Sexual development is a process embracing childhood, adolescence, and adult age. Children explore and discover parts of their body and process the images and sexual relations that they have observed in their environment. Adolescents undergo the changes of puberty, experience feelings and sexual desires and develop the ability to achieve intimacy and to reproduce. Sexuality in adolescents is based on a good knowledge of their sexual rights and sexual education, which also embraces the use of contraceptives that has to include the prevention of both sexually transmitted infections and pregnancies.
What are the sexual habits of adolescents?
The first choice for adolescents is the use of condoms or emergency contraception; with increasing age, and in case of longer relationships, there is a shift to hormonal contraceptives. Together, condoms and hormonal contraception can be good for adolescents as a double protection: condoms as a protection against sexually transmitted diseases and hormonal contraception as a better protection against pregnancy. Long acting reversible contraception (LARC), including both intrauterine contraception and implants, is secure and highly effective, thus suitable for adolescents. In different countries, there are significant differences in the types of contraceptive methods used by adolescents, which range from traditional methods to long acting reversible contraceptives (implants and IUD). Currently, long acting reversible contraceptive methods (LARC) are greatly recommended but the percentage of adolescents that use them is still relatively low. The knowledge and understanding of the different contraceptive methods and the desire to use protection are crucial for an effective contraception. In fact, it has been demonstrated how a complete sexual education improves the use and knowledge of contraceptives. This means that sexual education must be planned, continuous and adapted to different ages because it provides young people with the right information and values to understand and enjoy their sexuality and have more secure relationships.
Contraceptives in adolescence
Several exams should be carried out before the use of contraceptives. These include: breast exam, pelvis exam, genital examination, cytological cervical screening, routine blood tests, blood pressure and BMI. The doctor needs to be informed on the patient’s past and present medical conditions, family history, drug history and of any other risk factor that could be a contraindication to the use of contraceptives. Risk factors relative to cardiovascular diseases, obesity, hypertension, thrombophilia, previous venous thromboembolism, hyperlipidaemia should be specifically requested. Women characterised by more than one risk factor might need to avoid the use of combined oral contraceptives (COC) even if the single risk factors are not necessarily a contraindication to their use. Blinding migraine is quite common in adolescents and can be a contraindication to the use of COC, thus the doctor must be promptly informed.