The following issues need to be considered, and managed if appropriate, in all women requesting emergency contraception (even in those who did not end up using it):

• Ongoing regular contraception
• Offer to arrange ongoing, regular contraception, if appropriate [FFPRHC, 2006b].
• The following methods can be quick started after oral emergency contraception [FSRH, 2010]:
• Combined hormonal contraception (pill, patch, vaginal ring) — advise the woman to use barrier methods or abstain from sex for 7 days after levonorgestrel emergency contraception and for 14 days after ulipristal acetate emergency contraception.
• Progestogen-only pill — advise the woman to use barrier methods of abstain from sex for 2 days after levonorgestrel emergency contraception and for 9 days after ulipristal acetate emergency contraception.
• Progestogen-only implant.
• The woman should be informed of the potential risks and of the need to have a pregnancy test 3 weeks after the last episode of unprotected sex.
• Advance provision of emergency contraception
• Advance provision of levonorgestrel or ulipristal acetate can be offered to women to use when required [FFPRHC, 2006b; RPSGB, 2006]. This option should be considered only if other, more effective, methods are not acceptable.
• Sexually transmitted infection
• In women at higher risk for sexually transmitted infection (i.e. sexually active women younger than 25 years of age, those older than 25 years who have a new partner, those with more than one partner in the past year, women who abuse alcohol or other substances, and women whose sexual activity began at a young age):
• Consider opportunistic testing for Chlamydia trachomatis [SIGN, 2000; NICE, 2007].
• Have one to one structured discussions about preventing sexually trained infections if you are trained in sexual health, or arrange for these discussions to take place with a trained practitioner [NICE, 2007].
• Sexual abuse, rape and non-consensual sex
• With all people, but particularly with the young and/or vulnerable, it is important to be satisfied that sexual intercourse has been consensual and is not occurring in an abusive relationship [DH, 2004; HM Government, 2006].
• Consider informing young people of the law in relation to sexual activity [FFPRHC, 2004a].
• If it is suspected that force has been used or that any sexual abuse has occurred, health care professionals have a duty to follow national and local child protection procedures [DH, 2004; HM Government, 2006]. Follow appropriate child protection procedures and refer to a paediatrician if necessary.
• Consider the possibility of sexual abuse in any child or young person with gonorrhoea, particularly in the following circumstances [NICE, 2009]:
• The child is younger than 13 years of age, unless there is clear evidence of mother-to-child transmission during birth, or of blood contamination.
• The young person is 13 to 15 years of age, unless there is clear evidence of mother-to-child transmission during birth, blood contamination, or that the STI was acquired from consensual sexual activity with a peer.
• The young person is 16 to 17 years of age and there is no clear evidence of blood contamination or that the STI was acquired from consensual sexual activity and there is a clear difference in power or mental capacity between the young person and their sexual partner, in particular when the relationship is incestuous or with a person in a position of trust (such as a teacher, sports coach, minister of religion) or there is concern that the young person is being exploited.