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  • Title: [Contraception in adolescent girls: prevention].
    Author: Winaver D.
    Journal: Contracept Fertil Sex (Paris); 1987 Jun; 15(6):631-4. PubMed ID: 12280893.
    Abstract:
    Contraception for adolescents presents problems for physicians because the pediatricians and child psychologist with the greatest knowledge of adolescents are not the ones who prescribe contraception. Customary medical procedures may be inadequate for dealing with adolescents. Older women consulting for contraception usually themselves decide what method to choose, and their resistence to contraception and ambivalence to pregnancy can be explored. For adolescents, contraception may be a constraint rather than a choice. It may be imposed despite their conflicting desire for pregnancy and motherhood. Adolescents are usually accompanied by another person, who may make establishment of rapport difficult. If communication is not possible, it can be suggested that the examination be postponed. Attentive patience may eventually permit the examination to progress. The attitudes, preconceived notions, and emotions of the physician may prevent establishment of rapport with the adolescent patient. When contraception is imperative, there are usually no great risks in prescribing oral contraceptives even if the examination is refused. If the examination is done, the parts of the genital anatomy should be named and perhaps shown in a mirror to reassure the client that she is "normal", an important concern at this age. The examination should be used as an occasion to provide adolescents with the information they need to prevent gynecological and breast disorders, sexually transmitted diseases, cervical cancer, and other problems, and to seek prompt treatment if necessary. The immature reproductive systems and immune defenses of adolescent patients limit contraceptive choices for them, but lack of contraception brings its own serious risks of unwanted pregnancy, abortion, ectopic pregnancy, and even eventual sterility. Oral contraceptives (OCs) are completely effective, provide protection against some pelvic infections, and are safe when contraindications have been ruled out. OCs can be used before sexual activity commences, without risk to later fertility, and no interruption of the sexual act. OCs are generally well tolerated, but the daily discipline they require may be beyond the capabilities of some adolescents. The formulation should be changed if needed. Local methods provide some protection against sexually transmitted diseases but they are expensive and perhaps difficult for adolescents to obtain. Condoms can be useful if the male agrees to use them. Natural methods are unsuitable in very young girls with unstable cycles. IUDs are almost always contraindicated for adolescents because of the heightened risk of infection. Contraceptive methods should only be proposed for adolescents, never imposed. The physician should be readily available to answer questions. In the final analysis, a medical consultation is probably not the ideal approach to providing contraceptive information for adolescents, specialized centers or families might be better.
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