Gabbi Polite is just 14 years old, but when a friend wanted to talk to her about being bisexual, Gabbi was fine with it. Conversations about sex happen frequently in Gabbi’s home, and she knew where to turn for advice.

“If we see something on TV or a situation happens in my life or my mom’s life, we’ll talk more about that,” said the Mount Airy ninth grader. “When I told my mother my friend was bisexual, we talked about it for a full hour.”

Teens who report having open and honest conversations with their parents about sex are more likely to delay sexual activity, have fewer partners, and use condoms and other contraceptives when they do have sex, according to The Children’s Hospital of Philadelphia PolicyLab.

But for many parents and their kids, “The Talk” can be an uncomfortable conversation. That’s been true for generations, even when the discussion was mostly about puberty and premarital sex. Today, kids are more sophisticated. The Me Too Movement, openly transgender and gay public figures, and news events like Bill Cosby’s sexual assault trial bring new topics into the conversation. Parents — who may be grappling with their own feelings about such issues — may feel unsure of what to say to their children.

Starting the conversation

It can be easiest for parents to build on lessons their children learn in school. While all Pennsylvania and New Jersey public schools cover human relationships and sexuality, it’s up to each district, school or teacher to build the specific curriculum.

In Radnor Township, for instance, parents of fifth graders are invited to meet with a health and wellness teacher and nurse to discuss lessons that will be presented to their children. Teachers encourage parents to keep the information very straightforward and clinical in an age-appropriate way at first, giving students time to digest it, and encouraging them to come back with questions, said Brock Tracy, fifth-grade wellness teacher at Wayne Elementary School.

“Allowing students time to process information and get comfortable helps them to better open up,” said Tracy. “Teachers want parents to set the stage that it is all right to talk about these subjects. After that, family values and preferences drive the deeper conversations.”

The most important thing for kids to know is that healthy relationships are built with a solid foundation of trust and respect, said Ed McCallion, Radnor Middle School health and physical education teacher for grades six through eight. For example, a recent lesson focused on relationships and why you can’t know someone simply based on looks or a first-time encounter. "I provide a comfortable, safe atmosphere where the kids can get real, honest and accurate information that may be more awkward for them to discuss with their parents,” he said.

Talking in the car is a great place to start, said Heidi Weinroth, pediatrician at Cooper University Health Care in Moorestown, N.J. “There are less distractions and there usually isn’t the face-to-face-interaction, which may help a teen who may feel embarrassed about the subject matter.”

What to include in ‘The Talk’

Beyond puberty and safe sex (which includes awareness of HIV and other sexually transmitted diseases as well as pregnancy prevention,) the conversation should also involve gender identity, sexual preferences and consent. News events and TV show plot lines can offer a starting point for discussion. For example, Netflix’s teen drama, “Sex Education,” follows a group of teenagers through adolescent development, exploring how they are navigating puberty and romantic and sexual relationships.

News related to the Me Too Movement offers parents an introduction to talk about consent in ways that go well beyond “no means no.”

“I talk to my young patients about being aware of some of the traps that we know,” said Florencia Greer Polite, who leads the Division of General Obstetrics & Gynecology at Penn Medicine, and is Gabbi’s mom. “For example, we know that alcohol can blur their judgment and make both parties unable to give full consent. So I implore my patients to have conversations about consent while they are sober and to remain in full control of their own actions so that they are not compromising their ability to give consent.”

When a child questions their own gender identity, or says they think they might be gay or bisexual, Polite encourages parents to make an appointment with their pediatrician, asking the doctor in advance to broach the subject while the parent and child are in the room. Make sure your child knows you are open to the discussion.

Current events can provide an opening. For instance, one of the many Democratic candidates for president, Pete Buttigieg, is married to a man. “Talk about what your child’s opinion is about that,” suggested Polite.

She reminds parents that their kids are always watching them. If children perceive their parents are dismissive of people who are gay, or transgender, they are much less likely to be honest about their own feelings. “Setting the tone for openness is incredibly important.”

Including other trustworthy adults

If your child seems reticent about talking with you, make sure they have trusted adults they can turn to, such as teachers, coaches and doctors.

Speaking of doctors, the American College of Obstetricians and Gynecologists recommends that girls have their first gynecology visit between age 13 and 15. That may sound early, but “it’s just to get to know a gynecologist, not for an exam, but to literally talk about normal puberty, what to expect from menses, and to get girls comfortable with someone who’s their advocate,” said Polite. “It’s important that we get ahead of some of these conversations.”

When should parents start talking about sex with their kids? “The earlier, the better,” said Polite, who has delivered babies from moms as young as 11.

What you say will certainly depend on your child. Parents know their kids best, and every child matures differently, and has different experiences, said Weinroth.

Birth order may play a role: “The second child may watch more mature movies or see their siblings dating and have questions about it,” she said.

Also keep in mind that sex is far from the only danger kids face.

Weinroth uses a screening tool with her teenage patients that includes a range of safety topics, from wearing a seat belt to using protection if they’re having sex. “It’s a conversation starting point,” she said of the screening tool.

Sometimes, though, parents get surprised by their children, and the physician’s input.

The mother of one of her patients was angry when she learned her son was having sexual intercourse, and asked Weinroth to talk to him. “I spoke to him and he was in a relationship and had used protection,” Weinroth recalled.

“I told his mother that he had done everything right, that whatever she was teaching her son or he had learned in school, he had made all the right decisions.”

That wasn’t, however, the answer the mother had been looking for.