No parent wants to think about the possibility of their teen being sexually active. But the truth is, it’s happening. Kids everywhere are having sex. I practice in a very conservative part of the nation. People are very religious and promote sex after marriage. The problem is that the parental beliefs aren’t always shared by the teens and so the topic isn’t being addressed.

In my practice, I usually have the parents step out of the room at the end of an adolescent well child/physical exam. It gives the teen a chance to ask questions that they may not feel comfortable asking about in front of the parents, and it gives me a chance to ask the uncomfortable questions. In my experience, the teen is much more likely to be honest about topics like sex, drugs, and alcohol if the parents aren’t in the room. And honest they are. Parents would be blown away at the number of positive answers I get to these questions.

What does the doctor ask?

What exactly and how to ask is the art part of medicine. It’s a style point difference and undoubtedly everyone does it a little differently. In someone that is very young and naïve, I may ask if they have ever heard of sex. In other situations, I may ask if the friends are sexually active. Teens are often engaged in the same activities as their friends, and it can be an easy gateway into conversations about their own activity.

Once a teen is determined to be sexually active, my job is to determine what needs to be done. I’m asking the hard questions. I ask: how often, how many sexual partners, and protected or not? It gives me a chance to educate and intervene (e.g., test for infections, etc.).

My teen is sexually active, now what?

1. Educate, educate, educate. Teens need to know the physical and emotional consequences of sexual activity. Talk about more than just pregnancy prevention. Is the teen being pressured? Does the teen know how to properly use a condom? Does the teen know the signs of a sexually transmitted infection? Does the teen know the different kinds of infections out there (i.e., some are treatable and others are not). Teens often don’t realize that the sex can (indirectly) kill you (if you contract diseases like HIV).
2. Bring your teen in for STI (sexually transmitted infection) testing. Many teens are not in tune enough with their bodies to recognize symptoms of sexually transmitted diseases. In all the positive results I’ve got over the years, I can only think of a handful who came in specifically for testing due to some specific symptom.
3. Birth control. Generally speaking, parents don’t want their teens to be parents. Acknowledge the sexual activity and help prevent unwanted consequences.

What birth control options are there?

Many teens are surprised to find out that there are many more options beyond “the pill.” Talk with your doctor to tailor the treatment to fit your teen.

1. “Abstinence.” The only 100% effective method is no sex at all. However, for the sake of the article, let’s assume sexual activity and read below.
2. “The pill.” Oral contraceptive pills are taken once daily and typically have varying levels of estrogen and progesterone hormones. The effectiveness is dependent on your daughter’s ability to remember taking the pill every day.
3. “The patch.” The patch is a transdermal slow release of hormone (a.k.a., a sticker laced with hormone). It is put on the skin and the hormone is absorbed through the skin. It’s a good option for those who have trouble remembering something every day (not good for those with sensitive skin).
4. “The ring.” This is a hormone laced flexible plastic ring that is inserted in the vagina and sits around the base of the cervix. It lasts for a month (also a good option for those who can’t remember daily pills). However, the girl has to be really comfortable with her own body to stick her finger up her vagina to insert and take out the ring.
5. “The shot.” The shot is referencing Depo-Provera which is a progesterone shot given once every 3 months. There is often break through bleeding initially (spotting), but then results in months without periods.
6. “Implantable” options. These reference IUDs (intrauterine devices) and implantable rods (tubes filled with slowly released hormones that implant under the skin).
7. “Barrier methods.” These refer to options like condoms (which should be used regardless for STI protection and is the only method mentioned that the guy uses), cervical sponges, and diaphragms. The problem with all of these methods is that they require a few minutes of stop and demonstrate self control while implementing use. Teens don’t reliably do that.
8. “Rhythm method” (a.k.a., get pregnant method) requires a predictable cycle and only having sex during certain times. In my humble opinion, a terrible “option” in general. I mention it only for completions sake.

I’m pretty conservative. I’d rather my kids wait until they were older to have sex. I get it. However, if they are going to do it, I’d much rather they didn’t contract HIV, herpes, chlamydia, etc. I want to be a grandparent one day, but not before the time is right.