Contraception in adolescence

DES still “recommended” in 1982…


Adolescent care needs to include specific questions regarding the patient’s sexual development. The clinician who wants to address the contraceptive needs of his/her teenage patients must be familiar with the various psycho-medico-legal components of this issue. Male and female coitally active youth need to be taught responsible sexual activity. A thorough and honest discussion about sexuality and contraception should be held with youths who state they want to become, or are and will continue to be, sexually active. Contraception during adolescence is a complex and frequently emotionally charged issue. Contraceptive choice is dependent upon many factors, including the patient’s cognitive development, his/her specific choice to use or not to use contraception, the patient’s knowledge of specific methods, results of medical screening, the patient’s specific sexual activity, moral and religious attitudes, the clinician’s professional views about adolescent sexuality, and contraception.

The following specific contraceptive methods are reviewed in terms of their use by youth: abstinence, barrier methods, oral contraceptives (OCs), IUDs, postcoital contraception, and injectable contraceptives. Many youths are not sexually active and abstinence can always be suggested to individuals who have already been sexually active. Many teenagers choose to be and to remain coitally active, and realistic discussions with patients are essential.

In general the 1st choice of a contraceptive for sexually active youth should be some type of barrier method. The advantages and the disadvantages of the diaphragm, the condom, and vaginal contraceptives should be reviewed with specific application to the adolescent population. OCs continue to be the most popular of the effective contraceptives. Particularly with OCs there is a need for a careful medical history and physical examination with pelvic examination. It is this physician’s opinion that patients should be on OCs only until they will accept safer methods such as barrier contraceptives. The copper T or Copper 7 IUDs are very effective contraceptive methods which can be considered for carefully screened teenagers. Diethylstilbestrol has been recommended in emergency situations such as rape. Other postcoital agents which also work are ethinyl estradiol, conjugated estrogens, progestogens, and postcoital IUD insertion. Injectable contraceptives can be selected in certain situations were OCs cannot be used.



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