• Abstinence
• Pregnancy Prevention
• Using Condoms
• Communicating About Sex

Abstinence
Abstinence, or refraining from sexual intercourse, is the most effective and risk-free method of avoiding pregnancy and STD/HIV infection. Most adolescents decide that not having intercourse is the best decision for them. In addition to avoiding pregnancy and STD/HIV, abstinence protects against emotional and social risks that may accompany sexual intercourse.

People who choose not to have intercourse are still free to express affection in a variety of ways. Ways to show affection without intercourse include talking, hugging, massaging, smiling, holding hands, touching, sending notes, taking walks, doing things together and kissing. An advantage of abstinence is that refraining from sexual intercourse allows a couple to get to know and trust each other gradually before facing the emotions and stresses brought about by intense levels of physical intimacy.

Pregnancy Prevention
Only abstinence provides complete protection from pregnancy and STD/HIV. Condoms are the only other method that prevents STD/HIV infection. Condoms are the method of choice among sexually active teens. Along with condoms, withdrawal (an unreliable method) is the method most frequently practiced by teens that use contraception. Young women involved in serious relationships are more likely to use a reliable method of pregnancy prevention, such as the pill, than those who are just beginning to have intercourse.

Nonprescription contraceptives are available in drug stores, grocery stores and variety stores. Prescription contraceptives are available through prescriptions that are filled by a pharmacist. Norplant and Depo-Provera are available through doctor's offices and health clinics. Most contraceptive methods are available free or at greatly reduced prices through health and family planning clinics.

Contraceptive Summary
A summary of contraceptive methods commonly used by teens follows. The methods are listed in order of effectiveness (most effective to least effective in preventing pregnancy). Maximum effectiveness is only achieved when contraceptives are used consistently and correctly.

Abstinence

• Effectiveness: 100%
• Side-effects: None

Depo-Provera

• Effectiveness: 99%
• Description: Depo-Provera is a shot a woman gets from a doctor or nurse every three months. The shot contains a hormone that prevents the woman from becoming pregnant.
• Cost: A year's protection with Depo-Provera costs about $150.
• Advantages: This method is very convenient since no applications or interruptions are necessary before or during intercourse. Like Norplant, Depo-Provera does not rely on a woman's memory in order to be effective.
• Side-effects: Menstrual spotting, weight gain, headaches, breast tenderness, dizziness and mood changes have been reported. However, these side effects are infrequent. In about half of the women who use Depo-Provera, menstruation stops completely after a year of use. Depo-Provera may delay fertility (up to a year in some cases) until its effects wear off. The return to fertility seems to be affected by a woman's height and weight.

Birth Control Pills

• Effectiveness: 97%
• Description: The "pill" is the most popular form of reversible contraception in the United States. The pill is actually a series of pills (20-28 per package) containing synthetic estrogen and/or progesterone that regulates egg production and the menstrual cycle. Birth control pills accomplish some or all of the following: inhibit ovulation, thicken cervical mucus (preventing sperm entry), change the lining of the uterus, and alter the rate of ovum transport. Birth control pills must be prescribed by a doctor or family planning clinic. "The pill" should be take daily, as close as possible to the same time each day.
• Cost: A year's supply of birth control pills costs between $100 and $300.
• Advantages: Pills are easy to take, and no interruptions are necessary before or during intercourse. Women who take birth control pills usually have more regular periods with reduced menstrual flow and cramping.
• Side-effects: Slight breast enlargement and less acne are side effects of the pill. Other side effects include nausea or vomiting, weight gain or loss, spotty darkening of the skin, nervousness, loss of hair, change in appetite, mood changes, change (commonly a decrease) in sex drive, increase in body hair and an increase in vaginal discharges and yeast infections.

Condom

• Effectiveness: 88%
• Description: The male condom is a barrier method"it is designed to keep sperm and egg from uniting. The condom is a thin, soft flexible sheath of latex, polyurethane or animal tissue that fits over the erect penis to prevent semen from being transmitted. Condoms are available in a variety of sizes, shapes and colors. Some are lubricated, and some are treated with spermicides. The chief drawback of a condom is that it must be put on after the man has become aroused but before penetration. Condoms are 98-99% effective when used correctly and consistently. User effectiveness is about 88% because of mishandling the condom, but mostly due to failure to put the condom on before intercourse begins.
• Cost: A single condom costs anywhere from about 50 cents to $1.50. Condoms are available in drugstores and variety stores and are often free at health clinics.
• Advantages: Latex and polyurethane condoms help protect against STDs, including herpes and HIV. Some men complain that sensation is dulled; however, many of the newer condoms are very thin but are also strong; they conduct heat well and allow quite a bit of sensation to be experienced.
• Side-effects: Almost no medical problems are associated with the use of condoms. Infrequently, people are allergic to latex. Condoms should be stored correctly to prevent deterioration. Latex condoms should be used with water-based lubricants, because oil-based lubricants, such as Vaseline, weaken the rubber.

Foam

• Effectiveness: 79%
• Description: Foam is a barrier method. It contains a chemical that kills sperm. Foam is inserted with an applicator into the vagina before intercourse. Like condoms, foam can be purchased at any drugstore. Foam has a theoretical effectiveness rate of 98.5%. User failure brings its effectiveness down to as low as 71%. Failure tends to result from incorrect and inconsistent use.
• Cost: The cost per use is about 50 cents to $2.50.
• Advantages: Foam may help provide protection against STDs.
• Side-effects: Almost no medical problems are associated with the use of foam. Occasionally, a woman or her partner may have an allergic reaction to the foam. Some women dislike applying foam, and some complain of messiness and leakage.

Condom Plus Foam

• Effectiveness: 97%
• Description: The effectiveness of condoms and foam is very good when they are used together. The foam acts as an extra security. In case the condom breaks, foam will kill the sperm.
• Advantages: Condoms plus foam are effective in preventing pregnancy and protect against STD/HIV infection. The only methods more effective for preventing STD/HIV infection are abstinence and mutual monogamy with an uninfected partner.

Patch

• Effectiveness: 98%; appears to be less effective in women weighing more than 198 pounds.
• Description: Skin patch worn on the lower abdomen, buttocks, or upper body that releases the hormones progestin and estrogen into the blood stream. Available by prescription.
• Advantages: convenience and decreased pregnancy risk due to "forgetting" to take a daily pill; it's applied once a week for 3 weeks and not worn during the fourth week for menstrual period.
• Side-effects: similar to oral contraceptives - combined pill. NO protection against HIV/STD

Ring

• Effectiveness: 98%
• Description: A flexible ring about 2 inches in diameter that is inserted into the vagina and releases the hormones progestin and estrogen. It's inserted by the woman; remains in the vagina for 3 weeks, then is removed for 1 week.
• Advantages: No hormonal side effects.
• Side-effects: Vaginal discharge, vaginitis, irritation. Similar to oral contraceptives - combined pill. NO protection against HIV/STD. If the ring is expelled and remains out for more than 3 hours, another birth control method must be used until ring has been used continuously for 7 days.

IUD

• Effectiveness: 99%
• Description: A T-shaped device inserted nto the uterus by a health professional.
• Advantages: After insertion by physician, can remain in place for up to one or 10 years, depending on type. No hormonal side effects.
• Side-effects: Cramps, bleeding, pelvic inflammatory disease, infertility, perforation of uterus. NO protection against HIV/STD

Female Condom

• Effectiveness: 79%
• Description: A lubricated polyurethane sheath shaped similarly to the male condom. The closed end has a flexble ring that is inserted into the vagina. Applied immediately before intercourse; used only once and discarded.
• Advantages: No hormonal side effects. May give some protection against STD (not as effective as latex condom) Non-prescription;
• Side-effects: irritation and allergic reactions.

Diaphragm with Spermicide

• Effectiveness: 83%
• Description: A dome-shaped rubber disk with a flexible rim that covers the cervix so that sperm cannot reach the uterus. A spermicide is applied to the diaphragm before insertion.Inserted before intercourse and left in place at least six hours after; can be left in place for 24 hours, with additional spermicide for repeated intercourse.
• Advantages: no hormonal side-effects.
• Side-effects: Irritation and allergic reactions, urinary tract infection. Risk of Toxic Shock Syndrome when kept in place longer than recommended. NO protection against HIV/STD. Requires a prescription.

Using Condoms
Condoms are a popular, accessible and inexpensive method of contraception. Condoms protect not only against pregnancy, but also against STD/HIV.

However, condoms only provide protection when they are used consistently and correctly. Correct condom use includes these steps:

• Use latex, lubricated condoms.
• Check the expiration date.
• Carefully open the package.
• Put the condom on the erect penis.
• Squeeze the air out of the tip of the condom.
• Hold the tip of the condom as you roll it down to the base of the penis.
• After intercourse, hold the rim of the condom while removing the penis.
• Throw the used condom away.

Communicating about Condom Use
Communication about condom use ensures that partners use them correctly and consistently. As with all important topics, assertive communication helps ensure that partners understand important thoughts and feelings about condom use.

Assertive communication involves verbal and nonverbal messages. The content should be delivered in clear, specific statements. Voices should be clear and even. There should be eye contact and a self-assured posture. Speakers should feel confident and respectful of both their feelings and their partners' feelings. The goal of this communication is to avoid unprotected sex that could cause a pregnancy or transmit a sexually transmitted disease.

Communicating about Sex

Becoming pregnant or contracting a sexually transmitted disease requires intimacy. So does preventing them. Avoiding a pregnancy or an STD may require even more intimacy, because very often it means people have to talk. Communication isn't always easy. It can be embarrassing, especially for people who are not used to sharing personal feelings. But it gets easier with practice, and it is too important to avoid. Embarrassment or discomfort is not as bad as herpes, HIV infection or an unintended pregnancy.

Important Elements
Important elements in communication about sexual behavior include the following:

Initiate the discussion.
In some situations, nonverbal communication may be enough. Although it lacks the intimacy of verbal communication, nonverbal communication is preferable to no communication at all. For example, if you think you are going to have sex with someone, you can have a condom with you and simply put it on at the appropriate time. If you are a woman, you can offer the condom to your partner when the moment is right. However, if your partner refuses to use the condom, you will need to begin verbal communication about protection.

It is best to begin a discussion about protection before you are actively involved in sexual behavior. It is too easy to think, "Just this once will be okay." When sexual intercourse becomes a possibility, people need to be prepared to introduce the topics of contraception and STD prevention. Some people feel comfortable with a strong approach: Do you have condoms, or should I get them? Others may want to begin the conversation with a softer approach: I think we should talk about protection. Either approach should be assertive, respecting the feelings of both partners. Once the subject has been broached, the other person will usually be responsive to a discussion.

Mutual Disclosure
It would be nice if partners simply volunteered information about sexual health. Unfortunately, that usually doesn't happen. One of the best ways to find out about another's sexual history is to talk openly about your own. There is always some risk involved, but most partners will appreciate the honesty. Sincere concern about the partner's well-being usually overcomes feelings of embarrassment or shame.

Relationships that develop over time and are founded on mutual respect are likely to be safer sexually. A person with no emotional attachment may not be motivated to tell the truth. Therefore, taking time to get to know a partner is a good way to ensure your own sexual health. The information that potential partners should disclose to each other includes:

• having an STD or symptoms of an STD
• recent exposure to an STD
• past history of an STD
• risk factors (injection drug use, multiple partners, partners who use injection drugs)

Joint Decision Making
In order to have protected sex, both partners need to agree on what practices they will engage in and under what circumstances. Otherwise, one partner may not cooperate and may undermine the other person's resolve. It is wise to remember that not making a decision is a decision in itself. Protected sex is one of life's important decisions. A thoughtful decision-making process that examines the advantages of all options should be used.