Only a deluded Pietist would
be shocked to hear that teens are having unprotected sex,
getting pregnant, and contracting sexually transmitted
infections. But what's truly surprising is that, according
to StatsCan, kids who practise monogamy may be in greater
peril than their promiscuous classmates.
There's good and bad news about
teens and sex in the latest StatsCan numbers. First
the good news, teen pregnancy rates continue to decline.
Nationwide we can expect only about 40,000 teens to
get pregnant annually, compared to over 60,000 in the
smaller Canada of the mid-70s.
The bad news is that STI rates
are heading skyward. Believe it or not, monogamy —
or as Alex McKay, PhD, of the Sex Information and Education
Council of Canada, prefers: "serial monogamy"
— can be a factor in both scenarios.
SERIAL
MONOGAMY
"Two people form a relationship and their immediate
and primary concern may be equal between pregnancy prevention
and STI prevention," Dr McKay explains.
But all things aren't equal as
the relationship progresses and STI precautions quickly
take a back seat to birth control.
"What very commonly happens
is the female goes onto the birth control pill and because
they're in a monogamous relationship they assume they
are not at risk for STIs and they stop using condoms."
YOUTH'S
VICIOUS CYCLE
And because teen relationships aren't renowned for their
staying power the cycle repeats. Between the average
documented age of initial intercourse at 16 and the
average age of marriage at 28, serial monogamists continue
their faithful pattern, oblivious to risk.
"At the end of the day, even
though you have led a 'monogamous lifestyle', you have,
in fact, had unprotected sex with, say, six different
partners and that, as we all know, is going to contribute
to high STI rates," says Dr McKay.
YOUNG,
NOT SO FOOLISH
While he acknowledges that today's teens and young adults
are a pretty savvy lot when it comes to being informed
about their sexual health, some things never change.
Pregnancy prevention has historically been, and remains,
their primary concern.
"Modern generations of young
women in Canada are better than past generations in
controlling their fertility in particular. However,
there are important information gaps that they need
help with and physicians can play a key role in filling
those gaps."
GPs — like Toronto's Dr Andrea
Lobo who works in the House Community Health Services
Division of Planned Parenthood — know it's an uphill
struggle getting teens to take condom use seriously.
"Perhaps they think that certain
STIs are treatable with antibiotics and if they get
them, it's not the end of the world," says Dr Lobo.
"But there are some STIs that are becoming resistant
to antibiotics."
Like Dr McKay, Dr Lobo agrees that
most of her patients, all aged 13 to 25, are uniformly
aware that condoms protect against STIs.
"They are informed and use
birth control pills, but they let STI prevention through
condom use slide," Dr Lobo says, noting the majority
of her patients don't even bother with a "defence"
when they test positive. "Most people are honest
and say, 'You know what, I wasn't using a condom. I
know I should've, but I didn't.'"
THE
FOIBLES OF LOVE
"A lot of them don't know where they contracted
it from because they're thinking they're in a monogamous
relationship," adds Dr Lobo. "A lot of STIs
are asymptomatic and people don't even know they have
them."
Educating teens about the importance
of 100% condom compliance despite their 'safe' monogamous
relationships is only one part of STI prevention. An
equally important strategy is getting them in for regular
testing, regardless of their lifestyle. The latter,
Dr Lobo concedes, is a challenge.
"I think they're scared of
finding out they might have something," she says
of their reluctance.
She suggests the annual Pap smear
as an opportune moment for family physicians to repeat
information, screen for sexual risk behaviour, and encourage
further testing.
"When people come in yearly
for Pap tests, it's a perfect time to do screening for
Chlamydia and gonorrhea by doing swabs at the
time and then also talking about blood tests, like HIV
testing and syphilis ... just taking an extra minute
or two and talking to people about STI risks,"
she says.
"I think we need to remind
patients that a Pap test is not necessarily synonymous
with being STI tested."
And in an effort to reduce harm,
there's no harm in repetition.
"I know they've already heard
it all before," Dr Lobo concludes. "But it's
not a bad thing to reiterate."
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