President’s Corner for Late May 2016
Dr. Freda M. Bush
This week I had a mother bring her 17y/o daughter to the office for her first GYN examination. “Tamera” is graduating from high school this month and her mother wants her to get the SKYLA intrauterine device (IUD) inserted before heading to college in the fall. “Tamera” is a virgin and states she plans to remain so until marriage. She has never had a pelvic exam and stated she is “allergic” to pain.
SKYLA is one of the pregnancy prevention devices in the group of long-acting reversible contraceptives (LARC), specifically, intrauterine devices and implants. LARCs offer an unprecedented opportunity to reduce unintended pregnancies among adolescents because they are highly effective even with typical use. LARCs work to prevent pregnancy for 3-10 years depending on the device used.
Earlier this month, May 2016, JAMA Pediatrics published the article, “Long-Acting Reversible Contraception and Condom Use Among Female US High School Students: Implications for Sexually Transmitted Infection Prevention”. Research found that teens who use LARC were 60% less likely to use condoms than were those who used birth control pills. Their conclusion was that LARC users may no longer perceive a need for condoms as a back-up method to prevent pregnancy; and therefore are less likely to use condoms even if they have multiple partners, which places them at a risk for STIs.(1)
These findings have serious implications. If untreated, 10% to 20% of women with chlamydia and/or gonorrhea develop pelvic inflammatory disease (PID).(2) Gonorrhea and chlamydia account for one-third to one half of the acute PID cases in young women. (3) PID often leads to infertility, pelvic pain, and ectopic pregnancies. In 2013, 88,000 women between the ages of 15 and 44 were diagnosed with PID.(4)
Sexually Transmitted Infections (STIs) are very common among teens and young adults, and they have the potential to change a young person’s life forever. In the U.S. in the year 2013, an estimated 20 million cases of sexually transmitted infections occurred. About half of these infections occurred in 15-24-year-olds, even though they only represent about 25 percent of the sexually active population.(5)
The American College of OB GYN reported further sobering information that women and girls who have never given birth are more likely to be at increased risk for expelling the contraceptive device. Up to 1 in 5 is at risk for expulsion.(6) Additionally, package insert safety information for one LARC device includes the warning of “increased risk of ectopic pregnancy and increased loss of future fertility with infections and uterine perforation which may necessitate surgical removal.” (7)
Counseling adolescents and young adults is critical to stem the tide of transmission of STIs. Early Sexual debut is correlated with multiple sex partners, increased risk for STI’s, pregnancy and emotional factors. The CDC recommends annual screening for STI’s under the age of 26. Even without the infections causing long term physical disease, they can cause dis´-ease emotionally and spiritually.
“Tamara’s” mother with good intentions to prevent pregnancy was potentially putting her child at even greater long term risk. Now armed with health information about LARC, STI’s and risk avoidance, Tamara and her mother will discuss the information and return with an informed decision.
1Riley, J. Steiner; et al, JAMA Pediatr, 2016;170(5) 428-434.doi.10.1001/jamapediatrics 2016.0007
2 Centers for Disease Control and Prevention, “Sexually Transmitted Disease Surveillance 2014
3 Haggerty CL, Ness RB. Epidemiology, pathogenesis and treatment of pelvic inflammatory disease. Expert Rev Anti Infect Ther. 2006;4:235-47.
4 Centers for Disease Control and Prevention, “2013 Sexually Transmitted Diseases Surveillance,”http://www.cdc.gov/std/stats13/surv2013-print.pdf
5 Satterwhite CL, Torrone E, Meites E, et al. “Sexually Transmitted Infections among US women and men: prevalence and incidence estimates, 2008. Sexually Transm Dis. 2013;40(3):187-93
6ACOG Women’s Healthcare Physicians (2012. Reaffirmed 2014). Adolescents and Long-Acting Reversable Contraception: Implants and Intrauterine Devices. Washington DC:Author.
7Liletta, Levonorgestrel-releasing intrauterine system, Important safety Information and Full Prescribing Information, Parsippany, NJ.Actavis andMedicines360, 2015.