![[Sexual Integrity for Teens]](../images/logo_sit.gif){kind=logo}
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| One of the most important choices you will ever make is when, or if, to become a parent. Since becoming a parent affects your options in life, you need to ask yourself some difficult questions. What do I really want to accomplish in life? Would having a child now interfere with my ability to achieve that goal? Am I really ready to take on the responsibility of raising a child? What support would be available? Could I emotionally and financially handle this situation? |
If you decide that you do not want to become a parent at this time, the information contained in this leaflet will provide some of the information that will help you make an informed decision about the strategy for controlling birth that is "best for you."
Since discussions of birth control involve the topics of sex and relationships with intimate partners, many ideas of what is right or wrong and good or bad are involved. Some people's moral and religious values will lead them to view some of the alternatives as being unacceptable. How you view them and whether you practice them is your own personal decision. Being informed about the options will help you decide what you want to do.
NOT HAVING INTERCOURSE IS AN OPTION
The surest way to avoid pregnancy is not to have sexual intercourse. For many unmarried young people, this is the only viable option since they believe either that they are not ready to have intercourse or that sex outside of marriage is wrong. If this describes you, make up your mind to say "no" and stick with it. Remember that acting out your values is a characteristic of sexual integrity.
Whether or not abstinence is the best option for other groups of young people depends on a variety of factors such as the nature of their intimate relationships or their marital status.
Despite what you may have heard, everyone is not "doing it." When considering abstinence, it's important to remember that just because you've had sex in the past doesn't mean you have to continue this practice. It's possible to say "no" at any time.
IF YOU ARE SEXUALLY ACTIVE
If you are sexually active, knowing key facts about the most common methods of contraception can help you make informed decisions. As you consider each method, ask yourself the following questions:
Thinking about these questions can be confusing and embarrassing. That is normal, but you need to make yourself think about contraception if you are having, or plan to have, intercourse and do not want to become pregnant.
You also need to talk about these issues with your sexual partner. If you don't feel comfortable discussing contraception with your partner, ask yourself, "Should I be having sexual intercourse with someone I cannot talk to?" Contraception works best when a female and male choose and use it together.
THE BIRTH CONTROL PILL
"The pill" is among the safest and most effective forms of contraception for young women. Combination birth control pills, the kind most commonly prescribed, contain two hormones an estrogen and a progestin. Mini-pills contain progestin only. Both types of pills must be prescribed by a doctor or health care practitioner after a physical exam and risk evaluation.
When using birth control pills, you must take one every single day. It is best if you do this at the same time each day. When used correctly, the pill is a highly effective form of birth control. The lowest expected failure rate is less than 1 pregnancy per 100 users per year. On average, there are about 3 pregnancies per 100 users per year. The mini-pill is slightly less effective.
While the risks from the pill are slight, there are a few side effects like slight weight gain, breast tenderness, and light spotting between your menstrual cycles. In most cases, these are not serious and usually go away. When considering your options, it is important to realize that the pill, or any other form of contraception, is safer than the risks associated with an unplanned pregnancy. The pill does not, however, protect you from sexually transmitted diseases.
DIAPHRAGM OR CERVICAL CAP
The diaphragm and cervical cap are quite similar. A diaphragm is a shallow rubber cup stretched over a flexible ring. A sperm-killing cream or jelly (spermicide) is applied to it and it is inserted into the female's vagina to cover the opening to the uterus (cervix). A cervical cap, on the other hand, is a small thimble-shaped cup made of soft latex rubber that fits over the cervix inside the vagina. It too is used in conjunction with spermicidal jelly or cream. Diaphragms and cervical cups must be fitted by a clinician because women's vaginas vary in size. In addition, if a woman gains or loses considerable weight or gives birth, a refitting is necessary if she is using a diaphragm.
Both devices must be inserted before intercourse and provide protection in two ways. They block sperm from reaching the uterus while the spermicide kills sperm. The diaphragm can be put in the woman's vagina six hours before intercourse and left in for twenty-four hours. The cervical cap can be left in her vagina for up to forty-eight hours. After these devices are removed, they should be cleaned and stored. Directions on how to care for and store them are provided when they are purchased.
The lowest expected failure rate for diaphragms and cervical caps is about 3 to 5 pregnancies per 100 users per year. On average, there are about 18 pregnancies per 100 users per year. Users can get better protection by checking each time they have intercourse to make sure the diaphragm or cap covers the cervix and by having their partner use a condom. Also, reapplying the spermicide for repeated sexual encounters will increase the effectiveness.
NORPLANT
Norplant consists of six flexible capsules filled with progesterone that are inserted in a fan-like pattern beneath the skin of a female's upper arm. Once inserted they are only slightly, if at all, visible. A tiny amount of progesterone is released every day and works by inhibiting ovulation, thickening of the cervical mucous, and/or decreasing the thickness of the uterine lining. The procedure for inserting the Norplant device is not painful and can be performed during a 30-minute routine office visit.
Norplant is a very effective means of contraception. The lowest expected failure rate is significantly less than 1 pregnancy per 100 users per year. On average, there is less than 1 pregnancy per 100 users per year. Norplant is effective for five years. At the end of that period, or sooner if the user desires, the Norplant device is removed in a manner similar to that of the insertion procedure. If desired, a new set of capsules may be inserted at the same time the old set is removed.
DEPO PROVERA INJECTIONS
Depo Provera is a contraceptive injection or "shot" of long-acting progestins. Like the pill and Norplant, it keeps a woman's body from producing eggs. A woman using Depo-Provera goes to a doctor or clinic to be injected every three months. The first shot is given within the first seven days of a menstrual cycle (within seven days from the first day of bleeding). Since it does not become effective immediately, a woman should use an additional contraceptive method for two weeks after her first injection.
Like Norplant, Depo Provera is very effective. Its lowest expected and actual failure rates are significantly less than 1 pregnancy per 100 users per year. Unlike other hormonal birth control methods, the shot is safe for women who have just had a baby and can be used safely by women who are breast-feeding.
While Depo Provera is a good choice for many women, there are certain women who should not opt for this method. Women who want to become pregnant within the next two years should choose another birth control method since a return to fertility is sometimes delayed.
INTRAUTERINE DEVICE (IUD)
While you may have heard of intrauterine devices, they are not recommended for young women who have never had children. An IUD is usually made of soft flexible plastic in the shape of a "T" and come in various sizes. It is worn inside the uterus after insertion by a doctor or other clinician. While there are a number of theories, we are not completely sure how IUDs work. The lowest expected failure rate is about 1 to 2 pregnancies per 100 users per year. On average, there are about 3 pregnancies per 100 users per year.
MALE CONDOMS
The male condom, also called a "rubber" or "prophylactic," is an over-the-counter method used by men. You can buy it without a prescription. It is shaped like the finger of a glove and is made of latex rubber or animal tissue. The condom is rolled onto the erect (hard) penis before the penis comes into any contact with the vagina. It works by catching ejaculated semen (come), thus preventing sperm from getting inside the woman's vagina.
Those using a condom should be careful to leave a little space at the tip to catch the sperm and help prevent it from bursting. The male also should withdraw, while holding the base of the condom, before his erection subsides in order to keep the condom from slipping off. A new condom should be used for each act of intercourse. In addition, avoid storing condoms in warm places and using Vaseline or petroleum-based lubricants that weaken latex.
The male condom's lowest expected failure rate is about 2 pregnancies per 100 couples using condoms per year. On average, there are about 12 pregnancies per 100 couples per year. When used in conjunction with a vaginal spermicide, such as a jelly or foam, failure rates are significantly lower.
Use of latex condoms by those who are sexually active is the most effective way to prevent the spread of sexually transmitted diseases, including AIDS. Using a spermicide containing Nonoxynol-9 along with a condom results in even safer sex.
FEMALE CONDOMS
One of the newer over-the-counter birth control methods is the female condom. Made of polyurethane, which is a thin plastic, it covers the cervix and the vagina. There are flexible rings both at the opening and at the bottom of the device. The closed end is inserted near the cervix while the outer ring stays outside the vagina and holds the condom open.
The female condom works by catching the male's semen as he ejaculates (comes). It can be inserted up to eight hours before intercourse and is usable during a woman's period. Each condom should be used only once. The lowest expected failure rate is about 5 pregnancies per 100 users per year. On average, there are about 21 pregnancies per 100 users annually. Using the female condom helps prevent sexually transmitted diseases, including AIDS.
SPERMICIDES
Other over-the-counter birth control methods for women include contraceptive foams, creams, jellies, suppositories, films and sponges. All contain chemicals called "spermicides" and are inserted deep into the female's vagina before sexual intercourse. They work by blocking the entrance to the uterus and killing sperm.
Foams, which come in aerosol cans, and creams and jellies, which come in tubes, have plastic applicators. Suppositories and film are inserted by hand. Sponges come in one size and are made of polyurethane foam which contains the spermicide. They must be moistened with water before use and also are inserted by hand. Sponges have a nylon loop so they can be easily removed.
These methods are not as reliable as medical methods but they are easy to obtain and use. Some offer some protection against certain sexually transmitted diseases. Their lowest expected failure rate is about 3 to 5 pregnancies per 100 users per year. On average, there are about 18 to 21 pregnancies per 100 users per year. However, if the female's partner also uses a condom, failure rates are significantly lower.
FERTILITY AWARENESS
Fertility awareness, also called "natural family planning" or "rhythm method," is not very effective with young people. The female attempts to pinpoint the days of the month when she is fertile. She monitors daily changes in her body temperature, vaginal discharge, and/or keeps track of her menstrual periods on a calendar. This information is used to pinpoint which days she is most likely to get pregnant. Couples then can avoid intercourse during that time.
The lowest expected failure rate for fertility awareness is 2 to 10 pregnancies per 100 women per year. On average, there are about 24 pregnancies per 100 women per year.
While fertility awareness has no health risks or side effects, it is among the least effective methods of contraception. If your moral or religious values make this the only acceptable method for you to use, however, realize that it is more likely to work if careful records are kept and if both partners have a high degree of self-control.
METHODS THAT DON'T WORK
There are many wide-spread myths about sexuality that result in people relying on methods to control births that simply don't work. Ineffective methods include:
MAKING YOUR CHOICE
It should be obvious by now that there are many choices for controlling births. The first decision you have to make is whether or not you are going to have sexual intercourse. If you decide not to, you don't have to worry about controlling births. If, on the other hand, you are sexually active and don't want to become a parent, you need to practice one or more of the contraceptive methods discussed in this leaflet.
Deciding which method or methods to use is not easy. While some of the methods like condoms, contraceptive foams, creams, jellies, suppositories and sponges do not require you to see a medical professional and are readily available in local stores, some of the most effective methods must be either prescribed or fitted by a medically qualified person. Therefore, it's a good idea to talk with someone trained in helping others make contraceptive choices. Visit your private doctor, your county health department's family planning clinic, or a Planned Parenthood affiliate. These caring medical professionals can help you make the type of informed, responsible choice that characterizes those who act with sexual integrity.
AUTHOR: Gary L. Hansen, Ph.D., Extension Specialist in Sociology, Cooperative Extension Service, University of Kentucky; and William W. Mallory, Fayette County Extension Agent for 4-H/Youth Development, Cooperative Extension Service, University of Kentucky.
