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PUID 50:: Underage Contraception Request GP:: A PLAB 2 Mock:: 1st Attempt

Updated: Jul 25

Summary:

This scenario involves a teenage patient requesting emergency contraception following unprotected sexual intercourse. The consultation requires assessing the patient's competence (Gillick and Fraser guidelines), exploring safeguarding issues, and educating on sexual health, emergency and long-term contraception, and STI prevention.



Key Points:


Teenage Reproductive Health & Emergency Contraception

  • Confirm patient's age and situation

  • Clarify timing and context of unprotected sex

  • Assess knowledge of contraception and STI prevention

  • Discuss emergency contraception timing and efficacy (24-72 hours)

  • Offer follow-up for long-term contraception (COCP, POP, implant, IUD)


Gillick Competence and Fraser Guidelines

  • Assess patient’s understanding of:

    • Medication mechanism

    • Side effects

    • Usage instructions

    • Consequences of not receiving the medication

  • Determine if the patient can give informed consent without parental involvement

  • Ensure patient demonstrates responsible intent to use contraception


Safeguarding and Consent

  • Ask about:

    • Age of sexual partner

    • Nature of the relationship (coercion, consent, grooming)

    • Willingness to involve parents or trusted adult

  • If patient is not competent or risks are present, escalate safeguarding concerns appropriately

Important Considerations:

  • Timing of unprotected intercourse affects EC options

  • LMP and menstrual history critical for pregnancy risk assessment

  • Discuss dual protection: contraception and STI prevention

  • Encourage but not force parental involvement

  • Confidentiality: break only if serious risk is identified

  • Always document Gillick competence assessment and all advice given



Diagnostic Approach:

  1. Establish rapport and confidentiality clause (limited)

  2. Elicit presenting complaint and sexual history

  3. Clarify timing of intercourse and previous contraceptive use

  4. Explore understanding of EC and potential consequences

  5. Assess safeguarding and relationship dynamics

  6. Evaluate Gillick competence using appropriate questions

  7. Gather medical history, LMP, and any STI symptoms

  8. Gauge willingness to involve parents or other trusted adults



Management:


Emergency Contraception:

  • Offer Levonorgestrel or Ulipristal (based on timing and suitability)

  • Discuss how to take the medication and side effects

  • Advise on actions if vomiting occurs within two hours

  • Reiterate that it is not for routine use


Long-term Contraception:

  • Offer information on COC, POP, implant, IUD

  • Recommend follow-up for contraception counseling

  • Provide written resources and arrange clinic referral if needed


STI Screening and Prevention:

  • Offer STI screening and educate on STI symptoms

  • Emphasize consistent condom use even with other contraception


Safety Netting:

  • Advise on potential menstrual changes

  • Recommend pregnancy test if period is more than 7 days late

  • Ensure patient knows when and how to seek help


Communication Skills:

  • Use age-appropriate, non-judgmental language

  • Avoid medical jargon; check understanding via teach-back

  • Validate patient concerns and be supportive

  • Respect autonomy while guiding responsibly

  • Avoid overuse of scripted phrases; maintain natural flow


Ethical Considerations:

  • Maintain confidentiality unless there's a risk of harm

  • Promote autonomy while ensuring safeguarding

  • Uphold documentation standards to protect patient and clinician

  • Provide non-coercive, balanced information on parental involvement


Additional Resources:

  • GMC Good Medical Practice (2024)

  • Fraser Guidelines

  • Faculty of Sexual and Reproductive Healthcare (FSRH)

  • NHS Contraception Services

  • Brook Advisory Clinics (youth-focused sexual health support)

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