When condoms and spermicide (foam, gel, film, sponge) are used together in a correct fashion (film must be placed 10 minutes before intercourse), they are almost as effective as COCs in the prevention of pregnancy, especially in individuals who have infrequent intercourse. This method is available over-the-counter (latex and polyurethane condoms) without the need for a physician visit or prescription and reduces the risk of STIs, including human immunodeficiency virus (HIV). The female condom (Reality) is an additional barrier method made of polyurethane that affords females more control, but adolescents usually do not consider it aesthetically pleasing.
Sponge, Caps, and Diaphragm
The vaginal sponge (Protectaid) is a spermicide-impregnated synthetic sponge that is effective for 24 hours of intercourse. The FemCap is a silicone cap fitted by a health care provider and then placed on the cervix by the user before intercourse. This method is technically difficult, especially for an adolescent. The diaphragm is fitted by a health care provider but is technically simpler to use than the cap because the edges go into the vaginal fornices. To be effective, the diaphragm should be used with spermicide applied to the cervical side and along the rim. The diaphragm needs additional spermicide with each act of intercourse. The Lea’s Shield is a silicone device, similar to a diaphragm, that covers the cervix and adheres to the vaginal vault by a mild vacuum generated by its design. All of these methods need to be left in place for 6 hours after the last act of intercourse for optimal efficacy.
Withdrawal is a common method of birth control used by sexually active adolescents, but it is ineffective because sperm are released into the vagina before ejaculation, and withdrawal may occur after ejaculation has begun.
The rhythm method is the practice of periodic abstinence justbefore, during, and just after ovulation. This method requires the user to have an accurate knowledge of her cycle, awareness of clues indicating ovulation, and discipline. Adolescents tend to have unpredictable cycles and consequently lesspredictable ovulation, so it is difficult to determine with anyaccuracy a time of the month that can be considered completely safe.
Some adolescents engage in oral or anal sex because they believe that it eliminates the need for contraception. Many do not consider this activity to mean “having sex.” Condoms generally are not used during oral or anal sex, but the risk of acquiring an STI is still present. Adolescents should be asked specifically about nonvaginal forms of sexual activity, and adolescents who engage in oral and anal sex require STI and HIV counseling and screening.
Rape is a legal term for nonconsensual intercourse. Almost half of rape victims are adolescents, and the perpetrator is known in 50% of cases. Although gathering historical and physical evidence for a criminal investigation is important, the physician’s primary responsibility is to perform these functions in a supportive, nonjudgmental manner. The history should include details of the sexual assault, time from the assault until presentation, whether the victim cleaned herself, date of last menstrual period, and previous sexual activity, if any.