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A community-screening programme has detected a high prevalence of Neisseria gonorrhoeae in South London, especially in teenagers, male subjects and certain ethnic groups.

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A 29-year-old woman with an Implanon ® contraceptive device in situ presented with persistent and prolonged vaginal bleeding. The implant had been inserted 2 years previously; the patient had been happy with it and had been mainly amenorrhoeic with the occasional light period. She was concerned that the implant had broken during a game of 'rough and tumble'with her son in August 2000. Since the trauma to her arm her bleeding pattern had changed, and she began bleeding heavily for 3 weeks every month. The rod was removed and found to be fractured halfway across its width. A new Implanon ® device was inserted and the bleeding settled. Case report This patient was fitted with an Implanon ® contraceptive device in December 1999, in her right (non-dominant) arm, using the standard technique and without complications. When she was reviewed 5 weeks later she reported no problems, although she felt that the implant had moved. She had had no bleeding per vagina since insertion of the device. Upon review 6 months later she mentioned that she had had an infection around the Implanon ® site, which had settled. On inspection the site was healthy, the rod was straight and easily palpable subdermally. She occasionally had light periods but was otherwise amenorrhoeic. She was seen again in January 2001, 6 months after her previous checkup. She had bled heavily for 4 weeks in October 2000, and reported that she thought the Implanon ® rod had snapped during a game of 'rough and tumble' with her 7-year-old son. She had seen her general practitioner (GP) who agreed with her. The patient and the family planning consultant, from whom the GP had sought advice (LB), contacted the manufacturer's helpline and were given the same information. They were advised that it was very unlikely that the device had snapped and that contraceptive cover would not be lost in this situation. The patient was reassured. The patient attended again for a checkup a year later in January 2002. She complained of prolonged heavy bleeding lasting 3 weeks every month for the previous 5 months which she found unacceptable She was otherwise asymptomatic. She had had a stressful year and had been diagnosed as having an eating disorder (her weight had dropped from 64 to 51 kg), for which she was receiving outpatient treatment. She requested that the Implanon ® rod be changed as she was sure it had snapped, was not working, and was the cause of prolonged heavy bleeding. This was discussed in the clinic and other causes for the bleeding explored. The patient was up-to-date with her smears and was in a stable, mutually monogamous relationship for

The onset of puberty, periods and sexual relationships can be difficult for adolescents and parents. Adolescents with disabilities face a wide range of additional challenges (physical, mental, social and intellectual), which may impact the quality of their lives and those of their families and carers. Research on the use of contraception in young women with disabilities is limited, and clinicians have little practical guidance for best practice. This review article aims to summarise and assess the evidence and guidance for the use of contraception in this group, particularly with regard to management of menstrual and cyclical problems. Multidisciplinary teamwork is important for recognising and addressing the concerns of patients and their carers effectively. The legal and ethical considerations are also highlighted here, as this group of adolescents is highly vulnerable to sexual exploitation and abuse.