Making Healthy Decisions About Sex
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Before you decide to have sex, or if you are already having sex, you need to know how to stay healthy. Even if you think you know everything you need to know about sex, take a few minutes and read on. Your doctor wants to make sure you know the facts. 

Important Reminders

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    No one should be forced to have sex! If you are ever forced 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 to have sex.
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    Not using alcohol and drugs will help you make clearer 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 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

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    You can be completely honest and trust the other person, and the other person can trust you.
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    You can talk with the person about difficult topics (eg, feelings; other relationships; if the person has had a sexually transmitted infection [STI]).
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    You can be responsible, protecting yourself and your partner against STIs and pregnancy with condoms and birth control.
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    You can respect the other person’s decisions about not having sex and about using protection.
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.

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    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.
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    Your partner pressures you to have sex and doesn’t respect your reasons for not wanting to have sex.
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    Your partner manipulates you by bullying you or by threatening to hurt himself or herself if you end the relationship.

Why wait?

There’s nothing wrong if you decide to wait. Not everyone is having sex. Half of all teens in the United States have never had sex. If you decide to wait, stick with your decision. Plan ahead how you are going to say no so you are clearly understood. Stay away from situations that can lead to sex. If your boyfriend or girlfriend doesn’t support your decision to wait, he or she may not be the right person for you. 

Here are reasons why waiting to have sex makes sense.

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    Sex can lead to pregnancy. Are you ready to be pregnant or become a teenaged parent? It’s a huge responsibility. Are you able to provide food, clothing, and a safe home for your baby? Have you finished your education? Are you in a healthy relationship?
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    Sex has health risks. A lot of infections can be spread during sex. Sexually transmitted infections include chlamydia, gonorrhea, Trichomonas species infection, hepatitis B, herpes, HIV (the virus that causes AIDS) infection, human papillomavirus (HPV) infection, or syphilis.
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    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 even tell other people you had sex with him or her.

How can you prevent getting a sexually transmitted infection?

Nothing works perfectly to prevent STIs except for not having sex (abstinence). However, if you’re going to have sex, using condoms is the best way to reduce the risk for getting STIs. You can also get a vaccine to protect against HPV. 
Remember to use a latex condom every time you have sex, no matter what other type of birth control you and your partner might also use. To protect against getting an infection from having oral sex, use a condom or dental dam. Your doctor can explain all these things to you. 
To make sure you stay healthy, get regular medical checkups. If you have had sex in the past, or are having sex, your doctor may recommend testing for STIs. 

What do you need to know about condoms?

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    Condoms work best when used correctly. Male condoms used the right way have about a 98% chance of preventing pregnancy, and 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, male condoms may have only an 82% chance of preventing pregnancy, while female condoms may be effective only 79% of the time.
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    Most teens use male latex condoms. Female condoms are another option. Never use a male and female condom at the same time; they might tear.
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    Follow the instructions on the package to make sure you are using condoms the right way.
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    Check the expiration date on the package. Don’t buy or use expired condoms.
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    You can carry condoms with you at all times, but do not store them where they will get hot (eg, in the glove compartment of a car). Heat can damage a condom, and it may tear or break more easily.
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    Here are more tips about using male condoms from the “Condom Fact Sheet In Brief,” published by the Centers for Disease Control and Prevention.
     
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      Use a new condom for every act of vaginal, anal, and oral sex throughout the entire sexual act (from start to finish). Before any genital contact, put the condom on the tip of the erect penis with the rolled side out.
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      If the condom does not have a reservoir tip, pinch the tip enough to leave a 1/2-inch space for semen to collect. Holding the tip, unroll the condom all the way to the base of the erect penis.
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      After ejaculation and before the penis gets soft, grip the rim of the condom and carefully withdraw. Then gently pull the condom off the penis, making sure semen doesn’t spill out.
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      Wrap the condom in a tissue and throw it in the trash, where others won’t handle it.
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      If you feel the condom break at any point during sexual activity, stop immediately, withdraw, remove the broken condom, and put on a new condom.
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      Ensure that adequate lubrication is used during vaginal and anal sex, which might require water-based lubricants. Oil-based lubricants (petroleum jelly, shortening, mineral oil, massage oils, body lotions, and cooking oil) should not be used because they can weaken latex, causing breakage.

What types of birth control are effective?

Talk with your doctor about birth control. Your doctor can answer questions about safe and effective methods, side effects, and costs. Here are some forms of birth control for females, from most effective to least effective at preventing pregnancy. 
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    Contraceptive implant. A contraceptive implant is a tiny, flexible rod that a doctor inserts into the inside of the upper arm. It slowly releases a hormone that prevents pregnancy for 3 years. A contraceptive implant when used as prescribed is about 99% effective in preventing pregnancy.
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    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 years. There are 2 levonorgestrel IUDs, both of which contain a hormone and prevent pregnancy for 3 to 5 years, depending on which one is used. Intrauterine devices when used as prescribed are about 99% effective in preventing pregnancy.
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    Contraceptive injection. Depot medroxyprogesterone acetate (DMPA) (brand name is Depo-Provera) is a shot given every 3 months. It’s effective, and you don’t have to remember to take a daily pill. The contraceptive injection, when used as prescribed, is 99% effective in preventing pregnancy. However, when used typically (eg, women may occasionally forget to get a shot exactly on time), it is 94% effective in preventing pregnancy.
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    Birth control pills, patch, and ring. “The pill,” the birth control patch, and the ring all contain 2 hormones, an estrogen and a progestin.
     
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      boldBirth control pill. You take 1 pill each day. Birth control pills when used as prescribed are about 99% effective in preventing pregnancy. However, when used typically (eg, women may occasionally forget to take a pill), they are 91% effective in preventing pregnancy.
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      Birth control patch. The birth control patch is an adhesive patch that is placed on the skin. You wear the patch 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 in preventing pregnancy. However, when used typically (eg, women may occasionally forget to replace the patch on time), it is 91% effective in preventing pregnancy.
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      Birth control ring. You insert the birth control ring in 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 in preventing pregnancy. However, when used typically (eg, women may occasionally forget to put in a new birth control ring on time), it is 91% effective in 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. 
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    Withdrawal. The male “pulls out” before he ejaculates, or “cums.” It does not prevent pregnancy or STIs. Even a small amount of sperm can lead to pregnancy or an STI.
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    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.
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    Spermicides. These are creams and foams used during sex to kill sperm. They may add protection to other methods (eg, condoms) but are not effective when used alone.
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    Vaginal sponge. This is a small, round sponge that is 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 during sex, or forgetting to take birth control pills. 
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    Emergency contraception can be taken up to 5 days after unprotected sex but is most effective when taken as soon as possible after sex.
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    You can buy EC pills over the counter without a prescription. The types of EC pills available over the counter are levonorgestrel at 1.5 mg (eg, Plan B One-Step, Next Choice One Dose). 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 for tips on finding lower-cost pills at http://ec.princeton.edu/locator/concerned-about-cost.html.
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    Another type of EC pill is ulipristal acetate at 30 mg (eg, Ella), which you can get only with a prescription. You will need to call your doctor to get a prescription.
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    A doctor can also put in a copper IUD that will provide both EC and regular birth control.

Resources

American Academy of Pediatrics 
Center for Young Women’s Health 
The Emergency Contraception Website 
Power to Decide (the campaign to prevent unplanned pregnancy) 
Sex, Etc. (by Answer, Rutgers University) 
Young Men’s Health 

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. 

Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. Products are mentioned for informational purposes only and do not imply an endorsement by the American Academy of Pediatrics. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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