Adolescent contraception: nonhormonal methods

Abstract

A comparison of the advantages, disadvantages, and costs of each method is presented in Table 1. Barrier methods of contraception offer adolescents protection against both pregnancy and STDs, but innovative approaches are needed to enhance availability and acceptability. Condom use in conjunction with a vaginal spermicide would provide optimal protection. The "female condom" may prove to be an effective alternative. Diaphragms and cervical caps can be prescribed for well-educated, highly motivated adolescents comfortable with insertion and removal. The vaginal contraceptive sponge provides many of the advantages of the diaphragm and cap without the need for an examination and fitting and also may be used as a backup method with the condom. Vaginal spermicides used alone are significantly less effective than in combination with a mechanical barrier. The IUD is not considered appropriate for most adolescents due to its association with an increased risk of pelvic infection. Periodic abstinence requires accurate identification of the fertile period, extensive education, and partner cooperation. Sterilization is rarely considered an option in adolescents. Alternate forms of sexual expression are available to adolescents who choose to abstain from intercourse.

PIP: Traditional responsibility for birth control changed from the male to the female with the introduction of oral contraceptives and IUD's in the 1960's. Concern over AIDS and other sexually transmitted diseases has rekindled interest in barrier methods of birth control in the 1980's. There are now a large number of women who approve of condom use and along with a decline in the popularity of IUD's. The disadvantages of vaginal and barrier methods of birth control are the larger numbers of accidental pregnancies. Condoms have proven the most effective guard against all types of sexual diseases including AIDS. A new barrier device is being introduced and is called WPC-333, which is the female version of the condom. Diaphragms are more accepted by educated, highly motivated, mature teens who are comfortable with insertion and removal. Possible side effects of diaphragm use include discomfort, irritation, and an increased risk of urinary tract infection. Cervical caps are similar to the diaphragm in efficiency with a pregnancy rate of 17/100 users per year. It is smaller and more comfortable than the diaphragm and can be in place longer, but there are difficulties with insertion and removal, and there are cases of discomfort, dislodgment and vaginal odor. The vaginal contraceptive sponge is another device sold over the counter and studies show a 12-17% pregnancy rate in its use. It does provide some protection against sexually transmitted diseases, but there have been cases of toxic shock syndrome with its use. Spermicides are normally used in conjunction with other devices and pregnancy rates vary from 11-31% of those users. The possible side effects are irritation, allergic reactions, and urinary tract infection when used alone. The IUD is a highly effective birth control method but doctors do not recommend it for teens. Barrier methods seem most practical for adolescents for protection against pregnancy and disease.