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]}