Updated 20 January 2014

Your teenager and sex

It is nearly midnight and your 16-year-old hasn’t returned from her date with her boyfriend. You don’t want to think about it, but the thought does cross your mind.

It is nearly midnight and your 16-year-old hasn’t returned from her date with her boyfriend. You don’t want to think about it, but the thought does cross your mind: where exactly are they and what are they up to?

Most parents don’t want to face the fact that their teenaged daughter might be sexually active. But fact is, many teens are sexually active. You could go a long way to help ensure that your daughter protects herself against an unwanted pregnancy, or worse still, sexually transmitted infections (STIs), including HIV.

How should a teen protect herself?
“We advocate dual protection,” says a Cape Town gynaecologist. “Sexually active girls should not only use condoms, but should also make use of another form of contraception. Although condoms are useful in preventing STIs, they are not the most effective method to prevent pregnancy.”

Various options are available. Hormonal methods include oral contraceptives, commonly known as the “pill”, and hormonal injections – both are available free of charge at clinics. The contraceptive pill is most often used and rarely carry health risks for teens. They are available as a combination of oestrogen and progestogen or as progestogen-only pills. The prescribing doctor would be able to determine what is best suited for your teen.

If taken correctly, oral contraceptives are highly effective in preventing pregnancy. Added advantages are that they can make periods more regular and relieve acne, iron deficiency anaemia, premenstrual tension and period pains. The disadvantage is that they need to be taken regularly, preferably at the same time each day – it may therefore not be the ideal choice for an absent-minded, disorganised teen. Some drugs, including antibiotics, may cause the pill to become less effective in which case a different contraceptive needs to be taken until the next period. Some teens suffer side-effects such as pigmentation or nausea, in which case, a different pill may be prescribed.

Injectable contraceptives are also highly effective as long as the injection is repeated at the correct intervals. This may be a better option for someone who is not disciplined enough to use oral contraceptives. Some teens prefer this method, because they want to hide the fact that they are sexually active from their parents.

Intrauterine devices (IUDs) are highly effective methods of contraception. The advantage is that they provide immediate protection and are long acting. However, IUDs are usually not the preferred choice of contraceptive for teens. They are better suited for women older than 35 years and for those who have completed their families. An IUD should never be used by someone who has multiple sexual partners because they have a higher risk of STIs and therefore of developing pelvic inflammatory disease.

Barrier methods include diaphragms and cervical caps, condoms, diaphragms, cervical caps and spermicides. As mentioned, condoms (male or female) are effective in preventing STIs, but should not be used as the primary method of contraception. Spermicides are sperm-killing chemicals available as gel, foam, jelly, foaming tablets, vaginal suppositories or cream which are inserted into the vagina. They should be used with diaphragms, caps or condoms. On their own, they have a higher failure rate. Some spermicides require a waiting period before becoming active inside the vagina. Others must be inserted immediately before intercourse. Spermicides can be bought at most pharmacies.

Many teens fall pregnant because they mistakenly believe that natural methods, such as withdrawal (coitus interruptus) or the rhythm method, protect against pregnancy. Withdrawal (removal of the penis immediately before ejaculation) is a very unreliable method because some sperms can be deposited in the vagina before or during withdrawal. For the same reason, it does not protect against STIs. The rhythm method, which involves a woman keeping a menstrual calendar to predict her most fertile period, can be effective against pregnancy, but requires accurate record-keeping and additional measurements of the basal temperature. This is not a safe choice of contraception for teens, as they often don’t have regular, well-established menstrual cycles.

What about the morning after?
Most teens don’t plan their first sexual experience and are therefore not using contraceptives at the time. What do you do if your teen breaks the news that she has had unprotected sex the night before? Don’t panic - if you act fast, you can prevent an unwanted pregnancy. Emergency contraceptive pills (ECPs), also called the “morning-after- pill”, are a safe and effective method of birth control to prevent pregnancy after unprotected sex. ECPs prevent pregnancy by stopping or delaying an egg from being released from the ovary, by preventing the sperm from getting to the egg, or by stopping a fertilised egg from attaching to the womb.

Although ECPs may be used up to 120 hours (five days) after unprotected sex, they are most effective if taken 24 hours after sex.

But doctors warn that ECPs should not be used as regular birth control. They are not as effective as other birth control methods and furthermore, frequent use of high doses of hormones is not recommended.

Being forced to have sex
Unfortunately many teens are coerced into having sex and parents are usually not able to protect their children against this from happening.

The frightening fact is that most girls are not raped by a stranger, but by someone they know.

Rape victims should see a doctor as soon as possible after the incident. A doctor should prescribe prophylactic antiretroviral medication. Most specialists believe that taking antiretroviral medication will cut down the risk of HIV infection after rape. It is very important to start the antiretroviral medication as soon as possible after the rape, preferably within six to 24 hours. Antibiotics should also be prescribed to prevent STIs such as gonorrhoea. These can be obtained at any state hospital. If a girl is not using a contraceptive, then, depending on the sexual act, ECPs should be given.

Let's talk about it
Fortunately, sexuality is not such a taboo topic as it used to be. Nowadays most teens are exposed to sex education at schools.

But the primary responsibility still lies with the parent. Open communication between parents and their children is the key. Talking about sex does not encourage a child to have sex. The opposite is true: If done correctly, it could promote abstinence or at least, more responsible sexual behaviour. - Ilse Pauw


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