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

Practice a case with the AI patient 🤖

Summary:

This case involves a teenage girl seeking emergency contraception following unprotected sexual intercourse. The consultation emphasizes timely management, safeguarding assessment, communication about contraception options, and ensuring patient autonomy while exploring support systems.

Key Points:

Sexual and Reproductive Health

• Clarify details about the unprotected sexual encounter (timing, consensual nature, use of contraception).

• Assess menstrual history: last menstrual period, regularity, and cycle length.

• Offer emergency contraception promptly, emphasizing effectiveness within 24 hours.

Safeguarding and Consent

• Ask about the partner’s age and nature of the relationship to assess for coercion, grooming, or abuse.

• Establish whether the patient is under pressure or in a safe environment.

• Discuss patient’s willingness to involve parents or guardians in her care.

Medical and Drug History

• Enquire about past medical history, allergies, STI history, and current medications.

Long-Term Contraception

• Discuss that emergency contraception is not a regular method.

• Offer information on long-term methods (e.g., combined oral pills, implants, IUDs).

• Stress the importance of using condoms for STI and pregnancy prevention.

Important Considerations:

• Always explore safeguarding issues in underage sexual activity.

• Clearly explain confidentiality and its limits (i.e., will be breached only if there's a risk to the patient or others).

• Emergency contraception does not prevent STIs.

• Offer written information and refer to appropriate sexual health services.

Diagnostic Approach:

1. Take detailed sexual and menstrual history.

2. Assess understanding and expectations regarding emergency contraception.

3. Rule out contraindications to emergency contraceptive pills.

4. Evaluate need for safeguarding intervention based on relationship context.

5. Screen for STIs if sexually active and not recently tested.

Management:

• Offer emergency contraception (Levonorgestrel or Ulipristal) and explain how it works.

• Discuss side effects: nausea, vomiting, irregular bleeding.

• Advise on what to do if vomiting occurs within two hours of ingestion.

• Discuss long-term contraceptive options and arrange follow-up.

• Offer STI screening and advise on regular condom use.

• Provide written leaflets, clinic contact details, and emergency numbers.

• Ensure thorough documentation of the consultation and advice given.

• Include safety netting: advise a pregnancy test if the next period is >7 days late.

Communication Skills:

• Use open-ended questions and active listening.

• Validate concerns and reassure the patient supportively.

• Use clear, age-appropriate language.

• Respect autonomy and avoid judgment.

• Avoid rehearsed or artificial phrases; focus on genuine interaction.

Ethical Considerations:

• Balance between respecting confidentiality and addressing safeguarding.

• Avoid assumptions based on age; assess maturity and competence.

• Encourage but do not force parental involvement.

• Document discussions and decisions meticulously.

Additional Resources:

• GMC Good Medical Practice on safeguarding and confidentiality.

• Brook and NHS leaflets on emergency contraception.

• Local sexual health clinic resources.

• NICE guidelines on contraception and STI screening.