High school girls using an IUD or implant unwisely avoid condoms

Long-acting reversible contraception (LARC), specifically intrauterine devices (IUDs) and implants, are an effective means of contraception and have been reported to be suitable for women of all ages, including teens who have not yet borne a child. However, these devices offer no protection against sexually transmitted diseases (STDs). A new study examined the use of condoms among high school girls who were using a contraceptive. The findings were disturbing. The study was published online on March 14 in the journal JAMA Pediatrics by researchers at the Centers for Disease Control and Prevention (CDC) and Rollins School of Public Health, Emory University, Atlanta, Georgia.

The study authors note that LARCs offer an unprecedented opportunity to reduce unintended pregnancies among teens because they are highly effective; however, teen LARC users may be less likely to use condoms for preventing STDs compared with users of moderately effective contraceptive methods such as birth control pills, Depo-Provera injection, patch, and ring contraceptives. Therefore, they conducted a study with the objective of comparing condom use between sexually active LARC users and users of moderately effective contraceptive methods.

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For the study, the researchers accessed data from the 2013 Youth Risk Behavior Survey, which comprises a nationally representative sample of US high school students in grades 9 through 12. Analyses were conducted among sexually active female students (2,288 girls); statistical analyses were restricted to sexually active users of LARC and moderately effective contraception (619 girls). The analyses were conducted in July and August 2015.

Contraceptive method at last sexual intercourse was determined by one of the following methods: birth control pills; condoms; an IUD or implant; injection, patch, or ring; withdrawal or other method; or not sure. A separate item asked whether their partner used a condom at last sexual intercourse.

The investigators found that, among the 2,288 sexually active girls (56.7% Caucasian; 33.6% in 12th grade), 1.8% used LARC; 5.7% used Depo-Provera, patch, or ring; 22.4% used oral contraceptives; 40.8% used condoms; 11.8% used withdrawal or other method; 15.7% used no contraceptive method; and 1.9% were not sure. LARC users were approximately 60% less likely to use condoms compared with oral contraceptive users. No significant differences in condom use were observed between LARC users and Depo-Provera injection, patch, or ring users. The LARC users were more than twice as likely to have two or more recent sexual partners compared to oral contraceptive users and Depo-Provera, patch, or ring users.

The authors concluded that their observed differences in condom use may reflect motivations to use condoms for backup pregnancy prevention. They suggested that users of highly effective LARC methods may no longer perceive a need for condoms even if they have multiple sexual partners, which places them at risk for sexually transmitted infections. As uptake of LARC increases among adolescents, a definite need exists to incorporate messages about condom use specifically for STD prevention.

Take home message: IUD users who shun condom use are at particularly high risk for contracting an STD because the devices are a foreign body placed in the uterine cavity. The presence of a foreign body increases the risk of an infectious organism gaining a foothold. Suffering an STD increases the risk of damage to pelvic organs. This damage can result in medical problems such as infertility and ectopic (tubal) pregnancies.

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