Adolescent sexual health and contraception — formative SAQs

SAQ 1 — Confidential contraceptive visit (10 marks)

A 16-year-old attends requesting "the pill." Her mother answers every question and will not leave the room. The girl's last menstrual period was three weeks ago. [4]

Questions

1. Outline why private time and conditional confidentiality are required, and give a confidentiality script with its limits. (3 marks) [4]
2. Describe the 5 Ps sexual history and why a "pill request" is not a transaction. (3 marks) [4]
3. Discuss contraceptive method choice for this patient, including why LARC is first-line and how you apply Medical Eligibility Criteria principles. (4 marks) [1] [5]

Model answer

Private time and confidentiality (3). Parent presence and fear of disclosure suppress honest reporting of partners, coercion and pregnancy risk. Private time is standard youth care. Script: what we discuss privately stays private unless there is a serious risk of harm to you or others, abuse or exploitation, or a legal duty to act; if that happens I will tell you what I must share and plan it with you as far as possible. [4]

5 Ps and why not a transaction (3). Partners (number, gender, safety of the relationship), Practices (vaginal, oral, anal — to test the right sites), Protection (from STI and pregnancy, and whose choice), Past STI history, Pregnancy intention (desire, LMP, chance of pregnancy now). A pill request may hide periods, acne, a coercive partner or a friend's pregnancy, so take the history before prescribing. [4]

Method choice (4). Lead with effectiveness tiers: LARC (implant, IUD) typical-use failure under one per cent, far below user-dependent methods, because it removes the user from each act. The CHOICE Project showed most adolescents choose and accept LARC when counselled without barriers. IUDs are not contraindicated by age or nulliparity — Medical Eligibility Criteria categories guide safety by condition, not by habit. Counsel side-effects, bleeding changes and reversibility, add condoms for dual protection, and let the young person choose. [1] [2] [5]

SAQ 2 — Emergency presentation and dual protection (10 marks)

A 15-year-old presents after a single episode of unprotected intercourse 36 hours ago. She is not on a method. She discloses her boyfriend is "controlling." [6]

Questions

1. Outline your emergency contraception approach and how you decide between options by timing. (4 marks) [6]
2. Explain dual protection and the challenges young people face using it. (3 marks) [8]
3. Describe your assessment and safety actions regarding the disclosure of a controlling partner. (3 marks) [4]

Model answer

Emergency contraception (4). Earlier is more effective. Levonorgestrel and ulipristal acetate are oral options; ulipristal extends the post-coital window relative to levonorgestrel; a copper IUD is the most effective emergency contraception and can be placed within the locally permitted window, doubling as an ongoing LARC. Confirm the exact regimen and window from local protocol and product information. Rule out pregnancy before any ongoing method start; offer quick-start of a regular method alongside emergency contraception. [6]

Dual protection (3). No hormonal or intrauterine method prevents STI, so condoms must be added to the chosen pregnancy-prevention method. Research in adolescents and young adults shows dual method use is the practical route to reducing both pregnancy and STI, but negotiation with partners is hard — address this openly and rehearse language. [8]

Controlling partner / safety (3). Ask directly and privately about coercion, age and power imbalance, and whether she feels safe. A controlling partner is a red flag for exploitation and may meet a confidentiality override and a mandatory-reporting threshold. Assess safety, involve safeguarding and sexual-assault pathways as indicated, share the minimum necessary with her knowledge where possible, and document decisions. Do not discharge into a dangerous situation. [4]