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How a GP Should Manage an Underaged Patient in a Sexual Relationship: A Guide for PLAB 2 Candidates


Young people may present to a GP with requests for contraception, treatment for genital symptoms, or vague concerns that, on careful questioning, reveal they are in a sexual relationship with an older adult. Such cases require a structured approach, balancing medical care with safeguarding duties.

This blog outlines what to do in these scenarios according to UK law, GMC guidance, and safeguarding protocols, and highlights the key points examiners look for in PLAB 2.



1. First Principles: A Safe and Supportive Consultation

  • Build rapport: Open with empathy and non-judgment.

    “I can see this is difficult to talk about. Thank you for trusting me.”

  • Active listening: Allow the patient to speak, using gentle prompts.

  • Professional boundaries: Always have a chaperone present during sensitive history or examination.



2. Confidentiality and Its Limits

  • Young people value confidentiality and you should start by reassuring them.

  • But: UK law places limits when safety is at risk.

    • Under 16 in a sexual relationship with an adult (especially someone in authority, like a teacher) = child sexual abuse.

    • In such cases, confidentiality cannot be guaranteed.


How to explain:

“Normally what you share with me is private. But because of your age and your partner’s age, I cannot keep this to myself. I must involve professionals whose job is to keep you safe. This is to protect you, not to punish you.”

3. Gillick Competence & Fraser Guidelines

  • Gillick competence: Assesses if a child under 16 has the maturity to understand the nature, risks, and consequences of treatment.

  • Fraser guidelines: Specific to contraception, you may prescribe if:

    1. She understands the advice given.

    2. You cannot persuade her to involve her parents.

    3. She is likely to continue sexual activity with or without contraception.

    4. Her physical/mental health is likely to suffer without advice/treatment.

    5. It is in her best interests to give advice/treatment.


⚠️ However: if there is evidence of coercion, abuse, or exploitation (e.g. a 15-year-old with a 30-year-old teacher), safeguarding overrides Fraser guidelines.



4. Clinical Care to Offer

Even in safeguarding cases, you must address immediate health needs:

  • Pregnancy test.

  • STI screen (chlamydia, gonorrhoea, syphilis, HIV, hepatitis).

  • Examination (with consent & chaperone).

  • Contraception advice, explain the pill prevents pregnancy but not STIs; condoms are essential.

  • HPV vaccination if not already completed.



5. Safeguarding Duties


Red flags to identify:

  • Large age gap (under 16 with much older partner).

  • Relationship with a person in authority (teacher, coach, etc.).

  • Secrecy, reluctance to disclose details.

  • No use of protection, partner discouraging safe practices.

  • Signs of coercion, grooming, or emotional pressure.


Who to involve:

  • Practice Safeguarding Lead (first point of contact).

  • Children’s Social Services (child protection referral).

  • School Safeguarding Officer (if perpetrator is from school).

  • Police (statutory rape, abuse of trust).

  • Sexual Assault Referral Centre (SARC)- for forensic examination, STI screening, emergency contraception, counselling.

  • CAMHS / counselling services- for psychological support.



6. Emotional and Social Support

  • Acknowledge feelings: the young person may see the relationship as loving.

  • Reassure: they are not in trouble.

  • Encourage confiding in a trusted adult.

  • Provide leaflets and helplines:

    • NSPCC Childline (0800 1111).

    • Rape Crisis UK.

    • Victim Support.

    • Brook Advisory Services (sexual health for under-25s).



7. Role of the GP

  • Recognise safeguarding concerns.

  • Provide initial medical care (tests, advice, urgent needs).

  • Explain confidentiality limits clearly and compassionately.

  • Escalate immediately through safeguarding channels.

  • Do not arrange routine GP follow-up, ongoing care will be through GUM/SARC/social services.

  • Document carefully: record patient’s words verbatim, your assessment of competence, red flags, and actions taken.



8. PLAB 2 Key Take-Home Points

  • Stay calm, empathetic, and non-judgmental.

  • Always balance clinical care with safeguarding.

  • Explain confidentiality and safeguarding in plain words.

  • Mention Gillick competence and Fraser guidelines, but show you know when safeguarding takes precedence.

  • Know the referral pathway: Safeguarding lead → Social Services → Police/SARC → GUM clinic.

  • Reassure the young person they are not alone and will be supported.


📚 References

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