Providing effective reproductive health care and prescribing contraceptives for adolescents.

Abstract

1. Catherine Stevens-Simon, MD* 1. 2. *Associate Professor, Department of Pediatrics, Division of Adolescent Medicine, University of Colorado Health Science Center, Denver, CO. 1. The pregnancy rate among sexually experienced teenagers in the United States has declined since the 1980s, but the overall pregnancy rate has risen precipitously. 2. The accelerated rate of pubertal development makes it imperative for all pediatric clinicians to be familiar with problems created by unprotected sexual activity, to be able to develop the differential diagnosis in sexually active teenagers who are not using contraception, and to be knowledgeable about the efficacy of various contraceptive agents for preventing pregnancy and sexually transmitted diseases. 3. The differential diagnosis of sexually active teenagers who are not using contraception requires a thorough understanding of the developmental, physiologic, psychological, economic, social, and cultural factors that threaten consistent contraceptive use at this age. 4. The efficacy of contraceptive counseling may be improved by addressing factors and events in young people’s lives that could undermine their motivation to use contraceptives rather than stressing side effects of specific contraceptives. 5. Providing teenagers with information about contraceptives does not detract from the abstinence message of delaying the initiation of sexual intercourse. 6. The episodic nature of teenagers’ sexual relationships makes it difficult to maintain the high level of vigilance required to use oral and injectable contraceptives consistently and effectively; continuation rates for injectable medroxyprogesterone are no better than for oral contraceptives and significantly poorer than those for levonorgestrel implants. With its traditional emphasis on prevention, pediatrics affords a unique opportunity to promote safe sexual practices. To help pediatric clinicians who have varying levels of training in reproductive medicine, this article defines and reviews the epidemiology of the problems created by unprotected adolescent sexual activity, explores a variety of possible roles for practitioners who wish to prevent these morbidities by becoming involved in their patients’ reproductive care, and discusses the risks and benefits of various contraceptives and factors to be considered in helping teenagers …