She's Only 13, How Can A Doctor Ask About Her Sex History?
"Doctor, my child hasn't had a period for two months. Let's see what's going on."
The patient who walked into the clinic was still underage. Lu Chao, the attending physician of Ma'anshan Maternal and Child Health Hospital, looked up at the mother and daughter, "Let's ask regularly, does the little girl have a boyfriend?"
The girl hesitated and nodded.
"Oh, have you ever been 'together'?" Lu Chao thought about the girl's ignorant eyes, and then asked another way: "Has there been any more intimate behavior?"
Inquiry about sexual life history is a necessary link in gynecology. When faced with minors, this serious inquiry turned into a tug of mystery and truth.
Open Mouth Problem
Minors who come to the gynecology department mostly complain about menstrual disorders and occasionally some gynecological inflammation, and the sexual life history will greatly affect the diagnosis and examination methods.
In the case of menopause, irregular bleeding, etc., the possibility of pregnancy should be considered first, especially when there is coexisting abdominal pain, the risk of ectopic pregnancy should be ruled out. On the other hand, women without a sexual history cannot do transvaginal examinations, as well as some gynecological examinations such as sampling that may involve invasive procedures.
The routine and important sexual history consultation have become a somewhat difficult question when facing minors.
Wang Jingjing, the chief physician of the cervix department of the Shanghai No. 1 Maternity and Infant Health Hospital, clearly felt that with the emphasis on physical health by parents, minors can sometimes be seen in gynecological outpatient clinics. "The hypothalamic-pituitary-ovarian-gonadal axis in minors is not fully developed, and is prone to anovulatory dysfunctional uterine bleeding."
"Some parents thought they couldn't check during the bleeding period, so they dragged it on until the child bleeds heavily and fainted."
Different from the consultation of adults, most doctors will choose to start with euphemistic questions when facing minors. Lu Chao said, "I usually first ask if I have a boyfriend. If so, I will then ask if there is any 'intimacy', and then go further and ask about contraceptive measures."
Zhang Yang, an attending physician in the obstetrics and gynecology department of Peking University People's Hospital, said that how to ask about sexual history euphemistically is almost a compulsory course for young doctors who have just entered the department of gynecology.
Ultrasound doctor Xiao Meng (pseudonym) said that sometimes when she encounters an underage girl for a B-ultrasound examination to get pregnant, she will try to reduce the number of questions and does not want to cause secondary harm to the girl. "We cleared the room during the examination, and we didn't ask anything other than menstruation. It could be seen that the little girl was very shy, embarrassed, and scared, and didn't want to ask questions to aggravate her emotions. After the examination, let her go to the obstetrics and gynecology department. doctor."
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| Source: Visual China |
Polite Questioning Also Brings New Problems.
The age of menarche in girls tends to be earlier. A survey of girls in Chongqing showed that the average age of menarche was 12.09 years old, while the average age of menarche in the 2010 National Student Physical Survey was 12.76 years old. And this means that the possibility of pregnancy needs to be considered from a medical point of view, but the child itself may still be very ignorant about what "sex life" is.
Lu Chao said that the outpatient clinic has encountered some small patients who admitted that they had "intimate behavior" with their boyfriends. "But we asked 'how intimate', the little patient said that he was just holding hands, thinking that he might get pregnant."
On the other hand, most of the minors who come to the gynecology department are led by their guardians, and the participation of the three parties makes the inquiries about their sexual life history more subtle.
Typically, doctors keep parents present. Lu Chao said, "We need to establish a trusting relationship between parents and children who see a doctor, and I am a male doctor in gynecology, and this sense of trust is even more important."
Many doctors will first "observe" the parent-child relationship between patients and parents. Li Xin, a chief physician of the Obstetrics and Gynecology Hospital Affiliated with Fudan University, said, "Some mothers and daughters have a better relationship, and my mother would even take the initiative to say that my daughter was talking about her boyfriend."
Most parents understand the sexual life history inquiry, and the doctor will also explain it when asking questions. This is a routine inquiry link for a comprehensive understanding of the patient's situation.
Especially in the face of very young children, doctors also need parents to cooperate with questions to determine whether the child may be violated. Lu Chao said that occasionally, some children who are still in kindergarten will encounter abnormal secretions in the outpatient clinic. "At this time, parents may need to guide and ask the children whether their private parts have been touched by others. If it is suspected that the child has been violated, It needs to be reported by the requirements of the mandatory reporting system.” (For the mandatory reporting system, you can click to refer to the previous article: “13-year-old girl was raped by her father and became pregnant, but her mother knelt and begged me not to call the police”)
However, it is inevitable that some parents are conservative and consider such a question an "insult". On the Lilac Garden Forum, some doctors routinely asked about their sexual life history. The accompanying parents thought it was an offense to ask such a question to a minor and complained to the hospital.
Xiaomeng said that she once discovered a gestational sac while doing B for an underage girl, but was reprimanded by her parents when she explained the situation to her parents. "The parents themselves should be aware of the child's situation, but as soon as we talked about it in the clinic, she felt like she was exposed, and she felt very shameless, so she vented on our doctor."
Roundabout Truth
Another concern for doctors with minors is that the child's "firm denial of having sex" is sometimes not credible.
Especially when accompanied by parents, children are often afraid or unwilling, to tell the truth. Many parents have a strong attitude. Faced with the doctor's inquiries, they decisively answer for their children, "Our children can't have boyfriends." In such a situation, even if the child has sex, he would not dare to speak at this time.
When encountering some hesitant children, doctors sometimes use excuses such as "payment" and "make up a check-up" to pay parents to understand the patient's true condition.
Li Xin once treated an acquaintance's child, and denied the history of sexual life during the consultation, but ran back to the clinic while waiting for the examination. "She said to me, 'Auntie, I have actually had sex. If it is necessary to get an HPV test, you can help me get another test.' The patients themselves are also afraid of delaying the disease, but the parents may not dare to tell the truth when they are present. . "
Many children, after confessing to the doctor, will ask the doctor not to tell the parents or write it on the medical record.
Li Xin said that medical records must be filled out truthfully, but as a doctor, he would not take the initiative to tell a third party about the patient's privacy. "We may tell small patients to keep their medical records and not show them to others."
Concealing the sexual life history will lead to inaccurate judgments of the condition, and the last thing doctors want to see is the discovery of teenage pregnancy.
The hospital where Lu Chao works requires that the pregnancy of a minor must be reported to the medical department. "Some local customs can accept minors' pregnancy and childbirth, and even de facto marriages. But even so, our doctors still have to report regularly."
Lu Chao recalled that the department had seen a 16-year-old girl who had amenorrhea for two months and an endometrial thickness of 1.1. She denied having a history of sexual life. The doctor on duty thought it might just be a menstrual disorder and prescribed progesterone.
Half a month later, the girl and her mother, who had been late for menstruation after taking the medicine, returned to the outpatient clinic. At this time, the B-ultrasound showed that there was already a gestational sac. "When I first came to the clinic, the embryo was still growing, the gestational sac could not be found in the ultrasound, and the patient denied having a history of sexual life, so we did not consider the possibility of pregnancy."
The patient's parents complained to the hospital accordingly and asked why the doctor did not check HCG for the first time to rule out pregnancy. The medical records show that the patient denied a sexual life history, the doctor on duty's diagnosis and medication were in line with the standard, and he was not punished.
Such cases are not uncommon, and as a result, some doctors will always keep a recorder on the table to avoid medical disputes caused by concealing their sexual life history.
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| Source: Figure Worm Creative |
On the other hand, to avoid missed diagnosis and misdiagnosis, even if the patient denies it, doctors will further judge whether there is a possibility of pregnancy through auxiliary examination.
Zhang Yang said, "Especially clinically, we highly suspect the possibility of ectopic pregnancy, and we will explain the seriousness of the problem to parents and patients, which most people can understand."
Li Xin often encountered some small patients. During the consultation, he said that he had no boyfriend. After listening to the doctor's persuasion, he agreed to check the HCG. "At this time, a mother may understand, but she will not expose it. There is a tacit understanding between mother and daughter."
But most doctors do not support universal HCG testing in minors to rule out pregnancy.
Li Xin believes that "For experienced doctors, in many cases, it is possible to judge whether a pregnancy is not based on hormone levels, follicles, etc., and no additional examinations are required."
Wang Jingjing also said, "As a doctor, sometimes I am a little suspicious for the sake of patients, but there is no need to do too many tests. Especially some medicines for gynecological inflammation can be used even if you are pregnant. Doing more tests will affect the relationship between doctors and patients. Trust is also a waste of medical resources.”
Sex Education, Don't Cover Your Mouth
A study of college students in 18 provinces and cities showed that 1.9% of the respondents reported having sex before the age of 14, and among college students who had already had sex, more than half had sex before the age of 18. . And sex education to match doesn't seem to have caught up.
The "Regulations on the Protection of Minors' Schools", which will be implemented from September 1, 2021, clarifies that schools should carry out adolescent education and sex education in a targeted manner so that students can understand physical health knowledge and improve self-protection against sexual assault and sexual harassment. Awareness and ability.
During the two sessions this year, Chen Wei, deputy to the National People's Congress and vice president of the Quzhou Hospital of Traditional Chinese Medicine in Zhejiang Province, called for sex education in kindergartens. Chen Wei said that carrying out comprehensive sexuality education is important for improving children's reproductive health, strengthening gender equality awareness, preventing child sexual abuse, school bullying, early marriage, and early childbearing, reducing unsafe sex, unwanted pregnancy and induced abortion, and reducing sexually transmitted disease infection and HIV infection, etc., will play a positive role.
On the other hand, there is a certain lack of family sex education. "Sex" seems to have always been a difficult topic in Chinese families, and parents do not take the initiative to mention it. Lu Chao said, " If there is no correct guidance, 'sex' will be Pandora's box for minors, and it will be out of control when blindly opened. "
A survey by China Education Daily showed that 41% of the nearly 6,000 parents who participated in the survey said they had not given sex education to their children.
Without proper guidance, for minors, the sexual behavior that has already occurred is like a secret. I don't want to tell the doctor the truth.
On the online consultation platform, many minors are anxious to seek solutions online because they are embarrassed to go to the hospital for treatment. Wang Jingjing said, "Some people even think about what medicines they can use, but they make the situation worse."
Those parents and teachers may not be able to say the words that put the pressure of sex education on the doctor. Lu Chao said that the minors encountered in the outpatient clinic are very ignorant about "sex". At the same time as the consultation, they also need to communicate with their children, what is their sex life, what age group is suitable for having sex, and what is the correct form of contraception.
The age of having sex for the first time is earlier, but the corresponding knowledge of physical health has not been able to protect minors. A survey on the current situation of sexual and reproductive health knowledge among adolescents in 11 provinces and cities in China found that the pass rate was only 53.3%.
Unwanted pregnancy caused by sexual behavior without sufficient knowledge reserves will undoubtedly cause great harm to minors, and even some children have experienced a miscarriage at the age of 13.
The Experience Of Doctors In The Message Area In The Past
When Wang Jingjing was working in the family planning ward, she met several minors who were hospitalized to induce labor. "In most cases, little girls don't dare to tell their family when they don't have menstruation. They don't tell their family until their stomach grows bigger day by day. Aborted."
What's more, abortion is regarded as a conventional contraceptive method. The uterus of a minor is not yet fully developed, and the price paid for this will be gradually revealed in later life.
Lu Chao said that the outpatient clinic sometimes encounters some women who are trying to conceive, and who have experienced multiple miscarriages before adulthood. The examination found that there were severe intrauterine adhesions leading to infertility. "As doctors, it's heartbreaking for us to see such examples."
Being Ashamed To Talk About Sex Does Not Protect Minors.