Sexual Health

Sexuality often has an important role in the development, health and wellbeing of a young person. The topic of sexuality may arise during a psychosocial assessment, and this page provides tips for assessment and management of risks that may arise relating to sexuality and sexual health.

 

Assessment

  1. An accepting, non-judgemental approach is necessary to facilitate effective communication and management.
  2. Address confidentiality issues and concerns and obtain consent from the young person before discussing sexual health.
  3. Sexual health assessment is based on clinical judgement and should involve discussing romantic relationships and taking a sexual history, which may also be identified during a psychosocial assessment.
  4. Use of the formulation framework can assist in understanding the broader context of the young person’s romantic relationships, sexual activity and sexual health.
  5. How to assess if the young person has capacity to consent to healthcare decisions or assess maturity?
  6. Allied health professionals have an important role in discussing testing for sexually transmitted infections such as chlamydia, gonorrhoea, and syphilis.
  7. Checking vaccination status is important for key vaccine preventable STIs including Hepatitis A and B and HPV (genital warts and cervical cancer).
  8. Consider the potential for abuse, coercion or exploitation and other forms of intimate partner violence. The younger the person the more carefully these possibilities need to be considered. “The situation of a young person under the age of 14 being sexually active should present a ‘red flag’ requiring careful assessment and documentation.”[1]
  9. Mandatory reporting may be required if violence or a risk of violence is suspected or exists.
  10. Screening sexually active young people for substance use is recommended, as substance use can increase sexual behaviours that may put the young person at risk of harm. Problematic drinking is associated with an increased risk of STIs for both men and women.
  11. Romantic attractions, activities and relationships are associated with increased risk of experiencing depressive symptoms in adolescence, particularly for adolescent girls. See the clinical toolkit for depression and anxiety for more information.  It is therefore important to consider the impacts of romantic relationships in adolescents.

 

Videos:

Importance of talking to young people about early sexual risk taking

 

Considerations when working with LGBTIQA+ young people

  1. See the headspace clinical toolkit on engagement, including tips for engaging LGBTIQA+ young people, who may experience unique challenges as they progress through adolescence and young adulthood.
  2. Discussions around sexual health may be a young person’s first disclosure of their sexuality or gender. See guides by headspace for working safely and inclusively with sexuality diverse young people and trans or gender-diverse  young people.
  3. A young person experiencing significant distress and the symptoms described in the DSM-5 for a period of six months may meet the criteria for a diagnosis of gender dysphoria.
  4. Trans, gender-diverse, and sexuality diverse young people use alcohol and other drugs  at higher rates compared to cisgender, heterosexual young people, which may impact the decision to screen for substance use. See the alcohol and other drugs clinical toolkit  for more information including assessment recommendations.
  5. Men who have sex with men are at increased risk of contracting HIV. Prevention strategies can reduce these risks significantly. See the Management section for more information on HIV prevention and management.

Video:

Working with Young People who are both LGBTIQA+ and from Aboriginal and Torres Strait Islander Background

 

Considerations when working with Aboriginal and Torres Strait Islander young people

  1. See the headspace clinical toolkit on engagement, including tips for engaging Aboriginal and Torres Strait Islander young people, who may experience unique challenges as they progress through adolescence and young adulthood.
  2. Culturally safe assessment with Aboriginal and Torres Strait Islander young people may be enhanced by several factors within a clinician’s control.
  1. Aboriginal and Torres Strait Islander may be at greater risk of STIs due to barriers to condom use.

 

Video:

Working with Young People who are both LGBTIQA+ and from Aboriginal and Torres Strait Islander Background

 

 

 

 Management

Note that this section does NOT include all sexually transmitted infections. More comprehensive information including treatment guidelines can be found at the Australian Sexual Health Alliance website including young person specific content.

  1. Assess if the young person has capacity to consent to healthcare decisions and for assessment of maturity.
  2. Apply shared decision making where possible.
  3. Sexually active young people should receive appropriate education about the different contraception options available.
  4. Discussion of emergency contraception may be required if a young person has had unprotected sex.
  5. Allied health professionals have an important role in discussing testing for sexually transmitted infections such as chlamydia, gonorrhoea, and syphilis.
  6. Important information about preventing and managing Human Immunodeficiency Virus (HIV) infection:

 

 

Videos:

Motivational Interviewing – The Spirit of MI

Motivational Interviewing – Resisting the Righting Reflex

Motivational Interviewing – The Righting Reflex

Motivational Interviewing – Condom Use

Incorporating Family into Care

Cultural Considerations in Working with Family

 

  

Considerations when working with Aboriginal and Torres Strait Islander young people

  1. Culturally safe assessment with Aboriginal and Torres Strait Islander young people differs from other assessment approaches.
  2. Aboriginal and Torres Strait Islander may be at greater risk of STIs due to barriers to condom use.
  3. See the headspace clinical toolkit on engagement for more information on engaging with Aboriginal and Torres Strait Islander young people.

 

Videos:

Working with Young People who are both LGBTIQA+ and from Aboriginal and Torres Strait Islander Background

 

Resources for Young People

 

Resources for Friends and Family

 

Continuing Care

 

Comorbidity

Depression and anxiety

Romantic attractions, activities and relationships are associated with increased risk of experiencing depressive symptoms in adolescence, particularly for adolescent girls. The clinical toolkit contains more information on depression and anxiety.

Substance use disorders

Problematic drinking is associated with an increased risk of STIs, and this risk is present for both men and women.[2]

Alcohol and other drug use, particularly amphetamines, may be related to increased high-risk sexual practices because of increased arousal and decreased inhibitions.

 



[1] Claudio Villella. Management of Sexually Active Young People at headspace: confidentiality, consent and capacity. A Resource for headspace GPs. May 2015 p5

[2] http://journals.lww.com/stdjournal/Fulltext/2005/03000/Is_There_an_Association_Between_Alcohol.4.aspx