Jennifer Ashton, M.D., Ob-Gyn with Christine Larson WebMD Feature by “The Body Scoop for Girls”
Don’t expect to learn all you need to know about birth control in school. Many schools provide no instruction in birth control methods except for abstinence.
Five More Reasons to Love Condoms
They’re easy to get at any drugstore.
No prescription needed: Anyone can buy them.
Minors can buy them.
Did I mention that they’re the only way to avoid STIs?
True or False
Teens need a full gynecological exam, including a pelvic exam, before starting on the pill.
FALSE. It’s a good idea but it’s not a must.
Did You Know?
Pediatricians Can Prescribe the Pill
Yep, it’s true—your pediatrician can write your birth control prescription. Your pediatrician can also answer your questions about sex and guide you on safe practices. Of course, I think it’s a great idea to have your own gynecologist before you start having sex, but I know that’s not always possible. And not having a gynecologist is no excuse for getting pregnant!
Not for Teens: Don't Try These
Diaphragms, cervical caps, and shields are not good options for teens (or adults for that matter). These are all “barriers” inserted into the vagina. Unfortunately, they have a high failure rate—20 percent with a diaphragm, 40 percent with a cap. Plus, if a cap is left in for more than two days, there’s a higher risk of toxic shock syndrome—a potentially life-threatening infection. These methods require precise measurement and fitting by a doctor to make sure you get the right size. Last but definitely not least, most teenagers simply don’t want to insert stuff into their vaginas. Because of all these problems, I don’t even recommend these for my adult patients.
Great Ways to Get Pregnant: Methods That Don't Work
Here are a couple of things that just don’t work (unless, that is, you’re trying to get pregnant):
The so-called rhythm method, where you count the days of your cycle and avoid sex during and after ovulation. The rhythm method is a disastrous choice for teens. Until you’re in your twenties, your cycles are not regular enough to predict ovulation with any accuracy. Even for adult women this method has a 15 to 30 percent failure rate.
Withdrawal, where the man withdraws his penis from the vagina before he ejaculates. Not only does this method require enormous self-control -- not something teen boys are famous for -- but it also doesn’t work. Typically, withdrawal has a failure rate of about 20 to 30 percent. That’s because the fluid released before ejaculation can contain sperm, which can swim into the vagina from the vulva.
It’s a shame, because there are more birth control options than ever, many newly approved for teens. Of course, condoms are still the only way to prevent most STIs. But you need to use two birth control methods—condoms and a backup method to prevent pregnancy.
Why? Because condoms have a 15 percent failure rate with typical use—much higher than the failure rate of other methods, like the pill.
One of my patients, Susan, learned this the hard way. While she was away at college she got pregnant and had a termination procedure at a Planned Parenthood near her school. As if that weren’t enough, she also got chlamydia and HPV from her steady boyfriend—a triple whammy. When she came home for a checkup, I asked what had happened.
“I don’t know,” she said. “We used condoms every single time. And I never saw one that looked broken or torn.” It was a perfect example of the 15 percent failure rule: You might not even notice when a condom is leaking or torn. Remember Susan when you’re thinking that safe sex (sex with condoms) has no risks. The best way to be safe is to avoid sex; the second best way is to be discriminating and always use two forms of birth control.
Birth Control Menu
Here’s a guide to your choices.
Condoms The only method of contraception that prevents the spread of sexually transmitted infections. I tell my patients never to have sex without a condom. But even condoms have a 15 percent failure rate with typical use. (“Typical use” refers to the fact that they may rip, slip off, etc.) You absolutely must use a backup method (just don’t tell your boyfriend about it or he’ll think it’s OK to skip the condom).
Unfortunately, despite all the media campaigns and educational efforts to promote condom use, only 62 percent of high school students who have had sex say they used a condom the last time they had intercourse. That number is much too low. It needs to be 100 percent. Do your part: Always use condoms.
Hormonal Methods Most other contraceptive methods involve hormones, delivered through a pill, patch, shot, or other method. No hormonal method protects against STIs. (But . . . they do clear up acne!)
Oral Contraceptives (“The Pill”) Oral contraceptives usually are a combination of two hormones—estrogen and progestin. Working together they prevent ovulation, thin the uterine lining, and thicken cervical mucus. The progestin-only “mini-pill” doesn’t include estrogen but needs to be taken at exactly the same time each day, which can be tough for teens.