok?, are you having any discomfort?” If they are experiencing something like that, they probably do want help but don’t know how to ask.

CF: It is the same way you want to teach your daughter about her period – you want to prepare her a couple years before it starts and have a conversation. You don’t want to wait until she is dating someone and having an exclusive relationship and wonder if she has birth control. Get ahead of it and talk about it way before it happens because you won’t know what is happening unless you have established that trust with her.

NG: You have the right to ask your pediatrician/gynecologist. I believe it’s my responsibility to talk to you as parents starting at age 10/11 with permission from the parent to talk to the child in a way that is empowering to her, to want to be in control of her well-being. Your doctor should be helping girls own their own care of their body. It’s important for your doctor to also ask in front of you if it’s ok to speak to them in private or if you’d like to have the parent in the room. 

LF: This is a very interesting idea. It’s not just on us as parents. But to involve the pediatrician or doctor. If you were to meet with an adolescent and a parent what would you want her to know?

CF: American college of Ob/Gyn recommends pap smears at age 21 but I think that misses what Dr. Geary is saying. It’s a missed opportunity to not have a relationship with a gynecologist earlier. There is a lot of information you can give your adolescent on breast health, pelvic health, family planning, sexual transmitted infections, and the HPV virus. The majority of sexually active women in our city are infected with the HPV virus. During my first visit with clients, I establish that I am your ally. I am here to help you and be a resource. I am going to be a team with the parents. I’ll ask the mother/father/daughter if you’d like to come in for the first few minutes while talking and at some point I’ll try to speak to the child alone in my office, fully dressed. Oftentimes you don’t need an exam the first visit. It’s just to build trust and comfort and rapport. It’s scary the first time. I show them the stirrups, pap smear, etc. I focus on education on the first visit and then it’s what the individual needs.

NG: Yes, the chance you’ll need a pelvic exam is very low on first visit. It’s about building a relationship and explaining what they can expect. It is scary but it is important for young women to understand that it is unfortunately the story of the rest of your life. The sooner they can have a relationship [with their Ob/Gyn,] the better. Building trust and ownership is important for girls to feel safe when they go to their exams. 

LF: When should we take our daughter to an OB/GYN?

CF: If your daughter is 16 and hasn’t started menses that is a good time. If she is having problems with periods and they are too frequent or heavy and she has to miss events, they should see someone. If your daughter is thinking about becoming sexually active, well before that is a good time to come in to establish a relationship. Before leaving for college it is important to visit, because college is hit or miss when it comes to healthcare for women on campus. Many schools don’t have birth control available on campus, especially in restricted states now.

LF: Can you give information so parents feel equipped to talk to kids about sexually transmitted infection, abortions, pregnancy. How much do you see sexually transmitted infections, teen pregnancy and what would you suggest telling your daughter to help them be empowered? 

CF: Every single day I see STIs and pregnancy. This is real. One of the fastest rising STI in New York state is syphilis! You need to really drill home condoms, condoms, condoms. Data on birth control pills is 1/100 women will get pregnant but real use data is 92 percent efficacy. It is the greatest medicine invented for men and women but it’s not foolproof. Condoms are also best we have to prevent against syphilis and HIV, etc. but efficacy is low with a  real time use rate at 91 percent. So the combination is what we need to stress: condom + secondary backup method (birth control). By and large the birth control pill is a very good starting point but not everyone can take them. The IUD is becoming very common now. Efficacy is 1/100,000. It is very well tolerated, but insertion is not ideal as it can be very uncomfortable, but there are pain medications (cervical block) doctors can use. It can last 3-10 years and it’s a great option for a teenage girl.

AK: I love this idea of making this info more practical than personal. I came from an Indian family and we didn’t discuss sex at all. No conversation at age 12/13. It would have been really helpful if someone gave me a written packet that talked about everything. 

NG: The health provider should be helping with this information starting at age 11. Brochures should be available in doctor’s offices during checkups on HIV, condoms, HEP B, etc. They shouldn’t be because your kid is targeted or because of something she revealed, it should be standard.

CF: The #1 thing would be a sense of openness to conversation. Be calm, cool and collected and earn your child’s trust so nothing they say can shock you. You can’t be judgmental. And discuss consent. Talk to boys and girls about consent. Make sure they know what body autonomy is as well as consent.

LF: What about dads: do girls want dads involved? 

CF: I have every parent/child combo, caregiver and more and more two Dad families. I hug them harder as it’s less natural but just keep going and naturalize it. Know the terms and be nonchalant. “Oh you need maxi pads?” Make it really natural so you can build trust with your daughter.