While abstinence education should be encouraged, many young women and men will choose to become sexually active. Young women in the United States have one of the highest rates of unplanned pregnancy in the developed world. They also contract sexually transmitted infections at much higher rates than older women. The long-term consequences of both unplanned pregnancies and sexually transmitted infections can be devastating.
Adolescent women are at higher risk for non-compliance with contraception — that is, they're more likely not to use any, or an effective contraception method, or to not use it correctly. That means care must be taken to find a method that fits their lifestyle. Options for contraception are numerous, and young women and men should be counseled about the available methods.
Hormonal contraception, often in the form of birth control pills (oral contraceptives), may contain estrogen and progestin (combination) or a progestinal (progestin only) agent alone. Oral contraception may appear to be easy, but for an active young woman, taking a pill every day may be challenging. Oral contraception also does not provide protection against sexually transmitted infections.
However, for very motivated young women, oral contraceptives have several important non-contraceptive benefits: less bleeding, improvement in menstrual cramps and premenstrual symptoms.
The most popular progestin-only method is medroxyprogesterone (Depo-Provera). The advantage for young women with this method it requires an injection only every three months. The disadvantage is that bone loss occurs after two years of use. Because of compliance issues, other delivery systems such as the vaginal ring and transdermal patch are available; these options do tend to be more costly.
Intrauterine contraception such as the Mirena intrauterine device is also a reasonable option for young women, especially if compliance is an issue. Screening for infections should be done prior to insertion.
Because adolescents are at such high risk for sexually transmitted infections, condom use should be encouraged with all methods.
Educating young women and men about safe sex is extremely challenging. Young women and men are vulnerable to contracting sexually transmitted disease and sexually transmitted infections, often because of high-risk sexual behavior, such as multiple partners and failure to use condoms. In many communities the highest rates of chlamydia and gonorrhea are among 15- to 19-year-olds, while in other communities, the rates of teen HIV and syphilis are on the rise. Though oral antibiotics cure most chlamydia and gonorrhea cases, many cases show no symptoms, and reinfection rates are high. Ectopic or tubal pregnancy, infertility and chronic pain are all potential consequences of sexually transmitted infections.
The most common sexually transmitted disease is human papilloma virus or HPV. It is highly contagious but signs of infection may not show up for several years. Fortunately, in most exposed healthy young women, HPV infection clears without treatment. Some types of HPV may cause cervical cancer, but most types are symptomatic or are associated with warts. HPV is the only sexually transmitted disease that has an available vaccine. While HPV vaccine can be given to young women and men after they become sexually active, the optimal time is before they are exposed. The side effects are minimal and the potential benefits are high.
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