Talking To Children & Teens About Sex – PediaCast 331
- Dr Elise Berlan and Dr Wendy Anderson-Willis join Dr Mike in the PediaCast Studio for a discussion on talking with kids and teens about sex. When should these talks begin? What constitutes “THE TALK?” What is the parents’ role in sex education? And what about birth control and sexually transmitted infections? Arm yourself with accurate information… and the best ways to discuss these sensitive topics with your children and teenagers.
- Talking About Sex
- Sex Education
- Birth Control for Teens
- Sexually Transmitted Infections
- Dr Elise Berlan
Adolescent Medicine Specialist
Director, Young Women’s Contraceptive Services (BC4Teens)
Nationwide Children’s Hospital
- Dr Wendy Anderson-Willis
Physician Lead, Ambulatory Teen Clinics
Nationwide Children’s Hospital
- Adolescent Medicine at Nationwide Children’s
- Young Women’s Contraceptive Services Program (BC4Teens)
- BC4Teens – Birth Control for Teens (Teen Site)
- BC4Teens – Your Teen and Birth Control (Parent Site)
700 Children’s Blog
- How To Talk With Your Kids About Puberty
- Teens, Birth Control and “The Talk” – What You Need To Know
- The “Period” Talk! What’s Normal?
- Sex Ed Library (SIECUS)
- Talking to Your Child About Sex (AAP)
- Adolescent Sexuality: Talk the Talk Before They Walk the Walk (AAP)
- Helping Teens Resist Sexual Pressure (AAP)
- Effective Birth Control for Sexually Active Teens (AAP)
- Teaching Health Education in School (AAP)
Teens & Apps
- BC4Teens – Birth Control for Teens (Teen Site)
- Pink Pad App (iTunes)
- Pink Pad App (Google Play)
- My Pill App (iTunes)
- My Pill App (Google Play)
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is Episode 331 for October 28th, 2015. We're calling this one "Talking To Children And Teens About Sex". I want to welcome everyone to the program.
So, right out of the gate, I got to warn you, I have my very first viral upper respiratory infection of the year. It happens every year. You know, the kids go to school. They start passing viruses back and forth. I see them in urgent care. And it never fails, one of them gets me sick.
So, you're just got to bear with my voice. That's the point. And there may be occasional coughing, or I may have to take an extra sip of water. But we'll make it through. We always push through. It happens every year, and yeah,like I thought this year was going to be an exception. No, not going to happen.
So what are we talking about today? We are talking about talking to children and teens about sex. And as you can tell by that title, it's a sensitive topic that we have for you. So, if you're listening in the car or living room speakers, and there are little ears around, and you're not quite ready to answer questions that arise as they soak in the content — and you can bet they will soak in the content even if their hands and feet are doing other things — which given our topic today may generate some questions that you aren't quite ready to answer.
Now, of course, questions are a good thing, as we'll talk about later in the show. But you might want an opportunity to do your research first. And depending on how little the ears are, there really are some things that your kids, young ones don't need quite yet. So, you've been warned, and this is your last chance to ditch this episode and pick another one for now, then you can come back and listen ;to this one when the little ears aren't around anymore.
So it's a sensitive topic today but it's also an important ;topic. We covered a research study on sex education a few months ago on this program. It was a study that asked young adults where they learned about sex and if their questions were truly answered in the way that they wanted them answered — I mean, did they get their questions answered in the course of that education. The majority of the participants as they thought about their teenage years said, "We learned most of it at school, and no, we really didn't get ;all of our questions answered."
So as difficult as it is to talk about sex with our kids, it's an important thing to do. Starting in a young age, in an age appropriate fashion, of course, so that your kids feel comfortable asking you questions and confiding in you as they get older. Because if they aren't getting answers from a school curriculum or from you, you can bet they are going to find answers somewhere and those answers they find may not be the correct answers.
And, as we think about things like pregnancy and sexually transmitted infections, getting the correct right answers is important. Another reason this is an important topic today is evidenced by the statistics. According to the CDC, 47%, so almost half of all high school students admit to having sexual intercourse at least once, and 34%, so just over a third have had sexual ;intercourse in the previous three months.
So while the majority of you out there may be saying, "No, not my teenager," the number suggest that some of you are probably wrong about that. Furthermore, the CDC says 41% of high school students did not use condom the last time they had sex. Fifteen percent had sex with four or more people and only 22% of sexually experienced students have ever been tested for HIV, and there is a risk of that. Ten thousand13- to 24-year-olds are diagnosed with HIV each year in the United States. Of the 20 million new cases of sexually transmitted infections that occur each year in the United States, half of them occur in those between the ages of 15 and 24.
And then, we also have to think about teen pregnancy. Over 250,000 babies are born each year to teenage girls between 15 and 19 years of age. There's lots of consequences for teenage moms and their babies including increased risk of pre-term labor and other medical complications, depression, suicide, stalled education and socio economic implications.
So this is not only a sensitive topic. It's also a hugely important topic. Now, I also realized it's a controversial topic. People have strong opinions about sex. Some are very open-minded about it. Others call on religious and ethnic or cultural convictions. As doctors, we have to take care for everyone. Regardless of backgrounds or beliefs, we care about people, all sorts of people, even people who don't look or think like we do. And our jobs as doctors is not to make them more like us, but to help them be safe and healthy no matter who they are or where they are because we care about them.
Now, you don't necessarily see that when doctors are confined to the examination room. So the conversation I have with one family can be quite a bit different than the one I have with another family. So you may think the conversation I have with you is the conversation I have with everybody, ;but that's not necessarily true. So depending on needs and the characteristics of the family in question, the conversation can go in different directions. So the practice of medicine is not one size fits all.
So what's my point here? Well, we're going beyond the simple mechanics of talking to your children about sex. We're ;going to over some of the things, content-wise, that you need to know as you have these conversations — things like birth control for teenagers and sexually transmitted infections and how to prevent them. ;For some of you, there may be some discomfort in hearing about these things. For others, you may be very eager to learn and share these information with your teenagers. And there will be some who say we shouldn't be talking about these things at all. We should only teach our kids abstinence, that's the only thing, and we should expect them to listen to our teaching or face the consequences.
Unfortunately, it's not that simple for doctors. We're not in the position to judge values. We're called to take care of kids, and when you look at those statistics, it's revealing that kids need taken care of. There are some education out there that needs to happen. And while abstinence until marriage is a great value for many families, and/or absolutely prevent ;pregnancy and sexually transmitted infections, trying to bandage that solution on everyone is simply not going to work.
As the statistics bear out, there are a whole lot of teenagers who need accurate information and education and access to care when it comes to human sexuality. And, there's a lot of parents out there who need accurate information and education as they help their teenagers navigate this road.
It's not to say that religious and cultural and ethnic values aren't important. They are. But as a doctor, I have a responsibility to everyone, even on my podcast. That's why we won't shy away from talking about sensitive and important topics, even when they're controversial.
Now, thankfully, I'm not going at it alone today. I have two fantastic guests in the studio to help me out. Dr. Elise D. Berlan is an Adolescent Medicine specialist here at Nationwide Children's; also director of our Young Women's Contraceptive Services Program, also known as BC4Teens. And, Dr. Wendy Anderson-Willis is Physician Lead of our Ambulatory Teen Clinics. We'll get them both settled in and make proper introductions in a moment.
First though, I want to remind you, PediaCast is your show. So, if there's a topic you want us to talk about, if you have a question for me, or you want to point me in the direction of a news article or a journal article, it's really easy to get in touch. Just head to PediaCast.org and click on the Contact link. You can also call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.
Also, I want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination.
All right, let's take a quick break. We'll get our guest settled in to the studio and we'll talk about talking to your kids and teenagers about sex. That's coming up, right after this.
Dr. Mike Patrick: All right, we are back.
Dr. Elise Berlan is an Adolescent Medicine specialist at Nationwide Children's Hospital and an associate professor of Clinical Pediatrics at the Ohio State University-College of Medicine. She serves as director of the Nationwide Children's ;Young Women's Contraceptive Services Program, also known as BC4Teens. She frequently advocates for teenagers on Twitter, @EliseBerlanMD, and I'll include a link to her Twitter feed in the Show Notes for this episode, ;331, at PediaCast.org.
It's a genuine pleasure having Dr. Berlan in the studio today, so let's greet her with a warm PediaCast welcome. Thanks for stopping by.
Dr. Elise Berlan: Thanks, Dr. Mike.
Dr. Mike Patrick: Really appreciate it.
Dr. Wendy Anderson-Willis also joins us today. Dr. Wendy is a physician lead for the Ambulatory Teen Clinics at Nationwide Children's Hospital and a clinical associate professor of Pediatrics at the Ohio State-University College of ;Medicine. She, too, is on Twitter, @DrWendyWillis, and I'll include a link to her Feed.
This is a first. I haven't provided Twitter links to our guests before, but they both have a Twitter presence, and I thought, hey, what a perfect opportunity to connect the audience with our experts after the show. So feel free to engage with them on Twitter.
I'm delighted to have Dr. Wendy in the studio. Let's give a warm welcome to her as well. Thanks for joining us.
Dr. Wendy Anderson-Willis: Thank you, Dr. Mike.
Dr. Mike Patrick: Really appreciate it.
So Dr. Wendy, let's start with you. When we think about talking to kids about sex, when do you think parents should start talking to young kids about their private parts, about sexual topics. It can be sort of uncomfortable and I think a lot of parents just wonder, when do you start doing it?
Dr. Wendy Anderson-Willis: ;I think that's a great question, Dr. Mike. I always ask my parents to start as early as possible. Begin those conversations about body parts using the correct terminology. Just begin to kind of answer questions on the fly ;that the children ask of them and kind of make sure that you answer the questions and move on. It's just something that we need to talk about.
Dr. Mike Patrick: Yeah, so you don't need to have the talk with little ones but you want to answer their questions honestly. Call things by their appropriate names. We hear a lot of slang terms from little kids , and sometimes you can't tell exactly what they're talking about.
Dr. Wendy Anderson-Willis: I think it's great to use the correct terminology.
Dr. Mike Patrick: Yeah, absolutely. Are there any other information that young kids need to know about private parts?
Dr. Wendy Anderson-Willis: I think that there are different situations where concerns come up and a child may have a question. But I don't think there's a certain, they definitely need to know this, this or that. Just the correct terminology and kind of ;open the flood gates to more questions.
Dr. Mike Patrick: When do you start mentioning to them that these are private parts, and so, it's OK for mommies and daddies to look here — it's OK for the doctor to examine them — but this is something that no one else should be looking at? So to get that, is that something that… Are you then putting an idea in their head, or is that something that proactively they should know about?
Dr. Wendy Anderson-Willis: I think it's sort of comes naturally. Oftentimes, when we are examining kids, we can kind of pick up on the fact that they believe these are private parts in terms of changing diapers and moving forward from there. There's a comfort level that the child has with the parents, and I often overhear parents discussing these during exams, "You're here. You're safe with parents," and, "Here's your doctor and we're all here together, and this is the only time that this is appropriate."
So I think that sort of begins more around the preschool age, but I think kids have an intuitive feeling about that as well.
Dr. Mike Patrick: I have always done that also. So when I see a kid and I am examining that area, I always say "It's OK that I am a doctor. Only mommies and daddies and doctors are allowed to look down here," just to try to reinforce that as well.
What questions coming from little kids should alert parents to possible abuse?
Dr. Wendy Anderson-Willis: I think that if children are using sort of sexually explicit language and adult language that parents should be very concerned.
Dr. Mike Patrick: So if they're talking about sexual acts.
Dr. Wendy Anderson-Willis: Absolutely.
Dr. Mike Patrick: Things that you haven't told them about. That's not something that's innate that we know about coming out of the wombs. They've heard about it somewhere and you'd want to try to figure out where it is that they heard it.
Dr. Wendy Anderson-Willis: Absolutely, Dr. Mike.
Dr. Mike Patrick: Or actions, as well. So if they're acting out, pretending sexual kind of things, that might make you concern too.
Dr. Wendy Anderson-Willis: Absolutely, yeah.
Dr. Mike Patrick: But exploring and touching themselves or making themselves feel good, they may discover that on their own. So they may not be as much as a concern. Correct if I'm wrong.
Dr. Wendy Anderson-Willis: No, that's a natural process. And I think parents will often say, "This is appropriate to do in private," and just kind of make sure that the child understands that it's OK, but to do it in private.
Dr. Mike Patrick: Yeah, absolutely. This is something that there's an appropriate time and a place, but at the same time, you don't necessarily want to make them feel shame or guilt for doing something that's exploratory and natural.
Dr. Wendy Anderson-Willis: I agree.
Dr. Mike Patrick: All right, so as kids get a little older, then we start talking about the talk. Although, I would suspect that if you're answering their questions as they come up all along, does there really have to be a time that they have the talk?
Dr. Wendy Anderson-Willis: No, I don't think the talk really exist in that same format that it did couple of generations ago.
Dr. Mike Patrick: The birds and bees.
Dr. Wendy Anderson-Willis: Yes. I think it's more of cascading conversation that takes place over childhood and throughout adolescence and probably beyond that. It just comes in the form of questions and issues and responses to things that we see on television and things that happen within our community. It's an ongoing conversation absolutely.
Dr. Mike Patrick: Dr. Berlan, when you think about the talk, what kinds of component… Especially as you get into the pre-adolescent age, are there certain things, that if they aren't coming up in the course of regular conversation, that you probably should initiate talking about?
Dr. Elise Berlan: Yeah, absolutely. One of the things I think is so important is to prepare kids for puberty. Kids are going to see their friends changing and other kids at school changing, and they're going to notice the difference between their parents' bodies and their own bodies. I think that's the perfect time to really normalize the changes of puberty and to say, "This is what daddy looks like. This is what you look like. This is totally normal, and when you get a little bit older, these are the changes that are going to happen to you." I think making that just so normal helps remove kind of the shame factor that people feel about puberty, because we all go through puberty and we need to be healthy adults.
Dr. Mike Patrick: Do you get into the menstrual cycle, like the specifics? I would suspect that some parents aren't necessarily comfortable talking about it or even understanding all of specific things that are going on? Or, is that something that you just let the school do?
Dr. Elise Berlan: I have boys — I am a parent and a pediatrician — and they know about periods. There is, in the world around, a lot of shame and secrecy about periods that is absolutely unwarranted. So I think the more girls, — especially because it's going to happen to them — and boys know about periods, then it just really helps everybody feel more comfortable and just normalizing it. Like in the store, "Oh, these are the menstrual products." For little kids, "These are special bandage that mommies use." Just to make it so it's not a taboo I think is the most important. And then, kids will ask questions. Once they know, "Oh, this is something I can talk to my mom and dad about," they will ask.
Dr. Mike Patrick: And you're probably better off not cutting those questions off but actually answering them. What would you say, Dr. Wendy?
Dr. Wendy Anderson-Willis: ;Yeah, I think that's the fun part. You deal with the shock.
Dr. Wendy Anderson-Willis: You take a deep breath and you try to answer as openly and honestly as possible, and you just leave room for more questions.
Dr. Mike Patrick: Yeah, I like that. I also like, it's important that boys understand what's happening to girls and it's important that girls understand what's happening to boys. When I was in early middle school, it was like the girls went off in one direction and the boys went off in a different direction. Each learned about themselves but not each other, which then I think made it even more taboo. And then, you wanted to know more.
Dr. Mike Patrick: But I like this idea of learning about each other.
Dr. Elise Berlan: You know, one of the things that I talk with my patients about — I should say the parents of my patient, which I often feel are my patients — is fake it till you make it. So, the first time this happens, you might be completely unprepared and you just have to kind of take a deep breath. Don't make that scrunchy, icky face because that will stay with your kids. You have to take a deep breath.
If you're really not prepared, say, "You know what I want to talk to you about this." I'm not sure. Let me find some information and we'll talk about this later. Maybe when you feel a little bit more comfortable and are prepared. But I think just trying to put a brave face on it, and then the more you do it, you will really feel more comfortable.
Dr. Mike Patrick: You've written a couple of blog post that sort of address this issue that we'll share in the Show Notes. They're at the 700 Children's blog that we have here at our hospital. One of them was How to Talk To Your Kids About Puberty, ;and the other was Teens, Birth Control and "The Talk" — What You Need to Know. You and also one of your associates also wrote that one, correct?
Dr. Elise Berlan: Right, Angela Abenaim.
Dr. Mike Patrick: We'll put links in the Show Notes, so folks can find those and can share those as well.
Dr. Elise Berlan: And there's actually a blog post that I will send you about talking with your girls about their periods. I wrote for the Children's blog as well.
Dr. Mike Patrick: Great. We'll include that, too.
So Dr. Wendy, as kids then get older — I kind of joke about middle school and the boys in one directions, girls in the other — who's responsible for really the in-depth sex education for older kids and teens? I mean, whose is the primary responsibility for this. You think it's the parent or you think it's the school, or is there a partnership?
Dr. Wendy Anderson-Willis: I think there's certainly a partnership, but the primarily responsibility is on the shoulder of the parents. And I think it's really nice that ;a parent can talk to the child within the context of their belief system, their family values, their religious beliefs. They can kind of help the child look at the broader perspective and also really focus on what's going on for that particular child.
So, the partnership also is there, and we can kind of piggyback on conversations, on educational events, by talking at school, then talking about it again at home with that personal perspective that you're going to get only from your parents.
Dr. Mike Patrick: In each school, the quality of the sex education that kids get may be a little different too.
Dr. Wendy Anderson-Willis: Absolutely.
Dr. Mike Patrick: Would you recommend that ;parents know what the schools are teaching their kids?
Dr. Wendy Anderson-Willis: I think it's important to know. I'm hoping that most of the schools are focused on comprehensive sex education so that kids are learning about abstinence and having that supported and reinforced, and also learning about birth control. Because we know about 50% of kids are going to need access to birth control and those kinds of things. Many of those other kids are going to need that support in terms of abstinence and saving themselves until marriage and those kinds of issues. So I think that having that comprehensive picture is very, very important for our kids.
Dr. Mike Patrick: How do parents educate themselves in order to educate their kids?
Dr. Wendy Anderson-Willis: I think my go-to when I'm looking at the Internet, I always put in American Academy of Pediatrics, and then I put in my question or the concern or the area of interest. So I think that when you go to reliable websites, that's real nice way to go. A lot of my patients come in and I ask their positions. So I think making that appointment and scheduling that time to focus on these questions is really important as well.
Dr. Mike Patrick: Yeah, great. And I'm going to put a whole bunch of links in the Show Notes for some resources that parents can find. ;Most of them are from the American Academy of Pediatrics. But when I did the show on sex education back a few months ago, I came across the site called the Sexuality Information and Education Council of the United States.
So it's kind of a sex ed library. It's got its advantages and disadvantages. So it's basically a bunch of different materials and modules that people can submit, so admittedly, some things are going to be better quality than others. So parents really do have to kind of go through it and see like, This is something that maybe appropriate that I could use and these other ones are not going to be quite as helpful. But it just have a vast amount of resources. A lot of the stuff that I came across, and it was pretty good.
Have either of you heard of this before?
Dr. Elise Berlan: You know what, I'm not very familiar with it. I've heard of the acronym before but I have to say it's not something I use regularly.
Dr. Mike Patrick: Well, I'll include a link in the Show Notes so parents can look at it and see if it's something that they think would be helpful. I think for people who homeschool in particular — because it's like a whole curriculum, and I suspect that and I could be wrong about this — but I suspect that standard homeschool curriculums that folks get probably aren't as strong in the sex education part. Again, I could be wrong about that.
Although we home-schooled our kids, and as I think about it, it was a lot of us talking about things, and they had health stuff but my wife did most of that, so I don't know.
Dr. Elise Berlan: One thing I would add is for parents not to assume the schools are doing it, because depending on where you live, there may not be comprehensive guidelines or statutes about sexuality education in schools. So I would advise parents not to rely on the schools activities in that area. And, if they are sexuality education, to try to understand what information they are providing because there are not standards about what the content needs to be everywhere. ;
So it's really quite variable — from some areas are still providing abstinence-only education, which we know is not been linked with the best outcomes to other areas really providing wonderful comprehensive science-based sexuality education.
Dr. Mike Patrick: And I think this will be an opportunity too for some parents to be advocates for all the kids in their school districts. So if they are in a school where there's been a push to limit the type of sexual education that is presented in the school, maybe that district needs a parent's voice as an advocate for more comprehensive education. What do you think about that?
Dr. Elise Berlan: Absolutely.
Dr. Wendy Anderson-Willis: I ;agree.
Dr. Mike Patrick: To some degree, I feel like as we're travelling down this path, by saying comprehensive, at the same time, we're saying… I don't know, I think some people would get the idea that abstinence is… Like, let's push that aside, but that's important too, isn't it?
As I mentioned in the introduction, family values are important and I think that the abstinence component of that if you are presenting it, especially, and you'd mentioned Dr. Wendy the support of that, so like students supporting one another and that can be helpful.
Dr. Wendy Anderson-Willis: I think that support is critical because the environment are so different for each child, ;and you want to make sure that they understand and feel empowered to kind of be successful with their choice.
Dr. Mike Patrick: Yeah. But at the same time, you want them to know what's out there, what's available, what resources that they have. That all makes sense.
Let's talk about birth control. Dr. Berlan, there are lots of different options that teenage girls have for birth control. Let's talk about some of those. I think the one that sort of first comes to mind when you think about birth control in girls is the birth control pills. Are that something that's still being used? Or, with all these new things that are out there, have they fallen to the wayside?
Dr. Elise Berlan: So I love this question. So birth control pills are really the mainstay of birth control for women in this country, but there are an outstanding number of unintended pregnancies on birth control pills. And these days, there are birth control methods that are so much more effective that we really like to provide education to our families and patients, that review all of the options, so that those folks who are not aware of the more effective options can really learn.
One thing that we know about pediatricians is that a group, we really favor birth control pills and condoms as our birth control methods of choice for our patients. But we're really part of a movement that is working with the American Academy of Pediatrics to really promote the use of more effective methods for teenagers.
The reason why we want our teens to use more effective methods is that we know that when girls are not pregnant until they're older, that they're more likely to finish school. ;So we want girls to be educated. We want our girls to be healthy. We know that pregnancy poses risks to health for lots of girls, especially with chronic conditions. And we know that babies are healthier when they're intended and when their mom is healthy.
So even coming at this as pediatricians, our ultimate goal is for our communities to be healthy and our families to be healthy, and that really involves avoiding unintended pregnancy, and then planning to be a parent when you're healthy and ready.
Dr. Mike Patrick: Yeah, absolutely. When you talk about the pills not being as effective, I think the number that I've seen is right around 90% or so. Is that something inherent in the pill or is it just not using it correctly?
Dr. Elise Berlan: So the number we usually use that's for all women, typical effectiveness is 91%. ;If you were a robot taking the pill in a laboratory, that number would be higher than 99% but nobody takes medicine like that. We're all human beings, and we miss doses, especially teenagers. So the 91% number doesn't represent teenagers, and we understand that their number is even less. So that would be saying that more than one in ten teen girls who uses a birth control pill is likely to have a pregnancy even using that medication to the best of her ability.
Dr. Mike Patrick: So what are some of the other options that have a little higher of a effectiveness rate?
Dr. Elise Berlan: So the one that is the most effective option is the contraceptive implant, and this one is sold under the name Nexplanon currently. ;It is 99.95% effective. So a young woman who uses Nexplanon would be very confident that she would not have a pregnancy while using the method. It's reversible, very rapidly reversible. At discontinuation, a woman's menstrual cycle and fertility would resume within weeks to months.
There is a myth about kind of damage to the reproductive system by being on contraceptive. So none of these methods have any long term effect on a young woman's reproductive abilities for the future. So this method last for three years.
Dr. Mike Patrick: Let's say someone changes their mind once the implants are in, can it be taken out?
Dr. Elise Berlan: Absolutely. So we do empower our patients to kind of take control of this aspect of their health. We do generally try to support the maintenance of the method as long as they're happy with it. But if they're having side effects or other concerns, then we would be happy to remove it and would advocate for our patients to speak up for that.
Dr. Mike Patrick: Do you find if there are side effects, that tend to diminish over time? Or not really?
Dr. Elise Berlan: The Nexplanon, this method actually kind of what you see is what you get. All of the other methods that we have, the side effects do tend to get better with time. But the Nexplanon, the main side effects is irregular, unpredictable bleeding. And, essentially, the pattern that we see in the first three to six months of use is essentially what you're going to have during the three years of use.
That being said, a lot of listeners might thing, "Ooh, I'm not sure that's right for me. Maybe patients aren't happy with that." We actually know that patients who use this method are among the most happy of all methods. It has one of the highest satisfaction, highest continuation rates. ;
We have a study that we've done here at Children's, looking at all the implants that have been placed at Children's over the last several years. And about 90% of those maintain their implants past one year.
Dr. Mike Patrick: Great.
Dr. Wendy Anderson-Willis: So many of parents and teens that come in requesting Nexplanon, or have interest in Nexplanon, it's always the parent's perspective — which one is the most effective and which one is the safest? And I can usually recommend Nexplanon to answer the parent's question.
And then, the teens always ask, does it hurt? So, we kind of go over how it's placed. And it's really a simple procedure that takes about, I don't know, one to three minutes. So after we numb the area on the arm, it doesn't hurt at all. So it does feel like a shot to be numb, and then after that it's very easily placed.
Dr. Mike Patrick: And you don't have to remember to do anything, take anything. It's just in there working for three years.
Dr. Wendy Anderson-Willis: Right.
Dr. Elise Berlan: We call it forgettable birth control. I've just look at some information from The National Campaign, which will be included in the links that you sent out, that teens really like to think about this as low maintenance birth control. So that might be a really nice way to kind of talk about these more effective methods, that they just are low maintenance.
Dr. Mike Patrick: So what are some of the other options that folks have?
Dr. Elise Berlan: The first tier, as we mentioned, is the contraceptive implant. The next level, just below that is actually thinking about intrauterine device or IUD. There are several on the market right now. They range and lasting from three years to ten years. They can all be placed in teenagers, and I think that's important for people know. These methods are safe. They're reversible. They don't lead to long-term problems. Girls generally have very nice side effect profiles with very low doses of hormone on the IUD.
Dr. Wendy Anderson-Willis: I was encouraged when the American Academy of Pediatrics said last year that these are the top two options, and that we really want parents to consider these options because they're so effective and their safety profiles are excellent.
Dr. Mike Patrick: Yeah, I think when some parents think about IUDs, they kind of have this negative connotation because of some complications that may have occurred in the past. But those aren't things that were really that aren't showing up in researchers' studies now.
Dr. Elise Berlan: No. These methods have now been on the market in the US and across the world for some time, and they have been demonstrated to be among the most safe methods. A recent study that I reviewed showed that there were serious adverse events less than one percent of the time.
Dr. Mike Patrick: And how effective are those?
Dr. Elise Berlan: More than 99% effective.
Dr. Mike Patrick: Yeah, so that's really, really good. ;What about the shot? The ;Depo-Provera shot?
Dr. Wendy Anderson-Willis: We use the shot, and many of our kids were coming back every three months for their shot. When they come in, the conversation is always do you want to switch to something that last for three years, so you don't have to visit me every three months. But we use the shot. There are side effects to the shot and the main one that I think about is the change in periods and then weight gain.
So if there's an option to change to something like Nexplanon where there ;are no weight gain issues — the average is three pounds over three years — we find that the young person is very happy with an Nexplanon. That satisfaction is there. They keep it in. There's nothing to do and they do really well.
Dr. Mike Patrick: I was going to say, they're not quite as effective are they?
Dr. Elise Berlan: So yeah, the shot, the number is 94% effective. So we've gone from less than one pregnancy in a hundred down to about six. And you know, I have patients who love the shot, and if that's their choice, I really support them. But I want to make sure that they are able to come in for visits. So the reason the shot fails is generally because people don't get the shot on time.
So like Dr. Wendy said, just being aware that it does require some maintenance and then inquiring if that's not working for the patient or the young person, what might work a little bit better for them.
Dr. Mike Patrick: And then, there's a ring now, right, that goes into the vagina? Tell us about that.
Dr. Elise Berlan: So the vaginal ring is on the market in the US called NuvaRing. It's actually a great method. I personally haven't found a lot of my teens love this method. And I have found that it has a little bit more uptake in the kind of college young adult demographic. And I think that's just because younger women and teenagers might not be so comfortable kind of with the insertion because it does require that you insert the ring into your vagina and remove it on your own.
So I do think it's a great method for some women because you just need to change it once a month, and then you don't have to think of anything the rest of the month. But there is ;a little bit of kind of that factor that makes it a little bit less appealing.
For those girls who really like some of the benefits of the ring but aren't comfortable using the ring, there is a birth control patch, and that's something that you just change once a week. And so, for some people that really is a lot easier than taking the pill once a day.
And then, there are birth control pills. Some folks just really like birth control pills. There's lots of really nice advantages, not just birth control. So we're thinking about the pill, patch or ring, it helps treat acne, helps menstrual cycles be more regular, actually reduces risk for uterine and ovarian cancer.
So there are reasons that are quite personal and may have to do with someone's kind of medical situation, where they may actual favor using a pill, a patch or a ring.
Dr. Mike Patrick: Now the ring and the patch, are those then effective rates about the same as the pill?
Dr. Elise Berlan: They are, tend to be kind of lump in the same effectiveness as the pill and that number again is about 91% effective. The more someone can do to take their method as directed, the more effective it's going to be.
There are two apps that I recommend to my patients. There's one called Pink Pad, which is a free app they can get from iTunes or Google Play. I'm trying to remember the other one. I'll send you the link for the other one, all the information about it. But setting your phone alarm or doing things like that.
So if I do have a patient who picks one of the methods that does require more maintenance, I think it's really important to kind of go through with the patient, what do they actually need to do. Then, from the medical side, we like to have them come back in about three months just to check and see how they're doing. It's recommended now that we give them enough prescriptions for a year, because we don't want to create a barrier to them staying on the method but we do want to check in and make sure they're doing all right.
Dr. Mike Patrick: Yeah, absolutely. Yeah, we'll get all those links in the Show Notes so folks can find that stuff easily. Now, as we're thinking about all these different types of birth controls that are options for girls, we should mention that these only really protect you against pregnancy, not sexually transmitted infections, correct?
Dr. Elise Berlan: Yeah, so I'm making my kind of scrunch up bad face. So, citing the CDC data that you were referencing earlier, so if we look at among those same kiddos that were surveyed in 2013 which are the high school students in America, less than one in ten is actually using both a condom and a hormonal contraceptive at the same time. And that is terrible.
Dr. Mike Patrick: It's not acceptable.
Dr. Elise Berlan: Unacceptable. So I think the number is 8% or 9% report using both. It's an important part of messaging for parents, especially that condom are the only method for sexually active young people that will reduce pregnancy, as well as prevent sexually transmitted infections.
Dr. Mike Patrick: So a condom should be used every single time.
Dr. Elise Berlan: Absolutely.
Dr. Wendy Anderson-Willis: Absolutely.
Dr. Mike Patrick: And there is emergency contraception, and I think that some people have that confused with an abortion pill. Tell us what that is and how it's different.
Dr. Elise Berlan: So there are three methods of emergency contraception available in the US. The one that people are probably most aware of is Plan B. And there's another method that's similar to Plan B that's recently become available, called Ella.
Plan B, anybody can get it in the pharmacy. It's over the counter. Ella does require a physician's prescription, maybe a teensy bit more effective particularly in heavy women and overweight girls. And both methods should be taken within the first five days after an under protected or unprotected sexual encounter.
I think to your question, this methods act like birth control pills. It's like taking kind of a super dose of birth control pills, in that they prevent ovulation and they don't cause an abortion at all. They have not been demonstrated to do that in any studies.
The third method that people usually don't think about being emergency contraception is a copper IUD, which is actually the most effective emergency contraceptive and also provides ongoing contraception of birth control for someone who needs it.
Dr. Mike Patrick: And if let's say a condom breaks, then that would be an indication to use one of these?
Dr. Elise Berlan: Absolutely. ;Yes. Teens can go to a pharmacy and get Plan B and it will really reduce their risk of developing pregnancy.
Dr. Mike Patrick: So they can just go to… They have to talk to the pharmacist to get it.
Dr. Elise Berlan: It may depend in your pharmacy and it's not available in all pharmacies. The way that it isn't intended to be available right now is actually over the counter. And I, in fact, was in my local pharmacy in my neighborhood and I checked, and it was available over the counter.
Just in the aisle, it's probably likely to be in the kind of family planning area where there are condoms and lubricants and things like that. But parents, it's definitely something that can really help your teens to be aware of because…
Dr. Mike Patrick: And is that in all 50 states?
Dr. Elise Berlan: Yeah, it's all in 50 states now, and DC.
Dr. Mike Patrick: Then, it's readily available.
Dr. Elise Berlan: Yeah.
Dr. Mike Patrick: Now, but it should be pointed that because it's a high dose of hormone, this is not something that you should use ;every time that you're sexually active. So it's not a replacement for any of these other things.
Dr. Elise Berlan: Absolutely. It's a call to action. So it's like a little Band-Aid, and then it means really if someone needed to use them or just a contraception, that they really should consider moving forward with a more effective contraceptive. So they're not in that circumstance again.
Dr. Mike Patrick: OK. Now, we've really been focusing on girls. What should parents be telling their teenage boys with regard to contraception?
Dr. Wendy Anderson-Willis: I think talking about contraception is so important with the boys. We talked to them about condoms. We provide condoms in our teen clinic sessions. We talk about birth controls in terms of — well, these are all for kids who are sexually active — so we talk about what is your partner using to try and make sure that there is a dual method if the child is sexually active.
Dr. Mike Patrick: Yeah. Hopefully, this is a committed relationship between a boy and a girl, and then the boy can act as an advocate for the girl to have something that she's using. So good.
Now, we have a Birth Control for Teens Clinic here at Nationwide Children's that will help sort through all of this and present options. But a lot of our listeners aren't in the Central Ohio area. So where can families turn if they're interested in looking into these things.
Dr. Elise Berlan: Well, you know, one of the websites that's my favorite website specifically for teenagers is StayTeen.org. So I think that's a great one for families to check out. It's made by ;The National Campaign, and it's very teen-friendly.
Moving forward though from information to access is critical. Having ;conversation with a healthcare provider is really the best next step. Be that a pediatrician, ;a family practice, an OB-Gyn, I would encourage families to advocate for what they think their child needs. The sad reality is that a lot of doctors are not up to date with the fact that teenage girls really are great candidates for IUDs and implants. That's a little bit of a barrier for teens.
So it may take parents asking, saying, "Oh, I heard about this on this podcast. What do you think about an IUD?" And then, if you get a little bit of push back, I would say it's time to probably look around a little bit more. OB-Gyns are able to place IUDs. Family practice docs can place IUDs. Pediatricians are more and more placing implants. Pediatricians can certainly serve as a referral and an access point though to getting the most effective contraceptives.
Dr. Mike Patrick: Great. And most children's hospital are going to have an adolescent clinic that's geared into this, you think? Yes? No?
Dr. Elise Berlan: I think, yes. I don't think that is necessarily always the case. I think it is becoming more the case, but certainly talking with your child's health care provider will probably help you talk to someone who is most aware of the landscape and figure out whether it's going to be the adolescent clinic at the children's hospital or someone in the community.
But, part of the challenges that we have in the US is because, is that there are not enough providers of these methods. We're working really hard here at Children's and with the folks at the American Academy of Pediatrics to increase the number of providers of these really effective methods.
Dr. Mike Patrick: Now, let's say a teenager does become pregnant. What should families do? So a lot of times, it does come as a shock and there's a lot of stress that surrounds this. Where can families turn?
Dr. Elise Berlan: I think the most important thing is to go as quickly as possible to your doctor. We know this is potentially a real crisis for the family and for the child. Your doctor is trained to be able to kind of help you understand kind of all the potential scenarios that could happen out of a pregnancy. The doctor can form a real accurate pregnancy test.
So we get patients who come in with positive tests at home and we repeat the test in the office and sometimes it's negative. So I think it's really important to access the physician's office, talk about what the options are. If the young person decides to continue their pregnancy, it's really important to get into prenatal care as soon as possible. ;And if the young person decides to end the pregnancy, it's advisable to do that at the earliest opportunity. ;So really kind of getting an accurate test and then moving forward is really probably the best thing the girl and the family can do.
Dr. Mike Patrick: And your regular doctor is going to know what community resources are available and has probably helped families through this, so will know where to direct you.
Dr. Wendy Anderson-Willis: And Dr. Mike, we're going to connect that patient to the appropriate resources. We're going them to connect them to social work or whatever other resources they need. And then, we're really looking at follow up, because that person is likely still a teen after they have the baby or after this pregnancy, so we want to connect them back in and make sure that they finally get the appropriate birth control.
Dr. Mike Patrick: Yeah, absolutely. What sexually transmitted diseases do teenagers need to know about? What ones are we seeing that would need to be tested for and when do they need to be tested?
Dr. Elise Berlan: So this is a long list. I'll make it as brief as possible. So the most common one is human papillomavirus. So the reason we don't like human papillomavirus is because it's linked with a number of cancers in body. People think of cervical cancer, but also genital cancer and throat cancers. So that's really the most common sexually transmitted infection. It's a virus and most of the time, young people, boys and girls don't have any symptoms at all. But if they do have symptoms, they can cause kind of itchy bumps that we can genital warts.
Dr. Mike Patrick: It's preventable.
Dr. Elise Berlan: Well, I wouldn't say 100% preventable, but it's very preventable either with abstinence, limiting partners, condom use. It really has some potentially quite serious consequences, and the other thing to mention with that is there's a vaccine for human papillomavirus that is very effective, and it's important that young people get this at the earliest age possible.
Dr. Mike Patrick: And boys and girls.
Dr. Wendy Anderson-Willis: And boys and girls.
Dr. Elise Berlan: And boys and girls, yeah.
Dr. Mike Patrick: And I just want to say that there's no evidence that the HPV vaccine causes any brain issues or any other health issues at all.
Dr. Wendy Anderson-Willis: Absolutely.
Dr. Elise Berlan: No evidence at all. So this vaccine has wide uptake all over the world and as just as safe and effective as the other vaccines. I should say just as safe as the other vaccines and very effective for human papillomavirus.
Dr. Mike Patrick: OK, and then what other sexually transmitted infections are there?
Dr. Elise Berlan: The next down in my mind is Chlamydia. Chlamydia is quite prevalent in young people and can cause some really bad outcomes particularly for girls. We see pelvic inflammatory disease come through our clinic all the time, and one of the consequences of PID or pelvic inflammatory disease is infertility, chronic pelvic pain, tubal pregnancies. So, Chlamydia is a bad actor and the other sneaky thing about Chlamydia, it usually doesn't have any, any symptoms at all. So if it does have symptoms, a boy or a girl might have difficulty urinating. A girl might have some kind of changes in her vaginal discharge, pelvic pain.
That's one of the reasons that we recommend in the organizations that set out health standards across the country recommend annual screening for Chlamydia for girls 25 and younger.
Dr. Mike Patrick: You test that with a urine test?
Dr. Elise Berlan: So that's so exciting. You can test for it just with urine. So it doesn't require any invasive.
The next one down in that group is gonorrhoea. It's less common but it can also cause all the problems that we talked about with Chlamydia and presents pretty similarly.
Dr. Mike Patrick: Teenagers should know that one can cause a throat infection as well. So oral sex, you can get gonorrhoea through that route.
Dr. Elise Berlan: Trichomoniasis, kind of depends on where you are in the country. Like how much trichomoniasis have. Here in Central Ohio, we see gobs of trichomoniasis.
Dr. Elise Berlan: It's really an infection that's generally more symptomatic. So young people particularly girls are more likely to have difficulty urinating, kind of a vaginal discharge that's kind of foul and bothersome, or irritation.
So this is kind of the point in this podcast, I would say. This is the ;shout out to young people and parents, if your child is having any of these symptoms, that you should get seen by a healthcare provider whether it's a school nurse or their primary medical home but it should be addressed.
Dr. Mike Patrick: And doctors are going to check for this regardless if your teenager says they're sexually active or not. So I know sometimes families kind of get upset, like "You charge us for this test and my kid is not having sex," but it's really important that we test everybody.
Dr. Wendy Anderson-Willis: Not every doctor is going to test everybody. We know that if they're sexually active, we're going to do this Chlamydia/gonorrhoea screen every single year for kids between the ages of 16 and 18. Whether they've ever been sexually active or not, we're going to an HIV screen at least once. But not every doctor is going to test. So parents may need to ask, "Could you do that screening on my teen this year?" That may be important.
Dr. Elise Berlan: And the flip side of that though is that the patient may not disclose sexual activity. A lot of times, particularly younger teens, they actually don't know what sex is. So sometimes I might have a young teenager come in and tell me she's having difficulty urinating, and because I know that Chlamydia often causes this symptom and is common, I may go ahead and send for a Chlamydia, kind of to your point. It doesn't mean that she's sexually active or I think she's sexually active, but it just means that I know based on some folks developmental level, they don't understand sex. So I could potentially be missing something really important if I don't send the test.
Dr. Mike Patrick: That's the thing, you just don't want to miss it. I mean, we look at those CDC numbers, a lot of kids are exposed to these things.
Dr. Elise Berlan: Right, and a lot of kids are afraid of telling healthcare providers. Usually, we err on the side of doing the test if we're thinking about it.
Dr. Mike Patrick: What about syphilis? I just heard on the radio today that in central Ohio, there's an increase in syphilis. Are we seeing that?
Dr. Elise Berlan: There is an increase. There is a mini syphilis epidemic. And we see this from time to time in different communities, that there's a little syphilis outbreak. We care a lot about syphilis because it can be undetected and it can actually cause some really pretty unfortunate outcomes for newborns who are born of moms who have syphilis. So that is another one of the test that is something that we do when teens ask for sexually transmitted infection testing, is that we do screening for syphilis.
Dr. Mike Patrick: That one is a blood test?
Dr. Elise Berlan: That is a blood test, right.
Dr. Mike Patrick: You can't get a urine with that one.
Dr. Elise Berlan: Absolutely. So that is a blood test, but it's really important for folks to be screened for syphilis, particularly if there is a little bit more in their community.
Finally, I want to talk about HIV. It's something that people may or may not think about but it's really the only sexually transmitted infection that can kill you, and it's preventable. Young people often may not know they are infected. The symptoms are often non-existent, are very mild and might be confused with mild other viral infections.
So absolutely screening for HIV is recommended in teenagers, even if they don't report sexual activity. So depending on which kind of organization recommendations you look at — you might see 13, you might see 16 — but screening for HIV is really important because that is going to be only way we find it in young people who are at risk, ;and it's really important to find them as early as we can to help treat their infection and help prevent spread to other potential individuals.
Dr. Mike Patrick: And that can be tested with a mouth swab or a blood test?
Dr. Elise Berlan: Yup, mouth swab or blood test.
Dr. Mike Patrick: And if folks want tested and they sort of want it done anonymously — they don't want to talk to their parents, or they don't want to talk to their doctor about it — most health departments just will test, correct?
Dr. Elise Berlan: Yup. And something I'd like to point out is that in every state in this country, teenagers can confidentially get tested and treated for sexually transmitted infections, in every state and DC.
Dr. Mike Patrick: And that would be at their local health department?
Dr. Elise Berlan: At anywhere. That's a class of activities that's protected and intended to encourage teens to seek, getting tested and treated.
Mike Patrick: And then, herpes simplex virus.
Dr. Elise Berlan: Oh, right, yeah.
Dr. Wendy Anderson-Willis: We see herpes too often, actually. What I try to do is I try to get patients to come in immediately if they have sores that are present, because we need to test the actual sore to get an appropriate, a correct diagnosis. So coming in immediately, talking to the nurse triage or whoever it is you can talk to say, "I need to be seen today. Something's going on and I'm concerned." Or, going in to the emergency room or urgent care is important.
Dr. Elise Berlan: And I think couple of messages with all of these — so condom use as well as safe sexual behavior can minimize ;to prevent the development of all of these infections. Many of them, we just recommend routine screening because the symptoms are not very evident.
Dr. Mike Patrick: Then, hepatitis B and hepatitis C, just to be complete, can be transmitted sexually as well. So again, that's an important reason that we give all kids hepatitis B vaccine. There's not a hepatitis C vaccine at this point, but that's another vaccine like the HPV one that kids ought to get.
Dr. Elise Berlan: Yeah. ;
Dr. Mike Patrick: Then, we talked about where teens and families can turn if they're concerned about sexually transmitted infections. Really anywhere, any health facility and they can be seen anonymously anywhere in the United States.
Dr. Elise Berlan: Or confidentially.
Dr. Mike Patrick: Or confidentially. Sorry, obviously the hospital needs to know who they are.
Dr. Elise Berlan: They can consent for that.
Dr. Mike Patrick: Yes, yes, got you.
And talk a little bit about the importance about then notifying sexual partners about any diseases that are found.
Dr. Elise Berlan: Yeah, so because these are infections spread like other infections just with contact to body surfaces or bodily fluids, a person who has an infection received that infection from that somebody else and may continue to spread that infection to other persons. If someone is in a sexual relationship with someone else, if they're partner is not treated, they will likely reacquire that infection as soon as they have potentially sexual relations with that partner.
Dr. Mike Patrick: And you can't just assume that they're not infected because they don't have symptoms. They still could be, and those infections without symptoms can still lead to infertility.
Dr. Elise Berlan: Absolutely. So the Centers for Disease Control recommends that all partners going back essentially 60 days. They have to kind of draw the line in the sand somewhere, that they're notified that they had a partner who have a sexually transmitted infection. As well as get treated. So they shouldn't get tested, but if they have a partner for example who say has Chlamydia, that person actually needs to get treated for Chlamydia. Because the test are not a 100%.
Dr. Mike Patrick: Great. Well, we really appreciate both of you stopping by the studio ;today to talk about these things. I think there are topics that parents certainly need to know about and it's really important that we're talking to our kids and our teenagers about sex and about birth control and about sexually transmitted and private parts right from the beginning. So I think this has been hopefully helpful talk. So thanks both of you for stopping by.
Dr. Elise Berlan: Thank you, Mike.
Dr. Wendy Anderson-Willis: Thanks to you too, Mike.
Dr. Mike Patrick: We're going to have a lot of stuff in the Show Notes for you. All the things that we've been talking about as we've gone along. Lots of resources. We'll also have links to the Adolescent Medicine Program at Nationwide Children's Hospital, the Young Women's Contraceptive Services Program, also known as BC4Teens. We'll have a link to that.
We'll have links to all the blog post we talked about, all the sex education support materials. We'll talk about some apps, mobile apps, reminder apps that you can use. So we'll have links to all of that in the Show Notes.
Let's take a quick break and I will be back. We'll wrap up the show right after this.
Dr. Mike Patrick: All right, well, I made it to the entire show without my voice giving out, so that's a good thing. I want to thank all of you for taking time out of your day to make PediaCast a part of it. Really do appreciate that.
Also, thanks to Dr. Elise Berlan, adolescent medicine specialist and director of the Young Women's Contraceptive Services Program at the Nationwide Children's Hospital. You can find her Twitter @EliseBerlanMD. We'll put a link to that in the Show Notes.
Also, thanks to Dr. Wendy Anderson-Willis, physician lead of the Ambulatory Teen Clinics here at Nationwide Children's Hospital, and we'll put her Twitter handle which is @DrWendyWillis in the Show Notes as well.
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