Patient Presentation
An 18-year-old male came to clinic for a health supervision visit. During the interview he acknowledged being sexually active with the same female partner for more than 1 year. They always used male condoms for sexually transmitted infection (STI) protection and he said that his 19 year old partner had an intrauterine device (IUD) for additional contraception. Both partners had been tested for STIs before beginning their sexual relationship and had recently been retested at a health clinic as part of her health care. The pertinent physical exam showed a well male with normal psychosocial development.
The diagnosis of a healthy male was made. The resident physician congratulated him on consistent condom use and appropriate testing. He reiterated the need for consistent condom use, and also recommended that a spermicide could also be used for additional protection. When discussing the patient with his attending physician, the resident stated that he didn’t know that adolescents and young adults used IUDs. The staff physician agreed that it was a little unusual, but she had seen them used for patients with multiple adolescent pregnancies. Later on the staff physician looked up the American Academy of Pediatrics policy statement on contraception methods and shared it with the resident.
Discussion
Intrauterine devices (IUDs) are inserted into the uterus to remain in place for usually 1-10 years. They prevent implantation or fertilization by releasing hormones (progestin) or ions (copper). They are very effective when used appropriately amd are up to 99% successful in preventing pregnancy and they are generally safe. Infection is one of the biggest risks which is why IUDs often are not recommended for adolescents who often are serially monogamous or have multiple partners thus increasing their risk of a STI. Liability is also a concern for an adolescent who may have future infertility problems and attribute them to the IUD use. IUDs do not affect fertility in the absence of an infection.
Learning Point
IUDs can be useful in patients who are consistently using STI prevention methods (such as spermicide and condoms) and already have had children and want to prevent pregnancy. IUDs can also be useful for severe menorrhagia and dysmenorrhea.
Two of the major IUD brands in the US are Mirena®, which releases levonorgestrel for up to 5 years, and ParaGard® which releases copper for up to 10 years. Although there is a low pregnancy rate with IUD use, expulsion of the IUD can occur, usually in the first year of use. Problems with increased bleeding or pain may also cause women to have the IUD removed.
Questions for Further Discussion
1. What is the pregnancy failure rate for fertility awareness and periodic abstinence?
2. What is the pregnancy failure rate for other contraception and family planning?
3. What are some of the potential side effects of contraceptive methods?
Related Cases
- Disease:Teen Sexual Health | Teenage Pregnancy
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Specialty: Adolescent Medicine | Obstetrics / Gynecology
- Age: Teenager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Teen Sexual Health
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Klein JD, American Academy of Pediatrics Committee on Adolescence.Adolescent pregnancy: current trends and issues. Pediatrics. 2005 Jul;116(1):281-6.
American Academy of Pediatrics Committee on Adolescence, Blythe MJ, Diaz A. Contraception and adolescents. Pediatrics. 2007 Nov;120(5):1135-48.
Mirena. Bayer Healthcare.
Available from the Internet at http://www.mirena-us.com/index.jsp?WT.mc_id=MIS119497&WT.srch=1. (cited 8/30/11).
ParaGard. Duramed Pharmaceuticals Inc.
Available from the Internet at http://www.paragard.com/ (rev. 2009, cited 8/30/11).
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
6. Information technology to support patient care decisions and patient education is used.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.
16. Learning of students and other health care professionals is facilitated.
22. Sensitivity and responsiveness to patients’ culture, age, gender, and disabilities are demonstrated.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 