1. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Birth Control Methods Planned Parenthood of Houston and Southeast Texas, Inc. www.pphouston.org

2. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Key Dates in History

3. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Key Dates in History 1564: Fallopius, Italian doctor, describes the use of linen CONDOMS to protect against syphilis. 1840: First patented Diaphragm available in the United States. 1873: COMSTOCK LAW: restrict birth control by forbidding mailing and transportation of contraceptives and in some state their sale and use.

4. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Key Dates in History 1937: America Medical Association ends the 25 year opposition to contraception; recognized that birth control needs to be taught in medical school. 1960: BIRTH CONTROL PILL becomes available in the in the U.S. 1966: Griswold Decision: Supreme Court declares laws prohibiting sale and use of contraceptive are unconstitutional.

5. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Oral Contraceptive Pills “OCP’s” Available in many shapes, sizes, strengths, colors, and combinations. Pills per pack may vary: 21-day, 28- day, and new Seasonale, which is 3-months

6. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Oral Contraceptives: the Pill Description: Estrogen and Progestin 1 pill is taken daily Time sensitive, the pill is to be taken at the same time every day

7. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Effectiveness: Perfect Use Failure Rate in First Year: 0.1% (of every 1,000 women who take pills for one year 1 will become pregnant in the first year) Typical Use Failure Rate in First Year: 5 % (of every 1,000 women who take pills for one year 5 will become pregnant in the first year) Oral Contraceptives: the Pill

8. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Mechanism: Suppresses ovulation Thickens cervical mucus Thins endometrium Slows tubal motility Oral Contraceptives: the Pill

9. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health ADVANTAGES  Regulates menses  Decreases blood loss/ menstrual cramps  No disruption at time of intercourse  Decrease risk of ovarian/endometrial cancer  Treatment for acne DISADVANTAGES  Mood Changes, depression, anxiety  Daily pill taking may be stressful  No Protection against STI (Sexually Transmitted Infections), including HIV  Nausea, breast tenderness, especially in the first few cycles  Weight gain Oral Contraceptives: the Pill

10. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Special Considerations: Adolescents Failure rates are high in teens, due the regimented pill schedule At risk for STI, encourage condom use Most common reason for sick days at work/school, due to uncomfortable menstrual symptoms (under 25) Treats acne Oral Contraceptives: the Pill

11. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Ortho Evra: The Patch Description: Estrogen and Progestin 1 Patch a week, for 3 weeks 4 th week patch free, Menstruation Usually worn lower abdomen or buttocks

12. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Effectiveness: Perfect Use Failure Rate in First Year: 1 women of every 1,000 women will become pregnant in the first year Overall Failure Rate: ? Ortho Evra: The Patch

13. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Mechanism: Prevents pregnancy in the same way that oral contraceptives do (Ovulation, cervical mucus, endometrium, tubal motility) Ortho Evra: The Patch

14. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Ortho Evra: The Patch Advantages:  Menstrual (Similar to the Pills)  Nothing to do on a daily basis  No disruption at time of intercourse Disadvantages:  Mood Changes, depression, anxiety  No Protection against STI (Sexually Transmitted Infections), including HIV  Nausea, breast tenderness, especially in the first few cycles  Weight gain  Cannot use if breastfeeding

15. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Special Considerations: Avoid placing the patch on exactly the same site two consecutive weeks NEVER PLACE PATCH ON THE BREAST!!! Location of patch should not be altered mid-week No band aide, tattoos or decals on top of patch as it may alter absorption of hormones It is unknown if tanning beds interfere with efficacy Avoid placing lotion/creams/powders on site Ortho Evra: The Patch

16. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Nuva Ring: the Ring Description: Combined estrogen and progestin Thin flexible transparent ring Left in place in the vagina for three weeks and removed for a week to allow a menstrual period the fourth week. Maintains a steady low release rate while in place.

17. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Nuva Ring: the Ring Effectiveness: Overall pregnancy rate: 1.2 per 100 women

18. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Nuva Ring: the Ring Mechanism: Suppresses ovulation Similar to combined pills

19. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Advantages:  Only TWO TASKS: Insertion/Removal 1x month  Steady even hormonal levels in blood are achieved  Privacy/No visible patch or pill packages  95% of women say they cannot feel device Disadvantages:  Some women dislike placing/removing objects into/out of their vagina  Adverse side effects similar to the pill  Possible devise expulsion Nuva Ring: the Ring

20. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Special Considerations: Excellent option for adolescents: Require less discipline than taking pills Women wanting regular menstrual periods Nuva Ring: the Ring

21. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Depo Provera “The Shot” Private Don’t have to remember to take a pill Four times a year

22. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Description: Injected intra-muscularly into the deltoid or gluteus-maximums every 11 to 13 weeks. Progestin only Depo Provera “The Shot”

23. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Effectiveness: Perfect use failure rate in first year: 0.3% Typical use failure rate in first year: 3% Depo Provera

24. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Mechanism: * Suppresses Ovulation * Thickens cervical mucus * Slows tubal and endometrial mobility Depo Provera

25. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Depo Provera Advantages:  Less menstrual blood loss and anemia  After one year 50% of users will develop amenorrhea  80% will develop amenorrhea in 5 years  Only need to remember 1x every three months Disadvantages:  Irregular menses during first several months  Unpredictable spotting and bleeding  Possible weight gain: Progressive-Significant (5.4 1 st year, after 5 years 16.5)  Patient fear of pregnancy or build up of menses in uterus if not explained well  Decreased libido  Fear of needles  Return to fertility is long average 10 months from last injection

26. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Special Considerations:  Adolescent women: Extremely effective with long carry over if patient returns late for reinjection  All women, including teens, should be encouraged to take calcium tabs and exercise regularly Depo Provera

27. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Intrauterine Device “IUD” This is not your Mother’s IUD…. Most popular method in the world, although it is not very popular in the United States.

28. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Intrauterine Contraception: ParaGard/Mirena Description: T-shaped device with two flexible arms that bend down for insertion but open into the uterus. Two straw-colored strings protrude through the cervix into the vaginal canal

29. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health ParaGard/Mirena Effectiveness: ParaGard 99.2%-99.4% Effectiveness: Mirena 99.9%

30. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Mechanism: Paragard Works by preventing fertilization Works primarily as a spermicide,Copper ions inhibit sperm motility so they rarely reach the tube Mechanism: Mirena Progestin Only Causes cervical mucus to become thicker then by preventing sperm from moving up the reproductive track Prevents implantation Intrauterine Contraception: ParaGard/Mirena

31. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health ParaGard Advantages:  Effective long term (10 years) contraception from a single decision.  Requires no action at time of intercourse  Cost effective  Rapid return to fertility  Good option for women who cannot use hormones  95% user satisfaction, the highest of any other contraceptive currently begin used by women. Disadvantages:  Blood loss during menstruation increased by 35% and increase cramping  Must check strings monthly after menstruation  Requires office procedure for insertion and removal, can be uncomfortable Increase risk of infection PID Uterine perforation May be expelled

32. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Mirena Advantages:  After 3-4 months it decreases menstrual blood loss more than 70%  Amenorrhea: 20% by 1 year, 60% by 5 years  Reduced risk PID, ectopic pregnancy by 60%  As effective, or more effective than female sterilization  Long lasting method, up to 5 years  Immediate return to fertility Disadvantages:  Possible expulsion  Acne, Headaches, discomfort after insertion or removal  Risk of PID increased  Ovarian cysts, most regress spontaneously

33. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health ParaGard/Mirena Special Considerations:  Women at risk for STI’s may be discouraged from usage. (Paragard/Mirena)  Some clinicians require chlamydia and gonorrhea testing prior to insertion. (Paragard/Mirena)

34. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Implanon Description: Progestin only Thin, flexible, plastic implant about the size of a matchstick. Inserted under the skin by the bicep muscle. Implanted in the arm for 3 years.

35. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Effectiveness: Perfect Use Failure Rate in First Year: 0.3% Typical Use Failure Rate in First Year: 3% Implanon

36. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Mechanism: Constantly releases progestin into the bloodstream Suppresses ovulation Thickens the cervical mucus Implanon

37. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Implanon Advantages: Insertion only takes a few minutes Protection against pregnancy is immediate if you get the implant during the 1 st five days of your period Ability to get pregnant is immediate after removal Gives continuous long- lasting birth control without sterilization No medicine to take every day Disadvantages: Irregular bleeding is the most common side effect Periods become lighter and may stop altogether or periods may become heavier and last longer Some women will have longer heavier periods Acne, change in appetite, or sex drive Pain at the site of insertion

38. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Cervical Cap Inserted into vagina to cover cervix. Was once a very popular method. Used with spermicidal jelly or sometimes foam. Must be fitted by a clinician.

39. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Diaphragm Inserted into vagina to cover cervix. Was once a very popular method. Used with spermicidal jelly or sometimes foam. Like the Cervical Cap, it must be fitted by a clinician. 84%-94% Effective

40. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Emergency Hormonal Contraception: Plan B Description:  Progestin Only (More effective less side effects than combine EC)  ASAP, but can be used up to 120 hours, sooner is better  Pills must be taken 12 hours apart  Over-the-counter for women ages 18 and over  FDA recently passed a ruling allowing EC to be OTC for women beginning at 17 years of age, but it has not gone effect as of yet

41. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Emergency Hormonal Contraception: Plan B Effectiveness: Pregnancies/100 women: < 12 hours: 0.4% 1-3 days: 2.7% Average: 1.1%

42. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Emergency Hormonal Contraception: Plan B Mechanism: Prevents pregnancy and never by disrupting an implanted pregnancy Inhibits ovulation Thicken cervical mucus May effect tubal transport of sperm or ova

43. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Emergency Hormonal Contraception: Plan B Advantages  Opportunity to prevent pregnancy after, rape, mistake or method failure  Reduces anxiety  Process attaining EC may initiate women to use ongoing contraception Disadvantages  Time limitation  Next menses may be early  Notable changes in flow for next menses  Not as effective as other forms of birth control  Can be more expensive  23% experience nausea few experience vomiting

44. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Emergency Hormonal Contraception: Plan B Special Considerations: There is no limit to the number times in a year a woman can use EC, but it is not to be used in place of birth control (it is also expensive).

45. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Non-Prescription Methods

46. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Non-Prescription Methods Female Condom Male Condom Spermicidal Foam Spermicidal Film Natural Family Planning Abstinence

47. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health FEMALE CONDOMS Popular in developing nations because of its durability - in fact, women have been known to wash and reuse it. This is NOT recommended. NOT REUSABLE Purchase at a drug store

48. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Female Condom Description: Inserted into vagina with the moveable ring inside the vagina creating an internal sheath. The large ring externally covers the labia. Disposable single use sheath made of polyurethane Shelf life: 3-5 years More expensive than male condom

49. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Female Condom Effectiveness: Perfect use failure rate in first year of use: 5% Typical use failure rate in first year: 21% 79% - 95% Effective

50. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Female Condom Advantages:  Can be inserted up to 8 hours before sex to allow more spontaneity  Woman can make sure she is somewhat protected against STIs  No medical visit required, available over the counter  Can be safely used with individuals who have latex allergies Disadvantages:  Requires careful sexual practices during intercourse  Noise made during intercourse can be distracting, if occurs add more lubricant  In one study, 88% of females disliked using the female condom  Somewhat difficult for new users  Possible increase risk of UTI  Possible difficulty inserting and removing devise

51. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Female Condom Special Considerations: Need to have time to practice inserting prior to engaging in intercourse Never use a male and female condom at the same time. This will increase the risk of breakage of one or both condoms

52. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Male Condoms The condom is the oldest method around. Worldwide use to protect again HIV

53. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Male Condom Description: Made of latex, polyurethane or natural membranes Available in at least 2 different sizes and a variety of textures and thickness May come with or without spermicidal coating Reduces risk of pregnancy and contracting sexually transmitted infections Natural Skin condoms do not protect against HIV transmission

54. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Male Condom Effectiveness: Perfect use failure rate in the first year: 3% Typical use failure rate in the first year: 14% Overall: 85% - 98% Effective

55. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Male Condom Advantages:  Some men maintain erections longer with condoms  If the partner puts the condom on it can increase the pleasure  Makes sex less messy by catching the ejaculate  Intercourse may be more pleasurable because of the fear of pregnancy and STI’s may be decreased  Cost effective  Opportunity of couples to improve communication and negotiating skills Disadvantages:  Use may be perceived as interrupting love making  Requires discipline to resist impulse to progress to sexual act after erection  May cause loss of erection.  Decrease the sensation

56. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Male Condom Special Considerations: Users must avoid oil based lubricants (latex condoms) –Water-based lubricants instead Use of N-9 (chemical) coated condoms may be associated with an increased risk of contracting HIV Embarrassed about purchasing condoms due to the stigma.

57. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Spermicidal Foam Available over the counter. Can be messy. Protects against pregnancy (but not STD’s). Suppository or foam applicator. Best used with a condom for STD protection. Only 71%-82% effective if used alone

58. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Sponge Non-reusable piece of soft foam filled with spermicide Must be inserted into vagina before intercourse & six hours after intercourse 84-94% effective at preventing pregnancy No protection against STDs/STIs

59. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Vaginal Film Available over the counter. Small film containing spermicide that melt inside vagina to offer protection against pregnancy. Use with a condom for STD protection.

60. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Abstinence “Periodic Abstinence” has high pregnancy rate. “Continuous Abstinence” is effective when sustained over a long period of time. SEX

61. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Withdrawal Mechanism: The man pulls his penis out of the vagina before he ejaculates Thought to prevent pregnancy if the sperm is kept out of the vagina

62. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Effectiveness: Perfect Use Failure Rate: 96% Typical Use Failure Rate: 73% Semen can pick up enough sperm left in the urethra from a previous ejaculation Offers no protection against sexually transmitted infections. Withdrawal

63. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Advantages: Can be used when no other method is available No medical or hormonal side effects No prescription necessary Disadvantages: Not for men who don’t know when to pull out or ejaculate prematurely Not recommended for teens and sexually inexperienced men Requires great self- control, experience, and trust Withdrawal

64. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health SURGICAL PROCEDURES

65. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Vasectomy - Males Permanent method of birth control – Occasionally this method can be reversed (expensive) Closes the vas deferens that carry sperm 99.9% effective at preventing pregancy No protection against STDs/STIs

66. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Tubal Ligation - Females Permanent method of birth control to sterilize women – Occasionally this method can be reversed (expensive) Fallopian tubes are cut to prevent the egg and sperm from meeting

67. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health NATURAL FAMILY PLANNING/FERTILITY AWARENESS

68. The University of Texas Prevention Research Center Summer Course 2009: Adolescent Sexual Health Natural Family Planning/Fertility Awareness Keeping track of which days a pregnancy is most likely to happen – Daily record must be kept of body temperature & changes in secretions from cervix – A woman must also keep track of periods No STI/STD protection 75%-96.25% effective at preventing pregancy