Young People’s Sexual Health
Update
Dr Fiona Fargie
Sexual health and HIV
consultant
Sandyford, Glasgow
Reasons to talk about sex
What’s so great about teenage sex?
Regret
Coercion
Unsafe sex
STI risk
Pregnancy risk
Drug and alcohol use
• A quarter of girls and nearly a third of boys have sex under
16 but the average age for both sexes is 16
• Regret is a major issue for young people
- 67% young men
- 84% young women
who had sex aged 13 and 14 wished they had waited
• Up to 50% of adolescents used no contraception
• Working-class and lower educational YP begin sexual
intercourse 2 years earlier than middle-class YP and those
with educational aspiration
2002 National Survey of Sexual Health Attitudes and Lifestyles
(NATSAL)
Johnson,Wellings et al
Empowering young people!
Normal adolescent development?
Sexual education in the home!
Adolescents with chronic
conditions
HPV vaccine
Sally 17
Cystic Fibrosis
Attended GUM for treatment of very
bulky, keratinised genital warts
Lung transplant 2 years ago on
Tacro and Mycophenalate
Sexually active for 1 year
Quadrivalent vaccine?
How to talk about sex!
How do we make it more difficult?
Being embarrassed
Judgemental attitude/’disapproving’
Jargon/medical language
Failure to reassure/explain
Lack of time/ interruptions
Non-verbal communication
Being inflexible
Concern about consent/ confidentiality/
information sharing
The Legal bit….
New sexual offences legislation
Gillick competence/ Fraser guidance
(England/ Wales/ Northern Ireland)
Age of legal capacity (Scotland)
GMC guidance
Local policy and procedures
- The Glasgow protocol
- Child protection Committee guidance
Information sharing - GMC
1.
2.
3.
4.
5.
6.
7.
You should usually share information about abusive or
seriously harmful sexual activity involving any child or
young person, including that which involves:
a young person too immature to understand or consent
big differences in age, maturity or power between
sexual partners
a young person’s sexual partner having a position of
trust
force or the threat of force, emotional or psychological
pressure,
bribery or payment, either to engage in sexual activity
or to keep it secret
drugs or alcohol used to influence a young person to
engage in sexual activity when they otherwise would not
a person known to the police or child protection
agencies as having had abusive relationships with
children or young people
Barriers to the truth when asking about
sex
Fear of disapproval/
Disappointing people
Parental involvement
Embarrassment
Consent/
Confidentiality
Fear of authority
Internet
Worries about stigmatisation
GENITAL EXAMINATION
Communicating with adolescents
DON’T use open questions
Offer choices OR Yes/ No answers
Ask directly about risk taking
behaviours
Aim for curiosity NOT judgement
Get rid of mum/ dad/ granny etc
etc….
REMEMBER – your priorities wont
match theirs!
Taking a teen sexual history (1)
Have you ever had sex? OR When
did you last have sex?
Who was it with?
How old is she/ he?
Was that with a regular partner or
just a casual partner?
Did you have vaginal/ anal/ oral
sex?
Do you ever have sex with men/
boys?
Taking a teen sexual history (2)
Did you use a condom (and clarify
for what)?
Are you using any contraception?
Did you want to have sex?
Did you enjoy having sex?
Do you tend to have sex when you
have been drinking alcohol?
When was you last period?
Sign posting and building links
Where is your local young people’s sexual
health clinic?
What are the opening times?
How do you get an appt or is it a drop in
service?
Is there any capacity for working
together/ outreach?
Do you have literature/ information for
the service?
What do they offer beyond the clinical
consultation?
Susie 15
Presents to Sandyford Renfrewshire
LMP 12 weeks ago
13+3 on scan. Requests TOP
Doesn’t want parental involvement as
says they will stop her having a TOP
DNA Social Gyn and not answering mobile
Re-attends Sandyford now 15+6 and rerequests TOP
DNA next Social Gyn and not answering
mobile – WHAT TO DO NEXT?
Lara 15
Seen in our Termination service last
week. Seen on the SAU for
suspected appendicitits
USS abdomen showed a 13 week
foetus
REMEMBER - Always ask about sex
and LMP and do a PDT in case
anyway!!!
Questions?
