Contraception & Why It Is Important
Dr. Molly Falasco
Adolescence is a magical time fraught with hormones, angst, and that feeling of invincibility. Between the acne breakouts and school dances, however, teenagers have to figure out how to grow up. More difficult still is “getting through” to a teen on his/her quest to independence. Friends’ opinions tend to “rule the day.” Parents never seem to be “cool enough” to even warrant the time of day. Whether at home or the doctor’s office, topics especially dreaded by both parent and child pertain to puberty and sexual health. Let’s face it, that stuff is awkward. Luckily for you, Pediatric Associates has trained pediatricians, and our very own Reproductive Health Clinic, to educate families on reproductive health and contraceptive options. While having a face-to-face encounter with your pediatrician is best, use this article as a guide to the basics of contraception. This is not an easy subject, so discuss it with your family and/or your pediatrician.
Contraception (birth control) is any method, device, or medicine used to prevent pregnancy. Especially for a busy teenager’s schedule, it is important to choose a method that is easy and effective. There are three arms of contraception: abstinence, barrier devices, and medical interventions – all described below.
Abstinence is the decision to not have sex. This is the most effective method of contraception, and always our first choice for teenagers. While 100% effective in preventing pregnancy and STIs (sexually transmitted infections), abstinence may sometimes be difficult for an adolescent or young adult to practice in a mature, stable relationship, or in a “heat of the moment.”
Barrier devices block the sperm from meeting the egg. These devices are less effective than medical contraception due to inconsistent use. Barrier methods may be purchased over-the-counter.
Condoms: Made of latex or polyurethane, a male condom is unrolled over the penis and a female condom is inserted in to the vagina. Condoms prevent bodily fluids from mixing when two people have sex. Condoms provide the best protection against STIs. Even when used perfectly, however, male condoms are only 82% effective while female condoms are only 79% effective in preventing pregnancy.
Cervical Cap, Diaphragm, Sponge, Film, or Suppository: Usually used with spermicide (a chemical used to kill sperm), these devices are manually placed over or near the cervix (the muscular opening to the uterus at the end of the vagina). These devices have a high failure rate (<80% effective) and are often the most difficult to use correctly.
Medical contraception (consisting of progesterone with/without estrogen) regulates hormone fluctuations in a woman’s body, thereby preventing the release of an egg from a woman’s ovary (ovulation) and thickening her cervical mucous, making it more difficult for sperm to meet egg (fertilization). Additional benefits of medical contraception may include improved menstrual cycles, clearer complexions, and better moods. Some forms of medical contraception even reduce a woman’s risk of ovarian and endometrial cancer! All medical contraception requires a prescription from a healthcare professional. Also, all medical contraception is reversible and has no lasting impact on fertility once stopped.
Long-Acting Reversible Contraception (LARC): The Implant* and the IUD* are the easiest, longest lasting, and most reliable forms of contraception recommended by the American Academy of Pediatrics (AAP). With 99.9% effectiveness, LARCs are effective, hassle-free options for teenagers.
*The Implant (Nexplanon): A certified healthcare provider performs an easy outpatient procedure to insert a small plastic rod approximately the size of a matchstick underneath the skin of a woman’s inner upper arm. The Implant slowly releases progesterone and lasts for 3 years. Drs. Molly Falasco and Bill Long are certified Nexplanon providers at Pediatric Associates who are able to place Nexplanon the same day of consultation.
*The IUD, Intrauterine Device: Through an outpatient procedure akin to a pap smear, a certified healthcare provider places a small, flexible piece of T-shaped plastic in a woman’s uterus through her cervix. The progesterone IUD (Mirena, Skyla, Liletta, Kyleena) lasts anywhere from 3-6 years, whereas the hormone-free, copper-based IUD (ParaGuard) lasts for 10 years. A referral to Adolescent Medicine or Gynecology is necessary for administration.
The Shot (Depo Provera): Like a vaccine, a medical professional administers a progesterone shot in a woman’s arm once every three months (four times per year). When administered on time, The Shot is 94% effective. A referral to Adolescent Medicine or Gynecology is necessary for administration.
The Pill, Oral Contraceptive Pill (OCP): A combination of estrogen and progesterone (or just progesterone alone), a woman takes one pill at the same time every day. In a typical monthly pack, there are 21 hormone pills followed by 7 placebo pills, allowing for a shorter, lighter, less painful period in the final week of the month. When administered on time, The Pill is 91% effective. Even missing a dose by a few hours or taking certain other medication at the same time might significantly reduce The Pill’s effectiveness. Many OCPs exist on the market (Sprintec, Ortho Tri-Cyclen, Seasonique, to name a few), so an experienced healthcare provider should offer guidance in determining the ideal pill. Any pediatrician may prescribe The Pill.
The Patch (Xulane): A combination of estrogen and progesterone, a woman places the patch anywhere on her body, replacing once per week for three weeks. The woman then removes the patch for one week, allowing for a shorter, lighter, less painful period in the final week of the month. Like a nicotine patch for smoking cessation, the body absorbs medication through the skin. When administered correctly, The Patch is 91% effective. Any pediatrician may prescribe The Patch.
The Ring (Nuvaring): A combination of estrogen and progesterone, a woman manually places a rubbery ring inside her vagina once every three weeks. At the end of the three weeks, the woman then removes the ring, allowing for a shorter, lighter, less painful period in the final week of the month. When administered correctly, The Ring is 91% effective. Any pediatrician may prescribe The Ring.
Emergency Contraception or “The Morning After Pill” (Plan B, Next Choice, LNG, Ella).
Taken within five days of unprotected sex, Emergency Contraception (EC) prevents pregnancy in a number of ways. EC delays ovulation, prevents sperm from meeting egg, and may even inhibit implantation (when a fertilized egg attaches to the wall of a woman’s uterus). This is not an abortion drug. Sometimes adolescents may purchase EC directly from a pharmacist, but EC usually requires a prescription from a healthcare professional. Any pediatrician may prescribe Emergency Contraception.
As you can see, an experienced pediatrician may tailor contraception to fit a teenager’s specific needs and preferences. Learning about reproductive health in no way opens proverbial floodgates for sexual promiscuity, but instead empowers adolescents with the knowledge of how to make a responsible transition to adulthood. Whether that is a 14-year-old looking to better handle her heavy menses or a 18-year-old looking for a hassle-free form of birth control before heading off to college, contraception is an effective way to guarantee an adolescent’s reproductive safety. There are risks and benefits to each option, which is important to address with your pediatrician. For a more in-depth discussion and possible same-day intervention, consider the Pediatric Associates Reproductive Health Clinic! And the best news is: most insurance companies will completely cover both the visit and any contraception prescribed.