Paediatrics: Sexual health problems

Sexual health problems

Sexual health is a priority for adolescent care. The median age of first sexual experience in the UK is around 16yrs of age.

Sexual health matters: areas that should raise concern

• Age <13yrs.

• Suspect age or power imbalance in relationships.

• Evidence of bribery and coercion.

• Overt aggression.

• Misuse of substances as a disinhibitor.

• Whether the behaviour places him/her at risk so that he/she is unable to make an informed choice.

• Attempts to secure secrecy made by the sexual partner.

• Whether the sexual partner is known to social services or police.

• Whether the child denies, minimizes, or accepts concerns.

Experience of sex at an early age is often associated with unsafe sex prac-tice. This may be due to lack of knowledge, or access to contraception, being under the influence of drugs, or inability to resist peer pressure. Unsafe sex practices may lead to unwanted pregnancies and STIs.

Adolescent pregnancy

The UK has one of the highest rates of teenage pregnancy in Europe (approx 20–25 per 1000 women aged 15–19yrs). Many such pregnan-cies occur within marriage. Most unwanted teenage pregnancies occur in the context of poverty, low educational achievement, and adverse social factors (e.g. mental health problems, sexual abuse, and crime). Infants of teenage mothers are at increased risk of being low birth weight (SGA). Prevention of teenage pregnancies is a high priority. Health promotion and sex education are successful in this area.

Sexually transmitted infections

Rates of STIs in UK 16–19yr olds in the UK are increasing. The highest rates of infection occur in Afro-Caribbeans and Africans. 30–40% of sexu-ally active girls in high-risk groups may be infected with Chlamydia.

Adolescents: risk factors for STIs

• Avoidance of barrier contraception methods.

• Multiple, sequential, or concurrent partners.

• Mental illness.

• Substance misuse.

Clinical symptoms and signs similar to adults.

Symptoms of Chlamydia in adolescents

• Males: asymptomatic (50%); urethritis or discharge.

Females: asymptomatic (70%): confidential screening/testing programmes have been proposed and a national Chlamydia programme has been available in the UK since 2006; vaginal discharge (especially early adolescence); pelvic inflammatory disease.