A practitioner’s ability to provide family planning services to a person younger than 18 years old without parental consent depends on the state’s policies. Guttmacher Institute (2016) reports that in 21 states and the District of Columbia minors can consent to such services, while in 25 states there are particular circumstances under which minors can use family planning services without parental involvement. In addition, in four states, there are no explicit policies on the issue; it means that practitioners can provide services to mature minors without disclosure (Guttmacher Institute, 2016). If an adolescent demands confidentiality, a physician can prevent the transfer of billing information to parents by using confidential billing accounts and avoiding submitting itemized bills (Brittain, Williams, Zapata, Moskosky, & Weik, 2015).
Menarche is the first menstrual cycle or menstrual bleeding in female individuals. The normal age range for menarche is around 13 years, varying in different countries slightly (Markosyan & Arzumanyan, 2017). In some women, menstruation is presented with menstrual cramps or dysmenorrhea. This condition also causes lower back pain, diarrhea, and, sometimes, vomiting (Johnson, 2019). The common treatments for dysmenorrhea include the use of medicines, such as ibuprofen, and oral contraceptives to control menstrual pain. In addition, women are advised to avoid caffeine and salt, minimize tobacco and alcohol use, and massage abdomen and lower back areas (Johnson, 2019). It is vital to mention that females should see a medical professional when cramps are severe or last more than 2 or three days.
While evaluating a female adolescent’s health state, a physician should discuss the history of hospitalizations, surgeries, medications use, and family history. It is vital to ask about related genetic diseases, too. A physician should also ask the patient about her menstrual period, its length, and the amount of blood loss, if possible. Sexual activities should also be discussed during the visit. It may be necessary for a physician to talk about the causes and risks associated with sexually transmitted diseases, as well as address available birth control options, if applicable. To make a female adolescent feel safe and calm during the visit, the medical professional can also discuss the details of the physical and genital examinations before performing them.
According to the American College of Obstetricians and Gynecologists (2019), the normal cycle length is between 21 and 45 days, with the mean cycle interval of around 32 days in the first gynecologic year. It is typical for adults to have cycles up to 34 days. The normal amount of blood loss per period is between 10 and 35 ml or three to six tampons per day, depending on the day of the cycle (American College of Obstetricians and Gynecologists, 2019). The duration of flow is seven days or less; the majority of females bleed for two to seven days during their first menses.
Progestin-only contraceptive methods include progestin-only pills, birth control injections, and hormonal intrauterine devices (IUDs). Progestin-only pills do not contain estrogen; they stop ovulation and thin the lining of the uterus, making it difficult for sperm to fertilize the egg (American College of Obstetricians and Gynecologists, 2018). The common side effects of these contraceptive methods include headaches and dizziness, vaginal discharge, increase in acne, abdominal bloating, and the loss of libido. Moreover, females with a history of cancer or several medical conditions, including lupus, should not use some of the progestin-only contraceptive methods (American College of Obstetricians and Gynecologists, 2018).
Chlamydia and gonorrhea are conditions that require timely treatment, which means that they should be identified as soon as possible. Several methods can be used to perform screening for chlamydia or gonorrhea if a speculum exam cannot be done or if the patient refuses to undergo the procedure. Women can perform a self-swab test during which they can collect vulvovaginal swabs without the medical professional’s assistance. In addition, a urine test can be utilized for screening.
References
American College of Obstetricians and Gynecologists. (2018). Progestin-only hormonal birth control: Pill and injection. Web.
American College of Obstetricians and Gynecologists. (2019). Menstruation in girls and adolescents: Using the menstrual cycle as a vital sign. Web.
Brittain, A. W., Williams, J. R., Zapata, L. B., Moskosky, S. B., & Weik, T. S. (2015). Confidentiality in family planning services for young people: A systematic review. American Journal of Preventive Medicine, 49(2), 85-92.
Guttmacher Institute. (2016). Minors’ access to contraceptive services. Web.
Johnson, T. C. (2019). Menstrual cramps (dysmenorrhea): Symptoms, causes, treatment, prevention. Web.
Markosyan, R., & Arzumanyan, A. (2017). Age of menarche and related factors. Endocrinology & Metabolic Syndrome, 6(5). Web.