Adolescent Sexual and Reproductive Health
Confidentiality and consent
Sexual health care works only when the teen trusts it. Explain what will be shared before asking questions; many jurisdictions allow minors to consent to STI testing, contraception, and pregnancy care, but rules vary and should be verified rather than assumed. Offer time alone with the patient at every visit.
Contraception
Long-acting reversible contraception - the subdermal implant and IUDs - is first-line for adolescents because adherence, not efficacy, drives typical-use failure. Combined hormonal methods (pill, patch, ring) are reasonable options with counseling about consistent use and the added VTE risk from smoking. DMPA is acceptable; discuss bone density without withholding it. Only condoms prevent STIs, so dual protection is the standard message. Emergency contraception: levonorgestrel up to 72 hours, ulipristal up to 120 hours, and the copper IUD up to 5 days (most effective). No pelvic examination or Pap test is needed before starting hormonal contraception.
STIs and prevention
Annual chlamydia and gonorrhea screening for sexually active females 24 or younger and for males with risk factors; syphilis and HIV testing by risk; HPV vaccination through age 26 (catch-up to 45 by shared decision). Treat pelvic inflammatory disease with broad coverage and treat partners; expedited partner therapy is legal in many states. Offer PrEP to at-risk adolescents.
Traps
Irregular cycles in the first two years after menarche are usually normal, but heavy bleeding with iron deficiency, or pain unrelieved by NSAIDs plus combined pills, warrants evaluation for a bleeding disorder or endometriosis. Do not assume a teen is abstinent - or that they are not.
Rule of thumb
Ask about condoms and contraception separately; one answer does not cover the other.