Adolescent Reproductive and Sexual Health
Contraception and STI care
Adolescents can often consent confidentially to contraception and STI care under state law, but rules vary. Offer the full method mix, emphasizing long-acting reversible contraception (implants and intrauterine devices) as first-line, plus condoms for dual protection. Emergency contraception includes levonorgestrel (up to 72 hours), ulipristal (up to 120 hours), and copper IUD (up to 5 days). Screen sexually active adolescents annually for chlamydia and gonorrhea, and offer HIV and syphilis testing based on risk.
Reproductive concerns
Dysmenorrhea responds to NSAIDs and hormonal therapy. Secondary amenorrhea, hirsutism, and acne may suggest PCOS. Pregnancy options counseling should be nonjudgmental and include all options. Ask about sexual orientation and gender identity, use inclusive language, and protect confidentiality.
Traps
Do not require a pelvic examination to diagnose asymptomatic chlamydia; use nucleic acid amplification testing. Do not assume a patient is heterosexual. Do not disclose STI results to parents without consent unless required. Age of consent and mandatory reporting vary. Levonorgestrel is less effective with obesity and may be less effective after ovulation.
Rule of thumb
If a 17-year-old requests confidential contraception, confirm confidentiality limits, offer LARC and condoms, and screen for STI risk without requiring parental consent. Document the discussion and follow-up plan.