A Q-and-A on emergency contraception, safe sex

News came out last week that the Food and Drug Administration approved the sale of the emergency contraceptive pill without a prescription to girls 15 and older.

Specifically, the agency approved Plan B One-Step, an emergency contraceptive intended to reduce the possibility of pregnancy following unprotected sexual intercourse – if another form of birth control like a condom was not used or failed, the FDA said. It’s a single-dose pill that is most effective in decreasing the possibility of unwanted pregnancy if taken immediately or within 72 hours after unprotected sexual intercourse.

“Research has shown that access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States,” said FDA Commissioner Margaret A. Hamburg, M.D. “The data reviewed by the agency demonstrated that women 15 years of age and older were able to understand how Plan B One-Step works, how to use it properly, and that it does not prevent the transmission of a sexually transmitted disease.”

This presents a timely opportunity to talk to your child about safe sex. Think your kid isn’t having sex? That may be true. But, that doesn’t mean you should avoid talking about it.

We spoke with Children’s physicians Dr. Dave Aughey, medical director of adolescent health, and Dr. Rachel Miller, a pediatric gynecologist, about safe sex.

How/when do I start talking about sex with my child? How often should I have the conversation?

Dr. Miller: A 2011 national survey of high school students found that 19 percent of female and 24 percent of male ninth-grade students were sexually active. The percentage increases to 51 percent of female and 44 percent of male high school seniors. Rates of sexual activity, pregnancies and births among adolescents have continued to decline during the past decade to historic lows, however many adolescents remain at risk of unintended pregnancy and sexually transmitted infections (STIs). The United States has the highest rate of unintended teen pregnancy of any industrialized nation and adolescents acquire half of all STIs in the country each year.

Dr. Aughey: Parents should look for every opportunity to talk and encourage discussions with sons and daughters about feelings, emotions, friendships and relationships. In general, boys have fewer of these opportunities and a lower comfort level than girls.  Use these discussions to reinforce expectations and values. Ground these discussions in their lives — their music, movies, games, schoolwork. Frequent conversations build comfort and trust. Mothers have a particularly strong influence on their daughter’s sexual attitudes and behaviors.

Realize that most teens have their first sexual experience between 16 and 18.  If the current generation of adolescents ends up marrying, it’s not likely to be until their mid- to late ’20s.  So, the “sex talks” need to include protecting oneself from Chlamydia, dating violence, exploitation, getting drunk, and using condoms in addition to the risks of unplanned pregnancy or fathering a child.  Scare tactics never work.  But being responsible includes all of this and more.  Young men, in particular, need to hear these messages more than ever.

Parents hope their children will delay these things as long as possible. But it won’t be forever. The longer your child knows someone, the stronger their feelings, the more in love they are, the more the bets are off. Rather than being scared about the physical aspect of sex, parents should prepare their children to be prepared emotionally, spiritually, and if needed, contraceptively.

My child says he’s not having sex. Should I make protection available anyway – just in case?

Dr. Miller: Condom education and availability programs improve use of condoms, delay sexual initiation of youth and reduce the incidence of STIs and pregnancy. It has been shown that an advanced prescription increased the use of emergency contraception and decreased time to use. No randomized study has shown an increase in sexual activity or decrease in ongoing contraceptive use in adolescents given advanced access to emergency contraception.

Dr. Aughey: Be honest with yourself. You’ve known your child for at least the last 15 years.  What do you think? When teenagers fall in love, everything changes.  It’s not hormones. It’s human nature. It pains me when a patient tells me her mother found her birth control pills and threw them away. Or threw his condoms away.  Really…is this logical? In 25 years, I’ve never encountered a teenager who, in this situation, has said, “I’ve seen the errors of my way…I will break up with my lover.”

What are the most effective forms of protection for my child?

Dr. Miller: It is not only the use of contraceptive method but also the type of method used that can significantly impact unintended pregnancy. Long acting reversible contraceptives demonstrate the greatest success in reducing unintended teen pregnancy. Examples are the subdermal implant and intrauterine systems. I always recommend dual use of a condom to protect against STIs.

Dr. Aughey:With few exceptions, contraception is safe for adolescents, much safer than is pregnancy, by comparison.  That’s not even factoring in all the economic and social perils of unplanned pregnancy or fatherhood.  Long-acting methods like the intrauterine device (IUD) or implant are best as it is difficult for anyone to consistently use pill, patches, rings or condoms.

Plan B is “emergency” protection.  It is never as good as an ongoing method of birth control.  It’s most effective taken as soon as possible.  It needs to be easily accessible to the teen for “emergency” use.  This doesn’t mean calling a clinic the next day, waiting for a prescription, getting it filled, finally taking it and hoping for the best. Ideally it’s taken within 12 hours.

I know my daughter is sexually active. If she needs emergency contraception, where can she get it?

Dr. Miller: Emergency contraception is available at most every pharmacy. One dose usually costs $40 plus tax. Comparatively:

  • Four months of oral contraceptives are $9 per month. Without insurance, it’s about $36 plus tax at some local retailers.
  • 120 Lifestyles Ultra Thin condoms (3 40-count boxes) are about $33 plus tax.

For more information on talking to your child about sex.

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