Making Healthy Decisions About Sex

Important Reminders

• No one should be forced or pressured to have sex! If you are ever forced or pressured to have sex, it's important to never blame yourself and to tell an adult you trust as soon as possible. Medical and counseling supports are available to help someone who has been forced or pressured to have sex.

• Using alcohol and drugs can affect your choices about sex. Too many teens have sex without meaning to when they drink alcohol or use drugs.

Are You Ready for Sex?

Sex can change your life and relationships. Having sex may affect the way you feel about yourself or how others feel about you.

Many teens believe that waiting until they are ready to have sex is important. The right time is different for each teen. For example, some teens may want to wait until they are adults or married, or they may want to wait until they feel their relationship is ready.

You may feel your relationship is ready when

• You can be completely honest and trust the other person, and the other person can trust you. A good idea is to talk about sex with the lights on and clothes on!

• You can talk with the person about difficult topics such as feelings, other relationships, whether the person has had a sexually transmitted infection (STI), or condoms or pregnancy prevention.

• You can be responsible, by protecting yourself and your partner against STIs and pregnancy with condoms and birth control.

• You can respect the other person's decisions about not having sex and about using protection.

• You can have sex in a private place.

However, if you are in love or really like someone, you may ignore the signs of an unhealthy relationship.

Here are signs that your relationship is not ready for sex.

• Your partner is jealous or possessive. For example, your partner prevents you from spending time with your family or other friends, texts or instant messages you constantly, or checks your cell phone to read your texts.

• Your partner pressures you to have sex and doesn't respect your reasons for not wanting to have sex.

• Your partner controls you by bullying you or by threatening to hurt himself or herself if you end the relationship.

• Your partner doesn't respect your desire to use condoms or birth control.

Why Wait?

There's nothing wrong if you decide to wait. Not everyone is having sex.

About half of all teens in the United States have never had sex. If you decide to wait, plan how you are going to say no so you are clearly understood. Stay away from situations that can lead to sex, such as being alone with someone who has been pressuring you or using alcohol or drugs. If your partner doesn't support your decision to wait, he or she may be the wrong person for you.

Here are reasons why waiting to have sex makes sense.

• Sex can lead to pregnancy. Are you ready to be pregnant? If you become pregnant, you have to make difficult decisions such as becoming a teen parent, placing a child for adoption, or ending the pregnancy. Are you ready to make these sorts of decisions? What will be the effect of a pregnancy on your health, finances, education, relationships, or family?

• Sex has health risks. A lot of infections can be spread during sex. STIs include chlamydia, gonorrhea, "trich" (trichomoniasis), hepatitis B, herpes, HIV (the virus causing AIDS) infection, human papillomavirus (HPV) infection, or syphilis. Some infections are treatable, but some persist throughout a lifetime.

• Sex can lead to emotional pain and distractions. You may feel sad or angry if you let someone pressure you into having sex when you're not ready. You may also feel sad or angry if you choose to have sex but your partner breaks up with you. Your partner may tell other people you both had sex even if it was supposed to be private.

How Can You Prevent Getting a Sexually Transmitted Infection?

You can't tell by looking at or talking with someone whether they have an STI since many STIs don't cause symptoms. Nothing works perfectly to prevent STIs except for not having sex (abstinence); however, if you're going to have sex, here are tips to keep in mind.

• Using a barrier method, such as a condom or dental dam, is the best way to reduce the risk of getting STIs.

• Remember to use a barrier method every time you have sex, no matter what other type of birth control you and your partner might also use.

• To make sure you stay healthy, get regular medical checkups. You can also get a vaccine to protect against HPV.

• If you have had sex in the past, or are having sex, it's important to get tested for STIs.

What Do You Need to Know About Barrier Protection (Condoms)?

Condoms work best when used correctly. External (male) condoms have about a 98% chance of preventing pregnancy, and internal (female) condoms have a 95% chance, but they must be used each time you have sex and used correctly. When they are not used correctly, external condoms may have only an 82% chance of preventing pregnancy, while internal condoms may be effective only 79% of the time. External condoms are available to purchase without any age restrictions at stores, including convenience stores, and pharmacies. Internal condoms may require a prescription. Most teens use latex external condoms.

Here are tips to keep in mind.

• Never use external and internal condoms at the same time; they might tear.

• Follow the instructions on the package to make sure you are using condoms in the right way. To learn more about how to use condoms and other barriers, visit the Centers for Disease Control and Prevention "Condom Effectiveness" web page at www.cdc.gov/condomeffectiveness/index.html.

• Check the expiration date on the package. Don't buy or use expired condoms.

• You can carry condoms with you at all times, but do not store them where they will get hot or damaged (eg, in the glove compartment of a car or in a wallet). Heat can damage a condom, and the condom may then tear or break more easily.

What Types of Birth Control Are Effective?

Talk with your doctor about birth control or contraception. Your doctor can answer questions about safe and effective methods, side effects, and costs. Most contraception is covered by insurance. Here are some forms of birth control, from the most effective forms at preventing pregnancy to the least. None of these methods prevent STIs, so it's important to also use barrier protection.

Contraceptive implant. A contraceptive implant is a tiny, flexible rod that a doctor inserts into the inside of the arm, between the shoulder and the elbow. It slowly releases a hormone that prevents pregnancy for 3 to 5 years. A contraceptive implant when used as prescribed is about 99% effective at preventing pregnancy.

Intrauterine devices. Intrauterine devices (IUDs) are small T-shaped devices placed inside the uterus by a doctor. They are highly effective at preventing pregnancy and may also be prescribed to help decrease menstrual bleeding and pain. The copper IUD contains a small amount of natural copper and prevents pregnancies for up to 10 to 12 years. There are 2 levonorgestrel IUDs, both of which contain a hormone and prevent pregnancy for 3 to 7 years, depending on which one is used. Intrauterine devices when used as prescribed are about 99% effective at preventing pregnancy.

Contraceptive injection. Depot medroxyprogesterone acetate (DMPA) is a shot given every 12 weeks. The contraceptive injection, when used as prescribed, is 99% effective at preventing pregnancy; however, when used typically (eg, women may now and then forget to get a shot exactly on time), it is 94% effective at preventing pregnancy.

Birth control pills, patch, and ring. "The pill," the birth control patch, and the ring all contain 2 hormones, an estrogen and a progestin.

• Birth control pill. You take 1 pill each day. Birth control pills when used as prescribed are about 99% effective at preventing pregnancy. However, when used typically (eg, women may now and then forget to take a pill), they are 91% effective at preventing pregnancy.

• Birth control patch. The birth control patch is an adhesive patch placed onto the skin. You wear the patch for 3 weeks, remove the patch for 1 week, put on a new patch at the end of the fourth week, and repeat these steps. The birth control patch when used as prescribed is about 99% effective at preventing pregnancy. However, when used typically (eg, women may now and then forget to replace the patch on time), it is 91% effective at preventing pregnancy.

• Birth control ring. You insert the ring into your vagina near your cervix, it stays in for 3 weeks, and you remove it for 1 week and have your period. Then you get a new ring from the pharmacy and insert it again for another 21 days. The birth control ring when used as prescribed is about 99% effective at preventing pregnancy. However, when used typically (women may now and then forget to put in a new birth control ring on time), it is 91% effective at preventing pregnancy.

What Are Other Types of Birth Control?

Here are types of birth control that are less common and not as effective at preventing pregnancy.

Withdrawal. The male "pulls out" before he ejaculates, or "comes." It does not prevent pregnancy or STIs. Even a small amount of sperm can lead to pregnancy or an STI.

Natural family planning (the rhythm method). You avoid having sex during certain times of your monthly cycle. Because teens tend to have more irregular periods, this method is less effective at preventing pregnancy.

Spermicides. These are creams and foams used during sex to kill sperm. They may add protection to other methods (eg, barriers) but are not effective when used alone. They can irritate the skin and increase the risk of getting STIs.

Vaginal sponge. This is a small, round sponge coated with spermicide. It is inserted into a female's vagina up to 24 hours before intercourse and can be left in place after intercourse. It should be removed after 24 hours of use.

What Is Emergency Contraception?

Emergency contraception (EC) is a form of birth control that you use after you have unprotected sex. Unprotected sex includes not using birth control, condoms breaking or slipping off during sex, or forgetting to use birth control.

Emergency contraception can be taken up to 5 days after unprotected sex but is most effective when taken as soon as possible after sex.

You can buy EC pills over the counter, without a prescription. One type of EC pill available over the counter is levonorgestrel at 1.5 mg, which is most effective on days 1 to 3, but can be taken up to 5 days, after unprotected intercourse. Although EC pills are expensive, they are covered by many insurance plans. If you are concerned about the cost of EC pills, visit The Emergency Contraception website (https://ec.princeton.edu) for tips on finding lower-cost pills.

Another type of EC pill is ulipristal acetate at 30 mg, which is more effective later (on days 4 and 5) and you can get only with a prescription from your doctor.

A doctor can also put in a copper IUD that will provide both EC and regular birth control.

Remember

If you decide to have sex, it's important you know the facts about birth control, infections, and emotions. Deciding when to become sexually active, how to protect yourself from STIs, and how to prevent pregnancy can be confusing. These are important decisions and are worth talking about with adults who care about you, including your doctor.