Table 4

Example potential indicators of MSHT—sexual and reproductive health systems (non-exhaustive)45 68

Presenting concernPossible MSHT-related cause
Genital skin changes, discharge, bleeding, discomfort or painSexually 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.