Adolescents57,58 Abstinence59 Increased abstinence accounted for one-quarter of the drop in the US teen pregnancy rate observed between 1988 and 1995. This decline was caused by lower pregnancy rates among sexually experienced women aged 15–19 years, and not because of a rise in abortions. Abstinence, if a method chosen by the adolescent, should be actively supported and accompanied by specific peer negotiating strategies. Abstinence programs may help adolescents to postpone first intercourse. It may also be a valid method for teens who have been sexually active in the past, but now choose to defer further activity; it can be combined with other methods. EC Counseling regarding the availability of EC may provide a back-up method should abstinence not always succeed. Hormonal therapy OCPs are excellent choices because teens may benefit from non-contraceptive effects such as more regular periods, less dysmenorrhea, and improved acne. The contraceptive patch and Implanon may also be well tolerated. IUDs are generally avoided though data on future fertility in nulliparous women are conflicting. Injectable DMPA may adversely affect bone density and if weight gain occurs this symptom may be less well tolerated among adolescents. If used by adolescents it should be confined to less than two years unless there is convincing evidence that no other method is acceptable. Condoms should be encouraged to enhance whatever contraception the woman chooses as they provides additional contraceptive benefit and some protection from STIs. Information on EC should be offered and a prescription provided if a “back-up” method is desired. EC is available without a prescription only to those over 18 years of age so the younger adolescent benefits from a prescription on hand. The advantages and disadvantages of other over the counter products such as spermicides and the sponge should be addressed in case the woman decides on sexual activity before the next office visit. Abuse Ten percent of young women report that their first intercourse was either “not voluntary” or “rape.” Because coerced sex in this age group is prevalent, clinicians should be vigilant for signs and symptoms of potential abuse.
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