PUID: 62 || PLAB 2 Mock 6 :: Rape1: Statutory Rape Teacher Contraception

Practice a case with the AI patient 🤖

Summary:

This PLAB 2 case involves a 15-year-old girl requesting oral contraceptive pills. On further exploration, it is revealed that she is in a sexual relationship with her teacher. The case assesses the candidate’s ability to recognize child sexual abuse, handle safeguarding responsibilities, assess Gillick competence, maintain professional confidentiality with exceptions, and manage the patient’s physical and psychological wellbeing in line with GMC guidance.

Key Points

1. Safeguarding and Abuse Recognition

• Nature of abuse: The relationship constitutes child sexual abuse and abuse of power due to the significant age difference and authority imbalance.

• Teacher’s conduct: Violation of professional responsibility and safeguarding duty — statutory rape even if the child claims consent.

• Signs of abuse: Coercion, grooming, dependency, fear, secrecy, or reluctance to disclose full details.

2. Confidentiality and its Limits

• Confidentiality must always be qualified in child safeguarding cases.

• Inform the patient: “What you share is confidential unless I believe you or someone else is at risk of harm — then I must share this with the safeguarding team to keep you safe.”

• Breach of confidentiality is ethically justified when a child’s welfare or safety is at risk (GMC, Good Medical Practice, Domain 2, para 41–42).

3. Gillick Competence & Fraser Guidelines

Used to assess whether a minor can consent to contraception and understand its implications:

• Gillick test: Determines understanding, reasoning, and ability to retain information.

• Fraser Guidelines questions:

  • Why do you want contraception?

  • What do you understand about how it works?

  • Are you aware of the side effects and risks (e.g., STIs)?

  • What are your plans if you become pregnant?

  • Would you tell your parents or a trusted adult?

If the child demonstrates understanding but is in an abusive relationship, safeguarding overrides consent.

4. Sexual History and Risk Assessment

• Obtain a sensitive, non-judgmental sexual history:

  • Age and occupation of the partner.

  • Nature of the relationship — coercion, consent, frequency, last intercourse.

  • Any history of violence, threats, or secrecy.

• Ask open-ended questions: “Could you tell me a little about your partner?”; “How did you meet him?”; “Has he ever pressured you into anything you didn’t want?”

• Explore physical and emotional safety.

5. Immediate Management

• Safeguarding: Contact the Child Protection Lead, Social Services, and Local Safeguarding Board.

• Inform school safeguarding liaison (since perpetrator is a teacher).

• Involve parents if safe and appropriate.

• CAMHS referral: For psychological support and trauma counselling.

• STI screening: Offer tests for chlamydia, gonorrhoea, HIV, and syphilis.

• Pregnancy testing and emergency contraception if indicated (within 72–120 hours depending on type).

6. Contraception Considerations

• Assess contraindications: migraine, smoking, thromboembolic risk.

• If recently sexually active, consider emergency contraception before starting regular pills.

• Discuss barrier protection (condoms) to prevent STIs.

• Document assessment of competence, safeguarding concerns, and actions taken clearly.

Important Considerations

• This is not a consented sexual relationship — statutory rape applies.

• Always document and report concerns immediately.

• Do not promise absolute confidentiality.

• Offer empathy and psychological support.

• Follow GMC safeguarding standards and NICE child protection guidelines.

• Your primary duty is to protect the child’s welfare, even if she perceives the relationship as consensual.