A 17-year-old female presents to clinic to discuss contraception options. She is not sexually active but would like to talk about pregnancy prevention, as she and her partner have been discussing sex. During the conversation, she expresses interest in a long-term contraception option and considers condoms less important if she uses other contraception. What do you advise?
Rates of sexual activity, pregnancies and births among adolescents have declined to historic lows during the past decade. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs).
A revised AAP policy statement and accompanying technical report, Barrier Protection Use by Adolescents During Sexual Activity,provide guidance, resources and updated information for pediatricians. They discuss all barrier methods and update descriptions, effectiveness data and proper use of products. New terminology includes external condom (previously known as male condom), internal condom (previously known as female condom) and other barrier methods.
The policy statement and technical report from the AAP Committee on Adolescence are available at https://pediatrics.aappublications.org/content/early/2020/07/16/peds.2020-007237 and https://pediatrics.aappublications.org/content/early/2020/07/16/peds.2020-007245 and will be published in the August issue of Pediatrics. These statements can assist pediatricians in understanding and supporting the use of barrier methods by their patients and address obstacles to their use.
When used consistently and correctly, latex and synthetic barrier methods reduce the risk of many STIs, including HIV, as well as pregnancy.
However, barrier protection use by adolescents has declined while STIs have increased significantly over the past decade. The technical report provides detailed information on the trends in barrier utilization, STIs and adolescent pregnancies plus factors influencing barrier use, types of barrier methods and their effectiveness, obstacles to barrier use and practices to promote it.
The policy provides guidance on how to discuss correct barrier use with adolescents of all genders; strategies to promote barrier education and access; surveillance and screening for dual methods use (barrier protection and pre-exposure prophylaxis for HIV or contraception) and resources for pediatricians.
Following are among the recommendations in the policy:
- Support and encourage the consistent and correct use of barrier methods, as well as other reliable contraception, as part of anticipatory guidance during visits with adolescents who are sexually active or contemplating sexual activity.
- Emphasize the responsibility of all genders in preventing unintended pregnancies and STIs.
- Use Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th edition, to promote communication between parents and adolescents about healthy sexual development, sexuality, prevention of STIs and pregnancies, and proper use of barrier methods.
- Support the provision of free or low-cost barrier methods within communities, including providing barrier methods within clinics.
- Closely monitor adolescents who use pre-exposure prophylaxis or nonbarrier contraception, are bisexual or lesbian females, and/or are in relationships for risk compensation — the adjustment of behavior in response to perceived level of risk, leading to less frequent use of barrier methods.
After counseling your patient on the importance of barrier methods to prevent STIs and provide dual pregnancy protection, she chooses a contraceptive method. Her pre-contraception pregnancy test is negative, so she initiates contraception. You provide her with a handout and website that outline proper external condom use, discuss ways to talk about condom use with her partner and give her a small bag of condoms. You encourage her to contact you with any questions or concerns and schedule a follow-up appointment.
Dr. Grubb is the lead author of the policy statement and technical report and a member of the AAP Committee on Adolescence. She is the liaison from the Society for Adolescent Health and Medicine to the AAP Committee on Federal Government Affairs.