Contraception for the adolescent patient.

Physicians who provide care for adolescents are well positioned to help prevent the negative consequences of sexual activity--unintended pregnancy and sexually transmitted diseases. Physicians should look for opportunities to emphasize the advantages of postponing sexual involvement. Nonetheless, we should recognize that few adolescents come to us seeking opinions about their sexual behavior. Instead, they come for information on contraception and STDs. In caring for sexually active teens, therefore, our role should be to encourage responsible sexual behavior, not to moralize about it. Countries such as Holland, a society which focuses on providing health services for sexually active teens rather than value judgments, has achieved rates of pregnancy and abortion remarkably lower than those experienced by U.S. adolescents. Although oral contraceptives (OCs) are well tolerated by most teens, achieving OC compliance and continuation represents a major challenge for many teenage patients. Often, use of the long-acting hormonal methods Depo-Provera or Norplant represents a more practical approach to achieving effective contraception for teenagers. Initial experience in the United States suggests that teens appreciate the freedom from daily compliance provided by these long-acting hormonal methods. Practical issues relative to achieving patient satisfaction and effective, safe contraception will be reviewed with respect to Depo-Provera, Norplant and OCs. Because STDs occur so frequently in teens, the "belt and suspenders" approach to contraception often makes sense: hormonal contraception plus condoms. Many would agree with the comment: "It's no longer diamonds. Now, condoms are a girl's best friend." Physicians who focus on health care rather than moral issues can still encourage responsible behavior and improve health outcomes in this important group of patients.