When and How to Have "The Talk"

rn-remedies-bianca-salvetti-thumbBy RN Remedies blogger, Bianca Salvetti, MSN, CNS, CPNP

The importance of using contraceptive methods can be a difficult conversation to have with your child or teenager. In the Division of Adolescent and Young Adult Medicine at Children’s Hospital Los Angeles, I speak with teenagers and their parents about the importance of birth control and their options in selecting a method. Often parents don’t know where to start or don’t feel comfortable discussing the topic. As children mature into young adults, they will have questions about their sexual health and will look to you, as their parent, first for guidance. Children’s views on sex and sexuality are shaped by the beliefs of their parents. Providing children with information about safe sex will help them make good decision about contraception and lower their risk of unwanted pregnancies and sexually transmitted infections (STIs).

What is birth control and why is it important?

Birth control, also known as contraception, is any device or drug that prevents pregnancy. There are many types of birth control that differ in effectiveness in preventing pregnancy, protection against STIs, ease of use and cost. Although not 100% effective every time, condoms, a type of birth control, are the only contraceptives that can help prevent STIs, including HIV.

Tips for talking with young people about birth control

When and How to Have "The Talk"“Talking to your kids about birth control can be overwhelming, but if they don’t feel like they can talk to you, they might get their information – or misinformation – from somewhere else. It’s ok to encourage them to talk with their peers and to learn on their own, but set them up for success by being a well-informed, non-judgmental support for them at home, too,” says Jennifer Collins, LCSW, in the Division of Adolescent and Young Adult Medicine at Children's Hospital Los Angeles. Jennifer offers some advice on how to have a discussion with your child about the importance of birth control.

Be prepared. Reflect on your own views about sexual health and birth control. If you are co-parenting, be on the same page about the values you want to instill in your child.

Ask permission. It might feel awkward, sure. But remember when you were a kid—did you like being lectured? Give young people the opportunity to consent to conversations about their sexual health. This models empowerment. Sample language: “Would you be willing to talk with me for a few minutes about birth control?” If your teen declines, agree on a time to discuss it later.

Be real! Chances are your kid will let you know they are not especially psyched to be talking about birth control with you. That’s ok. You can acknowledge the awkwardness and maybe even have a laugh about it. Sample language: “Look, I know this is awkward. I’m bringing it up because I care about you. Let’s talk for a minute, and after that I’ll give you some space.”

Listen. It’s important that you give your teen time to speak and ask questions. Listen to what they are saying or asking and try to answer to the best of your knowledge. If you don’t know the answer, use it as a way to look into it together.

Praise them for being willing to listen or talk. Positive reinforcement works. Remind them that you appreciate them and focus on their strengths. Sample language: “You are so smart for taking care of your body. I’m proud of you. Thank you for talking to me.”

Give them options. Birth control pills and condoms are not the only way. Young people might not be aware of options. Be mindful of your child’s sexual orientation when offering choices of protection. If you’re unsure about options, work with your teen to research it online or speak with your medical provider.

“For all parents of teenagers and young adults: having a frank, open and respectful conversation with your young person about sex and pregnancy prevention is crucial to their developing an understanding of what your values are around these issues,” says Claudia Borzutzky, MD, Division of Adolescent and Young Adult Medicine. “Talking about sex and contraception, and opening the discussion, does not mean that you are condoning them or in any way making them more likely to happen–if they haven’t already. But talking about these sensitive topics will let your child know that you understand that sexuality is part of life and of growing up, and that you would want to support them in taking responsibility for their actions – and in preventing unplanned pregnancies.”

Types of contraceptives

Abstinence - Not having sex, either vaginally, orally or anally. If someone is abstinent, it means they are not having sexual relations with anyone. Long Acting Reversible Contraceptives (LARCs) Due to their high efficacy rates, the American Academy of Pediatrics recently released the recommendation that LARCs be the first-line contraceptive choice for adolescents who chose to have sex.

  • Implantable rods. A matchstick-sized, flexible, and plastic rod with only the hormone progestin in it, that is surgically inserted under the skin of the woman's upper arm and can be left for up to five years.
  • Intrauterine Devices (IUDs) – A small T-shaped device, either copper or hormonal, that is inserted into the uterus by a healthcare provider to prevent pregnancy. It can remain and function effectively for many years at a time. It is removed or replaced by a healthcare provider.

Barrier Methods - These prevent semen from entering the vagina and fertilizing the female’s egg. This includes:

  • Male condom - A thin material that covers the penis to collect sperm and prevents pregnancy. It also protects against STIs. They are usually made of latex or polyurethane. Each condom is for a single use only.
  • Female condom - A thin, flexible plastic pouch that is inserted into the vagina before sex. It prevents pregnancy and protects against STIs. These are discarded after one use.
  • Diaphragm - A small flexible cup made of latex or soft rubber that is inserted into the vagina before intercourse. Spermicides should be used with a diaphragm. The diaphragm should be worn for 6 to 8 hours after sex, but no longer than 24 hours.
  • Cervical cap - Similar to diaphragms, but smaller, firmer, more discrete and made of silicone. Like a diaphragm, the cervical cap should be used with a spermicide. It should remain in place for 6 to  8 hours after intercourse, but it should be removed within 48 hours.
  • Contraceptive sponge - A soft, disposable, spermicide-filled foam sponge that is inserted into the vagina before intercourse. The sponge prevents sperm from entering the uterus while the spermicide kills the sperm. It should be left in place for at least six hours after sex and then removed within 30 hours.
  • Spermicides - A spermicide destroys sperm. It can come in many forms, including foam, jelly, cream, suppository, and film. It can be used alone or in combination with a condom (female or male), diaphragm or cervical cap. It is inserted into the vagina 30 minutes prior to intercourse and left in place 6 to 8 hours after intercourse. Spermicides do not prevent the transmission of STDs and may cause allergic reactions.

Hormonal Methods - Uses hormones to regulate or stop ovulation (the process in which the ovary releases an egg, making it available for fertilization) and prevent pregnancy. Hormonal birth control is not only an effective way to prevent unwanted pregnancies, it can also be used for many medical conditions, including acne, menstrual cramps, or Polycystic Ovarian Syndrome. These include:

  • Oral contraceptives ("the pill") - Oral contraceptive pills (OCPs) contain different combinations of the synthetic estrogen and progestin. A woman takes one pill daily, preferably at the same time each day.
  • Contraceptive patch - A thin, plastic patch placed on the skin that releases hormones through the skin into the bloodstream. It is applied to the lower abdomen, buttocks, outer arm, or upper body weekly for three weeks, and no patch is used on the fourth week to enable menstruation
  • Injectable birth control - This is an injection of a progestin given in the arm or buttocks once every three months.
  • Vaginal rings - A thin, flexible ring that delivers a combination of a synthetic estrogen and a progestin. It is inserted into the vagina, where it continually releases hormones for three weeks. It is removed on the fourth week to enable menstruation and a new ring is inserted 7 days later.
  • Emergency Contraceptive Pills (ECPs, also called “the morning after pill”) - Hormonal pills usually taken as a single dose after an episode of unprotected sex. They can inhibit or delay ovulation for at least five days to allow the sperm to become inactive. It should be taken as soon as possible after having unprotected sex. It should not be used as a regular contraceptive method. It is not the abortion pill and will not terminate a pregnancy.

Talking to children about birth control should be an ongoing discussion. Although it can be scary it is a conversation that is a vital part of becoming an adult. If you don’t speak with children about how to protect themselves, you are leaving them vulnerable to unplanned pregnancies and/or STIs, which could alter their lives permanently. If you’re having trouble initiating the conversation, seek help from your medical provider.