Young girls seen at the Genitourinary Medicine department in Middlesbrough: findings, implications and ramifications
Young girls seen at the Genitourinary Medicine department in Middlesbrough: findings, implications and ramifications |
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Key words: adolescent girls; child sexual abuse; sexually transmitted infections; child protection
Introduction
People of all ages can attend the genito-urinary department for various reasons. Among the core services of GUM department are the diagnosis and treatment of sexually transmitted infections. Previous reports1,2 have documented the findings in older men and women who attended their local GUM dept. The contributions of teenagers to the workload in the GUM department have also been documented3. This present study was done to examine the findings on young girls aged 15 years or less who attended the GUM department at Middlesbrough, England.
Materials and methods
The case notes of all girls aged 15 years or below who were seen at the GUM department during years 1995-2000 were retrieved and carefully examined. Particular attention was paid to documentation of rape, prostitution, or child sexual abuse. Evidence for involvement of child protection services or the police was noted. The results of screening for sexually transmitted infections were also retrieved.
Results
These are shown in tables 1 and 2. During the period of the study, 3751 new and re-registered women attended the department. Records showed that twenty-two (0.6%) were aged 15 years or below, and among the twenty-two young girls, twelve (54.5%) were aged 13 or 14 years. There was no girl below the age of 13 years. Nearly all of the girls 21/22 (95.5%) had a regular sexual partner. The only girl in the group without a sexual partner had been raped. Among the 21 sexually active girls only ten (47.6%) were using contraceptives. With regards to lifestyles (use of alcohol, drugs or cigarettes), 14 girls (63.6%) admitted to regular use of at least one of these substances. The drugs used were cannabis, heroin and amphetamines. Four girls gave a history of rape; two girls were involved in prostitution and two had suffered child sexual abuse. Among this cohort, five girls had been referred to the area child protection services. With regards to pregnancy, four girls (18.2%) had been pregnant but they all had their pregnancies terminated. The commonest sexually transmitted infections diagnosed were genital warts, and four girls had HIV tests, all of which were reported negative.
Discussion
It would be naïve to imagine that this cohort contained the only sexually active 13-15 year old girls or those who might have needed GUM services in Middlesbrough during the period of study. This cohort represents the tip of an iceberg of service needs. So where were the others? What happened to them? The management of young people at risk of sexually transmitted infections often demands more than diagnosis and prescription of antibiotics. It may open the issues of child sexual abuse which demand a multidisciplinary assessment 4,5,6. Unfortunately, child sexual abuse has been occurring since the Byzantine empire7, and occurs in several parts of the world 8,9. The two girls in this cohort who were abused said the abusers were a stepfather and an uncle respectively. Both men served jail sentences. The multidisciplinary approach to the management of these children may also pose its own problems. For instance, who should take the lead? The various professionals involved may include - paediatricians, psychologists, psychiatrists, police, general practitioners, genitourinary medicine physicians, teachers, drug rehabilitation services and social workers! This list is not exhaustive, so there is a need for good inter-professional communication 10,11. This is despite reluctance on the part of some professionals12. The important thing is that the role of each of the professionals mentioned above should be defined. The amount of contribution by each professional will be determined by the need of the particular child. It is a delicate matter with issues of confidentiality involved and the importance of proper interviewing techniques cannot be over
emphasised13,14. The risk of sexually transmitted infections and their complications like pelvic inflammatory disease and future tubal infertility in those girls is a real one15,16. The incidence of STIs was high, with chlamydia/gonorrhoea diagnosed singly or together in seven (31.8%) of this cohort. One reason for high STI morbidity among teenagers is the low use of condoms. Among the ten girls who used contraceptives, only two of them were using condoms. More use of condoms needs to be encouraged. There are female street prostitutes in Middlesbrough17. Involvement of young girls in prostitution is child abuse and sexual exploitation. There is an ongoing project, SECOS (sexual exploitation of children on the streets) to help such girls in Middlesbrough. The problem of children involved in prostitution is worldwide and strategies need to be developed to rescue these children. In Thailand, thousands of children below the age of 16 years serve as prostitutes. Apart from medical and legal implications, it has been argued that there is a need for pastoral care for these children18. It is estimated that about 20% of them will end up with AIDS. The presentation of a young girl in the GUM department may be a cry for help. The staff in this department should be aware that there may be more than meets the eye!
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©2001 Sexual Health Matters. Published Quarterly by Express Print Works, Middlesbrough,
UK
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