Are all school nurses now encouraging teenage girls to have the contraceptive implant?

Yes, it's on Saturday and I have absolutely no idea why I put that!

And I have reported my feedback - thanks for the supervision.

My friend (who worked for another authority, not mine) did a pilot scheme with young people where they were mystery shoppers for sexual health services. It was brilliant. Then they got rid of her post.

MadameBoolala - that's very unfortunate. It would certainly be worth you reporting your feedback - not to moan but just to report your experience - to the head of department running it. Sometimes it can be hit and miss, I agree, but for many youngsters that could be the first and last time they go, and I know the clinicians take the issue of effective and efficacious communication seriously. Friday morning seems a very odd time to run an under-18 clinic considering a lot of their patients would be in school or college.....??

The nurse in my post was is a sexual health clinic. Kipper - I took the YP I was working with there because I thought she would get better advice there than from me. And given that I was trained to sit and go through leaflets with YP, and was trained by the same team within which she works, That is why I expected better.

They run an under 18's clinic on a Friday morning - and the advice has always been a bit hit and miss depending on who you get. I've been working with YP in our area since 1999 and this isn't the first time I've been disappointed with them.

Sometimes with regard these issues a sexual health clinic is better. I don't know if teenagers would have a prejudiced view about what sort of place it is, but many are nicely furnished, clean and pleasant - like a shopping mall cafe, nothing "medical" or "clinic" like about their atmosphere. If you enquire, many now have later opening hours (so they can go after school and take as long as they need). They can offer both contraception advice as well as sexually transmitted infection advice, and there is more of a feeling of respecting the patient as an individual - not a "kid" who "can't understand". (Actually, many adults don't read leaflets either!) And you don't have to give your actual name and address if you don't wish to, that's a unique feature of these clinics - although all clinics will ask for a phone number or some way of contacting you about your results or anything important that crops up.

Oh - also discussed the ins and outs of the YP's decisions about sex too of course.

Send them to me idohopenot

In all seriousness I'd love to do that job. I have recently had a very bad experience with the specific nurse for teenagers who works in our short stay schools (formerly pupil referral units). I had to take one of my YP to see her because she had misunderstood how her pill works and needed emergency contraception. The YP asked me to go in to the consulation room with her and I did. I expected that the nurse would go through how the pill works with her again and explain how emergency contraception worked. I was gobsmacked when she just gave her the pill with no explanation of how it worked.

I also asked for her to issue my YP with a leaflet with all the pros and cons of the various contraception. She said that it would be too much information for her to take in. I took her to our sexual health unit straight afterwards, got some leaflets myself and went through them with her. I have made a complaint about the nurse as well. It worries me greatly that this is the person who is supposed to be trained to do specific work with young people.

I work with young people and had a chat with 3 lads I was working with about such things only recently. I was driving them home from an activity in my car, and one of them asked the other if they knew a certain girl who was a 'slag'. I challenged the remark, and it developed into a brilliant conversation, which culminated in one of them asking, earnestly, how he can be sure that what he is doing is nice for the girl he is with.

I think having adults around them that are able to talk about this stuff with them with no embarrassment and up to date knowledge is essential - and they are often too embarrassed to share that stuff with their parents. I also think that they're happier talking about this stuff in smaller groups and one to one. I think that having an outside agency coming in to schools to do some proper discussion based work around this stuff, with the content being open for parents to peruse and opt in/out of would be ideal.

If this is as presented then it's a awful. Get the teens ready for sex. Forget disease, just make sure they don't trap the man by becoming pregnant. Sickening

Just caught up with the thread. I think classes on the CSA sound ace.

LapsedPacifist do you know if your DS's school arranged that training internally or if there was an external organisation that came in? If so, and you know the organisation's name, I'd really appreciate you posting it or PMing me with it, as it sounds like they are doing good stuff.

Excellent posts sunshine and saf.

and i think a part of that is to stop presenting 'sex' as if only PIV was sex. looking at sex as a spectrum of activities that can be partaken in without necessarily having to have PIV. we present it as such a fait accomplis that if you want to go further than snogging you will have penetrative sex. we need to encourage the idea that you can have oral sex or any manner of sexual play without it having to end up in PIV. this would help boys too and start getting rid of the idea that a woman who got into a man's bed and was engaging in sexual activiites doesn't have the right to then say no to PIV and doesn't get taken seriously as having been raped when she does say no and is ignored.

i agree with all that sunshine - no big surprise.

i also think we need to talk clearly with girls about feeling like you have to have sex and that you can't/shouldn't say no if you don't want it or if you do want it feeling like you can't/shouldn't insist on a condom. we need to talk to them about how as you get older you get more assertive and in that assertion and taking control of things sex becomes more pleasurable - that it's not possible to really enjoy sex when you aren't even sure if you want it or able to be confident in asserting what you do and don't want to do and doing so in a safe way re: using condoms. we need to encourage girls to fess up to that ambiguity and discuss it and encourage them, and they each other, to see themselves as more in control and confident and assertive about their boundaries.

i believe girls suffer that ambiguity and lack of assertion in silence because it appears that everyone else is all confident and fine about it. there are too many women who look back on sex that they didn't really want when they were young and a period of ambiguity about it all in their youth and only really discover their assertion and with it enjoyment of sexual activities later on.

i realise this doesn't apply to everyone and many will come on saying they loved sex as a teen etc but i've met a lot of women who've said these things and for whom sex as a youngster (particularly those who were vulnerable to predatory older men due to lack of parental supervision or care) was a sort of silent witnessing of something happening to them rather than something they were doing and taking an active part in.

I was on hormonal contraception from the age of 13 to 30 (when I started TTC), firstly on the pill at my parent's request as I was having very debilitating periods affecting my education (I didn't start having sex until some 4 years after starting the pill), then later on the implant. At the time, I thought hormonal contraception was fabulous. Seemingly I had few side-effects and it was really suitable for long-term relationships, which applied to most of my adult life (I used condoms in addition at other times).

However, once I came off it all and had children, I never went back on it, and it's only now - 6 years free of hormonal contraception - that I realise the minor side-effects it had. It's possible of course that some of this could be do to the effects of having children; I'll never know in all reality. But I believe that most of the minor niggles I had before were due to hormonal contraception. I will never go back to it again, and I would counsel my DD to avoid it too, although obviously it would be her body and her choice.

I have some sympathy with the school and HCPs. Fact is that too many parents aren't talking to their children about sex, stis and contraception in practical terms, let alone more 'abstract' ideas such as consent and coercion. HCPs are just trying to pick up the pieces. However, I agree with SaF that the best way to deal with this is to start ramming home consequences for boys as well as girls.

It may actually be lying (since the CSA are ineffectual and most NRPs don't pay for their children) but let's include classes on how the CSA works and how much boys will be expected to pay for a child if a girl gets pregnant. Let's have classes about consent in which we name coercion and pressure for what it is and label those who do it as rapists in no uncertain terms. Let's present it as 'how sad are you if you have to pressure a girl into having sex' as much as we do as 'what a horrible, totally unacceptable way to behave'. Let's have more classes like those given to LapsedPacifist's DS. Let's make it clear that STIs affect girls more than boys since they are twice as likely to contract them. Let's make it clear that anyone who doesn't take that seriously could be considered either really stupid or unpleasant, and let's make it clear that refusing to use a condom even when a girl has 'taken care of' the pregnancy risk, is a form of coercion, so even though a girl may be willing to have sex in principle, it is still a form of rape - rape of a girl's health.

It may seem harsh, but it can be done in a fun way and should surely be carried out before all but a tiny minority are having sex anyway - so that no one would feel personally attacked by any of this but be fully aware before they start having sex.

idohopenot - yes, that would be a big concern. Perhaps parents of adolescent daughters should ask the school headteachers if a meeting can be scheduled with their school nurse to ask what sort of advice is given at contraception consultations (and whether a sexual health specialist (nurse or doctor) sees the pupil) to cover advice from STDs/HIV/cervical cancer/HPV vaccination/smear tests and not just contraception.

In my area idohopenot it's a specific Sexual health team who work with young people and train other professionals. Although how long they'll keep their jobs is anyone's guess.

and if there is a hcp who is unable to have the expected conversations about benefits, risks and side effects then they are performing their role poorly. There are people in all jobs who are crap the system hopefully weeds them out, complaints from those badly served by them will be acted on.

The opinion of the nurse on implants is irrelevant, she still has to share accurate information. It is often the case that a conversation about the features of contraception that would be found most useful by the yp lead to the longer lasting forms.

Your child isn't going to be poached from their maths lesson and inserted with contraception that they have not chosen.

The least worse option? When I had mine fitted over, God well over 15 years ago I choose it as the best option not the least worse. For you it seems it is an option you wouldn't pursue, you are not alone on this. There are many women and girls who prefer not to use hormonal contraception, for those who do there is a lot of data available and all licensed products have been researched as well as any other medicine. Fertility is rarely affected by implants, the pill and injection and most rarely of all in the young. There are questions over whether injections or implants are appropriate for older women to use when only looking for temporary cover whilst spacing children.

I can't see that what worries you is likely to happen, it has already been explained why hcps work separately from schools and are obliged to discuss options and side effects.

As for the idea that schools aren't good venues for hcps, it is outreach part of removing barriers between potential services users and health care that can improve their lives. The NHS has many mobile units offering support with all sorts of health related concerns.

Being competent to assess your own contraception needs doesn't mean that you will have been proactive in managing your own sexual health, and we know that the lowest social and economic groups are the least likely to seek care. It makes it more necessary that these groups are reached through better targeting of services.

Elastamum your experiences sound rich and mirror what I have seen, such a shame the funding went. I find it hard not to associate reduced funding for out reach, for teen sexual health with right wing politics.

It's one thing for the girls to walk up to a GP/hospital/walk in centre/family planning clinic and ask for contraception but to keep it confidential. But if they are having a device/drug at school administered, the parents should be informed that this service is available - if they want to opt out, the girls have to be referred to have it done in an NHS clinic/hospital. I don't expect my child to turn up for maths, science and netball, and have her sent home with project work - and a pharmaceutical that can have serious side effects - from cramps to anaphylaxis. That is a conflict of interest. 13 to 14 year olds have the right legally to walk into a hospital or clinic and demand treatment, including contraception, if they are Gillick competent - they understand what the treatment is for, the pros and cons of taking it and the options available. In other words, they understand the information like an adult. But not if the setting is a school. And responsible clinics and GPs would also be automatically advising young girls about condoms, STDs, cervical smears at the same time. Would a school nurse have time to fit all that in?