Clinical Reference Systems: Pediatric Advisor 10.0

If you are thinking about having sex for the first time or you already are sexually active, you probably want to know about preventing an unplanned pregnancy. This handout discusses birth control methods most commonly used by teenagers. Although most methods depend on the girl to do or take something, it is important for guys to understand what is involved so that they can support their girlfriends. Also, don't forget that it is only the condom that can prevent sexually transmitted diseases (STDs).

Deciding to Have Sex

No method of birth control is 100% effective. Unless you decide to practice abstinence and not have sexual intercourse, you are always taking some risk of pregnancy. However, if you are correctly using one of the birth control methods described, the risk can be quite small.

Many sexual activities are almost always safe without having to take any special precautions. These include holding hands, hugging, touching, and kissing. Still, some teens decide to also have sexual intercourse. Having sex can be a very loving and special experience between two people. However, you should think about several important issues before you decide to have sex. Not only might sex give you a sexually transmitted disease or cause pregnancy, but you also can get hurt emotionally because of the strong feelings involved.

Decide ahead of time what is right for you. Find an adult with whom you can discuss your feelings and opinions, and ask questions. Although it is sometimes awkward to start the conversation, you can discuss these things with your parents. Other adults from whom you might be able to get valuable information or insights include pastors or rabbis at your church or synagogue, school counselors, teachers, or adult relatives. Also your doctor's office can help you. You can usually discuss issues with these adults confidentially.

Common Birth Control Methods

There are two main types of birth control:

• Hormone methods. Hormone methods include: birth control pills, Depo-Provera shots, and Norplant surgical implants. The hormones stop the egg from leaving the ovary and make the mucus in the vagina too thick for sperm to move in. They prevent pregnancy 99% of the time.
• Barrier methods. The condom is a barrier method. The condom blocks the sperm from getting to the egg. If used correctly, condoms prevent pregnancy 85% of the time.

In addition to using a condom each time, many young women and their male partners want additional protection from pregnancy. The condom is very effective at preventing STDs, but the hormonal methods are better for preventing pregnancy.

Birth Control Pills: Birth control pills must be taken once every day. Many women like them because they allow them to know exactly when they are going to have their period, and usually the period is lighter, shorter, and has less cramping than before they started taking these pills. All medicines have side effects, so you need to talk with your health care provider about possible side effects. Most women taking birth control pills have no problems at all. If you have a problem, usually your pill can be switched to a slightly different one by your doctor and that takes care of it.

Depo-Provera: Depo-Provera shots are injections of female hormones given in a woman's arm or buttocks every 3 months. You don't have to think about taking a pill every day, and you are protected from pregnancy for 3 months until you get the next shot. Usually the shot area is not sore. Most women have irregular periods while they are using Depo- Provera.

Norplant: Norplant surgical implants are female hormones contained in small capsules. The capsules are placed just under your skin on the inside of your upper arm. Placement of the capsules is done in the doctor's office. Norplant protects a woman from getting pregnant for 5 years. After 5 years the doctor removes the capsules from your arm, and you then decide whether or not to have new ones put in or change to a different method. If you have any problems with the capsules or you plan to get pregnant in less than 5 years, you can have the capsules taken out. Just as with the Depo-Provera shots, you probably will have irregular periods. Because the capsules are thin and underneath the skin, they usually can't be seen.

Condoms: Condoms are sold in drug stores and are put on a man's penis before sex. Condoms are the only good protection against sexually transmitted diseases.

• To use a condom:
  1. Hold the condom at the tip to squeeze out the air.

  2. Roll the condom all the way down the erect (hard) penis. Do not try to put a condom on a soft penis.

  3. After intercourse, hold onto the condom while the penis is being pulled out of the vagina.
• If the woman also puts spermicidal jelly or foam (available in the drug store without a prescription) inside her vagina right before sex, it helps make the condom method even better at preventing pregnancy. The jelly can kill sperm, but it doesn't work if used without a condom.
• Never use the same condom more than once. It is a good idea to have two condoms available in case one breaks.
• Buy latex condoms. Never use condoms made from animal skins because they can leak.
• If a condom breaks, as soon as you realize it take it off and put on another one. If you don't have another condom, stop having sexual intercourse until you can get another.
• The man should pull out of his sexual partner while his penis is still hard. If his penis gets soft first, the sperm can leak out of the condom.
• If you use a lubricant with condoms, make sure it is water based (like K-Y jelly). Do not use Vaseline or Crisco; these can cause the condom to break.
• Some condoms are lubricated with a chemical, Nonoxynol-9, which helps kill some of the germs that cause STDs. But it doesn't matter which kind you use as long as you use a condom every time you have sex.

There is a female condom, one that lines a woman's vagina, but it is more difficult to use. Talk with a doctor or nurse or other adult who knows how to use it before you try it.

The "Morning-After Pill"

You may have heard about emergency contraception, also known as the "morning-after pill." This type of birth control is sometimes used in an emergency. For example, it might be used when two people who always use condoms find out, after the guy ejaculates, that the condom has broken. Or a young woman who isn't yet taking birth control might unexpectedly have sex and not use a condom.

Emergency contraception can't prevent all pregnancies, but it can help a lot. However, you have to call the doctor's office less than 72 hours (less than 3 days) after you had sex, and the sooner the better. If you have sex without any birth control on a Friday and can't reach your doctor over the weekend, call first thing on Monday morning. It might be helpful to tell an adult you trust that you are worried about being pregnant and what happened.

For emergency contraception, the doctor gives you a few special hormone pills to take right away, and some others to take 12 hours later. In most cases, a pregnancy can be prevented. And then you can decide what birth control method will work best for you in the future.

Other Information About Preventing Pregnancy

• The "withdrawal" method, where the guy pulls his penis out of the vagina before he ejaculates, is not a good method for preventing pregnancy. It is very difficult for a guy to pull out exactly at the right time, and some sperm leaks out anyway.
• The "rhythm" method is where a couple has sexual intercourse only during certain times of the menstrual cycle. During certain times in the cycle, a woman is not as likely to get pregnant. This is not a very reliable method of birth control. This method is mostly used by married couples and is difficult to learn.

Call Your Physician's Office If:

• Your period is more than a week late.
• You have questions about sex.
• You know the condom broke, or you didn't use one, and no other method of birth control is being used.
• You think you might need emergency contraception (the "morning-after" pill).