The Talk etc. (birth control), teen version

[Kassia]

22 minutes ago, Noreen Claire said:

I learned this the hard way. 🤷‍♀️

I have a friend who learned this lesson the hard way too.

[Frances]

17 minutes ago, Kassia said:

I have a friend who learned this lesson the hard way too.

My college roommate also learned it the hard way. And unfortunately the marriage due to that pregnancy ended in divorce.

[Katy]

Only a few kinds of antibiotics interfere with the pill.  Unfortunately, they're some of the kinds that are most frequently prescribed.

Anyway I don't have a long time tonight to write advice, but Dr. Mama Jones on YouTube and Instagram is a board certified gynecologist who talks through ALL this stuff in an entertaining and accurate way. I worked in nursing on a Gynecology floor and I have still learned stuff from her.  Here's her channel: https://www.youtube.com/c/MamaDoctorJones

[MercyA]

11 hours ago, plaidpants said:

Hormonals and implants can really mess with your life, so if there's no reason to use them, you might want to consider other things.

Yes. Condoms used correctly, consistently, and in conjunction with spermicide are 99% effective at preventing pregnancy.

https://pubmed.ncbi.nlm.nih.gov/1743276/

[Clarita]

10 hours ago, wathe said:

 IUD's, injections (depo-provera), and implantable are probably the closest to "fool-proof" for teens, in that, once they are in place, they are passive.  Birth control pills next best - they only work if you remember to take them everyday, but don't have to worry about them in the moment.  Less reliable are methods that need to be used in the moment (spermicide plus condoms), and the very least reliable are those that rely on the partner to use in the moment (condoms)

I thought they don't recommend IUD for people who haven't already gotten pregnant before. I didn't like the pill at all and then my insurance changed and made me jump through hoops for the pill-lite which I was using, and my OB still didn't tell me about IUD until after my first. 

[wathe]

9 minutes ago, Clarita said:

I thought they don't recommend IUD for people who haven't already gotten pregnant before. I didn't like the pill at all and then my insurance changed and made me jump through hoops for the pill-lite which I was using, and my OB still didn't tell me about IUD until after my first. 

Nope.  They've been recommended for adolescents for some time now - at least 10 years.  ACOG has several guidance documents, as does AAFP (link is to a 2014 guidance document).

[wathe]

@SKL

If you are looking for resources to explore with your teens for more information, sexandu.ca is the Society of Obstetricians and Gynaecologists of Canada's (SOGC) sexual health information website.  It's a very good resource with solid, up to date information. Comprehensive.  Accessible for teens.

[Frances]

34 minutes ago, Clarita said:

I thought they don't recommend IUD for people who haven't already gotten pregnant before. I didn't like the pill at all and then my insurance changed and made me jump through hoops for the pill-lite which I was using, and my OB still didn't tell me about IUD until after my first. 

I think that is very old advice. 

[Frances]

1 hour ago, MercyA said:

Yes. Condoms used correctly, consistently, and in conjunction with spermicide are 99% effective at preventing pregnancy.

https://pubmed.ncbi.nlm.nih.gov/1743276/

I’m guessing it would be extremely unusual for a teen to consistently and correctly use both spermicide and condoms. And a 1% chance of pregnancy for any teen is still too much of a risk in my opinion.
 

Heck, I don’t think I would have ever been able to really relax and really enjoy sex after my only very complicated pregnancy using that combo.

[Wheres Toto]

I've had the same OB/GYN office since I was 18 (different doctors, my oldest now goes here as well) and the same pediatrician since my oldest was born (27 years, same doctor).   I think getting established in some medical practice is important beyond birth control concerns, especially if you want to avoid clinics.   You never know when an issue will come up and when you are established with a practice, you get in much faster than you usually will as a new patient.  

When my daughter was ready, I took her to my GYN and we went to the store and bought condoms.  She sets an alarm on her phone still at 27 year old to remind her to take her pill.  We covered the antibiotics issue and other issues with the pill.  I was on the pill most of my life for extremely heavy periods that resulted in hospitalization for severe anemia when I was a teenager, so I just stuck with that for birth control until I had my tubes tied.   So I'm very aware of all the quirks and nuances.  

[KungFuPanda]

20 hours ago, SKL said:

Just added this ETA to my OP since some folks are suggesting we use our family doctor /annual visits to discuss this....

ETA:  I should mention we don't have a "regular doctor" - not a pediatrician, not a gynecologist, not a GP.  I don't for myself nor for my kids.  I've only ever been to a gynecologist once (in middle age), to check out something I thought might be a concern.  So I can't really say this is a normal part of taking care of our health.  😛

We use a chiropractor for wellness and annual sports physicals.  We use a big hospital system for occasional one-off things the chiropractor doesn't do.

It’s easy. You make an appointment and you keep it. There may be a longer wait the first time, and new patient forms to fill out, but after that it’s fine. You don’t need a big personal relationship with your medical  provider to be well take care of. You just need a professional who is available and has your health history at their fingertips. That way, when something comes up, you’re not scrambling to choose a doctor. 
 

You could mail this down today. Go on FB and ask friends for local recommendations. Call around and see who is taking new patients. Just get it crossed off your list. Down the road, if anyone needs a specialist for anything, your doctor can guide you through that and make things happen sooner. They can catch things when they are tiny small problems so they never become big problems that you have to develop symptoms to notice. They’ll remind you of things that are easy to forget, like getting your tetanus shot. Set it up and get physicals, then the system is in place for your family. Then when someone gets strep, or a broken arm, or anything non-emergent you have an established place to go.

[MercyA]

7 hours ago, Frances said:

I’m guessing it would be extremely unusual for a teen to consistently and correctly use both spermicide and condoms. And a 1% chance of pregnancy for any teen is still too much of a risk in my opinion.

I suppose it depends how motivated they are and how well they understand their use. Thankfully it is not rocket science. 🙂 

I might be biased by the fact that DH and I have used condoms for a quarter of a decade and never had a single problem with one. (Trojans, in case anyone is wondering. Don't quote!)

Although I didn't explicitly say so, I was comparing the effectiveness of the Pill to condoms plus spermicide. Both are about 99% effective when used consistently and correctly.

[J-rap]

15 hours ago, prairiewindmomma said:

Things I haven't seen discussed yet:

1. If you have a latex allergy, there are latex free condoms, of a number of varieties.  Some of those varieties have contraindications with certain lubricants. 

2. Birth control pills don't work effectively when taking antibiotics.  You have to be consistent with taking them at the same time every day as well, generally. 

3. Sexual health is way more than birth control and disease prevention.  We've had these discussions early and often in part because even if you hit all of the societal "shoulds"--heterosexual orientation, waiting until marriage, etc. the marriage bed can be frought with challenges. Knowing how one's body works, knowing about self care and bodily health through the different phases of womanhood, etc.---that's all important too. 

4. If you haven't talked about consent---freely given, reversible, informed, enthusiastic, specific---you should have that conversation also.

Wow, I've never heard that!  You'd think this information would be more widely distributed.

[Spryte]

1 hour ago, J-rap said:

Wow, I've never heard that!  You'd think this information would be more widely distributed.

I’m always surprised when people don’t know this, and think it must be a failing of the prescriber. The prescriber should absolutely be telling every patient, every time BC pills are discussed. Also telling each patient that the pill must be taken at the same time every day. I started on the pill in HS for menstrual issues (by 27, I had to have a hysterectomy, so I’m talking severe menstrual issues), and every single doc and NP hammered this info home even when I was not sexually active and would inwardly roll my eyes.

I’m also going to just put in a plug for getting our girls comfortable with PAPs, and in the habit of going yearly. In my 20s, a roommate’s annual pap found easily treatable cervical cancer. Had she waited till she had symptoms, it would have been bad. As it was, she had a small procedure with a day’s recovery and no big deal. Makes it hard see the charm in not having regular health care that can catch important issues before they become big ones.

[prairiewindmomma]

Not only do we need paps (and/or blood serum HPV tests), but all teens—male and female—should be getting the HPV vaccine. The vaccine is cutting cervical cancer rates by 90%. The key is getting vaccinated before sexual exposure.

 

https://www.bbc.com/news/health-59148620

[wathe]

3 hours ago, J-rap said:

Wow, I've never heard that!  You'd think this information would be more widely distributed.

 

1 hour ago, Spryte said:

I’m always surprised when people don’t know this, and think it must be a failing of the prescriber. The prescriber should absolutely be telling every patient, every time BC pills are discussed. Also telling each patient that the pill must be taken at the same time every day. I started on the pill in HS for menstrual issues (by 27, I had to have a hysterectomy, so I’m talking severe menstrual issues), and every single doc and NP hammered this info home even when I was not sexually active and would inwardly roll my eyes.

 

Yes, prescribers should be counselling about drug interactions.

But also, to be fair, the list of drug reactions is also included on the package insert.  It's included with every pack.  (ETA, at least in Canada it is.  I can't imagine that the US would be any different)

Edited February 11, 2022 by wathe

[vonfirmath]

1 hour ago, Spryte said:

I’m always surprised when people don’t know this, and think it must be a failing of the prescriber. The prescriber should absolutely be telling every patient, every time BC pills are discussed. Also telling each patient that the pill must be taken at the same time every day. I started on the pill in HS for menstrual issues (by 27, I had to have a hysterectomy, so I’m talking severe menstrual issues), and every single doc and NP hammered this info home even when I was not sexually active and would inwardly roll my eyes.

I’m also going to just put in a plug for getting our girls comfortable with PAPs, and in the habit of going yearly. In my 20s, a roommate’s annual pap found easily treatable cervical cancer. Had she waited till she had symptoms, it would have been bad. As it was, she had a small procedure with a day’s recovery and no big deal. Makes it hard see the charm in not having regular health care that can catch important issues before they become big ones.

Yes. WHen I was on the pill, this was emphasized to me both when the pill was prescribed and everytime antibiotics were prescribed. The pharmacy STILL mentions it when antibiotics are prescribed even though I am no longer on the pill.

[Spryte]

28 minutes ago, wathe said:

 

Yes, prescribers should be counselling about drug interactions.

But also, to be fair, the list of drug reactions is also included on the package insert.  It's included with every pack.  (ETA, at least in Canada it is.  I can't imagine that the US would be any different)

Yes, it’s probably on the insert here, too.
 

And sometimes when I’ve been Rx’d antibiotics that prescribing doc has mentioned it, but not always. Usually that’s at an urgent care. My own doc never mentions it, but she knows I’m not on BC and can’t get pregnant. 🤣

[katilac]

On 2/11/2022 at 7:30 AM, MercyA said:

I suppose it depends how motivated they are and how well they understand their use. Thankfully it is not rocket science. 🙂 

I might be biased by the fact that DH and I have used condoms for a quarter of a decade and never had a single problem with one.  

You're old, though! 😂

(edited out a quote) 

 

Edited February 12, 2022 by katilac

[Frances]

15 hours ago, MercyA said:

I suppose it depends how motivated they are and how well they understand their use. Thankfully it is not rocket science. 🙂 

Although I didn't explicitly say so, I was comparing the effectiveness of the Pill to condoms plus spermicide. Both are about 99% effective when used consistently and correctly.

I don’t want to bring up anything painful, but didn’t you also have issues conceiving?

One of my amazing nieces was conceived while her engaged parents were using a condom. 
 

Personally, if it was my teen, 99% effective would not be enough for me. Ditto for anyone unmarried and not wanting to conceive. Plus in practice, very few teens are going to use either method consistently and correctly all of the time. The pill or IUD or contraceptive injection plus condom would be far, far better in my opinion, unless the female in question could not do any hormones. Then you are getting into the .01 % or less failure rate range which is significantly better than 1% with perfect usage.

Edited February 12, 2022 by Frances

[prairiewindmomma]

I think also, generally, there's more to just avoiding conception that should be at play here. About 1:4 teens contract a STD each year. Chlamydia, gonorrhea, syphilis have all been on a sharp uptick in the age 15-24 group (and really, every age group). That age group, 15-24, makes up like 13% of the population and almost 2/3 of the chlamydia cases.

About 2/3 of teens, by age 18, have had sex. People should be talking about sexual health information in a positive, informed way well before age 15.  Most teens who have sex before adulthood do it in the 15-18 year old bracket, and not before, but it's easier to start some conversations when it doesn't feel personally applicable or judgmental about a teen relationship, iykwim.

[Tanaqui]

Prairiewindmomma, according to the CDC only about 55% of teens in the USA have had sex prior to the age of 18.

 

https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2017/201706_NSFG.htm

That's a lot closer to one half than two thirds. Do you have more recent data? Or are you counting 18 year olds in this, and do you have the data for that?

[prairiewindmomma]

@Tanaqui, it looks like, from my browsing history where I was googling for that statistic that I pulled it from here: https://www.guttmacher.org/gpr/2020/04/reducing-sti-cases-young-people-deserve-better-sexual-health-information-and-services

In re-reading it, that number did include 18 year olds. (It's in paragraph 4.) In my head I was thinking "before graduating high school" and my teens all turned or will turn 18 before graduating, but you are correct, I did mis-state that and I apologize. 

[ktgrok]

On 2/10/2022 at 2:44 PM, rebcoola said:

If I had no primary like you I would probably just take them to planned parenthood or another women's clinic.  They would talk over all the methods shots, pills etc and likely have condoms free to take to.

Another option is Nurx, which is an online birth control service. You chat with a doctor via text, give a medical history, etc and can get a scipt sent to local pharmacy or the product mailed to your door. I used them for my birth control the last few years and was very very happy. I use the Nuva Ring (well, generic) because I can't remember to take a pill every day, but the shot made me INSANE and nearly suicidal, and the implant is similar to that from what I understand. 

[HS Mom in NC]

I don't have sons, but if I did I guess I'd phrase it something like, "Well, you're the one with a penis, it's up to you to keep a condom on it if you choose to have sex. You just shouldn't live your life expecting other people to be responsible for wrapping your penis in a condom."

[HS Mom in NC]

This skit just showed up on my Youtube homepage because I'm subscribed to the channel.  It might be a humorous way to introduce discussion of STDs with older kids (language/image warning.) The sponsor at the end of the skit is an at home STD testing kit provider with access to medication that people should know about.
 

 

[MercyA]

17 hours ago, Frances said:

I don’t want to bring up anything painful, but didn’t you also have issues conceiving?

Yes. I only meant I have never in 25 years had a single one break or malfunction in any discernible way. 🙂 

Edited February 12, 2022 by MercyA

[MercyA]

7 hours ago, katilac said:

You're old, though! 😂

LOL, katilac. No argument from me. 😉 

Would you mind removing the second paragraph of what you quoted above? I don't care, but DH is an intensely private person. 

[MercyA]

13 hours ago, prairiewindmomma said:

Not only do we need paps (and/or blood serum HPV tests), but all teens—male and female—should be getting the HPV vaccine. The vaccine is cutting cervical cancer rates by 90%. The key is getting vaccinated before sexual exposure.

 

https://www.bbc.com/news/health-59148620

YES. I don't understand the resistance to this in some circles. Some teens can and do wait for marriage. I personally know many couples who did. But even when they do wait, what if their partners did not? Or what if they are assaulted? Or what if they or their partners had sexual contact without intercourse--HPV can be passed that way, too. What if their partner is unfaithful?

HPV is very, very common and the majority of people will be exposed to it at some point.

Thank God for this vaccine.

Edited February 12, 2022 by MercyA

[Wheres Toto]

9 hours ago, HS Mom in NC said:

This skit just showed up on my Youtube homepage because I'm subscribed to the channel.  It might be a humorous way to introduce discussion of STDs with older kids (language/image warning.) The sponsor at the end of the skit is an at home STD testing kit provider with access to medication that people should know about.
 

 

Her 'talking to my past self' videos are hilarious.

[Carrie12345]

21 hours ago, vonfirmath said:

Yes. WHen I was on the pill, this was emphasized to me both when the pill was prescribed and everytime antibiotics were prescribed. The pharmacy STILL mentions it when antibiotics are prescribed even though I am no longer on the pill.

It is a *really* good thing that, even though our family isn’t 100% comfortable with all conversations, we’re pretty comfortable with the fact that life is what it is.  Because dh does NOT want to be having conversations about our kids’ birth control, but he was at least able to come home with an antibiotic prescription and ask me to make sure our daughter knew it could interfere with her pill.  The pharmacist told him so.

In another family, that could have been a disaster. But also, in another family, the pharmacist NOT saying something could have been a whole other kind of disaster!

[ktgrok]

I've had condoms fail more than once. Had partners take them off (ok, partner is a strong word for rapist, sigh). 

Had pills fail. 

Two methods, always!

Also, yes, pap smears are life saving. Even if OP doesn't get them done, she should give her daughter info about them. 

[wathe]

14 hours ago, HS Mom in NC said:

I don't have sons, but if I did I guess I'd phrase it something like, "Well, you're the one with a penis, it's up to you to keep a condom on it if you choose to have sex. You just shouldn't live your life expecting other people to be responsible for wrapping your penis in a condom."

Something like this, yes.

I have sons.  When they were little, they liked to throw things (rocks, pinecones, sticks, into the lake or at various "targets").  I drilled into them that yes, they could throw things, but they were responsible for every single projectile that left their hands, so they'd better be sure they weren't going to hit anyone or break anything.  The "you are responsible for every projectile you throw" mantra has very nicely transformed into "you are responsible for every sperm that comes out of your body".   

[Terabith]

I do believe in multiple forms of birth control, but we used condoms only for birth control without a failure.  And we are Uber fertile…every single instance of unprotected sex led to a pregnancy unless I was hard core nursing every two hours.  But statistics are important and 1% is huge, but I feel like less emphasis has been placed on condoms for preventing STDs in recent years, and that’s concerning.  

[Kassia]

51 minutes ago, ktgrok said:

 Had partners take them off (ok, partner is a strong word for rapist, sigh). 

 

I'm so sorry.  I didn't know.  😞 

And, yes, pap smears are life-saving. 

[SKL]

Right now all the advice says age 21+ for a pap smear, and then only once every 3 years if they are normal.

I will discuss all STDs including HPV (have in the past, will in the future).  As for the HPV vax, I had decided to let my kids decide on that one when they are making their own health decisions.  It's probably a good idea to start thinking about that now.

[wathe]

10 minutes ago, SKL said:

Right now all the advice says age 21+ for a pap smear, and then only once every 3 years if they are normal.

I will discuss all STDs including HPV (have in the past, will in the future).  As for the HPV vax, I had decided to let my kids decide on that one when they are making their own health decisions.  It's probably a good idea to start thinking about that now.

Paps:  Yes, 21 is the current recommendation for women who have ever been sexually active.  Though that recommendation is under review in my jusrisdiction, leaning toward raising age of first pap to 25.  (We have really high HPV vaccine uptake here.)

HPV vax: the earlier the bette, so yes, the time to think about that is now..  It has to be onboard before first HPv exposure - ideally before first sexual activity.  The risk of waiting for DC to be ready to make their own health decisions is that that might be too late.  We've treated it like we would any other standard vax in my household.  Here they give it in Grade 7 as part of the standard series.  

ETA Ontario cervical cancer screening guidelines, for interest

Edited February 12, 2022 by wathe

[wathe]

In a perfect world, with high HPv vax uptake, paps might become obsolete.  How great would that be!  We're still a long way away, but it's a nice thought.

[SKL]

So in general, having my kids take more responsibility for their health is a 2022 goal here.  Do you guys know of any good comprehensive resources that are interesting and accessible to teen girls?

I'm glad to say that my girls don't really have a problem talking to me about body stuff.  But their follow-up on actual health and hygiene practices leaves much room for improvement.

[wathe]

4 minutes ago, SKL said:

So in general, having my kids take more responsibility for their health is a 2022 goal here.  Do you guys know of any good comprehensive resources that are interesting and accessible to teen girls?

I'm glad to say that my girls don't really have a problem talking to me about body stuff.  But their follow-up on actual health and hygiene practices leaves much room for improvement.

For sexual health, sexandu.ca is really very good.

No for teens, but for parents, the Greig Health Record is a great resource.  It's meant to a be a kind of cheat sheet for primary care providers to guide periodic health exams, with an evidence based medicine focus.  The "Selected guidelines and resources: Page 1    Page 2    Page 3    Page 4    Page 5" links are pure gold:  a summary of all the relevant guidelines for all the preventive care topics, with direct links to them.