In a specialist psychosexual clinic, those under 20 years comprise less than 10% of the total workload. However, they are an important group. Some patients in this age group are able to tell their doctor openly about the problem (see Miss A., Chapter 12, p. 181). However, others do not find it easy to raise the subject, and doctors need to be alert to cover problems that may be suggested by a patient’s discomfort with her genitals or breasts. Problems that develop in a patient on the Pill may be straightforward physical side-effects, or a covert presentation of a psychosexual difficulty. Many younger patients feel they should report side-effects, more or less obeying the doctor’s instructions, whereas older contraceptive pill-users tend to report side-effects that they are worried about. Young patients who develop one side-effect after another, or those who cannot find a method to suit them, should make the doctor particularly alert to the possibility of underlying difficulties. The following case quickly developed a ‘thick folder’, that sign that general practitioners recognize so well as a warning of possible emotional problems.

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