Birth Control Choices for Teens

Introduction

Having sex is about making choices. We choose when we are ready and when we want to wait. We choose our partners. We choose what we want to do and what we don’t want to do with our partners. We can choose to do it in the safest way.

Teens who have vaginal intercourse need to make choices about birth control.

One of the great joys of life can be having a baby — when we are ready and are able to provide all the love and care a child needs. One of the great setbacks in life can be an unintended pregnancy — especially for a young woman.

Planned Parenthood believes that sexual experience can be a positive source of personal enrichment and satisfaction when it is based on informed choices and mature decisions – whether for pleasure or procreation.

Guidelines for Sex Partners

Have each other’s consent.
Never use pressure to get consent.
Be honest with each other.
Treat each other as equals.
Be attentive to each other’s pleasure.
Protect each other against physical and emotional harm.
Guard against unintended pregnancy and sexually transmitted infection.
Be clear with each other about what you want to do and don’t want to do.
Respect each other’s limits.
Accept responsibility for your actions.

Continuous Abstinence

If you choose continuous abstinence, you will not have sex play with a partner. This will keep sperm from joining egg.

Effectiveness

100 percent
prevents sexually transmitted infections

Advantages

no medical or hormonal side effects
is endorsed by many religious groups

Disadvantages

People may find it difficult to abstain for long periods of time.
Women and men often end their abstinence without being prepared to protect themselves against pregnancy or sexually transmitted infections.

Advantages for teens

Sexual relationships present physical and emotional risks. Abstinence is a very good way to postpone taking those risks until you are able to handle them.

Women who abstain until their 20s — and who have fewer partners in their lifetimes — may have certain health advantages over women who do not. They are less likely to

get sexually transmitted infections
become infertile
develop cancer of the cervix

Outercourse

If you choose outercourse, you need to know that for some people, outercourse is sex play without vaginal intercourse. For others, it is sex play with no penetration at all — oral, anal, or vaginal. Some people also believe that any kind of penetrative sex play is too risky to be called “safer sex.” But many people sometimes have oral and anal sex — to avoid pregnancy or to “preserve their virginity.”

Lower-risk forms of outercourse include

- Kissing — Many people explore different ways of kissing. They may also explore kissing different body parts.

- Masturbation — Many people enjoy touching their own sex organs. It’s the most common way to be sexual. Partners can masturbate alone, together, or watch each other. They may hug and kiss while they do it.

- Erotic Massage — Many couples touch and rub each other’s sex organs using their hands, bodies, or mouths.

- Body Rubbing/Frottage — Many couples rub their bodies together — especially their sex organs — for pleasure and orgasm.

Fantasy — Couples can read or watch sexy stories or pictures together. They can also share or act out sexy fantasies. People do it in person, on the phone, surfing the Internet, or through e-mail or instant messaging.

Effectiveness

Outercourse is 100 percent effective against pregnancy unless pre-ejaculate or sperm gets onto the vulva or into the vagina.

Outercourse is also effective against sexually transmitted infections. It reduces the risk of HIV/AIDS and many other sexually transmitted infections — unless body fluids, such as semen and vaginal fluids, are exchanged through oral or anal sex play. But some infections, like herpes and HPV, can be passed by skin-to-skin contact.

Advantages

no hormonal side effects
can be used as safer sex if no body fluids are exchanged
may make sex play last longer, enhance orgasm, and increase intimacy between partners
can be used when no other birth control methods are available

Disadvantages

Women and men may let outercourse lead to intercourse without being ready to protect themselves from pregnancy or infection.
Some people may find it hard to abstain from intercourse.
Sperm may come in contact with the vagina.

Advantages for teens

Outercourse can completely satisfy both partners and take a lot of pressure off young women and men.

Many teen women get little or no pleasure from sexual intercourse because their partners do not know how to give them pleasure. Outercourse helps partners learn about their bodies and how to give themselves and each other sexual pleasure.

Women have very different sexual response cycles than men. Men usually have one orgasm, and it is usually some time before they can have another. Women can have frequent and multiple orgasms. But many women don’t have orgasms from vaginal stimulation. Most of them can have orgasms when the clitoris is stimulated — whether or not they are having vaginal intercourse. Sex play without intercourse can help women learn how to have orgasms.

Men also enjoy outercourse — even if they’re shy about it in front of their partners. Outercourse allows men to be truly erotic without worrying about how well they “perform.”

Caution — Outercourse is a form of birth control. It is also a lot like foreplay. They both add to sexual excitement and pleasure. And they can both lead to orgasm. The difference is that foreplay usually leads to intercourse. Outercourse may make you feel like having intercourse. Be careful! If you are going to have intercourse, you need to use another form of birth control — and protection from infection.

The Shot (Depo-Provera, DMPA)

If you choose the shot, your clinician will give you a shot of the hormone progestin every 12 weeks to

usually, prevent release of egg
less often, thicken cervical mucus to keep sperm from joining egg

Effectiveness

97-99.7 percent
not effective against sexually transmitted infections
latex or female condom can reduce risk of infection

Advantages

prevents pregnancy for 12 weeks
doesn’t need to be taken daily or put in place before vaginal intercourse
can be used by women who cannot take estrogen
may reduce menstrual cramps
reduces anemia
helps prevent cancer of the endometrium (lining of the uterus)
can be used while breastfeeding

Disadvantages

Use of the shot is associated with temporary bone thinning. Talk with your health care provider about the risks.

To protect your bones, get regular exercise and get extra calcium and vitamin D — either through your diet or by using supplements.

Side effects include irregular or late periods as well as weight gain, headaches, depression, abdominal pain, hair loss, increased hair on the face or body, nervousness, skin rash, or spotty darkening of the skin.
Side effects cannot be reversed until medication wears off (up to 12 weeks).
May cause delay in getting pregnant after shots are stopped.

Cost
$50 for each injection. Often less at health center.
$35-$125 for an exam, if needed.

Some health centers charge according to income. Check with your local family planning health center for information.

Advantage for teens

The shot is one of the most private prescription methods of birth control. No one can tell you’re using it. There is no packaging or other evidence of use that might embarrass some users.

The Pill

If you choose the pill, your clinician will prescribe the right pill for you. Take one pill once a day. Complete one pill pack every month. Combination pills contain estrogen and progestin. Others are progestin-only. Pills contain hormones that work in different ways.

Combination Pills

usually, prevent release of egg
also, thicken cervical mucus to keep sperm from joining egg

Progestin-Only Pills

usually, thicken cervical mucus to keep sperm from joining egg
less often, prevent release of egg

Effectiveness

92-99.7 percent

not effective against sexually transmitted infections
latex or female condoms can reduce risk of infection

Advantages of Combination and Progestin-Only Pills

nothing to put in place before vaginal intercourse
less menstrual cramping and menstrual flow
reduces the risk of pelvic inflammatory disease

Advantages of Combination Pills

less acne, iron deficiency anemia, and premenstrual tension
periods become more regular
reduces risk of ovarian and endometrial cancers, noncancerous growths of the breast, and ovarian cyst
can be used to control timing and frequency of periods
fewer tubal pregnancies
may protect against osteoporosis (thinning of the bones)

Advantages of Progestin-Only Pills

can be used by women who cannot take estrogen

Disadvantages of Combination and Progestin-Only Pills

must be taken daily
temporary side effects that usually clear up after a few months include irregular bleeding, loss of monthly period, weight gain or loss, nausea, breast tenderness, changes in mood, headaches, and other discomforts

Disadvantages of Combination Pills

rare but serious health risks, including blood clots, heart attack, and stroke — women who are 35 and older and smoke are at greater risk

Disadvantages of Progestin-Only Pills

must be taken at the same time of day, every day
side effects include irregular periods and spotting between periods

Cost

$20-$35 for monthly pill pack at drugstores. Often less at health centers. $35-$125 for an exam, if needed.

Some health centers charge according to income. Check with your local family planning health center for information.

Advantages for teens

The pill is often appropriate for teens, even if they’re not having intercourse, because teen women are more likely than older women to have acne, cramps, and irregular periods. Women who take the combination pill have less acne, fewer cramps, and more regular periods than women who don’t use a similar hormonal method. Women who take the progestin-only pill have fewer cramps than women who don’t use a similar hormonal method.

Caution —

Don’t smoke while you take the pill. Doing so will increase your risk of heart attack, blood clots, and stroke.

Don’t forget to take your pill. About one out of three users often forget to take the pill. The pill won’t work for anyone who forgets to take it every day.

If you choose the pill, schedule taking it with something else you do every day — like brushing your teeth.

If you forget ONE active combination pill, take it as soon as you remember. This means you may take two pills in one day. If you forget TWO or more pills, call your clinician immediately.

If you forget ONE progestin-only pill, take it as soon as you remember. This means you may take two pills in one day. If you take your progestin-only pill more than three hours late, you must use a backup method of birth control — like a latex or female condom — for 48 hours.

Remember to take your pill whether or not you’re having sex.

Don’t share your pills. Prescription methods like the pill are personalized for each woman’s use. They should not be shared.

The Patch (Ortho-Evra)

If you choose the patch, you will place a thin plastic patch on the skin of your buttocks, stomach, upper outer arm, or upper torso once a week for three weeks in a row. Use a new patch each week. Do not use a patch for the fourth week.

The patch protects against pregnancy by releasing estrogen and progestin that

usually, prevent release of egg
also, thicken cervical mucus to keep sperm from joining egg

Effectiveness

Up to 99.7 percent

not effective against sexually transmitted infections
latex or female condoms can reduce risk of infection

Advantages

protects against pregnancy for one month
nothing to put in place before vaginal intercourse
no pill to take daily

Results of long-term studies won’t be available for some time, but researchers assume the advantages of using the patch are similar to the advantages of using the combination pill:

periods become more regular
less menstrual cramping, acne, iron deficiency anemia, premenstrual tension, and menstrual flow
reduces risk of ovarian and endometrial cancers, pelvic inflammatory disease, noncancerous growths of the breast, ovarian cysts, and may protect against osteoporosis (thinning of the bones)
fewer tubal pregnancies

Disadvantages

skin reaction at the site of application
may not be as effective for women who weigh more than 198 pounds

Results of long-term studies won’t be available for some time, but researchers assume the disadvantages of using the patch are similar to the disadvantages of using the combination pill:

temporary side effects that usually clear up after a few months include irregular bleeding, loss of monthly period, weight gain or loss, nausea, breast tenderness, changes in mood, headaches, and other discomforts
rare but serious health risks, including blood clots, heart attack, and stroke —: women who are 35 and older and smoke are at greater risk

Cost

$30-$35 for monthly supply of patches. $35-$125 for an exam, if needed.

Some health centers charge according to income. Check with your local family planning health center for information.

Caution —

Don’t smoke while you use the patch. Doing so may increase your risk of heart attack, blood clots, and stroke.

The patch works best when it is changed on the same day of the week for three weeks in a row. Pregnancy can happen if an error is made in using the patch — especially if

it becomes loose or falls off for more than 24 hours
the same patch is left on the skin for more than one week

The Ring (NuvaRing)

If you choose the ring, you will insert a small, flexible ring deep into your vagina for three weeks in a row and take it out for the fourth week.

The ring protects against pregnancy by releasing estrogen and progestin that

usually, prevent release of egg
also, thicken cervical mucus to keep sperm from joining egg

Effectiveness

Up to 99.7 percent

not effective against sexually transmitted infections
latex condoms can reduce risk of infection

Advantages

protects against pregnancy for one month
nothing to put in place before vaginal intercourse
no pill to take daily
does not require a “fitting” by a clinician

Results of long-term studies won’t be available for some time, but researchers assume the advantages of using the ring are similar to the advantages of using the combination pill:

periods become more regular
less menstrual cramping, acne, iron deficiency anemia, premenstrual tension, and menstrual flow
reduces risk of ovarian and endometrial cancers, pelvic inflammatory disease, noncancerous growths of the breast, ovarian cysts, and may protect against osteoporosis (thinning of the bones)
fewer tubal pregnancies

Disadvantages

increased vaginal discharge
vaginal irritation or infection
may not be suitable for women who have weak pelvic muscles or chronic constipation

Results of long-term studies won’t be available for some time, but researchers assume the disadvantages of using the ring are similar to the dsadvantages of using the combination pill:

temporary side effects that usually clear up after a few months include irregular bleeding, loss of monthly period, weight gain or loss, nausea, breast tenderness, changes in mood, headaches, and other discomforts
rare but serious health risks including blood clots, heart attack, and stroke — women who are over 35 and smoke are at greater risk

Cost

$30-$35 monthly for ring. $35-$125 for an exam, if needed.

Some health centers charge according to income. Check with your local family planning health center for information.

Caution — Don’t smoke while you use the ring. Doing so will increase your risk of heart attack, blood clots, and stroke.

Don’t use the ring with another vaginal contraceptive — female condom, diaphragm, cap, or shield.

The Condom

If you choose the condom, you will cover the penis before intercourse with a sheath made of thin latex or plastic to keep sperm from joining egg.

Lubricate condoms with spermicide to immobilize sperm for increased protection against pregnancy.

Effectiveness

85-98 percent

Latex condoms offer very good protection against HIV — the virus that can cause AIDS. They also reduce the risk of other sexually transmitted infections, including gonorrhea, syphilis, chlamydia, trichomoniasis, HPV, and herpes.

Increase your protection:

Do not use oil-based lubricants, like Vaseline on latex condoms.
Use correctly: Place rolled condom on tip of hard penis. Squeeze air out of half-inch space at tip. Pull back foreskin and roll condom down over penis. Smooth out any air bubbles. Lubricate with water-based lubricant, like K-Y jelly. Hold condom against penis to withdraw.
Also use spermicides for increased contraceptive effectiveness.

Advantages

inexpensive and easy to buy in drugstores, supermarkets, etc.
can help relieve premature ejaculation
can be put on as part of sex play
can be used with other methods to reduce risk of infection

Disadvantages

uncooperative partners
latex allergies
loss of sensation
breakage

Cost

$.50 and up. Some health centers give them away or charge very little — sometimes according to income. Check with your local family planning health center for information.

Advantages for teens

One out of four sexually active teens has a sexually transmitted infection. Teens are also likely to have more than one partner during their adolescence, which increases the likelihood of getting an infection. Using latex condoms is the best way to protect against infection for women and men of all ages who have sexual intercourse. They are also inexpensive and widely available.

Caution —

The cervix in pregnant women, young girls, and teen women is especially vulnerable to infection. Even as mature adults, women’s sexual anatomy makes them 10 to 20 times more likely than men to become infected with sexually transmitted infections.

No matter how old you are, it is very important to use condoms with your other method of birth control — whenever you are at risk for getting a sexually transmitted infection.

Using the spermicide nonoxynol-9 many times a day, by people at risk for HIV, or for anal sex, may irritate tissues and increase the risk of HIV and other sexually transmitted infections.

A Prescription Barrier Method

If you choose a prescription barrier method, your clinician will fit you with a shallow latex cup (diaphragm), a silicone cup shaped like a sailor’s hat (FemCap), or a silicone cup with an air valve (Lea’s Shield). The clinician also will show you how to put spermicide into the diaphragm, cap, or shield and insert it in your vagina to keep sperm from joining egg.

Effectiveness

84-94 percent — diaphragm
about 85 percent — Lea’s Shield
about 86 percent — FemCap for women who have never been pregnant or given birth vaginally*
about 71 percent — FemCap for women who have given birth vaginally*

* Effectiveness rates for FemCap are those for an earlier version of the device. Although no studies have been published yet, the manufacturers of FemCap report that the current device is likely to be more effective.

not effective against sexually transmitted infections
latex or female condoms can reduce risk of infection

Advantages

no major health concerns
can last from six months up to several years

Disadvantages of Prescription Barrier Methods

can be messy
allergies to latex, silicone, or spermicide
should not be used during vaginal bleeding or infection

Disadvantages of the Diaphragm

increased risk of bladder infection
can only be left in place for up to 24 hours

Disadvantages of FemCap

difficult for some women to use
can only be left in place for up to 48 hours

Disadvantages of Lea’s Shield

difficult for some women to use
may cause discomfort for some women or their partners
can only be left in place for up to 48 hours

Cost

$15-$75 for diaphragm, cap, or shield. Often costs less at family planning health centers.
$50-$200 for examination.
$8-$17 for supplies of spermicide jelly or cream.

Some health centers charge according to income. Check with your local family planning health center for information.

Advantages for teens

Many teen women have vaginal intercourse only now and then. Many of them prefer to use a prescription barrier method on those occasions. That way they avoid the possible ongoing side effects of prescription methods with hormones.

Caution — Prescription methods like the diaphragm, FemCap, Lea’s Shield, and the Pill are intended for each woman’s use. Do not share them with friends. The diaphragm should be checked to see if it’s the right size after a change of 20 percent of your weight, childbirth, or abortion. FemCap is prescribed based on whether a woman has been pregnant — some women may need a new FemCap following pregnancy. All prescription barrier methods should be checked for weak spots or holes by being held up to a light or filled with water and checked for leaks.

Using the spermicide nonoxynol-9 many times a day, by people at risk for HIV, or for anal sex, may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

The Female Condom or Spermicide

If you choose the female condom or spermicide, you will follow package instructions and insert female condom — a plastic pouch with flexible rings at each end — deep into your vagina to keep sperm from joining egg,

you will follow package instructions and insert spermicide — contraceptive foam, cream, jelly, film, or suppository — deep into your vagina shortly before intercourse to immobilize sperm and keep them from joining egg.

Follow package instructions to remove female condom. Spermicide dissolves in vagina.

Effectiveness

79-95 percent — female condom
71-85 percent — spermicide

The female condom reduces the risk of sexually transmitted infections, including HIV. But spermicide doesn’t offer protection from infection. Use the female or latex condom with other methods for protection against infection.

Advantages

easy to buy in drugstores, supermarkets, etc.
insertion may be part of sex play
erection unnecessary to keep female condom in place
female condoms can be used by people allergic to latex or spermicide
external ring of female condom may stimulate clitoris

Disadvantages of the Female Condom

may be noisy
may irritate vagina or penis
may slip into vagina during intercourse
may be difficult to insert

Disadvantages of Spermicide

not particularly effective when used alone — using condoms or a prescription barrier method, as well, greatly increases Effectiveness
can be messy
may irritate vagina or penis — which may increase risk of infection
may set off allergies

Cost

$2.50 for female condom.
$8 for applicator kits of foam and gel.
$4-$8 for refills.

Similar prices for films and suppositories.

Some health centers charge according to income. Check with your local family planning health center for information.

Advantages for teens

Many teen women have vaginal intercourse only now and then. Many of them prefer to use over-the-counter methods on those occasions. That way they avoid the possible, ongoing side effects of prescription methods.

Caution — Using the spermicide nonoxynol-9 many times a day, by people at risk for HIV, or for anal sex, may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

Four Methods Not Usually Recommended for Teens

1. Sterilization

A surgical procedure to keep sperm from joining egg.

Tubal sterilization is intended to permanently block a woman’s tubes where sperm join egg.

Vasectomy is intended to permanently block a man’s tubes that carry sperm.

Effectiveness — 99.5-99.9 percent. Not effective against sexually transmitted infections.

Reason not recommended for teens —

This method is intended to be permanent. It is not appropriate for anyone who may want to have a child in the future. Because people so often change their minds about having families, sterilization is usually discouraged for people under 30 who have not had children.

2. Withdrawal

The man pulls his penis out of the vagina before he ejaculates (comes) to keep sperm from joining egg.

Effectiveness — 73-96 percent. Not effective against sexually transmitted infections.

Reasons not usually recommended for teens —

Many young men lack the experience and self-control to pull out in time.
Some men have been known to say they will pull out, and then they get so excited and carried away that they don’t.
Some men cannot tell when they are going to ejaculate.
Some men ejaculate very quickly, before they realize it.
Before ejaculation, almost all penises leak fluid — pre-ejaculate — that may contain sperm and cause pregnancy.

3. The IUD (Intrauterine Device)

A small plastic device inserted into the uterus. The IUD contains copper or hormones that

keep sperm from joining egg
prevent fertilized egg from implanting in uterus

Effectiveness — 99.2-99.9 percent. Not effective against sexually transmitted infections.

Reasons not usually recommended for teens —

Unless she has had a child, a young woman’s uterus may be unable to hold an IUD.

4. Fertility Awareness Methods

A professional teaches a woman how to chart her menstrual cycle and to detect certain physical signs to help her predict fertility or “unsafe” days. She must abstain from intercourse (periodic abstinence) or use condoms, diaphragms, cervical caps, shield, or spermicide during the nine or more “unsafe” days of her cycle.

The physical signs that are charted include

daily basal body temperature
daily texture of cervical mucus
occurrence of menstrual cycles

Effectiveness — 75-99 percent. Not effective against sexually transmitted infections.

Reasons not usually recommended for teens —

These methods work best for women with very regular periods — teen women often have irregular periods.
Their partners may not wish to cooperate in using this method.
A teen’s relationship may not be stable or committed enough to develop the trust and cooperation necessary for effective use of this method.
It may take 6-12 months of training and record keeping before a couple can try to use the method. Teens may not be that patient.

Emergency Contraception

You may want emergency contraception if you forgot to take your pills. He didn’t pull out in time. You weren’t using any birth control. He forced you to have unprotected sex. His condom slipped off.

Emergency Contraception (EC) is designed to prevent pregnancy after unprotected vaginal intercourse. It’s provided in two ways:

- Emergency contraception can reduce the risk of pregnancy if started within 120 hours of unprotected sex. It works best when taken within 72 hours — during this time it can reduce the risk of pregnancy from 75 to 89 percent. The sooner a woman starts EC, the more effective it may be. Nausea, vomiting, and cramping are common side effects when combined hormones — estrogen and progestin — are used. But progestin-only pills cause fewer of these side effects.

- Emergency IUD insertion within five days of unprotected intercourse is 99.9 percent effective.

EC is for use only if a woman is sure she is not already pregnant from a previous act of intercourse. It delays release of egg or keeps sperm from joining with egg. It will not cause an abortion.

Don’t use emergency hormonal contraception if you

are pregnant
are allergic to the medication

Consult your clinician about what kind of emergency contraception may be best for you.

Cost

The medication costs between $10 and $35. The cost of a visit, tests, and an exam, if needed, ranges between $35 and $170. Medicaid covers costs in some cases.

Updated May 2006.