Comments OffOctober 27, 2014by admin

Fostering the Sexually Active Teen

By Dr. Todd Lantz and June Bond, B.A., M.Ed.

In a perfect world, there is an orderly sequence to life events. As the old saying goes, “first comes love, then comes marriage, and THEN comes Susie with a baby carriage.” Most of us know that foster care denies the prefect world syndrome. After all, if this was a perfect world, there would be little or no need for foster care.  That being said, “here comes Susie with a REALITY carriage.” Many teens are sexually active. An even higher percentage of teens in foster care have been exposed to explicit sexual content and sexual abuse, thus leading to a very high percentage of teens that are or have been sexually active or sexually abused.

A generation ago, the biggest concern for the parents of the sexually active teen was the fear of an unplanned pregnancy. Today, the fears run from the life long effects of sexually transmitted disease to the stark reality of acquiring HIV. This article is intended to inform foster parents of the medical advancements in birth control, testing for sexually transmitted diseases, and advances in the prevention of sexually transmitted diseases.  Hopefully this article written in cooperation with a board certified OBGYN will help foster parents to discuss issues with their foster child, their caseworker, and the child’s health care provider.

Birth control advancements in the past ten years have lessened the number of unplanned pregnancies significantly. It is important for a foster parent and caseworker to understand the new advancements and assist in the selection of the available birth control options depending on the special needs of the young lady. Birth control options can now be divided into short acting options and long acting options.

Short Acting Options: Birth control pills have been the most popular method of contraception for adolescents in the past 20 years.  The initial visit for birth control pills does not always require a pelvic exam, if the adolescent is very young.  As one can imagine the pelvic exam can be a deterrent to many adolescents seeking birth control. Birth control pills are highly effective when used correctly and consistently. Some brands of the pills contain estrogen and progestin, while some versions contain only progestin. The combination pills have the side effects of headaches, breast tenderness, nausea, missed periods, irregular bleeding, depression and cardiovascular issues. The progestin-only pills have the same side effects coupled with acne,hirsutism, weight gain, depression, and anxiety. The emotional side effects of the progestin-only pills may exacerbate the depression and anxiety that may already exist in some adolescents.  Honest discussions about the possible side effects of the birth control pills can assist the adolescent with finding which combination is best for her. It should be noted, however, adolescents are not always reliable about taking the pills correctly and consistently.  Teens with ADHD, teens that have been on run away or are prone to run away, and/or teens that may be in and out of different foster homes and residential settings have the greatest likelihood of not taking the pills on a consistent basis, thus increasing the chances of an unwanted pregnancy. Another short acting option for birth control is the transdermal patch, which releases the hormones estrogen and progestin. The patch is applied once/week for three weeks. Week four is patch free.  Side effects can include cramps, allergies to the patch, breast tenderness, nausea, and cardiovascular problems.  The vaginal ring is another short acting birth control option, but requires pelvic insertion on a monthly basis. The pelvic insertion component makes this form of birth control a less favorite option for most adolescents. Vaginal discharge, infection, weight gain, along with nausea and cardiovascular issues are unwanted side effects.

Longer Acting Options:  Longer acting options may be a good choice for adolescents in foster care based on their ADHD diagnosis, frequent moves from one foster home to another, and special medical issues and/or the vulnerability of some adolescent females. The progestin- only injection has a very high rate of effectiveness and only has to be administered every three months. In addition to the three month coverage, the return to fertility can be delayed on the average 9 – 10 months. The length of coverage and non-invasive application is positive. However, side effects such as irregular bleeding, headache, weight gain, worsening of depression, acne, hirsuitism, dizziness, and slowing of bone growth are side effects to consider with the physician. An even longer option is the progestin implant that is placed just under the skin. The implant is changed every three years and is considered 99% effective. As with most birth control, irregular bleeding, mood swings, weight gain, acne and depression are possible side effects. Contradictions to this method of birth control can include liver disease, blood clotting issues, and breast cancer. Intrauterine devices are also long acting options. The Progestin-only intrauterine system can remain in place for five years, while the copper intrauterine device can be in place for ten years.

Extensive discussion with the doctor, foster parent, and caseworkers should take place when looking at the needs of an adolescent that may be non-ambulatory and non-verbal.  The high degree of venerability for sexual abuse and hygiene issues need to be discussed and options explored for a foster child with these severe needs.

Foster parents also need to be aware of emergency contraception in the event of sexual abuse, forced sex, and/or other unforeseen circumstances such as missing two or more birth control pills, starting a pill pack two or more days late, a broken condom, or the lack of any birth control. Emergency contraception must be taken within 72 hours of intercourse.  The emergency contraception prevents the fertilization and implantation of the egg.  Adolescents should understand that this is not a form of regular birth control, but an emergency plan that requires a prescription from a doctor.

Sexually transmitted diseases are a major health issue for adolescents.  In fact, adolescents account for over 25% of all new cases of STD’s. Chlamydia and gonorrhea are the most prevalent STD’s in the adolescent population. The good news in medical advances is that both of these STD’s can be detected with a simple urine test, thus eliminating the fear of an invasive exam for girls and boys. Likewise, both sexually transmitted diseases can be cured by antibiotics. Another good piece of medical news in the fight against STD’s is the vaccination for the human papilloma virus, (HPV).  The vaccination can prevent some of the viruses that cause most cases of cervical cancer and genital warts. The vaccination should be considered for girls that are between the ages of eleven and twenty-five. In fact, many pediatricians are discussing this vaccination with parents as a part of their daughter’s well-child checkups. It is important to note that the HPV vaccinations only cover some of the viruses. Consequently, girls that are diagnosed as positive with one of the viruses should still be vaccinated for others. At the current time, an adolescent infected with herpes will live with a management issue for the rest of their life.   The diagnosis of herpes is more invasive than the one for Chlamydia and gonorrhea and is best preformed by a culture taken from an active lesion.  It is also important to note that if a younger non-sexually active child makes a disclosure about sexual abuse, they should be tested for STD’s.

A good male role model is essential when talking with sexually active adolescent males. The male role model or physician needs to stress that just because a partner  is taking precaution about birth control, it is not the same as protection against STD’s  One doctor stated that a picture of an infected male with an STD is truly when “a picture is worth a thousand words.”

When talking to sexually active teens it is crucial that we are honest, open and unafraid to discuss sexual information in an accurate manner. The day of “let them hear it in health class at school” is gone. Many foster children have already been sexually active or sexually abused by the time they are in the sixth grade.  Helping foster children understand the ramifications of sexual activity and the warning signs that they may be infected with a STD can help prevent others from becoming infected and in the case of AIDS…could save a life.  Providing accurate and non judgmental access to birth control could prevent a new life born into foster care and the abrupt end to a childhood, strained by an unplanned pregnancy.