The Importance of Prevention

Although teen pregnancy rates have been on the decline in the US, there are still thousands of babies being born to females aged 15-19 years.  Although reasons for the declines are not totally clear, evidence suggests these declines are due to more teens abstaining from sexual activity, and more teens who are sexually active using birth control than in previous years.

Still, the U.S. teen pregnancy rate is substantially higher than in other western industrialized nations and racial/ethnic and geographic disparities in teen birth rates persist.

Teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children.

• Pregnancy and birth are significant contributors to high school dropout rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age, whereas approximately 90% of women who do not give birth during adolescence graduate from high school.
• The children of teenage mothers are more likely to have lower school achievement and to drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult.

Evidence-based teen pregnancy prevention programs have been identified by the US Department of Health and Human Services (HHS) TPP Evidence Review, which used a systematic process for reviewing evaluation studies against a rigorous standard. Currently, the Evidence Review covers a variety of diverse programs, including sexuality education programs, youth development programs, abstinence education programs, clinic-based programs, and programs specifically designed for diverse populations and settings.  In addition to evidence-based prevention programs, teens need access to youth-friendly contraceptive and reproductive health services and support from parents and other trusted adults, who can play an important role in helping teens make healthy choices about relationships, sex, and birth control.  Efforts at the community level that address social and economic factors associated with teen pregnancy also play a critical role in addressing racial/ethnic and geographical disparities observed in teen births in the US.

Contraception

How Effective are Birth Control Methods?

The effectiveness of birth control methods is critically important for reducing the risk of unintended pregnancy. Effectiveness can be measured during “perfect use,” when the method is used correctly and consistently as directed, or during “typical use,” which is how effective the method is during actual use (including inconsistent and incorrect use).

Aside from abstinence, the best way to reduce the risk of unintended pregnancy among women who are sexually active is to use effective birth control correctly and consistently. Among reversible methods of birth control, intrauterine contraception and the contraceptive implant remain highly effective for years once correctly in place. The effectiveness of the contraceptive shot, pills, patch and ring, and barrier and fertility awareness-based methods, depends on correct and consistent use-so these methods have lower effectiveness with typical use.

What are STDs or STIs?

Sexually transmitted diseases or infections (STDs or STIs) are passed from one person to another through intimate physical contact – such as heavy petting – and from sexual activity including vaginal, oral, and anal sex. STIs are very common. In fact, CDC estimates 20 million new infections occur every year in the United States. STIs can mostly be prevented by not having sex. If you do have sex, you can lower your risk by using condoms and being in a sexual relationship with a partner who does not have an STI. STIs do not always cause symptoms, so it is possible to have an infection and not know it. That is why it is important to get tested if you are having sex. If you are diagnosed with an STI, know that all can be treated with medicine and some can be cured entirely.

There are dozens of STIs. Some STIs, such as syphilis, gonorrhea, and chlamydia, are spread mainly by sexual contact. Other diseases, including Zika and Ebola, can be spread sexually but are more often spread through ways other than sex.

Examples of Sexually Transmitted Infections:

STI Risk and Oral Sex

• Many sexually transmitted diseases (STIs) can be spread through oral sex.
• Using a condom, dental dam or other barrier method each and every time you have oral sex can reduce the risk of giving or getting an STI.
• Although oral sex may carry a lower risk for spreading HIV than other forms of sex, repeated unprotected exposures may increase risk of transmission.

What is Oral Sex?

Oral sex involves using the mouth, lips, or tongue to stimulate the penis (fellatio), vagina (cunnilingus), or anus (anilingus) of a sex partner. The penis and testicles and the vagina and area around the vagina are also called the genitals or genital area. Oral sex is commonly practiced by sexually active adults. Oral sex can happen between heterosexual (straight) and same-sex (gay or lesbian) couples.

Can STIs Be Spread During Oral Sex?

Many STIs, as well as other infections, can be spread through oral sex. Anyone exposed to an infected partner can get an STI in the mouth, throat, genitals, or rectum. The risk of getting an STI from oral sex, or spreading an STI to others through oral sex, depends on a number of things, including

• The particular STI.
• The sex acts practiced.
• How common the STI is in the population to which the sex partners belong.
• The number of specific sex acts performed.

In general:

• It may be possible to get some STIs in the mouth or throat from giving oral sex to a partner with a genital or anal/rectal infection, particularly from giving oral sex to a partner with an infected penis.
• It also may be possible to get certain STIs on the penis (and possibly the vagina, anus or rectum) from getting oral sex from a partner with a mouth or throat infection.
• It’s possible to have an STI in more than one area at the same time, for example in the throat and the genitals.
• Several STIs that may be transmitted by oral sex can then spread throughout the body of an infected person.
• STIs can be spread to a sex partner even when the infected partner has no signs or symptoms. If you are infected with an STI, you might not know it because many STIs may have no symptoms.

Is Oral Sex Safer than Vaginal or Anal Sex?

• Many STIs can be spread through oral sex. However, it is difficult to compare the exact risks of getting specific STIs from specific types of sexual activity. This is partly because most people who have oral sex also have vaginal or anal sex. Also, few studies have looked at the risks of getting STIs other than HIV from giving oral sex on the vagina or anus, compared to giving oral sex on the penis.
• Studies have shown that the risk of getting HIV from having oral sex with an infected partner (either giving or getting oral sex) is much lower than the risk of getting HIV from anal or vaginal sex with an infected partner. This may not be true for other STIs – in one study of gay men with syphilis, 1 out of 5 reported having only oral sex.
  • Getting HIV from oral sex may be less likely than vaginal or anal sex, but it still carries risk. If you are having oral sex you should still protect yourself. Repeated unprotected oral sex exposure to HIV may represent a considerable risk for spread of HIV, as well as other STIs for which the risk of spread through oral sex has not been as well studied.
• It is possible that getting certain STIs, such as chlamydia or gonorrhea, in the throat may not pose as great a threat to an infected person’s health as getting an STI in the genital area or rectum. Having these infections in the throat might increase the risk of getting HIV. Having gonorrhea in the throat also may lead to spread of the disease throughout the body. In addition:
  • Having infections of chlamydia and gonorrhea in the throat may make it easier to spread these infections to others through oral sex. This is especially important for gonorrhea, since throat infections are harder to treat than urinary, genital or rectal infections.
  • Infections from certain STIs, such as syphilis and HIV, spread throughout the body. Therefore, infections that are acquired in the throat may lead to the same health problems as infections acquired in the genitals or rectum.
  • Mouth and throat infections by certain types of HPV may develop into oral or neck cancer.

What Can You Do to Prevent STI Transmission During Oral Sex?

You can lower your chances of giving or getting STIs during oral sex by using a condom, dental dam or other barrier method each and every time you have oral sex.

• For oral sex on the penis:
  • Cover the penis with a non-lubricated latex condom.
  • Use plastic (polyurethane) condoms if you or your partner is allergic to latex.
• For oral sex on the vagina or anus:
  • Use a dental dam.
  • Cut open a condom to make a square, and put it between the mouth and the partner’s vagina or anus.

Treatment of STIs

Bacterial STIs can be treated with antibiotics. Some of these bacterial STIs can still cause permanent damage prior to being treated. For example, chlamydia can negatively impact female fertility.  Viral STIs cannot be cured, but can be treated.  Herpes, HIV and HPV would be examples of viral STIs.

Effective strategies for reducing STI risk:

It’s important to remember that many infected individuals may be unaware of their infection because STIs often have no symptoms and are unrecognized. The only way to avoid STIs is to not have vaginal, anal, or oral sex.

If you are sexually active, you should get tested regularly for STIs and HIV and talk to your partner(s) about STIs. If you think you might have an STI, stop having sex and visit your doctor or clinic to get tested. There are free and low-cost options for testing in your area. It is important that you talk openly with your health care provider about any activities that might put you at risk for an STI, including oral sex.  

The most reliable way to avoid infection is to not have sex (i.e., anal, vaginal or oral).

Vaccines are safe, effective, and recommended ways to prevent hepatitis B and HPV. HPV vaccines for males and females can protect against some of the most common types of HPV. It is best to get all three doses (shots) before becoming sexually active. However, HPV vaccines are recommended for all teen girls and women through age 26 and all teen boys and men through age 21, who did not get all three doses of the vaccine when they were younger. You should also get vaccinated for hepatitis B if you were not vaccinated when you were younger.

Reducing your number of sex partners can decrease your risk for STIs. It is still important that you and your partner get tested, and that you share your test results with one another.

Mutual monogamy means that you agree to be sexually active with only one person, who has agreed to be sexually active only with you. Being in a long-term mutually monogamous relationship with an uninfected partner is one of the most reliable ways to avoid STIs. But you must both be certain you are not infected with STIs. It is important to have an open and honest conversation with your partner.

Correct and consistent use of the male latex condom is highly effective in reducing STI transmission. Use a condom every time you have anal, vaginal, or oral sex.

If you have latex allergies, synthetic non-latex condoms can be used. But it is important to note that these condoms have higher breakage rates than latex condoms. Natural membrane condoms are not recommended for STI prevention.

Masturbation

Masturbation is self-stimulation of the genitals to achieve sexual arousal and pleasure. This is a normal, healthy form of sexual expression with multiple health benefits. Scientific and educational communities in the US have not provided this information along with other public health information that is available to consumers. This is in contrast to other countries such as Australia and the United Kingdom that provide significant information covering the health benefits of masturbation on their public health websites. Benefits that are discussed include the following.

Masturbation:

• is safe sex with no risk of sexually transmitted infection or unintended pregnancy.
• allows for the release of sexual tension.
• promotes release of endorphins.
• is a useful treatment for issues with sexual dysfunction.
• can reduce menstrual cramps.
• may reduce prostate cancer in men

Masturbation is considered a problem when it is done in public, interferes with sexual activity with a partner, or causes distress due to being done compulsively or interferes with activities of daily living.