Contraception

You may have come across stuff in teen magazines about sex and contraception. Maybe you and your friends talk about this from time to time. Magazines often refer to condoms and other forms of contraception as the answer to unwanted pregnancy.

Teen pregnancy is a big issue for girls who are sexually active. Using contraception is no guarantee they won’t get pregnant. Estimates vary, but it is believed that around one in four sexually active teenage young women become pregnant by mistake (Healey, 2005). Contraceptive failure is a common factor in teenage pregnancy. About half of all teen pregnancies end in abortion.

These are life altering decisions. How would an unplanned pregnancy affect you?

Decisions about sex
Whether or not get into sex is something to really think about – not just because of the risk of pregnancy, but because of sexually transmitted infections (STIs) and emotional hurts. There’s no such thing as casual sex. People’s emotions and physical well being are always on the line.

Most teen magazines, movies and TV soaps give the impression that pretty much all teens are having sex. Not true! By age 19 only half the teen population has had sexual intercourse. If you are a virgin you are not alone – and you’re keeping safe. Saying No to sex as a teenager is a smart move.

Read on for more info about contraception.

Before we talk about contraception, let’s discuss what conception is.

Conception occurs when a man’s sperm unites with a woman’s ovum (egg).

Sperm is released from the man’s penis during sexual intercourse, travels from the woman’s vagina into the uterus and out into the fallopian tubes. Human life begins when one sperm meets and joins with an ovum that has been released into the fallopian tube. The fertilised ovum will continue on to the uterus where it will implant into the rich lining of blood and mucous that forms each month for the purpose of nourishing a developing embryo.

There are only a few days in a woman’s monthly cycle when conception can occur – this is the most fertile time.

NOTE – full intercourse is not required for a pregnancy to occur. Any release of sperm near the woman’s genital area eg. on the vulva or outside the vagina may cause pregnancy.

Contraception is any means used to try and prevent pregnancy occurring during sexual intercourse. No method of contraception is 100% effective. Contraceptive failure is a huge factor in teenage pregnancy.
Some methods prevent fertilization of the egg by the sperm. Other methods interrupt pregnancy by preventing the fertilized ovum settling in the uterus. Some methods carry risks and side effects.
Condoms, the Pill and so-called ‘emergency contraception’ are the methods most relied upon by sexually active teenagers who use contraception. These methods are described here, plus things to know about each.

Condom

A thin latex or rubber sheath placed over a man’s erect penis, designed to prevent the sperm from entering the woman’s vagina.
Effectiveness
Although condoms are widely promoted as the key to ‘safe sex’ they have a high failure rate in practice

  • 15 out of 100 women whose partners use condoms will become pregnant during 1st year of typical use
  • 2 out of 100 per year will become pregnant with perfect use
  • offers some protection against certain STIs (sexually transmitted infections)

Disadvantages

  • can break (especially if a water-based lubricant is not used)
  • may slip off
  • may not be put on properly
  • may not be put on in time, that is prior to genital contact
  • difficulty may occur when withdrawing after intercourse
  • may be damaged or old (out of date)
  • do not protect against STIs passed by skin contact such as genital herpes, Human papilloma virus.

The Pill (Combined Pill)

A drug containing two synthetic hormones, oestrogen and progesterone, which act on the female’s whole system. A prescription must be obtained from a doctor following a thorough medical check-up. The Pill must be taken every day to be effective.
The Pill is thought to work in three ways:

  • by preventing release of ovum from ovary
  • by changing lining of uterus so embryo cannot implant
  • by thickening cervical mucous making it difficult for sperm to enter uterus.

Effectiveness
Generally very effective IF used strictly according to instructions. Works best if taken at same time every day

  • 8 out of 100 women will become pregnant during 1st year of typical use
  • less than I out of 100 per year will become pregnant with perfect use
  • offers no protection from STIs

NOTE: The Pill may no longer be effective if the woman has been vomiting or is taking antibiotics.

Disadvantages and possible side effects

  • headaches, nausea, weight gain, skin problems
  • depression and mood swings
  • interrupts normal menstrual cycle
  • increased risk of blood clots

Despite extensive research there are still questions about long term effects of using the Pill.

Women advised NOT to take the Pill include those who

  • smoke
  • wear contact lenses
  • suffer from migraines, epilepsy, diabetes, high blood pressure
  • have a history of blood clots, heart attack or stroke
  • have unexplained vaginal bleeding

Emergency Contraception

A drug composed of a synthetic hormone used in a much higher dosage than the contraceptive pill. It is designed to prevent or interrupt a pregnancy if taken within 72 hours (3 days) of unprotected sexual intercourse, preferably within 24 hours following unprotected sex. It is now available without prescription from chemists.

The dosage is two tablets given 12 hours apart.

It is thought to work in a number of different ways –

  • altering the cervical mucous making it more difficult for sperm to reach the ovum
  • Preventing or delaying ovulation
  • Preventing a fertilized ovum from implanting in the uterus.

Effectiveness

  • Success rate is unknown as it is too early to know if a girl is pregnant or not.

Disadvantages, cautions and possible side effects
As with the Pill, emergency contraception should not be administered to anyone with a history of blood clots, anemia, high blood fat levels, breast cancer, uterine cancer, liver disease, migraines, epilepsy, diabetes. Side effects include –

  • Nausea in about 25% of women
  • Vomiting occurs in 5%
  • Disturbed menstrual pattern
  • Breast tenderness
  • Headache
  • Dizziness
  • Fatigue

Other concerns
Over-the-counter purchase at chemist reduces opportunity for private discussion about above side effects and a girl’s medical history.

Anxiety is not reduced as she must still wait until a pregnancy test can be done. Side effects of the drug can mimic symptoms of pregnancy. If the girl discovers she is pregnant after using emergency contraception she may fear damage to the embryo and feel pressured into an abortion decision.

Regular use of emergency contraception may increase health risks including ectopic pregnancy (development of pregnancy in fallopian tube instead of uterus).

The Mini Pill

Contains synthetic progesterone only. Usually prevents ovaries from releasing an ovum. Less often it thickens cervical mucous, preventing passage of sperm to ovum. May also prevent implanting of a fertilised ovum in uterus.

Effectiveness
Only effective if taken at exactly the same time every day

  • pregnancy rate for Mini Pill is much higher than for the combined pill because of the need to take it at exactly the same time daily
  • 8 out of 100 women will become pregnant during 1st year of typical use
  • less than 1 out of 100 per year will become pregnant with perfect use

Disadvantages and possible side effects

  • menstrual problems ie: no periods or continuous bleeding
  • headaches, nausea, dizziness, sore breasts

NOTE: The Mini Pill may no longer be effective if the woman has been vomiting or is taking antibiotics.

Depo Provera

A synthetic progesterone. Works like the Mini Pill but is given to the woman by injection every three months. The drug is absorbed slowly and continuously. Any unpleasant side effects will last until the end of the three month dose.

Effectiveness

  • 3 out of every 100 women will become pregnant during 1st year of use
  • effective for 12 weeks

Disadvantages and possible side effects

  • irregular bleeding – periods may become fewer and lighter or may even cease
  • periods may take years to resume after stopping Depo-Provera
  • longer and heavier periods
  • spotting and breakthrough bleeding
  • headaches, nausea, dizziness, sore breasts
  • change of appetite and weight gain
  • provides no protection against STIs
  • increased chance of ectopic pregnancy if pregnancy occurs whilst on Depo-Provera

Implanon

A progesterone-only contraceptive implant. Consists of a small plastic rod inserted just under the skin on inside of the upper arm. The rod is very flexible and not likely to be visible. The hormone is released slowly from the device into the bloodstream over 3 years.
It works by:

  • stopping the release of an ovum from the ovary every month
  • thickening the mucous in the cervix making it difficult for sperm to get through
  • changing the lining of the uterus, altering bleeding patterns.

Effectiveness

  • thought to be highly effective.  No contraception is 100% effective.
  • can be removed easily
  • its location must be checked regularly
  • must be replaced after 3 years

Disadvantages and possible side effects

  • can cause light or no periods at all
  • may cause irregular bleeding patterns, weight gain, acne, headaches
  • a small number of women have experienced mood swings, abdominal pain, painful periods and hair loss
  • not to be used where there is history of liver disease, abnormal vaginal bleeding, thrombosis of lung or leg.

Withdrawal or ‘pulling out’

The man withdraws his penis from the woman’s vagina just before ejaculation (release of sperm).
Effectiveness
27 out of every 100 women whose partners use withdrawal will become pregnant in 1st year of typical use.
Disadvantages
This method is extremely unreliable

  • it is not always possible for a man to control the timing of ejaculation. This is particularly true in young males. Some men commonly experience premature ejaculation
  • sperm may be present in the fluid released from the man’s penis just before ejaculation
  • sperm that is released just outside the vagina is able to travel through the vagina into the uterus

Most teenagers are not sexually active. There are good reasons for this choice.
Having sex can complicate single relationships. You are free to choose to have more control of your sexual and emotional health.
Remember

  • It’s OK to delay sexual activity. You don’t have to justify yourself.  Not everyone is ‘doing it’
  • Sex is worth waiting for, and so are you
  • Enjoy many friendships
  • You can have affectionate and fun times without having sex
  • Support each other and your friends in the decisions you have made
  • If someone puts the pressure on you they don’t care about you
  • Alcohol, drugs, and even your emotional state can affect your decision making
  • Have a support network of trusted adults you can talk to.

Sometimes we make mistakes about sex, especially if we are feeling down about something, or lonely and sad. Sex can seem like a promise of love and affection but afterwards we can feel really let down and used and somehow lonelier than ever. This emotional state can get in the way of making clear decisions and leave us open to risk.

References
The Abortion Issue (2005) Edited by Justin Healey, The Spinney Press.