News Highlights
Teen sexual health update reveals need for comprehensive education
The results of a new study released by the Centre for Disease Control in the U.S. indicate that there is still much work to do with educating young people on the use of birth control and consistent condom use during sexual activity.
Statistics from the Youth Risk Behavior Survey show no change since 2001 in the percentage of teens engaging in unprotected intercourse (condom use), using substances during a sexual encounter, and having more than four partners—risky behaviours that may result in pregnancy or unwanted infections.
Statistics on teen sexual health:
- 49% of high school students have had sex
- 62% of sexually active high school students used condoms at last intercourse, and similar percentages were also involved in risky behaviours, such as having more than 3 partners, and using substances during their last sexual encounter.
- 27 in 100,000 people aged 13-29 in the U.S. are infected with HIV, according to figures from 2006.
Teens in general are at higher risk for unplanned pregnancy and sexually transmitted infections. This is partly due to lack of education about STI prevention and access to contraception. Adolescents have particularly high contraception discontinuation rates and they need to be given all the appropriate options so that they have access to what will work best for them.
In short, young women need to be aware of contraceptive options like condoms, the birth control pill, the patch, and the Nuvaring, as well as those options that many healthcare providers have made a habit of avoiding like the intrauterine device (IUD). Only 40% of women 14-24 years old have heard of the IUD, but this may be a good choice for them since this method depends the least on the user, only requiring a single insertion to provide up to 5 years of pregnancy protection.
More facts and statistics on sexual health among Canadian youth.
Gold M and Duffy K. Get focused on status of teen sexual health. Contraceptive Technology Update. 2009;30(1):10-12.
Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance — United States, 2007. MMWR Surveillance Summaries 2008; 57(SS-4):1-131.
Extended 4-week grace period for late Depo-Provera® injections does not increase pregnancy rates, researchers find
Depo-Provera® is a widely used contraceptive, especially in developing countries where women may not be able to access health services as easily as they do in North America. Depo-Provera® comes at a low cost and is highly effective at preventing pregnancy, making it an ideal choice for these women—the contraceptive is given as an injection every three months (13 weeks), and based on recommendations from the World Health Organization, a woman may receive a missed dose from healthcare professional up to two weeks late.
Beyond 15 weeks, a negative pregnancy test is required before a woman can receive her injection, so the hormones have no chance of harming a fetus if she is pregnant. However, in some areas of the world there is no access to pregnancy tests and women have to wait for their periods to return before they are given another injection, all the while these women are at risk of becoming pregnant.
A new study performed in Africa and Thailand compared pregnancy rates between 2,290 women who had received their Depo-Provera® injections either on time, within the standard 2-week grace period, or within an extended 4-week grace period.
Researchers found that the pregnancy rate was not increased with the extended interval of 2 weeks or 4 weeks. In addition, giving the injection as soon as possible after a negative pregnancy test helps to decrease pregnancy rates and increase continuation rates. So making a woman wait longer for her injection may put her at risk of unintended pregnancy.
The results of this study suggest that even when a woman receives the shot 4 weeks late, the risks of pregnancy are not increased within this time period. That means the theoretical risks of a fetus being exposed to Depo-Provera® are also not increased. It must be emphasized, however, that the recommendation is still to schedule injections every 13 weeks.
Learn more about Depo Provera®.
Steiner MJ et al. Injectable Contraception: what should the longest interval be for reinjections? Contraception 2008;77:410-414.
FOR HEALTH PROFESSIONALS
Singapore study on the effects of Mirena® intrauterine system on lipid metabolism
The Mirena® intrauterine system (IUS) is an effective contraceptive that once inserted in a woman’s uterus can remain there for up to five years, providing long-term protection against pregnancy.
The IUS works by releasing the levonorgestrel progestin hormone into the body. Most of the hormone released from the Mirena® acts locally, on the uterus, resulting in very few side effects aside from less menstrual bleeding (up to 97%) and cramps, two outcomes many women find desirable. This may be a benefit to using the Mirena IUS instead of other hormonal contraceptives like the pill and the injection, which release systemic progestins. Systemic progestins have been shown to affect lipid metabolism, including cholesterol levels, and this could translate into increased cardiovascular risks.
A Singapore study of 92 Asian women randomly assigned participants to receive either the progestin containing Mirena® IUS or a copper intrauterine device (IUD) containing no hormones. Researchers measured the women’s triglyceride levels and cholesterol levels—including their total cholesterol, bad cholesterol (LDL), and good cholesterol (HDL)—prior to insertion, and every six months during the 18 month study.
There was only one temporary difference found between the two groups. Women receiving the Mirena® had an initial decrease in their HDL cholesterol levels at 6 months, which returned to baseline at 12 months. The results of this study suggest that the progestin in the Mirena® does not adversely affect the lipid profile of long term users. Therefore, it is not likely to be a factor in increasing cardiovascular risk.
Ng YW, Liang S, Singh K. Effects of Mirena (levonorgestrel-releasing intrauterine system) and Ortho Gynae T380 intrauterine copper device on lipid metabolism – a randomized comparative study. Contraception 2009;79:24-28.
Ask Sexualityandu
My boyfriend says we don’t need contraception, because he will pull out at the last minute. Is this effective?
Withdrawal (also known as coitus interruptus) is better than nothing. However, the failure rates of this method are high, around 27% with typical use. The idea is to withdraw the penis from the vagina prior to ejaculation. This is very difficult to do consistently because it requires considerable self-control. This method also does not provide protection from sexually transmitted infections.
Does the vaginal contraceptive ring interfere with sex?
Although many women are hesitant to try the vaginal contraceptive ring (NuvaRing®) because they don’t like the idea of a foreign object in the vagina, it is rare for the contraceptive to cause women problems related to intercourse. A male partner will not usually notice the ring and if he does, it generally is not bothersome. Only 1-2% of women using the NuvaRing® will stop using it because of problems related to intercourse, such as the ring falling out.
Before I started using the NuvaRing® I occasionally used vaginal yeast treatments. Can I still do this with the NuvaRing®?
Yes, you may safely use vaginal yeast treatments or spermicides with the ring in place and the effectiveness of the treatments and the NuvaRing® will not be compromised.
How soon can I have sex after I have an IUD inserted?
You may have sex any time after having either a copper-containing IUD (Nova-T®) or hormone-containing IUD (Mirena®) places. They are both effective immediately.
A friend recently used emergency contraception, but it did not work and she is still pregnant. Will there be anything wrong with her baby from the effects of the medication?
Emergency contraception is effective in preventing pregnancy the majority of the time, from 75-97%, depending on the method you use. There are no cases of birth defects as a result of using emergency contraception pills. Similarly, birth control pills which contain some of the same components as emergency contraception, have not been shown to cause birth defects. Intrauterine devices (IUDs) are even more effective for emergency contraception than the pills. They also are not associated with birth defects.
If the IUD is left inside the uterus once a pregnancy in diagnosed, there is an increased risk of miscarriage—which may also be associated with infection. When a pregnancy occurs despite the presence of an IUD, an ultrasound can ensure that the pregnancy is not in the fallopian tube (an ectopic pregnancy). If the IUD is in the uterus, the usual recommendation is for it to be removed if this can be done by pulling gently on the IUD strings.
