Teens' Questions About Love, Sex, Pregnancy, and Birth Control
Male condoms are thin sheaths made of latex, polyurethane, or natural skin that are unrolled onto the erect penis prior to intercourse, and worn during sex (from start to finish) to prevent pregnancy.
Condoms are available in different sizes, colors, textures, and flavors. They are inexpensive, are available without a prescription, and may be purchased almost anywhere, including Family Planning Plus.
When used perfectly (correctly and consistently), condoms are 98% effective in preventing pregnancy. However, most people don’t use them perfectly. Condoms typically have a failure rate of about 14% because of incorrect or inconsistent use. That means that about 14 couples out of 100 will experience a pregnancy within the first year of condom use because they failed to use them correctly or did not use them every time they had sex.
Condoms also offer various levels of protection for both partners against sexually transmitted infections(STIs). Unfortunately, condoms may not cover all infected areas or areas that could become infected. Therefore, they are likely to provide greater protection against STIs that are transmitted only by genital fluids (e.g., gonorrhea, chlamydia, trichomoniasis, and HIV) than against infections that are transmitted primarily by skin to skin genital contact (e.g., genital herpes or HPV – the virus that can cause genital warts or cancers).
For Maximum Protection…
- Use a new condom for every act of sex (vaginal, anal or oral) from start to finish (throughout the entire sex act).
- Use a latex condom. Individuals who are allergic to latex can use polyurethane condoms. Do not use natural skin condoms for STI prevention. Natural skin condoms are porous and do not provide an adequate barrier against bacteria and viruses that can cause STIs. Natural skin condoms do provide pregnancy protection, however.
- Always check the expiration date on the package to make sure the condom is not too old to use. Expired condoms are more likely to break.
- Store condoms at room temperature in a sharps free environment.
- Never use an oil-based lubricant with a latex condom. Oil-based lubricants weaken latex and the condom is more likely to break. If you need additional lubricant, use a water-based type like KY Jelly or Astroglide.
- Before any genital contact, put the condom on the tip of the erect penis with the rolled side out.
- Pinch the tip of the condom between the thumb and forefinger while rolling it onto the erect penis to ensure that there is no air pocket in the tip of the condom. If there is an air pocket in the tip, the force of ejaculation may cause the end of the condom to burst.
- Smooth out the sides of the condom once it has been rolled on to ensure there are no air pockets in the sides of the condom.
- After ejaculation and before the penis gets soft, hold onto the rim or base of the condom while withdrawing the penis to prevent leakage and slippage.
- If you feel the condom break at any point during sex, stop immediately, withdraw, remove the broken condom, and apply a new condom before resuming intercourse.
Withdrawal or the pull out method is not considered a very reliable method of birth control. However, it is more effective when it is done correctly. Of every 100 women whose partners use withdrawal, four will become pregnant each year if the method is done perfectly. Of every 100 women whose partners use withdrawal, 27 will become pregnant if withdrawal is not always performed correctly.
Couples who have great self-control, experience, and trust tend to use the pull out method more effectively. The male partner must be able to know exactly when ejaculation is coming and must be able to pull out before any semen is deposited in the vagina. Generally, younger or less experienced men have a more difficult time predicting the time of ejaculation and have more difficulty pulling out in time.
However, even if a man pulls out in time, pregnancy is still possible because of pre-seminal fluid (also called pre-ejaculate). Pre-seminal fluid leaks out of the penis prior to ejaculation. Sometimes this fluid contains sperm that is left in the urethra from a previous ejaculation. If a man urinates between ejaculations before having sex again, it will help clear the urethra of sperm and may increase the effectiveness of withdrawal.
Pregnancy is also possible if semen or pre-ejaculate is spilled on the vulva (the external female genital area that contains the labia or lips, the clitoris, the vagina, and the urethra). Also, withdrawal does not provide protection against sexually transmitted infections. When used consistently and correctly, condoms can reduce the risk of infection.
It’s not really possible to compute the exact “odds” of a pregnancy occurring as a result of unprotected sex. However, some acts of unprotected sex are more likely to result in a pregnancy than others. The risk of pregnancy is dependent on a number of different factors. Some of these include:
- Age (Women between the ages of 20 and 29 are of the optimum age to achieve pregnancy. The older a woman is, the less likely it is that she will become pregnant.)
- Weight (Women who have a healthy weight are more likely to become pregnant than those who are underweight or overweight.)
- Frequency of sexual intercourse (The more times you have unprotected intercourse, the greater the chance of pregnancy.)
- The timing of the intercourse in relationship to the menstrual cycle. (You are less likely to become pregnant if the intercourse occurred just before, during, or just after your menstrual period, and more likely to become pregnant if it occurred mid-cycle.)
Pregnancy is most likely to occur during your fertile window which is a six day period. The fertile window begins five days before ovulation and ends on the day of ovulation. Just before ovulation, estrogen levels increase. This increase in estrogen generally allows sperm to live up to six days inside the female reproductive tract. Unfortunately, it’s very difficult to know exactly when you ovulate. In general, women with a 28 day cycle (when there are 28 days between the first day of your period to the first day of your next period) ovulate approximately 14 days before the first day of menstrual bleeding. Some women ovulate regularly; others do not. It is even more difficult to determine ovulation in women who have irregular periods.
Couples who do not want to become pregnant can significantly reduce their risk by using a reliable method of birth control. For maximum protection, the method should be used correctly and consistently. For those not using a method of birth control, use of the morning after pill within five days of the unprotected sex can reduce the risk. For more information about the morning after pill, please see the FAQ “How effective is the morning after pill and how does it work?”
For those attempting pregnancy, it takes on average about four months to get pregnant. About 40% of couples who are trying to become pregnant will do so within the first three months, 70% within the first six months, and 85% within a year. If you have been unsuccessful in achieving pregnancy after a year of trying, you may want to consult an infertility specialist.
The only way to know if the unprotected sex resulted in a pregnancy is to take a pregnancy test. Pregnancy tests are most reliable if they are taken after a missed period. Women experiencing a missed period should take a pregnancy test. If the result is negative, the test should be repeated every two weeks until a normal period has occurred or the test shows a positive result.
What is the morning after pill? The morning after pill (also known as emergency contraceptive pills or ECPs) is a pill you can take after unprotected sex to reduce the risk of pregnancy. There are several different brands available in the United States but the most commonly used are Plan B One-Step and Next Choice. The morning after pill works best if it is used within the first 24 hours after sex but can be used up to 120 hours (or five days) after, with decreased effects after the first three days. The sooner you use it, the more effective it is.
How does it work? Emergency contraceptive pills (ECPs) work just like regular birth control pills by preventing ovulation, interfering with fertilization, and possibly preventing implantation. The hormones in ECPs and regular birth control pills are similar to hormones that are produced during pregnancy. The brain sees these hormone shifts and recognizes it as a pregnancy. The brain then sends a message back down to the ovaries to suppress ovulation as eggs are no longer needed because of the perceived pregnancy. As long as the brain continues to see these hormone levels, ovulation does not occur. ECPs temporarily prevent ovulation since the hormones are delivered in one large dose. Eventually, hormone levels return to normal and the contraceptive effect wears off. Women using regular birth control pills theoretically never ovulate while taking pills as they are receiving a steady dose of hormones.
How effective is it? Use of ECPs will reduce the risk of pregnancy by 75-89%. According to the manufacturer of Plan B One-Step, the treatment prevents seven of eight pregnancies that otherwise would have occurred.
Can I just use ECPs as my regular birth control method? ECPs should not be used in place of regular birth control methods. The failure rate, while low based on a single use, would accumulate over time with repeated use. Failure rates of routine methods of birth control are based on a year’s use. Therefore, hormonal methods like the pill, the vaginal ring, and the shot are much more effective than repeated ECP use. If you are going to continue to have sexual contact, you may want to think about using a regular form of birth control. If you live near one of our offices, please call us for an appointment to discuss your contraceptive options. If you live further away, contact the Family Planning or Planned Parenthood office closest to you.
What if I’m already pregnant? If you are already pregnant when you take the morning after pill, it will not cause you to miscarry or abort. Also, research has shown that they do not increase the risk of birth defects. ECPs are very safe to use.
How can I get them? If you are 15 or older, you can purchase ECPs at most drug stores without a prescription. They are located on the shelves in the family planning section (with the condoms and pregnancy tests). You may need to show ID to prove your age. The cost ranges from $50-$70 at the drug store. If you are under 15, you will need a prescription from a doctor. You can also get ECPs from a Family Planning or Planned Parenthood clinic. We offer Plan B One-Step at all of our clinics at a reduced cost. The cost, based on household size and income, ranges from $26-$40 and includes the visit fee. Teens under 18 years old and individuals who meet certain income guidelines qualify for free services and supplies (including Plan B One-Step).
Are there any side effects? The most common side effects of ECPs are nausea and irregular menstrual bleeding. To reduce nausea, take the medication with food. You can also use an over-the-counter anti-nausea medication half an hour before the dose and every 4-6 hours after, as needed. A change in menstrual bleeding patterns is also common. Some women may experience spotting a few days after taking the morning after pill. Your next period might be earlier than usual, later than usual, or spotty (meaning you may bleed for a few days, stop, and then bleed some more). However, most women (about 75%) will have vaginal bleeding similar to their normal period. If you are a week or more late for your next period, take a pregnancy test. If it is negative, repeat the test every two weeks until you have a normal period or a positive test result. Other less commonly reported side effects include abdominal pain, fatigue, headache, dizziness, breast tenderness, and moodiness.
Do ECPs also prevent STIs? No, ECPs do not provide any protection against sexually transmitted infections. Always use a condom in addition to your regular method of birth control to reduce your risk of infection.
Q: Antibiotics and Pill Use: If I use antibiotics while on the pill, will it decrease the effectiveness of the pill?↓↑
The effectiveness of any type of estrogen-containing birth control pill may be impaired during treatment with some types of antibiotics. However, the risk is very slight, and the supportive evidence is primarily limited to anecdotes from case reports and findings from uncontrolled or poorly controlled studies. In fact, according to Contraceptive Technology, 19th Edition, it is not necessary to use a back up method of birth control while on antibiotics because they do not lower the levels of hormones in your blood to the point that you would be at risk for pregnancy. The only exception to date is the medication, rifampin (which is primarily used to treat tuberculosis). To be on the safe side, however, we do recommend that our pill-users also use condoms or abstain from sex during antibiotic treatment and for at least one week after.
If your birth control pill was prescribed by another medical provider, we would encourage you to contact your provider or your pharmacist to ask if there are any drug interactions between the medications you are using and your birth control pill. Please follow their medical advice.
The following drugs or herbal products can decrease the effectiveness of hormonal contraceptives:
- St. John’s wort
- HIV protease inhibitors or non-nucleoside reverse transcriptase inhibitors
The United States has the highest teen pregnancy and birth rates of comparable countries. In 2008, our teen birth rate (number of teen births per 1,000 teens) was two times higher than the United Kingdom’s, 10 times higher than Switzerland’s, and over three times higher than that of our neighbor, Canada. However, the U.S. teen pregnancy rate, despite a 3% increase between 2005 and 2006, declined by 37% between 1991 and 2009. Despite this impressive decline, it is still the case that one out of every three teen girls will become pregnant at least once before the age of 20. Approximately 750,000 American teens get pregnant every single year resulting in approximately 400,000 teen births.
When to have your first sexual experience is a personal decision that no one can make for you. Generally, you should be mature enough to fully understand and accept the possible consequences of sexual intercourse (pregnancy, STDs and their possible long-term complications, a change in your reputation or self-esteem, etc.). We can give you a few guidelines. Never have sex if you feel you are being pressured. On the flip side, never try to pressure anyone else into having sex. Never have sex just to keep your girlfriend or boyfriend. If his or her staying is contingent on your having sex, then you’re not getting the respect that you deserve – get out of the relationship yourself. Never have sex out of curiosity, boredom, or because your friends are doing it. These are very poor reasons to risk a pregnancy or a life-threatening illness. Don’t have sex if you can’t talk to your partner comfortably about sexual limits, birth control, and reducing STD risks. Most adults believe that young people should wait (at least) until after they graduate from high school to begin having sex. Some adults believe that sexual intercourse should be saved for marriage. Talk to your parents or another caring adult and find out how they feel. Love is a wonderful feeling. But, you don’t have to have sex to show your love for another person. Waiting is sometimes the most mature and loving choice you can make.
Again, this is a personal issue. Refer to the answer above. Also, examine your feelings. In general, if you feel uncomfortable about the idea of doing something, then that is probably too far for you. Think about what you are and are not willing to do within a relationship. These are your sexual limits. For example, I’m willing to kiss, hug, and hold hands, but I’m not willing to have my private areas touched in any way.” Make your sexual limits very clear to your partner. We know this isn’t always easy. Take advantage of a TV show or movie you’re watching to make your limits known. You might say: “I can’t believe that girl had sex on the first date. I could never do that! I love kissing and hugging, but that’s as far as I’d go.”
Sometimes it’s difficult to know the difference between love, lust, and infatuation. According to Nathaniel Branden in his book What Love Asks of Us, “Romantic love represents the integration of three factors: 1) a strong sense of affinity, a sense of being ‘soulmates’ 2) the presence of admiration 3) strong sexual attraction.” Lust simply refers to strong sexual attraction without affinity and admiration. Infatuation refers to a strong attraction to another arising from our focusing on one or two aspects of the other, not the whole person. For example, you might be infatuated with someone at school who is good looking and great at sports, but you really don’t know much else about him or her. Generally, healthy loving relationships share the following characteristics (brace yourself – it’s a long list): mutual respect, trust, honesty, commitment, faithfulness, being able to apologize and forgive, genuine care for the well-being and feelings of the other person, feeling safe and at ease with one another, being able to freely spend time away from each other, maintaining other friendships and not feeling guilty about them, being able to freely express your opinions and ideas, being able to say and accept the word “no”, being able to listen and empathize with the other person, making your own decisions, deciding together what to do as a couple, talking out problems, not feeling pressured to do something or act a certain way, a sense of balance (giving and taking equally), and acceptance of the other person for who he or she is (not for who you want them to be). If you have all of the above, then you just may be in love. Did you notice that having sex was not even mentioned?
Be firm, honest, and empathetic. Don’t wait until you’ve gone too far – it will be harder to say no. Talk about your sexual limits before you start hugging and kissing. Try to say no privately, not in front of his/her friends. Give a reason for saying no – for example, “I’m just not ready for sex right now. It’s not that I don’t love you. I’d just like to get to know you better before we go any farther. I’m sorry, but my mind is made up.” Or you might say, “I don’t believe in sex before marriage. I care about you, and I don’t want to lose you, but I have to be clear about this. I hope you’ll respect my feelings.” Whatever you say, be sincere. Don’t say something that you don’t really mean or believe. If he or she continues to pressure you, then it’s time to be firm. Tell him/her that you will not be bullied into doing something you don’t want to do. Pressuring someone to do something they’re not ready for is disrespectful, uncaring, and selfish.
Some teens who become pregnant actually do so on purpose. Their reasons? To feel loved by someone. To escape from what they perceive to be a bad home situation. To trap a guy into marriage. To put a mark on the world. To do something meaningful. To become an adult. Unfortunately, most teens who plan their pregnancies have very unrealistic expectations about pregnancy and parenting, and they regret their decision later. With regard to unplanned pregnancies, there are many reasons. Some younger girls may not understand how one becomes pregnant or how to avoid pregnancy, or may believe local myths about pregnancy prevention. Occasionally, a girl gets pregnant before she ever has a period (a girl ovulates or releases an egg 1-3 weeks before her first period, and thus pregnancy is possible). Some teens have sex while under the influence of drugs or alcohol, and either forget to use birth control or use it incorrectly. Some girls may be afraid to use a more reliable method of birth control because they are misinformed about risks. Others simply don’t like some of the side effects, like the possibility of weight gain. They don’t think about the possibiilty that they may gain 35 pounds if they get pregnant. Some feel that if they seek out contraception, they will be seen as “easy”. These girls believe that planning to have sex is bad, and that purchasing a birth control method is evidence of planning. Some simply think it can’t happen to them. Many teens who become pregnant have a history of sexual abuse, and feel like they have no control over what happens to them. Some are afraid that their parents will find out, or they fear their friends or relatives will see them walking into a family planning clinic. Finally, some girls use contraception, but do so incorrectly or inconsistently. And, unfortunately, a few become pregnant even when they use their birth control method perfectly. Remember, only abstinence works 100% of the time.
Teens give a variety of reasons for having sex before marriage including curiosity, boredom, to keep a boyfriend or girlfiend, to prove their love, peer pressure, lack of self-control, or simply because it feels good. Some teens feel that premarital sex is okay as long as the people involved are in love. Other may not have a choice – they may be coerced or forced into having sex. Some individuals choose to remain single their entire lives, but still want to enjoy sexual relationships. Others may be gay or lesbian, and cannot ever legally marry in most states, including Pennsylvania. Choosing to have sex is a big step in any relationship – a decision that shouldn’t be taken lightly. Anyone, regardless of their age, should think carefully about possible consequences and effects on the relationship before taking the plunge. In essence, it depends on personal values and circumstances. What’s right for one person may not necessarily be right for another. If you personally feel that premarital sex is wrong, then you should pay attention to those feelings, and stick to your guns. When you go against your own personal values, you cheat yourself – your self-esteem drops, and you end up feeling guilty and anxious. Live by your own values, but be tolerant of the values of others. Everyone is unique with a very personal set of feelings, experiences, thoughts, and ideas. It’s impossible to entirely understand someone else’s perspective without being able to step into their shoes and actually live their life.
The best place to go when you want any information about sex is your parents. They love and care about you, and they have your best interests at heart. They can provide you with values as well as facts. However, if you just want the basic facts about birth control, visit Family Planning…Plus or another reproductive health care provider. Medical professionals who specialize in reproductive health can provide you with the latest information possible.
Q: How can I ask my parents about sex – or tell them I’m ready to have sex – without them having a heart attack?↓↑
Here are some suggestions:
- Look for talkable moments and take advantage of them. Discuss movies, TV shows, or song lyrics that have sexual themes with your parents. Sometimes it’s a lot easier to talk about sexual issues in general than it is to talk about your own personal sexuality. In this way, you can discover your parents’ values and feelings about sex. This may help you predict their reaction to a more personal conversation.
- Try the direct approach – simply ask. But be ready for a strong response if your question is about you and your behavior. Let your parents express their feelings first before continuing the conversation. Try to put yourself in their shoes. Your parents want the very best for you, and when they consider the possibility that you may be having sex, they imagine the worst (someone hurting you, an unintended pregnancy interfering with your future, sexually transmitted diseases, AIDS).
- If you’re nervous about your topic, you may want to initiate a conversation in the car (when it’s just you and your parent). That way, your parent has to listen, and you don’t have to make eye contact.
- Before you approach your parent, decide what you want to say and how you’ll say it. You may want to write ever\ything down and practice in front of a mirror or close friend. Pick a good time and place for your discussion. Telling your parents that you just started to have sex right after they’ve had an argument is not a good idea. Make sure that your parents have time to talk, are relaxed, and are feeling good about you. Your setting should be private and free from interruptions.
- Treat your parents the way you would like to be treated. If you want to be listened to with respect and without interruption, be sure to show the same courtesy to them.
- When they’re talking, use active listening skills such as giving them your full attention, maintaining eye contact, asking for clarification, reflecting their feelings, and summing up their basic ideas before responding to what they’ve said. Try not to interrupt.
- Avoid behaviors that tend to block communication including threats, name-calling, judgments, labels, ridicule, and sarcasm.
- If you really fear baring your soul, try the “my friend has this problem” approach or write your parent a letter.
Q: If I have sex but don’t use any birth control, what are my chances of getting pregnant / getting my girlfriend pregnant?↓↑
If you have unprotected sex just once, your risk of pregnancy is quite low. However, you can reduce your risk even further by taking Plan B (the morning after pill) within 72 hours of the unprotected sex. Each time you have unprotected sex, your risk of pregnancy increases. If you continue to have unprotected sex regularly over the course of one year, your chance of pregnancy jumps to 85%. Nine out of 10 sexually active couples who do not use birth control will become pregnant within a year. That’s why it’s so important to use birth control if you do decide to have sex.