Contraceptive Choices for Chronically Ill Adolescents

Reproductive and contraceptive issues in chronically ill adolescents

OBJECTIVES

To address reproductive and contraceptive issues in adolescent girls with chronic medical conditions in order to assist health-care providers when they counsel teenagers about contraceptive methods.

METHODS

The review is based on a literature search in Medline (1973-2010) about specific contraceptive use by adolescents with obesity, endocrine, cardiovascular, haematologic, oncologic, neurological, psychiatric, gastrointestinal, hepatobiliary, autoimmune, renal, pulmonary conditions and disabilities. The latest recommendations from the World Health Organisation for adolescents are also added. Contraceptive methods studied were combined hormonal contraceptives, progestogen-only contraceptives, and intrauterine contraceptives.

RESULTS

Adolescents are eligible to use any method of contraception. Contraceptive choices of chronically ill adolescents have changed over time. Given new developments in the field of adolescent sexual and reproductive health care, safe and effective forms of contraception are available for almost every adolescent with a chronic condition. When selecting a method, the nature of the medical illness and the expressed desires of the teenager must be taken into account.

CONCLUSIONS

Adolescents, including those with chronic conditions, are sexual beings; they are entitled to sexual and reproductive health care. Decisions on appropriate contraception must be based upon informed choice, after adequate sexual health education.

Concepts of contraception for adolescent and young adult women with chronic illness and disability

Sexual behavior is common in adolescents and young adults with or without chronic illness or disability, resulting in high levels of unplanned pregnancy and STDs. Individuals with chronic illness or disability should not receive suboptimal preventive health care. These individuals have a need for counseling regarding issues of sexuality and contraception. Sexually active adolescent and young adult women can be offered safe and effective contraception if they wish to avoid pregnancy. Women with chronic illnesses and disabilities who are sexually active should also be offered contraception based on their specific medical issues. Condoms are also recommended to reduce STD risks. Table 36 summarizes basic principles of contraception application for specific illnesses, which have been identified since the release of the combined OC in 1960. Clinicians should also consider the noncontraceptive benefits of this remarkable and life-changing technology that allows all reproductive age women to improve their lives, including those with chronic illnesses and disabilities.

Sexuality issues and gynecologic care of adolescents with developmental disabilities

All human beings are sexual from birth to death and all children and adolescents with or without disability or chronic illness must incorporate appropriate sexuality concepts into their processes of development from childhood to adolescence. This article considers sexuality issues and reproductive care of adolescents with developmental disabilities. Potential consequences of disability on sexuality are reviewed, including sexual abuse and sexual dysfunction. Comprehensive sexuality education is vital for normal growth and development of all youth including those with developmental disabilities.