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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 a clinician.3

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 of Contraception

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