Dr. Jennifer Johnson -- Orange County's Doctor for Adolescents and Young Adults

20+ years helping young people achieve optimal health

 
 

Dr. J Answers Questions: Sex & Birth Control

Dr. Johnson is a member of the editorial advisory board of the Teengrowth website. Reproduced below are a few of Dr. Johnson's answers to original questions submitted to the site.

 

 

Topics

Ready to Have Sex?

Emergency Contraception

NuvaRing
Birth Control Shot
(Depo-Provera)
Questions about Your Body

Ready to Have Sex?

I’m a 14-year-old girl and I believe I'm ready to have sex. I’m not scared about pain, but I’m scared I might get pregnant (a lot of women in my family get pregnant when they lose their virginity). Of course I’ll use a condom but what if it tears? What should I do? Do condoms labeled “ultra thin’ tear more easily?

Good for you for thinking about preventing pregnancy and this important “what if” in advance! You are so right to be concerned about getting pregnant, even the first time you have sex. (I assume that “having sex” means penis-in-the-vagina intercourse – just checking!) It’s critical to use protection every time you have sex, both to prevent pregnancy and to protect yourself from getting a sexually transmitted disease (STD). Using a condom is a great way to start, but you’re right – they do break or tear occasionally. Should this occur, taking oral contraceptive pills for emergency contraception (EC) greatly decreases the likelihood of pregnancy. The first dose must be taken within 120 hours of unprotected intercourse. You can learn about EC and find out how to get it in your area from the EC website. Some doctors prescribe EC in advance, so that women can have it on hand if it is needed. Below is some additional information about condoms and sex that might be helpful to you.

But first, please let me ask you to step back for a moment and think about the “big picture.” Between the lines of your message, I think I might be hearing you say you’re not quite certain that you are ready to have sex. I wonder whether you might be especially concerned about getting pregnant at your age because something similar has happened in your family. Maybe you know firsthand about the challenges that early parenthood can bring and don’t feel ready to meet them. Maybe you have other thoughts that cause you to write that you “believe” you are ready to have sex, rather than you plan on having it. In case you’re not quite sure you’re ready, let me share my perspective. This includes me as a professional and me as a woman and mother of daughters. It is this: there is absolutely no reason to have sex, or to be physically intimate, with someone unless you yourself know and feel certain that you are ready to do so, and that this partner is the person to do it with. (To help know if you’re ready, type “ready” into the search engine at Planned Parenthood.

Whether or not you decide you’re really ready, here are some recommendations about sex and condoms.

If you haven’t already done so, spend some quiet moments with your partner just to talk about having sex. Make sure he is willing to use a condom each and every time you have sex. If he’s not, that should give you pause. If your partner has already had sex with other people, he may have gotten infected with an STD. Could he be at high risk for HIV? Perhaps he should get counseling and testing at Planned Parenthood or an STD clinic. Always use a spermicide (“foam,” for instance) along with the condom. Spermicide gives an extra measure of protection against pregnancy if the condom should break. There are different kinds of condoms. Never use a “lambskin” or “natural” condom; they don’t provide as much protection. “Ultrathin” condoms and others made of polyurethane are more likely to break. So, condoms made of latex are generally best. I recommend purchasing lubricated condoms and/or placing several drops of a liquid “personal lubricant” on the condom tip just before having sex. Often this makes sex more comfortable for the woman. I hope this information is helpful. Again, the most important advice at age 14 is to talk with your family and consider this decision very, very carefully. Not having sex is by far the safest choice. For more in-depth information, I recommend you spend some time at Planned Parenthood’s site for teens.

I’m only 15 and my mom wants me to start birth control. I told her I wanted to wait to have sex and have birth control in the future. She won't listen. What should I do?

What a difficult spot you are in. I imagine your mother has concerns that she has not been able to communicate with you. Such concerns could be based upon her own experiences in the past, behaviors she has observed in you or your friends, or information from any number of sources. If you haven’t already done so, it would be ideal for you to bring the subject up at a quiet time. Ask your mother to explain why she wants you to start birth control. Remind her you have no plans to have sex now. Reassure her that you plan to continue to take care of your body in a responsible way. (Of course, this includes using condoms if you should ever decide to have sex before you start a reliable form a birth control such as the pill.)

If such a conversation with your mother is not possible, or if it is unsuccessful in convincing her that you do not need to start birth control now, your health care provider is the best person to help you. Suggest that you and she meet together with your pediatrician to talk about this. If she wants you to see another provider instead, that ought to work out well for you, as well. Physicians do not prescribe birth control to teens like you only because their mother wants them to have it. Good luck!


Emergency Contraception

Imagine: You and your girlfriend just started having sex; she has an appointment to get started on birth control pills. You’ve been using condoms, but last night the condom slipped off your penis when you pulled out. What to do? Imagine: You and your boyfriend have been together exclusively for more than a year. In this time, you’ve both been tested for HIV (twice) and for gonorrhea and chlamydia. You’re using “the patch” for birth control. All the tests were negative, so you decided to stop using condoms. You were too busy to get your prescription refilled last week. And yesterday you had sex before you remembered you didn’t have your patch! What to do?

In both scenarios, the answer is this: use Emergency Contraception (EC). Years ago, this method had a different name (the “morning after pill”), used different ingredients, sometimes had unpleasant side effects, and had to be started within 24 (or 72) hours of unprotected sexual intercourse.

Today, EC is very safe and highly effective. It’s easy to use, consisting of two pills taken 12 hours apart. It has mild side effects, if any, and can be started up to 5 days (120 hours) after unprotected sex. In fact, this one-day dose of hormones is so safe that it is now available without a prescription for those 18 and older. However, at present EC does require the order of a health care professional for teens younger than 18.

How Does It Work? Like all other hormonal methods of contraception, EC works by delaying or preventing ovulation, inhibiting fertilization of an egg by sperm, and/or preventing the implantation of a fertilized egg in the uterus. The difference is that EC is an emergency high dose of hormones, and not intended as a regular method of birth control. It is used to help prevent pregnancy from an unexpected exposure.

How to Get EC Many providers will call in a prescription without requiring an office visit. No pelvic exam is necessary. In some states, trained pharmacists can distribute EC without a doctor’s prescription. A woman should call her doctor, family planning clinic or Planned Parenthood right away. By calling the toll-free, 24/7 Emergency Contraception Hotline (1-888-NOT-2-LATE), you can get more information and learn who provides EC in your area. There is also a Web site (http://www.not-2-late.com) where you can find EC providers in your zip or area code and get answers to many questions about EC.

Additionally, some health care providers prescribe EC in advance, so that women can have it on hand if it is needed. In cases of sexual assault, EC may be offered in the Emergency Department.

What Happens Next? Your next period might start right on schedule. Otherwise it should come within a week before or after you would normally have expected it. If your period hasn’t started more than a week after you expected it, we recommend getting a pregnancy test.

Think carefully about the situation that resulted in needing EC. If you are having sex and not currently using a highly reliable method of contraception, do make arrangements to start one as soon as possible. Your health care provider may be able to prescribe a starter pack of oral contraceptives when prescribing emergency contraceptio


NuvaRing

I'm 16 year old and I've had my period since I was 13 years old. I've started to be sexually active when I was 14 years old and about a few months ago I've decided to go on birth control. So I got this Nuva Ring, a type of birth control that is inserted into the vagina and my prescriber told me not to use it until seven days after I start my period. When I used the Nuva Ring I've realized that a lot of things about myself has changed. For example my weight, mood, and etc. but also... I've been getting mild head ache, cramping, and I've been feeling a little dizzy from time to time. I had the Nuva Ring in for about 5 days until it was removed during intercourse... and that's when I decided not to use it again. But anyways... my main problem is that I've just got off my period about a week ago and I just start it again. My period is usually really heavy... changing a super plus tampon every 2-3 hours. I just want to know... if this is normal. Am I loosing too much blood. Also... if the early period is caused by the Nuva Ring.

Great that you tried an effective hormonal contraceptive (in addition to using condoms, we assume). It sounds as if the ring was in place for 5 days. It’s possible that some of the symptoms you describe could be related to the NuvaRing®. If they were, however, we suspect they would probably disappear within the first couple of months using the NuvaRing®. It is quite common for teenagers to occasionally have a period that comes too early and/or to have heavy bleeding for the first day or two of their periods. It is unlikely that the changes you describe are due to the ring. We recommend you see your doctor to talk about your periods. If you can bring the dates of your most recent periods, that will help your doctor decide whether tests or treatment are needed.


Birth Control Shot

Where can I get more information on the Depo-Provera shot?

Depo-Provera is a method of birth control available only by prescription. It is an injection of a man-made form of a female hormone and needs to be re-injected every three months. It is not foolproof however, out of every 1,000 women who use it, three will become pregnant during the first year of typical use and it offers no protection from sexually transmitted diseases. You can find information online at Center for Young Women’s Health.

In late 2004, the federal Food and Drug Administration (FDA) issued a special alert, cautioning against possible irreversible bone mineral loss caused long-term Depo-Provera use. This is especially of concern in teens, since their bones are still growing. If you’re interested in trying Depo-Provera, discuss it with you health care provider.

I've heard that if you're on Depo-Provera you don't get your period. Is that OK?

Yes, that can happen, and yes, that's OK. Depo-Provera contains a long-acting progesterone hormone that can make your menstrual periods unpredictable. When you first start getting the shots, you might notice irregular bleeding or spotting. Eventually however, most women get fewer and fewer periods and often their periods stop altogether (“amenorrhea”). This is because very little lining is building up in the uterus and therefore there is no lining that needs to be shed. The lack of periods is not something to be worried about. In fact, many teenagers consider this a real benefit. As long as you have not missed any of your injections you don't have to worry about being pregnant, even if you don't get a period. When you stop using Depo Provera as a birth control method, your periods will resume and become regular again (usually within 6-12 months.) Your doctor can explain this to you in more detail if you wish.

If you are using Depo-Provera, be aware that late in 2004, the federal Food and Drug Administration (FDA) issued a special alert, cautioning against possible irreversible bone mineral loss caused long-term Depo-Provera use. This is especially of concern in teens, since their bones are still growing. Be sure to discuss this with your health care provider when you get your next visit.


Reprinted with permission from TeenGrowth.com. (c)1999-2010. www.TeenGrowth.com