It is normal for teenagers to believe in "the personal fable": they think they are special and unique (no argument there!) and invulnerable to harm. So naturally they believe that unprotected sex will not result in pregnancy. Couple this belief with the normal pubertal rise in hormones, sexual feelings and curiosity, and we have a problem! About half of all teens have sex before they graduate high school. By the time they realize that they have no special "immunity" to an accidental pregnancy, it is often too late.
One 14-year-old girl was brought to me by her mother, who was concerned because she had not menstruated for the previous four months. In fact, my patient was pregnant—and was stunned when I told her. Another teenage girl had taken birth control pills for many months, never skipping a dose. Then her prescription ran out; after missing several pills, she got pregnant.
The personal fable becomes more powerful when mixed with drugs and alcohol. Some boys have told me that the only time they didn't use a condom was when they were under the influence, and now they are teenage fathers.
Failing grades. People have tried many courses of action to prevent teenage pregnancy. Here's the report card for some of them and they get failing grades:
Abstinence-only education – "F". Abstinence-only education has not been shown to be effective.
Condoms – "F". Almost all sexually active teens have used condoms, but only half used them the last time they had sex. Seem like a harsh grade? Think about it: sex just once without a condom is enough to get pregnant.
Birth control pills – "F". On average, teenagers start using birth control one year after their first sexual experience, but most teen pregnancies happen within that first year. Ideally, if a young woman thinks she may have sex, she should start on birth control pills if she has no major health-risk factors such as migraines with aura.
Making the honor roll. There is one course that has the potential to make the grade:
Teens being honest – "A". Teenagers will likely talk to their parents and doctors if we give them the opportunity, time and support. But instead of giving them a pop quiz about sex, here's my advice: Start a dialogue.
Talk with teens about ...
... the correct use of condoms. When teenagers use them every time, pregnancy and many sexually transmitted infections (STI's) can usually be prevented.
... the correct use of birth control pills (always with condoms to prevent STI's!). Birth-control pills are highly effective if taken at the same time every day. I suggest girls set the alarm on their cell phones. How crazy is this? A doctor prescribing cell phone use for a teenager!
... hormone injections (always with condoms to prevent STI's!). These are very convenient – one injection every 12 weeks - and helpful for teens who don't remember to take a daily pill.
... Plan B, a.k.a. the "morning after" pill or emergency contraception. Accidents happen. So girls and boys who decide to have sex need to know how and where to get emergency contraception.
The lesson: There are effective ways to prevent teen pregnancy, but they only work if teens learn about them and use them correctly.
Tell us: Do your teens believe in the personal fable? Can you help them to "make the grade" in preventing accidental pregnancies?
Rima Himelstein, M.D., is a Crozer-Keystone Health System pediatrician and adolescent medicine specialist.