Adolescent contraception. Review and recommendations
Turetsky, R.A.; Strasburger, V.C.
Clinical Pediatrics 22(5): 337-341
1983
ISSN/ISBN: 0009-9228 PMID: 6839616 DOI: 10.1177/000992288302200503Document Number: 393925
This discussion attempts to respond to the following set of questions that private practitioners might have when treating sexually active teenagers: what is the best type of contraception for teenagers (oral contraception, IUD, diaphragm, the condom, withdrawal, and abstinence); is taking oral contraception (OC) dangerous for teens; which OC is best to prescribe; what are the legal ramifications of dispensing birth control to minors; and what can be done to control the problem of adolescent pregnancy. The modern private practitioners can become a leader in community efforts for sex education, an effective lobbyist on behalf of government funding for pregnancy services, and a catalyst for parent's groups seeking to control the influence of television and other media on children. It is important when prescribing contraception to match each patient's needs and preferences to the specific device to be used in order to minimize error in use and reduce the rate of discontinuation. OC is the most widely used contraceptive method for adolescents and is the best in many ways. Although OC has the highest theoretical effectiveness of any available contraceptive, when taken by teens the actual effectiveness drops off. This may be because of poor comprehension of directions or lack of motivation. The IUD is probably among the least acceptable methods for the adolescent because of its increased risk of sterility, but it may still be the treatment of choice for teens who are mentally retarded or who have no motivation for contraceptive use. For the highly motivated teenager, the diaphragm is an excellent contraceptive method. Adolescents who use tampons are more willing to insert the diaphragm, and this is a good screening question to test compliance. The condom may well be the contraceptive of choice. It offers a degree of protection against sexually transmitted diseases and in combination with spermicidal agents is almost as effective as the OC or IUD. The condom is inexpensive and readily available without prescription. The efficacy of withdrawal is limited, and motivation during intercourse is required. The teenager who chooses not to be sexually active should be supported in his/her decision. Teens are at lower risk for complications of OC than adult females. A pill with a low estrogen content may be most desirable. In 1965 the Supreme Court ruled that forbidding the prescription of contraceptives to married adults violated marital privacy. The same "rights of privacy" were extended to minors by the Supreme Court in the case of Carey v. Population Services International. The physician's or counselor's responsibilities in prescribing contraception to the mature teenager are to obtain a thorough history and document the extent of sexual activity so that the appropriate contraceptive device may be selected.