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Treating teens

Dr Olive Buckley gives advice gleaned from running a teenage sexual health service in her practice

Dr Olive Buckley gives advice gleaned from running a teenage sexual health service in her practice

1 Be serious

Consider each problem, no matter how trivial it seems, with grave seriousness. One solitary spot may be as devastating as full-blown acne to the teen. It requires the same patience and empathy.

2 Be flexible

Expect that teenagers will postpone their appointment or not turn up. See them as soon as possible after they arrive as they tend not to hang around long.

Don't lecture them on your own importance and time commitments; that's the quickest way to ensure this needy population remain infrequent attenders and an opportunity to influence them positively will be lost.

3 Be sure to bite your tongue

When the horrible gungy ingrown toenail is prised from the much too small but nevertheless height-of-fashion boot resist the obvious temptation. Treat the toe first and be sure to remark on the loveliness of the boots.

It is then sufficient to drop in a little afterthought that perhaps the severe gruelling tortuous conditions may be a contributory factor. Then let them decide for themselves.

4 Be kind to piercings

Do not remove a piercing because it looks a little weepy and you think it was a silly thing to have done anyway.

Remember it's not your body. It's just your duty to look after this body that makes its own choices. Redness, swelling and discharge are normal features of any healing wound.

Salt in boiled water is just as effective as marketed cleaning solutions. Frequent turning of the ring or bar is recommended.

Some piercings heal faster than others. Clitoral hood piercings heal most quickly, often within days. On the other hand umbilical piercings heal in three distinct phases, taking nine-12 months for complete healing.

Piercings that are slow to settle are more likely to be due to pressure than infection. Granulation tissue suggests pressure on the ring and may indicate that the ring is too large. The piercer can easily sort this out.

5 Be bold with bald

Approach the examination couch boldly with the assumption that there is no hair anywhere and you won't go far wrong. This will relax the timid teenager who has just recently discovered the blade and is now wishing he/she was anywhere but on your couch.

Certain conditions appear differently clinically. Body louse on the hair-covered mons pubis slither around secretly with lethargy. In the more fashionable arrangement they skirt around like a busload of daddy long-legs on a field trip.

6 Be grateful for the new-age POPs

Historically progesterone-only pills (POPs) were less frequently prescribed to the teenagers. This was in part due to the higher failure rate as it became less effective if the next pill was not taken within 27 hours, ie they only had three hours to remember they had forgotten it.

The new generation of POPs, such as Cerazette, are more forgiving than the older generation, retaining its efficacy up to 36 hours, ie as with the combined contraceptive pill there is 12 hours to remember it has been forgotten. This may suit the teenager who may be more imprecise in the timing of pill taking.

7 Be mindful of the mammy's

Does mum have the right to know her 15-year-old daughter is being prescribed contraceptives without her prior knowledge and approval?

The more you look at the various legal judgments the more it becomes obvious that even the majority of judges do not agree among themselves. The Law Lords failed to give clear guidance on the law of consent and confidentially.

A 15-year-old might or might not have the capacity to consent and doctors might or might not be under a duty to respect the confidentially of any such consultation.

To assess the competence as per the Fraserguidance it is essential that dialogue is established. Texting is a quick and easy way of opening the channels of communication and developing trust.

Try to establish what prevents them involving a parent or adult. If these fears are ill-founded, empower them to realise that.

8 Be on your guard for abusive relationships

What constitutes an abusive relationship? We hear daily of the crimes of yesterday's sexual deviants. Today we all would hope to spot the obvious. But what about the less obvious?

What about the teenage sexual relationships resulting from the influence of drugs and alcohol? What about coercion among peers? Who consents for what and who has the capacity to consent?

9 Be patient

Most histories and examinations don't have to be completed today. Let the young person dictate the pace.This is difficult, especially if you suspect an abusive situation. However, better to gain the confidence and watch-and-wait than frighten them off.

10 Be nostalgic

Turn back the clock and remember what it was like. That's the best tip for treating teenagers!

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