Example potential indicators of MSHT—sexual and reproductive health systems (non-exhaustive)45 68
| Presenting concern | Possible MSHT-related cause |
| Genital skin changes, discharge, bleeding, discomfort or pain | Sexually transmitted infections (including chlamydia, gonorrhoea, herpes and syphilis), child may present late with symptoms. |
| Infertility, pregnancy symptoms, request for antenatal care. | Pregnancy may be intentional during MSHT exploitation (ie, benefit fraud, planned illegal adoption). Fertility problems may be secondary to sexually transmitted disease. Perpetrator may seek to override a female victim’s wishes—her views must be sought and assumptions based on ‘culture’ should not be made. |
| Requests for emergency contraception or abortion. | Sexual exploitation, abuse, unplanned pregnancy. |
| Late presentation of pregnancy, lack of antenatal care. | Victim may have been prevented from accessing care for her and her unborn child. Immigration status issues and fear may be an added barrier to seeking maternity help. |
| Collapse, systemically unwell, | Body-packing into the vagina of wrapped drugs (especially cocaine and heroin) risks acute toxicity and overdose on rupture. Sexual exploitation and unprotected sex increases risks of blood-borne virus infections including HIV and hepatitis. Such infections may also be present pre-exploitation. |
MSHT, modern slavery and human trafficking.