There are many reasons teens may not use birth control. They may:

Think they will not get pregnant Be afraid to go to a doctor or clinic to ask for birth control Not know how to get birth control or think they cannot afford it Worry about their parents finding out Be afraid of what their partner thinks about birth control Think that birth control might hurt their ability to get pregnant in the future Have sex that was not planned

More teens are deciding to protect themselves from pregnancy and STDs and you can too.

Sex and Reproduction

Knowing what happens during your menstrual cycle will help you understand how the different methods of birth control work. A woman has two ovaries, one on each side of the uterus. Each month, one of the ovaries releases an egg into a fallopian tube. This is called ovulation. It usually occurs about 12–14 days before the start of the menstrual period.

What Does Not Work The following things DO NOT stop you from getting pregnant: Douching—Squirting water or any other liquid into the vagina after sex does not kill sperm or prevent pregnancy. Plastic wrap instead of a condom—Plastic wrap or a plastic bag can tear and let sperm escape. Urinating right after sex—Urine does not pass through the vagina so it does not get rid of the sperm. Having sex for the first time—You can get pregnant even if you have never had sex before. Having sex in a special position—No matter what position you have sex in, if the penis enters—or comes close to—the vagina, you can get pregnant.

During sexual intercourse (sex), the man's penis goes into the woman's vagina. This can lead to ejaculation. When a man ejaculates ("comes"), his penis releases semen, which contains millions of sperm. If this happens during sex, the semen spurts into the vagina. Sperm in the semen can swim up the cervix and into the uterus and the fallopian tubes. If a sperm meets an egg in the fallopian tube, fertilization—joining of an egg and sperm—can occur. The fertilized egg then can travel to the uterus and attach to the lining. Once the fertilized egg has attached to the lining of the uterus, the woman becomes pregnant, even if it is her first time having sex.

Birth control methods can be used to prevent pregnancy. Some methods also prevent STDs. You may have heard about "tricks" you can use to not get pregnant (see box). Do not depend on them—they do not work.

Types of Birth Control

When choosing a type of birth control, you should know your options. Most teens use methods that contain hormones, like the pill, the patch, the vaginal ring, the birth control shot, or the implant. Others use barrier methods, like condoms. Things to think about before choosing a method include:

• How easy is it for you to use?
• How easy is it for you to get?
• Does it protect against STDs?
• Do you have any health concerns?
• How well does it prevent pregnancy?

Hormonal Methods Some types of birth control use hormones to prevent pregnancy. Hormones are made by the body to control its functions. Most hormonal methods of birth control keep a woman's body from releasing an egg each month. If your body does not release an egg (ovulate), you cannot get pregnant. Some methods thicken the mucus in front of the cervix and prevent sperm from getting into the uterus.

There are many types of hormonal methods. They are safe and work very well when used as directed. Hormonal methods of birth control prevent preg-nancy about 99% of the time if they are used consistently and correctly. Hormonal methods of birth control do not protect against STDs.

Oral contraceptives. Often referred to as the "pill," these are the most popular hormonal method. You have to take a pill around the same time every day. The pill may make menstrual periods lighter and more regular and cramps less painful. They also may improve acne.

Skin patch. The patch is a small (1.75 square inches) adhesive patch that is worn on the skin to prevent pregnancy. A new patch is worn for a week at a time for a total of 3 weeks in a row. Then the patch is taken off for a week. The patch is worn on the buttocks, chest (excluding the breasts), upper back or arm, or abdomen. The patch can be worn during activities such as bathing, exercising, and swimming.

Vaginal ring. The ring is a flexible plastic ring that is placed in the vagina. It is worn inside the vagina for 21 days and then removed for 7 days. Then a new ring is inserted.

Birth control shot. This injection (depot medroxyprogesterone acetate [DMPA]) is given in the upper arm or buttock every 3 months. The birth control shot is a good choice for people who have trouble remembering to take a daily pill.

Implant. The implant is a small plastic rod about the size of a matchstick that is inserted under the skin of the upper arm. It protects against pregnancy for 3 years.

Barrier Methods

Barrier methods keep sperm from reaching the eggs. You must use barrier methods before each time you have sex. When used consistently and correctly, barrier methods prevent pregnancy about 85–98% of the time, depending on the method. Types of barrier methods that may be good choices for teens include condoms, spermicides, diaphragms, sponges, and cervical caps. Condoms, sponges, and vaginal spermicides can be bought in drugstores. A diaphragm or cervical cap must be fitted to your body and requires a prescription.

Condoms.Condoms come in male and female versions. The male condom ("rubber") is the most popular barrier method (see box). It covers the penis so that after a man ejaculates, the sperm stays inside the condom. Condoms are easy to put on and can be bought in many places, including drugstores, without a prescription. Condoms can be used alone or with other birth control methods to protect against STDs. Condoms that are made of latex and are coated with lubricant provide the best protection from STDs.

The female condom is a thin plastic pouch that lines the vagina. It may be put in place up to 8 hours before you have sex. It also can be bought in drugstores. The female condom is best suited for women whose partners will not use a male condom.

Spermicides. These are chemicals that are put into the vagina to kill sperm. Spermicides come as foam, gel, cream, suppositories, and film. They must be put in the vagina just before you have sex (10–30 minutes before for suppositories and film).

Diaphragm. The diaphragm is a roundrubber dome that fits inside the vagina and covers the cervix. It always is used with a spermicide. A diaphragm may be put in place up to 6 hours before you have sex (but spermicide must be added within 2 hours before sex). It must be left in place at least 6 hours after sex, but not more than 24 hours.

Cervical Cap. The cervical cap is a small, thin latex or plastic dome shaped like a thimble. It fits tightly over the cervix. The cervical cap can remain in place for up to 48 hours. Like the diaphragm, it also must be used with a spermicide. Less spermicide is needed, though, and it does not need to be added before each act of sex. After sex, the cap should be left in place for 6 hours but not longer than 48 hours.

Sponge. The sponge is a doughnut-shaped device made of soft foam that is coated with spermicide. It is pushed up in the vagina to cover the cervix. The sponge is effective for up to 24 hours. It is good for more than one act of sex during this time. The sponge must be removed within 30 hours of the time it is inserted. But it must be left in at least 6 hours after the last act of sex.

Intrauterine Device

The intrauterine device (IUD) is a small, T-shaped, plastic device that is inserted and left inside the uterus. Two types are available in the United States: the hormonal and the copper. The hormonal IUD must be replaced every 5 years. The copper IUD can remain in the uterus for as long as 10 years. IUDs prevent pregnancy about 99% of the time, but they do not protect against STDs.

Once the IUD is inserted, nothing else needs to be done to prevent pregnancy. The two types work in different ways, but both help prevent the sperm from joining with an egg and cause changes in the uterus that keep an egg from implanting in the wall of the uterus. The IUD must be inserted and removed by a doctor or nurse. It has a string that can be checked to be sure the device is in place.

Birth Control in an Emergency

If you have sex without using any birth control, if the birth control method did not work (for instance, the condom broke during sex), or if sex was forced, you can use emergency contraception to prevent pregnancy. This is used only in an emergency—not for regular birth control.

The most common method for teens is one in which special birth control pills that contain higher doses of hormones than regular birth control pills are used. You may have heard this called the "morning-after pill" even though it can be taken later than the morning after. This will prevent pregnancy in most cases. The pills work best if taken within 120 hours (5 days) of having sex. The sooner they are used, the more effective they are. If you are already pregnant, emergency contraception will not work.

If you are aged 18 years or older, emergency contraception can be bought in many places, including drugstores, without a prescription. If you are younger than age 18 years and need emergency contraception, call your doctor's office or go to a family planning clinic or hospital emergency room. Tell them you need treatment right away. In some cases, your doctor can call in a prescription for you to your drugstore or you can get it directly from a pharmacy. You also can call the Emergency Contraception Hotline (888-NOT-2-LATE) or go to the website www.not-2-late.com to find a doctor who will provide you with a prescription.

Some doctors will give you a prescription for emergency contraception before you need it. This way, you will have it on hand if you do need it.

Your Parents and Your Privacy

In most states, minors (people younger than age 18 years) have the right to make choices about birth control without their parents' permission. Ask your doctor or nurse if the visit will be kept private.

Be aware that if you use your parents' health insurance to pay for birth control or a special doctor's visit, it may appear on the bill that your parents receive. You may want to talk about birth control with your doctor at a visit for something else, such as a physical exam.

Often, the best way for a teen to have privacy and to afford birth control is to go to a family planning clinic. Some clinics may provide free birth control.

Talk to Your Partner

Before you have sex, talk to your partner about using condoms. This is the best way to prevent STDs. Do not be shy—be direct. Be honest about your feelings and needs. You can talk about it in many ways, for instance:

• "You know, it makes sex even better for me knowing that both of us are protected. Let's use a condom."
• "I'd really like to have sex with you as long as we use condoms. Condoms protect both of us."

As a teenager, you face many decisions. To help you make choices that are right for you, talk to someone you trust, such as your parents, your doctor, or your school counselor. If you decide to have sex, use birth control and protect yourself against pregnancy and STDs. No matter which method of birth control you choose, be sure that you know how it works and how to use it.

Glossary

Fallopian Tube: One of two tubes through which an egg travels from the ovary to the uterus.

Sexually Transmitted Diseases (STDs): Diseases that are spread by sexual contact.

Uterus: An organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © March 2007 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

ISSN 1074-8601

Requests for authorization to make photocopies should be directed to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923.

To reorder Patient Education Pamphlets in packs of 50, please call 800-762-2264 or order online at sales.acog.org.

The American College of Obstetricians and Gynecologists
409 12th Street, SW
PO Box 96920
Washington, DC 20090-6920

12345/98765