Appropriate contraceptive and sexual health counselling can reduce these poor health outcomes by identifying those at risk and reducing the rate of unplanned pregnancy. Provision of brief, simple information regarding effective contraception methods, correct condom use and where to access condoms and emergency contraception can help reduce unplanned pregnancies. Family Planning Alliance Australia (http://familyplanningallianceaustralia.org.au) has excellent online resources for GPs and patients.
Defining sexual coercion
The term sexual coercion encompasses a range of scenarios where one person feels uncomfortable or uncertain about what they are doing. It occurs when a person feels pressured into not using a condom, or ‘stealthing’, where one person removes a condom without the other person’s knowledge, right through to sexual assault. Sexual coercion often results from an imbalance of power between the two people, for example due to a significant age gap.
About 20% of Australian women over 15 years of age have experienced sexual violence. The number of people in Australia experiencing sexual coercion over the past few years has remained static, as has the number of people seeking help for this.7 Drug and alcohol use and inexperience are risk factors for sexual risk-taking behaviour. Alarmingly, unwanted sex is reported by almost one-third of sexually active young women in year 12.5
Identifying and assisting young people who have experienced sexual coercion can be challenging. Box 5 gives some examples of questions to ask to identify risk of sexual coercion.
What to do when a young person discloses nonconsensual sex
Discovering that a young person is or has been coerced into unwanted sexual activities can be a confronting and at times frightening experience for many GPs. It is important for the GP to remember they are not alone and that in most situations they do not need to come up with all the answers in one consultation. It is important to establish what the young person wants to happen and what their main concerns are.
Familiarity with the relevant state laws is important as they may vary from one state to another. The following services offer further assistance:
- local sexual health centres
- Family Planning Australia
- child protection units
- local sexual assault teams.
The Flowchart summarises the above steps for assessing sexual health in adolescents and young people.
Awareness of same-sex attracted young people
Same-sex attracted young people often face additional challenges, including increased rates of mental illness and attempted suicide. Discrimination can lead to higher rates of anxiety, depression and sexual risk-taking behaviour. Same-sex attracted young people are more likely to commence sexual activity at a younger age and have sex without a condom, and hence are more likely to acquire STIs.7 Pregnancy is twice as likely in same-sex attracted women who have sex with men then in heterosexual women. Discrimination and feelings of isolation and lack of support are higher among those who are same-sex attracted and living in regional and remote areas. Extra consideration needs to be given to these groups of young people. Box 6 gives a brief summary of additional important considerations and ways in which GPs can assist same-sex attracted young people.
Overall, undertaking a sexual health risk assessment of a young person is essential to ensure optimal health care. Engaging with a young person is key, and developing competence in this in general practice is essential. Being open and comfortable with questioning will help the young person feel comfortable and be honest with their responses. Although the assessment outlined above may appear time-consuming, with practice it can be completed in just a few minutes for most patients and more complex cases can be managed over several consultations. MT