Contraception and Emergency Contraception

Adolescents who are sexually active or considering sexual activity need to have the knowledge to protect themselves against both pregnancy and sexually transmitted diseases. Contraception refers to methods that prevent pregnancy by preventing the sperm from fertilizing the egg. It includes behaviors, (e.g. abstinence), medications (such as birth control pills) or barrier devices (condoms).

The most effective way to prevent pregnancy and sexually transmitted diseases is abstinence. Adolescents need to be aware of ways they can decline to be involved in sexual activity. Role playing exercises in how to say "no" are very effective in this age group. Concrete ways to avoid sexual activity need to be discussed. Adolescents need to be aware that any form of sexual contact, not just sexual intercourse, has the potential for transmitting STDs.

The most commonly used barrier form of contraception is the male condom. If used correctly and consistently they are about 95 % effective in preventing pregnancy. However perfect use is not the norm and in practice there will be about 15 pregnancies per 100 women using condoms as their sole form of contraception in a year. Condoms have been shown to decrease the incidence of many STD’s including the virus that causes AIDS. They are less effective in preventing transmission of other STDs, such as genital warts and the herpes virus as these may cause infections in areas not covered by the condom. Consistent use of condoms to prevent STDs sends a message that partners care about each other’s health.

Other than abstinence the most effective forms of contraception are the hormonal methods. Birth control pills are the most popular. Hormonal forms of contraception do require a prescription from a physician and thus a visit to a doctor’s office or family planning clinic. Massachusetts does not require a parent’s permission for an adolescent to access contraceptive services. Birth control pills work by preventing ovulation, making the cervical mucous thicker and thus less penetrable by sperm and by making the lining of the uterus thin. They are more than 99 % effective in preventing pregnancy if used correctly. However they do not protect against STDs and should be used with condoms. Birth control pills are a very safe medication in the vast majority of adolescents. They have other health benefits such as making menstrual periods more predictable, lighter and less crampy; they can decrease acne and actually decrease the risks of getting ovarian and uterine cancers. They do not cause weight gain in most women.

The biggest disadvantage to birth control pills is having to remember to take them every day. To overcome the need to take a pill every day there are two new methods to deliver the same hormones that are in the pill. There is a birth control patch that is changed weekly and a ring that is inserted into the vagina every three weeks. Both work the same way as the pill and are equally effective in preventing pregnancy. The Patch has been advertised a lot and is often requested by adolescents. In fact adolescents will often request a type of pill they have seen advertised or that is used by a friend. The depo provera shot is given every three months. It is effective in preventing pregnancy but has 2 side effects that make it less appealing to many adolescents. The first is a change in menstrual bleeding that can range from daily bleeding to no bleeding at all. The second is weight gain, this seems to be quite varied among individuals but in general 5 pounds a year can be attributed to using depo provera.

Adolescents, especially those who are relying on condoms for contraception, should be aware of emergency contraception. This can be used within 72 hours of unprotected intercourse such as when no protection was used, a pill or shot was forgotten, the condom breaks or in the case of a sexual assault. There are two prescription medications available, one called preven and the other plan B. Both work by either delaying or interfering with ovulation.

Teenagers who have decided to be sexually active need to be aware of their chances of pregnancy and contracting STDs. Effective contraception can prevent pregnancy and consistent use of condoms decrease the chance of contracting STDs.