What are the safest sexual practices to prevent teen pregnancy and STIs (Sexually Transmitted Infections) in adolescents?

Safe Sexual Practices for Adolescents to Prevent Pregnancy and STIs

The most effective approach for preventing teen pregnancy and STIs is consistent and correct use of barrier methods (condoms) combined with reliable contraception, along with comprehensive sexual education and open communication between healthcare providers, parents, and adolescents. 1

Prevention Hierarchy

Primary Prevention

1. Abstinence

   • Abstaining from sexual intercourse is the most effective way to prevent genital STIs, HIV infection, and unintended pregnancy 1
   • Should be discussed as an option with all adolescents
   • However, perfect adherence to abstinence over time is low, making additional prevention strategies necessary 1

2. Barrier Methods (Condoms)

   • Male condoms:

     • Failure rate: 2% with perfect use, 18% with typical use 1
     • Provide protection against STIs transmitted via penile urethra (gonorrhea, chlamydia, trichomoniasis, hepatitis B, HIV) 1
     • Also reduce risk of skin/mucosal contact diseases (herpes, HPV, syphilis) 1
     • Should be used with water-based lubricants only (oil-based lubricants weaken latex) 1

   • Proper condom use includes:

     • Checking expiration date
     • Opening package carefully
     • Placing on erect penis before any genital contact
     • Leaving space at tip
     • Unrolling to base of penis
     • Holding rim during withdrawal while penis is still erect
     • Using a new condom for each act of intercourse 1

3. Hormonal Contraception (for additional pregnancy prevention)

   • Combined hormonal methods (pill, patch, ring): 9% typical-use failure rate 1
   • Injectable contraception (DMPA): 6% typical-use failure rate 1
   • Long-acting reversible contraception:
     • IUDs: 0.2-0.8% failure rate
     • Implant: 0.05% failure rate 1

4. Emergency Contraception

   • Levonorgestrel tablet (Plan B) can be used within 72 hours of unprotected sex
   • Most effective when taken as soon as possible after unprotected intercourse
   • Reduces pregnancy risk by approximately 7 out of 8 women who would have become pregnant 2
   • Not intended for regular contraception 2

Dual Protection Strategy

For sexually active adolescents, the most effective approach is dual protection:

• Consistent condom use to prevent STIs
• Reliable hormonal or long-acting contraception to prevent pregnancy 3
• Continue condom use even with hormonal contraception until STI status of both partners is confirmed negative 3

Important Considerations

Effectiveness Factors

The prevention of unintended adolescent pregnancies requires four elements:

1. Desire to use protection
2. Access to good contraceptive methods
3. Ability to obtain the contraceptive method
4. Ability to use it correctly and consistently 3

Common Pitfalls to Avoid

• Relying solely on abstinence education: While abstinence is 100% effective when used perfectly, user-failure rates can be high (26-86% based on periodic abstinence studies) 4
• Inconsistent condom use: Effectiveness drops dramatically with inconsistent use 1
• Oil-based lubricants with latex condoms: Can cause condom breakage 1
• Delayed emergency contraception: Effectiveness decreases with time 2
• Lack of education: Many adolescents lack correct information about contraception and STI prevention 5
• Assuming condom availability increases sexual activity: Research shows making condoms available does not increase sexual activity but does increase protection when activity occurs 1, 6

Healthcare Provider Role

Pediatricians and healthcare providers should:

1. Discuss abstinence as an option but also provide comprehensive contraception information 1
2. Support and encourage consistent and correct use of barrier methods 1
3. Promote communication between parents and adolescents about healthy sexual development 1
4. Remove barriers to contraceptive access 1
5. Provide confidential services in accordance with state laws 1
6. Make condoms available in their offices when possible 1
7. Monitor adolescents using pre-exposure prophylaxis or non-barrier contraception closely 1

Special Considerations

• Confidentiality: Many states allow minors to consent to contraceptive services without parental notification 1
• Accessibility: Condoms should be made easily available without requirements for education, ideally at no cost 6
• Comprehensive education: Should include both abstinence and contraceptive information 1, 3
• Risk compensation: Some adolescents may engage in riskier behavior if they feel protected by contraception, requiring additional counseling 1

By implementing these evidence-based strategies, healthcare providers can effectively help adolescents prevent both unintended pregnancies and STIs, leading to improved sexual health outcomes.