Paeds · adolescent-and-young-adult-medicine
Adolescent sexual health and contraception
Also known as Adolescent contraception · Youth sexual and reproductive health · LARC for adolescents · Confidential contraceptive counselling · Dual protection in youth · Teen pregnancy prevention
A fellowship approach to adolescent sexual health and contraception: confidential, youth-centred sexual history (the 5 Ps), LARC-first counselling using Medical Eligibility Criteria principles, dual protection against pregnancy and STIs, quick-starting, emergency contraception, HPV vaccination, red-flag safety action, and follow-up across ANZ, UK, US and Canada.
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Target exams
Red flags
- Disclosure of sexual coercion, assault, exploitation or trafficking
- Pregnancy with coercion, partner age/power imbalance or unsafe home
- Capacity to consent to care is in doubt or being overridden
- Acute pelvic or abdominal pain, fever or suspected ectopic/STI complication
- Severe adverse effect (e.g. possible venous thromboembolism on combined hormonal method)
- No confidential space available and a high-risk history cannot be explored safely
- Parent or billing/portal pathway about to leak sensitive adolescent content
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Adolescent sexual and reproductive health
- Current 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own culture
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Clinical Applications
- Adolescent sexual health and contraception
- Long Cases
- Short Cases
- Communication stations
- 4. Professional skills and knowledge: Patient management
- 5. Health promotion and illness prevention
- 11. Adolescent health
- General Paediatrics: Provides confidential, developmentally appropriate sexual health and contraceptive care to young people within legal frameworks
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Adolescent sexual health, contraception and safeguarding
- History
- Communication
- Clinical
- General Pediatrics Content Outline — Domain 11: Adolescent Medicine and Gynecology
- General Pediatrics Content Outline — Domain 12: Infectious Diseases (STI screening)
- General Pediatrics EPA 3: Providing well-child and adolescent care including preventive care and anticipatory guidance
- General Pediatrics EPA 11: Promoting equitable care at the level of each individual patient and the population
- Patient Care 1: History and Physical Examination
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice 3: System Navigation for Patient Centered Care – Coordination of Care
- Professionalism 1: Professional Behavior and Ethical Principles
- Professionalism 5: Confidentiality and adolescent rights
- Communicator
- Health Advocate
- Professional
- Pediatrics: Foundations EPA — Providing sexual and reproductive health care for adolescents
- Pediatrics: Core EPA — Providing preventive care and anticipatory guidance
Overview & Definition
A 16-year-old asks for "the pill." You write the script, never ask about partners, pressure or periods, and miss a coercive relationship and an unsafe home. Six weeks later the same young person is pregnant. The failure was not the molecule. It was a sexual health visit without youth-centred process. [6] [16]
Adolescent sexual health is the lifelong wellbeing of young people in relation to sexuality — physical, emotional and social — not merely the absence of disease or unplanned pregnancy. Contraception is one tool within that frame. The clinician's job is confidential counselling, accurate information, method provision, STI prevention and timely safety action, delivered with respect for the young person's emerging autonomy. [6]
Long-acting reversible contraception (LARC) — the intrauterine device (IUD) and the subdermal implant — is the effectiveness backbone for this age group. In the Contraceptive CHOICE Project, LARC methods had far lower failure than pills, patches or rings precisely because they remove the user from the equation. [1] [4]
Core sequence of a contraceptive consult
- 1
Private frame
Time alone and conditional confidentiality stated before any history.
- 2
5 Ps history
Partners, Practices, Protection, Past STI, Pregnancy intention — plus coercion.
- 3
Screen and rule out
Pregnancy test, STI risk, contraindications using Medical Eligibility Criteria principles.
- 4
Method counselling
Full options, LARC-first, side-effects and reversibility — the young person chooses.
- 5
Dual protection + plan
Condoms for STI, HPV vaccine, emergency contraception plan, close follow-up.
References16ShowHide
- [1]Winner B, Peipert JF, Zhao Q, Buckel C, Madden T, Allsworth JE, Secura GM Effectiveness of long-acting reversible contraception. N Engl J Med, 2012.PMID 22621627
- [2]Mestad R, Secura G, Allsworth JE, Madden T, Zhao Q, Peipert JF Acceptance of long-acting reversible contraceptive methods by adolescent participants in the Contraceptive CHOICE Project. Contraception, 2011.PMID 22018123
- [3]Grunloh DS, Casner T, Secura GM, Peipert JF, Madden T Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use. Obstet Gynecol, 2013.PMID 24201685
- [4]Birgisson NE, Zhao Q, Secura GM, Madden T, Peipert JF Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review. J Womens Health (Larchmt), 2015.PMID 25825986
- [5]Usinger KM, Gola SB, Weis M, Smaldone A Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review. J Pediatr Adolesc Gynecol, 2016.PMID 27386754
- [6]American College of Obstetricians and Gynecologists Committee Opinion No. 710: Counseling Adolescents About Contraception. Obstet Gynecol, 2017.PMID 28742675
- [7]Tepper NK, Krashin JW, Curtis KM, Cox S, Whiteman MK Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2016: Revised Recommendations for the Use of Hormonal Contraception Among Women at High Risk for HIV Infection. MMWR Morb Mortal Wkly Rep, 2017.PMID 28934178
- [8]Rome ES, Issac V Sometimes You Do Get a Second Chance: Emergency Contraception for Adolescents. Pediatr Clin North Am, 2017.PMID 28292452
- [9]Haeger KO, Lamme J, Cleland K State of emergency contraception in the U.S., 2018. Contracept Reprod Med, 2018.PMID 30202545
- [10]Davidson KW, Barry MJ, Mangione CM, et al. Screening for Chlamydia and Gonorrhea: US Preventive Services Task Force Recommendation Statement. JAMA, 2021.PMID 34519796
- [11]Cantor A, Dana T, Griffin JC, Nelson HD, Weeks C, Winthrop KL, Chou R Screening for Chlamydial and Gonococcal Infections: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA, 2021.PMID 34519797
- [12]Lei J, Ploner A, Elfström KM, Wang J, Roth A, Fang F, Sundström K, Dillner J, Sparén P HPV Vaccination and the Risk of Invasive Cervical Cancer. N Engl J Med, 2020.PMID 32997908
- [13]Busen NH Bone mineral density in adolescent women using depot medroxyprogesterone acetate. J Am Acad Nurse Pract, 2004.PMID 15055422
- [14]Hood JE, Hogben M, Chartier M, Bolan G, Bauer H Dual contraceptive use among adolescents and young adults: correlates and implications for condom use and sexually transmitted infection outcomes. J Fam Plann Reprod Health Care, 2014.PMID 24293508
- [15]Carter MW, Hock-Long L, Kraft JM, Henry-Moss D, Hatfield-Timajchy K, Singer M Strategies for managing the dual risk of sexually transmitted infections and unintended pregnancy among Puerto Rican and African American young adults. Am J Public Health, 2012.PMID 22390507
- [16]Whitfield B, Vizcarra E, Dane'el A, Palomares L, D'Amore G, Maslowsky J, White K Minors' Experiences Accessing Confidential Contraception in Texas. J Adolesc Health, 2023.PMID 36604208