1. Young People’s Sexual Health Update Dr Fiona Fargie Sexual health and HIV consultant Sandyford, Glasgow

3. Reasons to talk about sex

4. What’s so great about teenage sex? Regret Coercion STI risk Pregnancy risk Drug and alcohol use Unsafe sex

5. 2002 National Survey of Sexual Health Attitudes and Lifestyles (NATSAL) Johnson,Wellings et al 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

6. Empowering young people!

7. Normal adolescent development?

8. Sexual education in the home!

9. Adolescents with chronic conditions

10. HPV vaccine

11. 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?

12. How to talk about sex!

13. 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

14. 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

15. 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

16. 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

17. 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!

18. 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?

19. 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?

20. 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?

21. 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 re- requests TOP  DNA next Social Gyn and not answering mobile – WHAT TO DO NEXT?

22. 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!!!

24. Questions?