Contraception is a health behavior that often begins during adolescence and
evolves throughout reproductive life. On initiation of sexual activity,
the majority of adolescents actually report contraceptive use, most typically
a condom, but there is a significant difference between younger
and older adolescents’ contraceptive use (35% of
girls under 15 used no method at first intercourse compared to 17% of
17–19 year olds reporting no method use at first sex).1 Use
of contraception at first sex is positively associated with higher
continuation and consistency of method use over time.2 Discussions
of sexual decision making, abstinence, sexual activity, reproduction,
and contraception occur frequently as a normal part of the well-adolescent
visit for female adolescents. In contrast, male adolescents, who
are not at risk for pregnancy and do not require prescriptive contraceptives,
may have clinician contact only during a sports physical or treatment
of an injury or acute illness. Although sexuality and contraceptives
are not traditionally discussed during “the sports check,” which
often substitutes for the annual examination for male adolescents,
clinicians should emphasize the need for such discussions because
this visit may be the only contact between the male adolescent and
Common methods of contraception for male and female adolescents
are reviewed in Table 78-1. Adolescents should
be encouraged to choose a contraceptive method that they feel comfortable
with, believe they can use successfully, and that meets their needs
related to both pregnancy and sexually transmitted disease (STD)
risk reduction. For some, using condoms, which are relatively inexpensive, easily
obtained, and highly effective for protection from pregnancy and
STDs, may be the best choice, but many adolescents have difficulty
following through on consistent condom use. Heterosexual adolescents,
like adults, tend to decrease their use of condoms over time in
a relationship, and higher relationship quality and more frequent
intercourse are associated with less condom use.4
Table 78-1. Methods
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Table 78-1. Methods
|Method||Mechanism of Action||Efficacy: Rate of Pregnancy First Year of Use*||Coital Dependence||Prescription Required||Protection from STDs/HIV||Complications||Comments|
|Combined hormonal contraceptive (pill, patch, ring)||Inhibits ovulation||0.1%||8%||No||Yes||Some protection against pelvic inflammatory disease||Side effects, STDs (see text)||(See text)|
|Alters cervical mucus and endometrium|
|Intrauterine contraception||Probably prevents implantation; thickens cervical mucous||< 1%||-||No||Yes||No||(See text)||(See text)|
|Condom (female)||Barrier||5%||27%||Yes||Slippage||Expensive, difficult|
|Condom (male)||Barrier||2%||17%||Yes||No||++||Reaction to latex||Some dislike|
|Vaginal spermicides (foam, jelly, film, suppositories)||Spermicidal agent||18%||29%||Yes||No||+/-||Reaction to spermicide||Some describe as “messy” to use|
|Coitus interruptus||Withdrawal prior to ejaculation||4%||18%||Yes||No||No||None||Requires self-controlPre-ejaculatory semen contains sperm|
|Periodic abstinence||Abstinence during times of peak fertility||2–5%||12–22%||No||No||No||None||Requires monitoring menstrual cycle...|
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