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ADO L E S C E N T MED IC IN E Specialized Approach Addresses Reproductive-Health Needs of Adolescents and Young Adults Anna-Barbara Moscicki, MD, chief of adolescent and young-adult medicine. “Teens who are sexually active can find it challenging to choose a birth control method and then to stay on birth control. Many adolescents also have difficulty in discussing problems such as heavy or prolonged menses, amenorrhea or painful menses. Some of these abnormalities may be linked to eating disorders, which make them even more difficult to treat. Young men often find it equally difficult to discuss birth control and possible sexually transmitted disease.” Like children and the elderly, adolescents and young adults often have unique healthcare needs and issues that are particular to their age. In addition to the usual teen-angst- producing issues of acne and ever-changing bodies, many face emerging questions about sexuality and sexual behavior. “It is important that we address the special reproductive-health needs of adolescents and young adults and provide them with the full range of appropriate services,” says Loris Hwang, MD, director of the recently established UCLA Adolescent and Young Adult Reproductive Health Clinic, which offers clinics twice weekly for young women and once a week for young men. Adolescent-health specialists are doctors who have received extra training to help them to understand and meet the unique needs of this age group. These doctors typically train in pediatrics, family medicine or internal medicine, and they complete an additional three-year fellowship in adolescent health. “There is a clear need for reproductive- health services for the young women and young men in this population,” says UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) In addition to frank discussions about contraception and the availability of newer long-acting options, talking about and screening for sexually transmitted diseases also is essential, Dr. Moscicki says. Adolescent-health specialists also are trained to address the reproductive-health needs of teens or young adults who may have other medical conditions. “At UCLA, we see some very medically complex kids,” Dr. Moscicki says. “It is important to understand such issues as contraception and potential side effects when you are working with adolescents who have a past history of blood clots, lupus or cardiac disease, for example.” Dr. Hwang notes that adolescents and their parents might elect to come to such a specialized clinic because many adolescent patients are uncomfortable in a pediatric setting with young children and babies, or in a traditional OB/GYN office. “We offer the full spectrum of contraceptive methods, which includes both placement and removal of intrauterine devices and the arm implant in our clinic,” Dr. Hwang explains. While Dr. Moscicki encourages adolescents to bring a parent or support person to their visits, she notes that state laws permit confidential medical care of adolescents for sensitive topics. While insurance may cover many services provided to adolescents and young adults, she also points out that a state program, the Family PACT program (Family Planning, Access, Care and Treatment), provides for free and confidential family-planning services to eligible patients. In addition to reproductive health, adolescent-health specialists perform routine physical exams and can address growth and development issues, acute and chronic illnesses, acne, substance abuse and psychosocial issues. They also provide care related to nutrition, obesity and eating disorders, and they will identify appropriate additional specialists for their patients if necessary. Establishing a safe space where adolescents and young adults can freely talk about such issues of concern is essential to delivering the highest quality of care. “The goal of good adolescent and young-adult care is to create an environment where these young patients feel comfortable,” Dr. Hwang says. In addition to reproductive health, adolescent-health specialists perform routine physical exams and can address growth and development issues, acute and chronic illnesses, acne, substance abuse and psychosocial issues.