Predictors of sexual activity:

• following predictors for early sexual activity

  • etoh

  • cigarette smoking

  • non-attendance at school

  • conduct disorder

  • mother first child \<20yo

Competence

Fraser guidelines

(Gillick competency)

• Young person understands advice being given

• cannot be persuaded to involve parents/carers or allow medical practitioner to do so on their ehalf

• likely to begin , or continue, having sexual intercourse with or without contraception

• unless young person receives contraception, theri physical or mental health (or both) is likely to suffer

• young person’s best interests require contraceptive advice, treatment or supplies to be given with or without parentla consent

Specific issues:

Physical and immunological immaturity

• young girls

  • lower genital tract lined with columnar epithelium

  • during puberty cells slowly regress inot endocervix

  • until they regress

    • remain exposed on exocervix

    • more susceptivle to attachment and invasion by organisms

  • immunologically immature compared to adults

  • more likely to acquire infection when exposed for first time

lack of use of barrier contraception

• lack of knowledge, access to condoms, misperception condoms not required

Age at first intercourse

• younger age = longer period of exposure

co-existence of other risk behaviours

• drug/etoh missuse

Key points when starting pill

• when to start

• improtance of taking pill same time each day

• call practice with any questions or problems