Young people are poorly informed
It seems impossible, yet in terms of contraception young people have turned back compared to some years ago. But estimates and inquiries are clear: in Italy the level of information provided to adolescents in terms of contraception is still insufficient, given that false myths, recourse to do-it-yourself remedies and little awareness are on the agenda. The risk? Not only unwanted pregnancies, but also the spread of so-called sexually transmitted diseases (STDs). We talk about it with Professor Rossella Nappi, University Researcher, Gynecological Endocrinology Clinic IRCSS Salvatore Maugeri Foundation of Pavia.
Professor Nappi, let's start by taking stock of the situation right away. According to his experience and the observatory represented by his Outpatient clinic, what is the level of information on contraception by young people and adolescents?
My impression is that the information is available but that, as often happens among adolescents, it is passed from mouth to mouth without the mediation of the experts and therefore there are still too many false myths and taboos that affect its use. There are also regional differences, and in this the South seems to be penalized with greater difficulties for adolescents to acquire correct information.
In particular, what are the major risks for adolescents? And what are the most common sexually transmitted diseases among young people today?
First of all, the unwanted pregnancies and the excessive use of the morning-after pill: two conditions often associated with the incorrect use of contraception, both hormonal and with the use of condoms. Certainly the viral infections from papilloma viruses are the most widespread, since the condom does not always fully protect against these contaminations. There is no doubt that some of these viruses have an oncogenic power and therefore can lead to alterations of the cervix with important repercussions on health. For this reason it is necessary to start the pap-test early (immediately after sexual intercourse begins) and to consider the vaccine against the papilloma virus (HPV)
Let's move on to the essential information. Can you give us a quick overview of the available contraceptive methods?
The condom is the most used and always necessary barrier method when "dancing with a stranger". Unfortunately it is not always used correctly (hence numerous failures) and, moreover, young women do not always have the courage to ask their partner to use it … Not everyone lives it positively and some people, men and women, can demonstrate allergies or intolerances. As for the pill: today it is more customizable in terms of administration regime, estrogen dosage and progestin association, increasingly antiandrogenic (and therefore safe on the metabolic risks side). However, forgetfulness is frequent, especially among adolescents. This is why the use of a weekly contraception (such as a patch) or a monthly one (such as the vaginal ring) can represent a valid alternative, reducing method failures or side effects such as blood loss between one cycle and another derive from bad pill intake. Without underestimating many other advantages due to the fact that the hormones are absorbed through the skin or at the level of the vaginal mucosa, with less impact on the function of the liver. The IUD or spiral is a method less suitable for adolescents and is more widely used in women who have already given birth or who have particular conditions, such as abundant menstrual flows. Natural methods are very useful for getting to know each other physically, but they find little application in young women, especially if the cycles are not well regulated and there is still no real couple harmony like in more adult partners.
A method for every need: but how to orient yourself?
Inquiring well, especially from your gynecologist. The condom also protects against sexually transmitted diseases (so it is recommended if you often change partners) and must always be used at the beginning of a new relationship or even in the stable couple if there are contraindications for hormonal contraception. For the pill instead (not recommended in some cases as the predisposition to thrombosis), it is necessary to always make an evaluation of the clinical history of the woman; to know that it does not protect against MSTs; remember to take it every day, etc … Finally, it is necessary to know that today the pill (but also the patch and the ring) is really recommended only to a minority of women. To all of which we must remember to abolish or at least reduce the habit of smoking (a real killer on all fronts of women's health).
Speaking of the pill, some clichés are still widespread: it makes you fat, it causes tumors, and so on with this step …). How are things really?
They are all urban legends. Even the most recent studies show that the pill does not significantly change the risk of breast cancer, while significantly reducing ovarian and endometrial cancer, the internal mucosa of the uterus. Weight gain is generally eliminated thanks to the reduction in the dosage of estrogen and the use of the new progestin drospirenone or to vaginal contraception. And in any case the side effects depend on the individual characteristics of the woman, which can be very well with pills with a higher estrogenic dose and with different progestins.
Finally, who is responsible for imparting sexual education to adolescents?
Unfortunately, not enough sex education is done at all levels. There is a need for true information without barriers on the part of adolescents who have a lot of confusion in their heads even about their anatomy, let alone on sexuality and reproduction. According to a survey conducted by Astra Ricerche “Young Italian women, sexuality and menstruation” among the under 25 are still widespread uncertainties and taboos related to the body and femininity: many of them, for example, have no idea what they are the size of the genital organ, they know that a clitoris exists but they think that it is inside the vagina and they cannot give an explanation of the origin of the menstrual blood. Advice to parents: although it is a very private area, a door can and should be opened to encourage dialogue, perhaps urging adolescents to consult a specialist to clarify doubts, fears and uncertainties.
(Edited by Minnie Luongo)