This document discusses topics related to sexual health and prevention, including screening recommendations for STIs, birth control options and effectiveness, emergency contraception, signs of pregnancy, and issues specific to men's and women's sexual health. It emphasizes the importance of understanding sexuality and notes challenges adolescents face in developing healthy attitudes towards sex due to developmental immaturity and lack of comprehensive sex education. The doctor's office, CDC website, and Planned Parenthood are recommended resources for sexual health information.

1. Sexperts: Sexual Health and
Prevention
Mike Guyton, MD
Assistant Clinical Professor/Academic Faculty in General
Pediatrics

2. Sexual Health and Prevention
• Screening
• Birth Control
• Pregnancy
• Gender Specific Topics
• Sexuality

3. STI Screening
• Chlamydia
– All SA females (</=25yo) annually
– All SA MSM (</= 25yo) for urethral and/or rectal annually; screen
every 3-6 months if high risk
– Screen those </=25yo exposed to an infected partner within the last
60 days
– Consider screening sexually active males in high prevalence areas
• Gonorrhea
– Overall same as above, but also screen pharyngeal swabs in MSM if
engaging in oral sex
• Trichomonas
– Routine screening not recommended in asymptomatic individuals
• Syphilis
– All SA </= 25yo MSM annually or every 3-6 months (no routine
heterosexual/non-pregnant screening)

4. Rescreening
• “Rescreen all adolescents infected with
chlamydia or gonorrhea 3 months after
treatment, regardless of whether they believe
that their sex partners were treated.”

5. A word on HIV screening
• Test: HIV Ag/Ab Combo
• CDC Recommendations:
– Opt-Out HIV testing for all patients 13-64 years old
• AAP Recommendations:
– Routine HIV testing to be offered at least once to all
adolescents (despite report of sexual activity) by 16-
18yo in clinic settings where HIV prevalence is >0.1%
– Prevalence <0.1%: HIV testing for all sexually active
adolescents and those with other risk factors

6. Birth Control

7. Birth Control
• Hormonal Contraceptives
– Pill: Effectiveness depends on taking as prescribed,
concurrent medications, and even body habitus
– Pills, Vaginal Devices, Injections, Implantables
• Barrier Protection
– Male Condom most widely used and most widely
studied
– Female condoms, diaphragms, spermacides
• Withdrawal Method
– Risky, not well studied, no guarantee

8. Birth Control
• No method of contraception is perfect
– Heavily dependent on personal preference
• Effectiveness also varies
– Theoretical vs Actual Effectiveness
– Most Effective = LARC
• Other benefits exist
– Prevention against STI
– Menstrual cycle stability
– Reduced rates of: ectopic pregnancy, endometrial
cancer, ovarian cancer
– Improvement in acne and hirsutism

9. Emergency Contraception
• Indication: Recent unprotected intercourse or those who
have had a recent possible failure of another method of
contraception
• Mechanism: Delaying ovulation
• Pregnancy test not needed prior to administration
– Oral regimens will not adversely affect an establish
pregnancy
• Failure rates differ depending on method used
– IUD = 0.04-0.19%
– Mifepristone/Ulipristal acetate = 1.4%
– Levonorgestrel = 2-3 %

10. EC Options
• Intrauterine Device (Copper)
– Most effective overall
– Requires a doctors visit for insertion
• Ulipristal (Ella)
– Most effective oral method (up to 120 hours)
– Requires a prescription
• Levonorgestrel (Plan B)
– Less effective than Ulipristal
– Over the counter
• Yuzpe Regimen
– Estrogen/Progestin combo pill
• Least effective oral regimen

11. Pregnancy
• Costs of unintended pregnancy in the US as high as 4.6
billion yearly
• Symptoms of pregnancy can be vague and non-classical
– Amenorrhea is the cardinal sign of early pregnancy
– Other common: Nausea +/- vomiting, Breast
enlargement/tenderness, increased frequency of
urination, fatigue
– Other associated: Bloating, constipation, heart burn, SOB,
mood changes
• Many women do not realize they are pregnant until
well into the 2nd trimester

12. Reasons for unprotected intercourse
• Felt like they could not get pregnant at time of
the conception (33%)
• Didn’t mind if they got pregnant (30%)
• Partner did not want to use contraception (22%)
• Reported side effects (16%)
• Believed themselves or their partner to be sterile
(10%)
• Unable to access protective measures (10%)
• Other (18%)

13. Men’s Sexual Health Topics
• UTI:
– Less common in men, but seen more in the MSM
population
• “Man-scaping”:
– Increasing prevalence in adolescents
– Associated with decreased rates of pubic lice
– Also associated with ingrown hairs, cellulitis, local irritation
• Testicular Tumors:
– Some benign (spermatocele), some cancer
– Incidence 2.3-10/100,000 males
– Recommend self screening exams in the adolescent
population

14. Women’s Sexual Health Topics
• Douching:
– Used as a manner of personal hygiene in some
women
– Often leads to contact/irritant dermatitis and vaginitis
• Pap Smears:
– Recommended to start after at 21yo and occur every
1-3 years after that (depending)
– Best way to screen for cervical cancer development
• UTI:
– Slight increase in incidence after sexual debut
– Similar organisms, importance of voiding after coitus

15. Gender and Sexuality
• Not often understood that gender is completely
separate from sexuality
• Sexuality may not be fully discovered or
understood until late teenage/early adulthood
years
• Sexuality is closely tied to psychological and often
social well being
– Affect feelings of depression and anxiety
– Can be source of teasing/bullying/isolation (or
community, belonging, strength)

16. Sexuality
• Sexuality is inherently related to sexual behavior,
which can be associated with some risk
– Men who have sex with men (MSM) have higher rates
of certain STI’s (Syphilis, HIV) as well as STI infection in
other parts of the body (Pharyngeal, Anal)
– Women who have sex with women (WSW) have
variable rates of STI infection, often dependent on the
presence of bisexuality
– Rates of STI’s still prevalent in heterosexual practices
as well

17. Why is understanding sexuality
important
• Opposing views of sexuality
– Often seen as an index of maturity to adolescents (rite of passage)
without understanding consequences
• Menarche vs marriage
– Earlier menarche = earlier reproductive capability
• Difficulties in communication with parents
– 2/3 feel like they can’t communicate with parents
• Media and Peer Pressure
– Unrealistic views of sex and increasing pressure
• Developmental stage
– Impulsivity is hallmark of adolescent  trouble developing healthy
attitudes towards sex
• Sex Education
– Lacking across the board; related to teen pregnancy rates

18. Where to Look for Info
• Remember, the doctor's office is often the
best place to start
• The CDC website has a lot of info regarding
STI’s and other common illnesses, as well as
statistical data
• Planned Parenthood
(www.plannedparenthood.org) has great info
for teens, parents, and educators