PE6.{4,7,12} | Adolescent Sexuality — Summary & Reflection

KEY TAKEAWAYS

Adolescent sexuality encompasses normal sexual development (orientation, gender identity, sexual behaviour), common sexual health problems (STIs — chlamydia, gonorrhoea, syphilis, HIV; unintended pregnancy; dysmenorrhoea), sexual abuse (POCSO Act 2012 mandates reporting by ANY person within 24 hours when abuse of a person <18 years is suspected — no consent required, failure to report is a criminal offence), and drug abuse (tobacco/inhalants → alcohol → cannabis sequential pattern; CRAFFT score ≥2 = positive screen). Confidentiality is the foundation of the adolescent clinical encounter: stated explicitly at outset with its limits (breach when there is imminent risk of serious harm or POCSO-mandated reporting situation). The HEEADSSS S and D domains are the clinical tools for probing these issues, introduced after rapport is established, using open non-judgmental questions. Condom use is the first-line recommendation for sexually active adolescents for dual protection.

REFLECT

Consider the tension between respecting an adolescent's confidentiality and fulfilling the POCSO mandatory reporting duty. Imagine a 16-year-old who discloses a sexual relationship with a 21-year-old teacher, describes it as consensual and loving, and explicitly asks you not to tell anyone. Under POCSO 2012, you have no choice — you must report. How would you explain this to the adolescent in a way that preserves trust and does not re-traumatise her? What would you say, and what would you do in the next 24 hours? Reflect on the broader conflict between legal duty and the therapeutic relationship in adolescent medicine.