Contraception & Teens: Providing the FACTS!

Contraception: contra – against ception – creation

Contraception: the prevention of conception or pregnancy by any drug, techniques, or devices

Female Reproductive Tract

Types of Contraception (Permanent)  Tubal ligation – cutting and/or tying off both fallopian tubes  Vasectomy – cutting and/or tying off both vas deferens  Hysterectomy – removal of the uterus

Types of Contraception (Reversible)  Hormonal  Intrauterine  Spermicidal  Fertility awareness  Withdrawal  Barrier

Hormonal Methods of Birth Control  Birth control pills  Injections  Vaginal rings  Patches

Birth Control Pills (BCPs) (Oral Contraceptives)

Birth Control Pills (BCPs): How Do They Work? Contain estrogen and progesterone (or progesterone only) Inhibit ovulation (prevent the release of eggs from the ovary) Thicken mucus in the cervix Thin the lining of the uterus

Birth Control Pills: Failure Rate  With perfect use, approximately 1 sexually active women out of 100 using the pill for 1 year will get pregnant Teens have a much higher pregnancy rate using the pill than adults.

Birth Control Pills: Protection from STDs Do NOT Decrease Your Chance of Getting STDs NONE

Birth Control Pills May Be Used to Treat Medical Problems  Treat severe facial acne  Decrease painful cramps with periods  Decrease bleeding with periods  Regulate periods

Birth Control Pills: Summary  BCPs are not 100% effective in preventing pregnancy  BCPs provide no protection from STDs  Many teenagers using BCPs are not sexually active. They use BCPs to decrease menstrual problems or acne.  Require a prescription

Patches & Vaginal Rings

Patches & Vaginal Rings: How Do They Work?  Similar to BCPs in that the patch and ring contain estrogen and progesterone  Approved for use in the U.S. in 2001  The patch is placed on the skin every week for 3 weeks and the ring placed in the vagina for 21 days.

Patches & Vaginal Rings: Failure Rate  Not 100% effective in preventing pregnancy  Failure rates similar to BCPs

Patches & Vaginal Rings: Protection from STDs Do NOT Decrease Your Chance of Getting STDs NONE

Patches & Vaginal Rings: Summary  Not 100% effective in preventing pregnancy  NO protection from getting an STD  Require a prescription

Birth Control Injections: DMPA (Depot medroxyprogesterone acetate)

DMPA Injections: How Do They Work?  Inhibit ovulation (prevents the release of eggs from the ovary)  Thickens mucus in the cervix  Thins the lining of the uterus  Must get a shot every 12 weeks at a clinic or doctor’s office

DMPA Injections: Failure Rate  If given every 12 weeks, pregnancy is very rare (less than one per 100 users)  Most teenagers do not return every 12 weeks for injections  Most stop the injections in less than one year because of side effects

DMPA Injections: Side Effects  Irregular bleeding/spotting  Weight gain  Headaches

DMPA Injections: Protection from STDs Do NOT Decrease Your Chance of Getting STDs NONE

DMPA Injections: Summary  If injection is given every 12 weeks, DMPA is highly effective in preventing pregnancy  Teenagers usually do not return every 12 weeks for repeat injections and usually stop receiving them because of side effects  NO protection from STDs

Intrauterine Devices (IUDs)

Intrauterine Devices (IUDs): How Do They Work?  Small “T” shaped devices less than 2 inches in size placed through vagina and cervix, inside the uterus Contain a progesterone-like hormone

IUDs: How Do They Work?  Interfere with sperm movement preventing sperm from reaching the fallopian tubes  Thickens cervical mucus  Preventing the fertilized egg from implanting in the uterus

IUDs: Failure Rates  Very effective - less than one pregnancy per 100 users  Effective for 5 to 10 years or can be removed from the uterus sooner if pregnancy is desired

IUDs: Protection from STDs Because teens are at increased risk of STDs such as chlamydia and gonorrhea, IUDs are not recommended in this age group for fear of pelvic inflammatory disease (PID). NONE

IUDs: Summary  No protection from STDs including HIV  Because IUDs are placed inside the uterus, women at increased risk of STDs (chlamydia and gonorrhea) should not use an IUD  Because of the increased risk of STDs, IUDs are not recommended for teens

Spermicides

Spermicides: How Do They Work?  Gels, foams, creams, and suppositories which contain a chemical (nonoxynol-9) that kills sperm  Placed in the vagina before intercourse

Spermicides: Failure Rate  If used without another birth control method (such as condoms), not very effective  Typical use results in 29 out of 100 users getting pregnant in one year

Spermicides: Protection from STDs  May decrease your risk of getting some STDs  But… may actually INCREASE your risk of getting HIV infection

Spermicides: Summary  Gels, foams, creams, or suppositories which contain a chemical to kill sperm  High failure rate in preventing pregnancy  May increase your risk of getting HIV infection if exposed  Do not need a prescription

Barrier Methods  Male condom  Sponge  Female condom*  Diaphragm*  Cervical cap* * Not commonly used today

Male Condom

Condoms: How Do They Work?  Designed to prevent semen from getting into the vagina  Must be placed on the penis before any genital-to- genital contact  Can be obtained without a prescription

Condoms: Failure Rate  Condoms have the highest pregnancy rate of the most common methods of birth control  Teens have a higher failure rate than adults Typical use results in 15 out of 100 users getting pregnant each year

Condoms: Protection from STDs  Correct and consistent latex condom use does decrease the risk of HIV by 85%  With less than “perfect” use, the HIV risk is much greater  Natural membrane (lambskin) condoms do NOT provide protection from STDs including HIV

Condoms and STDs While condoms used correctly, every time, do greatly decrease HIV transmission, they have been shown to provide less protection against those infections spread by genital skin-to-skin contact.

The Problem with Condoms: People Are Not Perfect People...  do not use condoms consistently - every time.  do not use condoms correctly - before any genital-to-genital contact.

 Condoms can slip off or break  Some STIs are spread by genital skin to skin contact and…  Condoms do not cover the entire genital area so…  People keep on spreading STIs even though they think they are practicing “safe sex” The Problem with Condoms: Condoms Are Not Perfect

Condoms: Summary  Condoms do greatly reduce the risks of pregnancy and HIV but only if used consistently and correctly with every act of intercourse.  Even if used correctly with every sexual encounter, condoms have the highest pregnancy failure rate of any of the popular methods of birth control.

 Using condoms correctly will reduce the risk of pregnancy and STDs  They are less effective against STDs spread by skin-to-skin contact  Does not require a prescription Condoms: Summary

Sponge

Sponge: How Does It Work?  Blocks and absorbs sperm  Continuously releases spermicide  Must be placed in the vagina prior to intercourse; may be placed up to 24 hours before sexual activity  Does not require a prescription

Sponge: Failure Rate  The sponge has very similar rates to those seen with use of condoms  Teens have a higher failure rate than adults Typical use results in 16 out of 100 users getting pregnant each year

Sponge: Protection from STDs  No studies have been done with the sponge  May decrease your risk of getting some STDs  But… may actually INCREASE your risk of getting HIV infection because of the spermicide

Sponge: Summary  Contains a chemical designed to kill sperm  Also serves as a barrier preventing sperm from entering the uterus  High failure rate in preventing pregnancy  May increase your risk of getting HIV infection if exposed  Does not require a prescription

Withdrawal Method (“Pulling-out”)

Withdrawal: How Does It Work  Penis is removed from the vagina prior to ejaculation  Sperm may be released prior to ejaculation  Sperm released near the vaginal opening may enter the vagina

Withdrawal: Failure Rate  Risk of pregnancy before ejaculation (pre- ejaculate may contain sperm)  Typical use results in 27 out of 100 people getting pregnant in a year

Withdrawal: Protection from STDs Does NOT Decrease Your Chance of Getting STDs NONE

Withdrawal: Summary  Not a highly effective method to prevent pregnancy  Does not protect against STDs

Fertility Awareness Methods

Fertility Awareness Methods: How Do They Work?  Attempt to predict the fertile period – immediately before, during, and after ovulation  Monitor timing of periods, cervical mucus, and body temperature  Avoid intercourse (periodic abstinence) during the fertile period

Fertility Awareness Methods: Failure Rate  Typical use: 25 out of 100 users becoming pregnant in 1 year  Very effective with a highly motivated couple  Not recommended for teens

Fertility Awareness Methods: Protection from STDs Do NOT Decrease Your Chance of Getting STDs NONE

Fertility Awareness Methods: Summary  Involves observing a variety of body changes  Avoidance of sexual activity during the fertile period around the time of ovulation  Very effective in only highly motivated couple  Does not protect against STDs

Emergency Contraception

Emergency Contraception: How Does It Work?  Higher dose of hormones prevents ovulation if taken during the first two weeks of the cycle  Thickens cervical mucus  Thins the lining of the uterus

Emergency Contraception: Failure Rate  Much more effective when taken in the first two weeks of the cycle; ranges from 20% - 40% failure  Does not affect a developing baby if pregnancy has already occurred

Emergency Contraception: Protection from STDs Does NOT Decrease Your Chance of Getting STDs None

Abstinence

Abstinence: How Does It Work?  Abstinence is not having sex (vaginal, oral, or anal sex, or outercourse)  Renewed Abstinence is when someone has had sex in the past but makes a renewed commitment to abstinence

Abstinence: Failure Rate  Abstinence is 100% effective in preventing pregnancy  It is the most effective method of birth control

Abstinence: Protection from STDs Abstinence is 100% effective in preventing all STDs 100%

Abstinence has many benefits  No side effects or health risks  Prevents pregnancy and STDs  Prevents emotional problems that can occur with teen sex  Endorsed by many medical, religious, and community groups

Abstinence: Summary  Abstinence involves not having sex  It is the only method of birth control that is 100% effective against preventing pregnancy and STDs.

Reduction vs. Elimination  Risk reduction – using condoms and/or other methods of birth control attempts to decrease your chances of suffering from one of the many consequences of adolescent sex.  Risk elimination – practicing abstinence eliminates your chance of suffering from the consequences of adolescent sex.

Safer Sex MethodFailure Rate – Typical Use HIV/STD Protection None85%None Barrier (condoms, sponge)15%Most effective against HIV (85%); less effective against other STIs; not effective against those spread skin-skin Spermicide (foams, gels) 30%None – may actually increase the risk of HIV Hormonal Contraceptives (pill, patch, ring) 5%-8%None Depo-Provera (shot)3%None Intra uterine devices1%-2%None – may actually increase the risk of STDs Abstinence0%100% *Contraceptive Technology. New York: 2004