Tafelski T, Boehm K E
Department of Family Medicine, Medical College of Ohio, Toledo, USA.
Prim Care. 1995 Mar;22(1):145-59.
Having presented an overview of the available methods of contraception, the authors present one approach to prescribing contraceptives based on their experience. First, adolescent patients in our practice are discouraged from engaging in sexual intercourse. Abstinence is the only fail-safe method of contraception and provides benefits both emotionally and physically (i.e., prevention from sexually transmitted diseases and unwanted pregnancies). If the adolescent plans to be sexually active, however, she is encouraged to select some form of hormonal contraception, namely Norplant, Depo-Provera, or oral contraceptives, in conjunction with condoms. The authors have had little success recommending barrier methods alone. Condoms are used sporadically and the diaphragm is very awkward for adolescents who are still uncomfortable with their bodies and with touching themselves. Of the three hormonal methods, Depo-Provera seems to be well-accepted by our patients. It offers several advantages that we believe make it attractive. First, it does not require any forethought by the patient other than coming in for the injection every 3 months. There is an effective grace period, so the patient is afforded good contraception even if she is up to a month late for her injection. The frequent visits for injections actually can be looked upon as positive, frequent contacts with the patient and can provide opportunities for counseling. In addition, some patients become amenorrheic, which teens view as an advantage, increasing compliance. If it is not likely that a patient will be compliant with every-3-month injections, Norplant is recommended. Studies have shown good acceptance of Norplant by adolescents and that has been the experience of the authors. With appropriate counseling prior to insertion and a counseling session with patients who request removal, the number of actual Norplant removals has been limited. If Depo-Provera and Norplant are not acceptable to the patient, then oral contraceptives are recommended. Of the three methods, more opportunities for failure exist with oral contraceptives. Pills are missed for a variety of reasons, including going away for the weekend; not having a regular schedule, which can interrupt pill-taking; and even ambivalence about becoming pregnant. One recent study demonstrated certain patient characteristics that were associated with good compliance with oral contraceptives, including white race, higher education level, suburban residence, and older age of both the patient and her mate. Keeping these characteristics in mind may be helpful when prescribing oral contraceptives. Of course, it is the patient's prerogative to choose the type of contraception she feels will be best suited for her.(ABSTRACT TRUNCATED AT 400 WORDS)
在概述了现有的避孕方法后，作者根据自身经验介绍了一种避孕药具的处方方法。首先，我们不鼓励青春期患者进行性行为。禁欲是唯一万无一失的避孕方法，在情感和身体方面都有益处（即预防性病和意外怀孕）。然而，如果青少年计划进行性行为，我们鼓励她选择某种形式的激素避孕方法，即皮下埋植避孕剂、醋酸甲羟孕酮避孕针或口服避孕药，并同时使用避孕套。作者单独推荐屏障避孕法的效果不佳。避孕套只是偶尔使用，而对于那些对自己的身体和自我触摸仍感到不自在的青少年来说，子宫帽使用起来非常不便。在这三种激素避孕方法中，醋酸甲羟孕酮避孕针似乎很受我们患者的欢迎。它具有几个优点，我们认为这些优点使其颇具吸引力。首先，除了每三个月来注射一次外，患者无需事先考虑其他事情。有一个有效的宽限期，所以即使患者注射时间晚了一个月，也能得到有效的避孕保护。实际上，频繁前来注射可以被视为积极的一面，即与患者保持频繁的接触，并能提供咨询机会。此外，一些患者会出现闭经，青少年认为这是一个优点，从而提高了依从性。如果患者不太可能每三个月按时注射，建议使用皮下埋植避孕剂。研究表明青少年对皮下埋植避孕剂的接受度很高，作者也有同样感受。在植入前进行适当的咨询，并对要求取出的患者进行咨询，实际取出皮下埋植避孕剂的数量一直有限。如果患者不接受醋酸甲羟孕酮避孕针和皮下埋植避孕剂，那么建议使用口服避孕药。在这三种方法中，口服避孕药失败的可能性更大。漏服避孕药有多种原因，包括周末外出、没有固定日程安排（这可能会中断服药），甚至对怀孕抱有矛盾心理。最近的一项研究表明，某些患者特征与良好的口服避孕药依从性相关，包括白人种族、较高的教育水平、居住在郊区，以及患者及其伴侣年龄较大。在开口服避孕药处方时，记住这些特征可能会有所帮助。当然，选择她认为最适合自己的避孕方式是患者的特权。（摘要截选至400字）
