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The Informed Parent

Teenage Sexuality and Contraception

by Lori A. Livingston, M.D., F.A.A.P.
Published on Feb. 18, 2008

While there is no debate over the fact that abstinence is the best protection against teenage pregnancy and sexually transmitted infections (STI’s), the REALITY is that many parents are faced with teens who are at least thinking about having sex. The REALITY is that at least 50 percent of teens report having sex by the time they graduate from high school. The REALITY is that STI’s like gonorrhea, chlamydia, herpes, syphilis, genital warts, and even HIV are common in teens and young adults.

Parents, pediatricians, and family doctors should ideally start having open and nonjudgmental discussions about sex, abstinence, pregnancy, sexually transmitted infections, and in some circumstances, contraception, with teens early-- even 12 to 13 years old may be too late.

So how can we prepare our teenagers for a bright future, and prevent unplanned pregnancies and sometimes incurable infections? Here are the most common contraceptive options to discuss with your teenager and of course your doctor for more information:

1. Condoms (Barrier Method)

This is the only contraceptive that will protect against STI’s. They have higher failure rates in protecting against pregnancy since they must be used correctly each and every time there is sexual contact. They should ideally be used in addition to a hormone based contraceptive (like the pill) to prevent pregnancy and infections.

2. Oral Contraception or The Birth Control Pill (Hormonal Method)

This is the most popular method amongst teens. There are many different types with different combinations of hormones to prevent pregnancy, but not infections. It may be necessary to try a few to find the right match for each teen. Often your doctor may suggest the pill for its other benefits--more regular periods, reduced frequency of periods, decreased cramping, bloating and mood changes associated with menstruation, decreased acne, and decreasing heavy blood flow that can interfere with daily activities. Hormone based contraceptives can also have long term benefits such as protection against iron deficiency anemia, ovarian cysts, ovarian cancer, and endometrial cancer. Compliance is a problem since a pill must be taken every day, and even one missed pill is a big deal. There are also some potential side effects like headaches, nausea and bloating or breakthrough bleeding, depending on how much hormone is in each pill.

3. The Patch or Ring (Hormonal Methods)

These work like the pill to prevent pregnancy, but not STI’s. They don’t require remembering to take a pill every day, which is easier for many teens. The PATCH (OrthoEvra) is placed on the skin and changed once per week. The RING (Nuvaring) is flexible and inserted into the vagina once per month. If a girl is comfortable with tampons, this is easy.

4. Injection or Depo-Provera (Hormonal Method)

This is a shot given once every three months at the doctor’s office. There is no need to remember anything, except to be on time to the doctor’s appointment. This method tends to be less popular with teens due to common side effects of breakthrough bleeding and weight gain, and also does not protect against infections.

5.  Implant or Implanon (Hormonal Method)

This is a single rod, about the size of a matchstick, that is implanted under the skin of the arm which releases low doses of hormone to prevent pregnancy. It lasts up to three years and is easy to insert and remove. The downside is unpredictable periods and not every doctor is equipped to insert it.

There are, of course, many other options that are less commonly used by teenagers. Your family doctor or pediatrician can certainly discuss any questions or concerns since this information is somewhat limited.

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