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Sexual health history taking in the adolescent

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  • See also

    Engaging with and assessing the adolescent patient
    Sexually transmitted infections
    Vulval and vaginal conditions
    Contraception

    Key points

    1. Sexual health history taking is a standard part of health care for adolescents
    2. Communication with adolescents about sexual health should be non-judgemental and gender neutral
    3. The adolescent’s legal right to confidentiality and exceptions to this right should be explicitly discussed
    4. Sexual health history taking should lead to individualised advice on sexually transmitted infections (STIs) prevention, screening and contraception

    Background

    • In Australia, almost three in four people aged 14-18 years have had an intimate relationship. Almost half of people aged 16-18 years have engaged in sexual intercourse
    • Adolescents are an ‘at risk’ group for STIs and unplanned pregnancy
    • Young people consistently have the highest incidence of chlamydia infections in Australia over the last decade. They are the age group least likely to use the most effective contraceptive options

    Assessment

    History

    • Normalise sexual health history taking as a routine part of healthcare for adolescents
    • Provide the opportunity for the adolescent to discuss sexual health without parents or caregivers present
    • Use gender neutral terms and communicate in a non-judgemental manner
    • Give the adolescent the opportunity to ask questions
    • The “PARTNERS” mnemonic may be useful in remembering the key elements of a sexual history

    Topic

    Example phrase

    Follow up actions

    Introduction

    “Sexual health is an important part of everybody’s health; however, it is often not talked about. Would it be ok if I asked you some questions about your sexual health? You do not have to answer anything you don’t feel comfortable with.”

    Yes: “Great. What we discuss today will remain confidential between us. The only exception would be if I was worried about you or someone else being harmed, or if I do not have all the answers to your questions and will discuss with a colleague. Is that ok?”

    No: “That’s ok. We always aim to bring up sexual health when we see you. If at any time in the future you have questions or you would like to discuss sexual health, please let me know.”

    Sexual activity

    “Have you ever been sexually active?”

    Yes: “I’d like to ask some further questions to check your sexual health, is that ok?”

    No: “If you do become sexually active, or if you would like to discuss some important things to consider when you become sexually active, we can talk about this.”

    P: Partner/s

    “Do you have a regular sexual partner?”

    Yes: “Have you had sex with anyone other than your regular partner?”

    No: “How many sexual partners have you had in recent months?”

    Establish age and gender of partner/s

    A: Activities

    “What types of sex do you have/have you had?”

    Establish types of sexual activity and body parts involved eg vaginal, anal, oral sex

    R: Reproduction
    (Contraception)

    “Are you, or your partner/s, using contraception to prevent pregnancy and STIs?”

    Establish the types of contraception used, frequency of use, acceptability

    T: Transmission of infection
    (STIs)

    “Have you ever been tested, or required treatment, for a STI?”

    Take history of STIs, screening, treatment and follow up testing

    Check for current STI symptoms

    N: No
    (Sexual abuse)

    “Has anyone ever tried to hurt you during sex, or make you have sex when you’ve said no?”

    If sexual abuse is suspected, refer to local guidelines/mandatory reporting requirements. Recent sexual assault (<72 hours) requires urgent specialist consultation

    See child abuse

    E: Etiquette
    (Consent)

    “It’s important that you always feel safe during sex. Can we talk about what consent means?”

    See discussing sexual consent with teens

    R: Risk reduction
                 

    “Can we talk about ways to reduce your risk of pregnancy and STIs?”

    Barrier contraception should be recommended in addition to more reliable forms of contraception to reduce risk of STIs

    See contraception

    S: Screening
     

    “STIs are common in young people, and they often don’t cause symptoms. In Australia we recommend that all sexually active young people get tested for STIs each year. Can we do this today?”

    See sexually transmitted infections

    Examination

    • Not usually required. If there are symptoms suggestive of STIs such as abnormal genital discharge or pain, an examination including abdominal and/or pelvic examination may be warranted

    Management

    Investigations

    • In Australia, it is recommended that all sexually active people aged under 30 years have an annual STI screen. This may include self-collected and/or clinician collected samples. See sexually transmitted infections
    • If there is a concern of amenorrhoea in the context of recent unprotected sex, pregnancy testing may be indicated

    Treatment

    • Long-acting reversible contraceptives are the contraception of choice for adolescents as they are reliable, cost effective and have the highest satisfaction rates. See contraception
    • Barrier contraceptives (eg condoms) should always be recommended in addition to more reliable contraceptives to reduce the risk of STIs

    Consider consultation with local paediatric team when

    • Further STI screening and/or treatment required
    • Further contraception management required

    Consider consultation with Paediatric Forensic Medical Service if:

    • Non-consensual relationship or abuse suspected

    For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

    Parent information

    Raising Children Network

    ReachOut 

    Youth Law Australia  

    Additional resources

    Australian Society for HIV, viral hepatitis and sexual health medicine

    Centre for Excellence in Rural Sexual Health, University of Melbourne

    Last updated October 2023

  • Reference List

    1. Australian Institute of Health and Welfare, Young Australians: their health and wellbeing 2011, Canberra, AIHW, 2011.
    2. Department of Health. Third national sexually transmissible infections strategy 2014–2017. Canberra: DoH, 2014.
    3. Faculty of sexual & reproductive healthcare. Clinical guideline: Contraceptive choices for young people. 2019. Accessed 21.9.22. Available at https://www.fsrh.org/standards-and-guidance/fsrh-guidelines-and-statements/contraception-for-specific-populations/young-people/
    4. Goldenring JM, Rosen DS. Getting into adolescent heads: an essential update. Contemp Pediatr. 2004;21(1):64-90.
    5. Guy RJ, Ali H, Liu B, Hocking J, Donovan B, Kaldor J. Genital chlamydia infection in young people: A review of the evidence. Sydney: The Kirby Institute, 2011.
    6. Jaworska, N et al. Adolescence as a unique developmental period. Journal of psychiatry & neuroscience: JPN. 2015. 40 (5): 291-293.
    7. Kauer S, Fisher C. Victorian Young People and Sexual Health 2018, Bundoora: Australian Research Centre in Sex, Health & Society, La Trobe University
    8. Klein DA, Goldenring JM, Adelman W. HEEADSSS 3.0. Contemporary paediatrics. 2014. 16-28
    9. Sawyer S et al. The age of adolescence. The Lancet Child & Adolescent Health. 2018. 2 (3): 223-228.
    10. The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2015. The Kirby Institute. Sydney, NSW.
    11. The Royal Australian College of General Practitioners. Guidelines of preventative activities in general practice. 9th edition. 2016. RACGP. East Melbourne, Vic.