Adolescents with chronic conditions Sex, drugs and chronic illness: health behaviours among chronically ill youth. Sex, drugs and chronic illness: health behaviours among chronically ill youth. “chronically ill adolescents are as likely, or more likely, to take risky behaviours than their healthy counterparts” Suris J-C. European Journal of Public Health. 15(5):484-488, October 2005
What’s are the risks of teenage sex? Regret Coercion STI risk Pregnancy risk Drug and alcohol use Unsafe sex Transmission RiskDisclosure of status
What is the reality of teenage sex? oA quarter of girls and nearly a third of boys have sex under 16 but the average age for both sexes is 16 oRegret is a major issue for young people with 67% of young men and 84% of young women who had sex aged 13 and 14, wishing they had waited. oUp to 50% of adolescents used no contraception oWorking-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
Sexually Transmitted Infections Important to screen for STI’s for patient and partner benefit Chlamydia and Gonorrhoea Non invasive methods available – urine/ self taken swabs
Contraception Reluctance to use any method that causes menstrual change Concern about bone density issues Medication interactions Promoting the dual protection approach – what use are condoms as a method of contraception?
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
Information sharing - GMC You should usually share information about abusive or seriously harmful sexual activity involving any child or young person, including that which involves : 1. a young person too immature to understand or consent 2. big differences in age, maturity or power between sexual partners 3. a young person’s sexual partner having a position of trust 4. force or the threat of force, emotional or psychological pressure, 5. bribery or payment, either to engage in sexual activity or to keep it secret 6. drugs or alcohol used to influence a young person to engage in sexual activity when they otherwise would not 7. 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 Embarrassment Fear of disapproval/ Disappointing people GENITAL EXAMINATION Internet Consent/ Confidentiality Worries about stigmatisation Parental involvement Fear of authority
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?