What are the recommended safe sexual practices for adolescents to prevent STIs and unintended pregnancy?

Safe Sexual Practices for Adolescents

Adolescents should consistently and correctly use barrier methods (condoms) combined with reliable contraception to prevent sexually transmitted infections (STIs) and unintended pregnancy, along with comprehensive sexual education and open communication between healthcare providers, parents, and adolescents. 1

Primary Prevention Strategies

Abstinence

• Abstaining from sexual intercourse is the most effective way to prevent genital STIs, HIV infection, and unintended pregnancy 2, 1
• However, perfect adherence to abstinence over time is low, making additional prevention strategies necessary 1

Barrier Methods (Condoms)

• Male condoms are critical for STI prevention with:
  • 2% failure rate with perfect use for pregnancy prevention
  • 18% failure rate with typical use 2, 1
• Condoms reduce risk of:
  • STIs transmitted via penile urethra (gonorrhea, chlamydia, trichomoniasis, hepatitis B, HIV)
  • Diseases transmitted through skin/mucosal contact (herpes, HPV, syphilis) 2, 1
• Female condoms are available but more expensive and less accessible than male condoms 3

Proper Condom Use Instructions

1. Check expiration date
2. Open package carefully (avoid teeth, scissors)
3. Place on erect penis before any genital contact
4. Leave space at tip
5. Unroll to base of penis
6. Hold rim during withdrawal while penis is still erect
7. Use a new condom for each act of intercourse 1
8. Use only with water-based lubricants (oil-based lubricants weaken latex) 2

Hormonal Contraception

For additional pregnancy prevention, adolescents should consider:

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

Implementation Approach

Healthcare Provider Role

1. Discuss abstinence as an option but also provide comprehensive contraception information
2. Support and encourage consistent and correct use of barrier methods
3. Promote communication between parents and adolescents about healthy sexuality
4. Remove barriers to contraceptive access
5. Provide confidential services in accordance with state laws 2
6. Use the HEADSS (home, education and employment, activities, drugs, sexuality, and suicide and depression) interview structure to discuss sexual health 2
7. Make condoms available in offices when possible 2, 1
8. Monitor adolescents using pre-exposure prophylaxis or non-barrier contraception closely 2

Education and Communication

• Comprehensive education should include both abstinence and contraceptive information 1
• Pediatricians should advocate for barrier method availability programs through collaborative community processes 2
• Support school barrier method educational programs that reach large adolescent populations 2
• Communicate to parents and communities that making barrier methods available does not increase adolescent sexual activity 2

Common Pitfalls and Caveats

1. Inconsistent condom use: Dramatically decreases effectiveness; emphasize the importance of using condoms with every sexual encounter 1

2. Improper lubricant use: Oil-based lubricants can cause latex condom breakage; recommend only water-based lubricants 2

3. Risk compensation: Adolescents may engage in riskier behavior if they feel protected by contraception; requires additional counseling 1

4. Mental health considerations: Mental health is central to HIV prevention behavior uptake and coping with STI diagnosis; integrate mental health assessment and referral to services 4

5. Focus on immediate consequences: When counseling adolescents about condom use, focus on immediate, short-term consequences like ease of use rather than solely on health benefits, as these factors more strongly influence adolescents' intentions to use condoms 5

6. Special monitoring needs: Adolescents who use preexposure prophylaxis or nonbarrier contraception, are bisexual or lesbian, and/or are in established relationships require closer monitoring 2

By implementing these evidence-based strategies, healthcare providers can effectively support adolescents in preventing STIs and unintended pregnancy while promoting overall sexual health.