#8 Young adult contraception

A 14-year-old female presents to her primary care provider wanting to start the pill.  She has been with her boyfriend for 8 months.  They both agreed that they wanted to start a sexual relationship and have already had intercourse on two occasions where they did not use contraception.  She had never been sexually active before.  Her periods started 3 years ago and were initially irregular but she now reports a regular 27 day cycle.  She has never had any gynecological or other medical problems.

She reports that she is happy at school and she is one of three children, with a brother of 21 and sister of 19 years.  She lives with her parents in a house locally.  She has presented today with a friend from school.

Questions:

  1. What issues are important in determining how this situation should be managed?
  2. How would you further investigate (diagnostics), advise and manage this patient?
  3. Resources needs to be less than 5 years old and scholarly 

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