Considering the increasing number of adolescents beginning their sexual life and the risks involved in unprotected sexual activity, pediatricians and gynecologists need to be prepared to address this issue when providing care to young people. Proper sexual guidance is a major challenge, which implies emphasizing the participation of the family, school, health sector and society as a whole in this ongoing process of education. To this end, it is necessary for health professionals (general practitioners or specialists) to also have knowledge about sexuality, including contraception, as well as the ethical aspects involved in prescribing contraceptive methods.

The Brazilian Society of Pediatrics (SBP) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), supported by the Federal Constitution (articles 226, paragraph 7 , and 227), by the Statute of the Child and Adolescent (ECA) (articles 7 and 11), by the United Nations (UN) (Cairo + 5, 1999) and by the Code of Medical Ethics (articles 1 , 8 , 11, 102 and 103), and, later, by the 2002 Forum – Adolescence, Contraception and Ethics, establish the following guidelines regarding the sexual and reproductive health of adolescents.

1. The adolescent has the right to privacy, that is, to be seen alone, in a private consultation space. It should be remembered that privacy is not necessarily related to confidentiality.

2. Confidentiality is defined as an agreement between the health professional and the client, in which the information discussed during and after the consultation or interview cannot be passed on to the patient’s parents and/or guardians without the adolescent’s express permission. Confidentiality is based on rules of medical bioethics, through moral principles of autonomy.

3. The guarantee of confidentiality and privacy, fundamental for prevention actions, favors the approach to topics such as sexuality, drug use, violence, among other situations.

4. The importance of the health professional’s attitude during the care of young people is highlighted, respecting their moral, sociocultural and religious values.

5. Medical confidentiality is a right guaranteed and recognized by article 103 of the Code of Medical Ethics, according to which “A doctor is prohibited from revealing professional secrets regarding a minor patient, including to their parents and legal guardians, provided that the minor is capable of evaluating his/her problem and of conducting himself/herself by his/her own means to solve it, except when non-disclosure could cause harm to the patient.”

6. In exceptional situations, such as significant intellectual deficit, psychiatric disorders, the adolescent’s desire not to be seen alone, among others, the presence of a companion during the consultation is necessary. 7.

In cases where there is explicit reference or suspicion of sexual abuse, the professional is obliged to notify the Guardianship Council, in accordance with Federal Law 8.069/90, or the Child and Youth Court, as determined by the ECA, and the presence of another professional during the consultation is relevant. It is recommended that cases be discussed by a multidisciplinary team, in order to assess the conduct, as well as the most appropriate time for notification.

8. The physician should take advantage of opportunities to contact adolescents and their families to promote reflection and dissemination of information on topics related to sexuality and reproductive health.

9. Guidance should focus on all methods, with an emphasis on dual protection (use of condoms), without value judgment.

10. The prescription of contraceptive methods must be related to the adolescents’ request, respecting the medical eligibility criteria, regardless of age.

11. The prescription of contraceptive methods to an adolescent under 14 years of age, provided that the above criteria are met, does not constitute an unlawful act on the part of the physician.

12. In the care of a sexually active minor under 14 years of age, the presumption of rape ceases to exist, given the information that the professional has that it did not occur, based on the information provided by the adolescent and the careful evaluation of the case, which must be duly recorded in the medical record.

13. The physician may prescribe emergency contraception, with criteria and care, as it is an exceptional resource, to adolescents exposed to imminent risk of pregnancy, in the following situations:

a) not using any contraceptive method;
b) failure of the contraceptive method used;
c) sexual violence.

Notes: emergency contraception is not an abortive method, as scientific evidence demonstrates; Failure to offer emergency contraception in situations where it is indicated may be considered a violation of the patient’s rights, since the patient must be informed about essential precautions.

14. In cases of sexual violence, the Ministry of Health’s standards must be respected, which include emergency contraception, and it must be available in the services that serve these adolescents.

15. Adolescents of both sexes have the right to sexual education, to confidentiality regarding their sexual activity, and to access and free availability of methods. Awareness of this right implies recognizing the individuality of adolescents, encouraging them to take responsibility for their own health. Respect for their autonomy transforms them from being objects to subjects of rights.