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.

Video:

• 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.
3. 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:

• Current evidence suggests that all people living with HIV should start Anti-retroviral treatment (ART) as soon as possible after diagnosis. Refer for specialist advice.
• Post-exposure prophylaxis (PEP) can be offered within 72 hours of potential HIV exposure. See the National HIV PEP Guidelines and Policy for more information.
• Pre-exposure prophylaxis (PrEP) can provide highly effective prevention of HIV in HIV-negative individuals. See the National PrEP Guidelines for more information.
  
  

What to do when an STI screen comes back positive:

1. Build motivation for reducing risk from sexual activities and increasing contraceptive use using motivational interviewing.
2. If unvaccinated, support young people to obtain access to catch-up-vaccines including for vaccine preventable STIs including Hepatitis A and B and HPV (genital warts and cervical cancer).
3. Encouraging assertiveness and negotiation skills may enable a young person to have and maintain healthy relationships.
4. Motivational interviewing can also help build motivation to have healthy, fulfilling and safe relationships and sexual activities.
5. Enable and encourage commitment to change with change talk.
6. Substance use during pregnancy can severely impact the developing child. Education on these impacts and available contraception options may enable a sexually active young person who uses alcohol or other drugs to protect their health and avoid harm to an unborn child. Use motivational interviewing to discuss these risks. Refer to the Substance Use Clinical Toolkit for more information.

Videos:

• Motivational Interviewing – The Spirit of MI
• Motivational Interviewing – The Righting Reflex
• Motivational Interviewing – Resisting 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.

Video:

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

Resources for Young People

• How headspace can help
• Understanding sex and sexual health fact sheet or article
• I want to cope better after a relationship breakup
• What is sexting and image-based abuse?
• Understanding sexual consent
• What is gender identity?
• Understanding sexuality and sexual identity.
• Resources for Aboriginal and Torres Strait Islander young people.
• ReachOut has more information on sex and romantic relationships.

Resources for Family

• How headspace can help
• Understanding teenage relationships
• Understanding sexting and image-based abuse - for families
• Understanding gender identity - for families
• Understanding sexuality and sexual identity - for families

Continuing Care

• Consider engaging family support.
• Key facts about hormone therapy for trans or gender-diverse young people.
• Regularly review relationship status, sexual health and any risks identified during assessment.
• Continue using motivational interviewing for reducing risks from sexual activities and increasing contraceptive use.
• Continue encouraging commitment to change with change talk.
• Review headspace guides for working safely and inclusively with sexuality diverse young people and trans or gender-diverse young people.

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.