Talking with Teens

Middle School

Actual questions middle schoolers are asking, and the answers that you might use to keep the conversation going.

Q: My periods are irregular. Am I normal?

A: Most of the time irregular periods are part of the normal changes that can happen when you’re a teen. At some point as you get older, your cycle probably will settle into a recognizable pattern. Most women have periods every 26–30 days. Why don’t you mark on a calendar when your periods start and when they end? Then if you still are worried about irregular periods, we can schedule an appointment with your doctor and you will have a record to help you answer the doctor’s questions. Also, it’s important that you know that irregular periods make it harder to know when you might get pregnant.

To learn more about the menstrual cycle, check out the Menstruation and Menstrual Cycle Fact Sheet from the Office on Women’s Health.

Q: How can I say “no” to sex and still be in a relationship with my girlfriend?

A: What a great question and I’m glad you came to me with it. Being intimately involved and having sex with someone is a big step in a relationship. Your mom and I hope you will (wait until you are older/until you are married/until you are in a committed, long-term relationship/your personal value), but it is your decision. If you are getting pressure and it’s not what you want, then say, “No, I really like you and want to be friends, but I’m not ready for sex right now.” You’ve got a lot of other things to focus on right now and sex would really complicate a relationship. What else might you say to her?

For other examples of ways to avoid pressure to have sex, check out the Girlshealth.gov’s Dealing with Pressure to Have Sex fact sheet.

Q: When is it OK to have a baby?

A:  Your dad and I want you to be able to have a baby when you are an adult, have finished your education, and have the ability to financially support a child and your family. Until then, it is really important that when you start having sex, you use contraception to prevent pregnancy. Having a baby is a big responsibility, both emotionally and financially. Most people are adults and are married when they have children. What do you think?

Q: What do you do with a condom?

A: When people decide to have sex, a condom is placed over the penis to prevent pregnancy and sexually transmitted diseases. What else would you like to know about condoms?

To learn more about condoms, including how to correctly put on a condom, check out the CDC’s Condom Fact Sheet.

Q: I want to use tampons. Will I still be a virgin?

A: A virgin to me is someone who has not had sexual intercourse. Using a tampon won’t change that. Can you tell me a bit more about why you asked that question?

Q: Can you get pregnant if you have sex during your period?

A: Yes, it is possible depending on a girl’s cycle, especially if she has long periods and short cycles. It’s best to use protection at all times if you don’t want to get pregnant.

Q: Is it normal to get an erection for no reason at all?

A: It is very normal, especially when you are going through puberty. It can be embarrassing because you can’t predict them. Sometimes thinking of a totally different subject can make it go away. Sometimes it can even happen when you are sleeping. What else would you like to know?

For more information on what boys can expect during puberty, visit MedlinePlus’ resource on Puberty in Boys.

For more advice on how to talk with teens, check out OAH’s e-learning module: Talking with Your Teens About Reproductive Health.

Check out questions that high schoolers are asking and model responses.

Preventing Teen Pregnancy

Teen childbearing can carry health, economic, and social costs for mothers and their children. Teen births in the US have declined, but still more than 273,000 infants were born to teens ages 15 to 19 in 2013. The good news is that more teens are waiting to have sex, and for sexually active teens, nearly 90% used birth control the last time they had sex. However, teens most often use condoms and birth control pills, which are less effective at preventing pregnancy when not used consistently and correctly. Intrauterine devices (IUDs) and implants, known as Long-Acting Reversible Contraception (LARC), are the most effective types of birth control for teens. LARC is safe to use, does not require taking a pill each day or doing something each time before having sex, and can prevent pregnancy for 3 to 10 years, depending on the method. Less than 1% of LARC users would become pregnant during the first year of use.

Doctors, nurses, and other health care providers can:

  • Encourage teens not to have sex.
  • Recognize LARC as a safe and effective choice of birth control for teens.
  • Offer a broad range of birth control options to teens, including LARC, and discuss the pros and cons of each.
  • Seek training in LARC insertion and removal, have supplies of LARC available, and explore funding options to cover costs.
  • Remind teens that LARC by itself does not protect against sexually transmitted diseases and that condoms should also be used every time they have sex.

Problem: Few teens (ages 15 to 19) on birth control use the most effective types.

Use of Long-Acting Reversible Contraception (LARC) is low.

  • Less than 5% of teens on birth control use LARC.
  • Most teens use birth control pills and condoms, methods which are less effective at preventing pregnancy when not used properly.
  • There are several barriers for teens who might consider LARC:
    • Many teens know very little about LARC.
    • Some teens mistakenly think they cannot use LARC because of their age.
  • Clinics also report barriers:
    • High upfront costs for supplies.
    • Providers may lack awareness about the safety and effectiveness of LARC for teens.
    • Providers may lack training on insertion and removal.

Providers can take steps to increase awareness and availability of LARC.

  • Title X is a federal grant program supporting confidential family planning and related preventive services with priority for low-income clients and teens.*
    • Title X-funded centers have used the latest clinical guidelines on LARC, trained providers on LARC insertion and removal, and secured low- or no-cost options for birth control.
    • Teen use of LARC has increased from less than 1% in 2005 to 7% in 2013.
  • Other state and local programs have made similar efforts.
    • More teens and young women chose LARC, resulting in fewer unplanned pregnancies.

*More information on Title X

LARC use among teens ages 15-19 seeking birth control at Title X-funded centers

Graphic: LARC use among teens ages 15-19 seeking birth control at Title X-funded centers. Click to view larger image and text description.

SOURCE: Title X Family Planning Annual Reports, United States, 2005-2013.

How effective is LARC at preventing pregnancy compared with other birth control commonly used by teens?

Infographic: How effective is LARC at preventing pregnancy compared with other birth control commonly used by teens? Click to view larger image and text description.

SOURCE: Trussell J., Contraception, May 2011

Sexual Risk Behavior: HIV, STD, & Teen Pregnancy Prevention

Photo: group of adolescent boys and girls

Many young people engage in sexual risk behaviors that can result in unintended health outcomes. For example, among US high school students surveyed in 2013:

  • 47% had ever had sexual intercourse.
  • 34% had had sexual intercourse during the previous 3 months, and, of these
    • 41% did not use a condom the last time they had sex.
  • 15% had had sex with four or more people during their life.
  • Only 22% of sexually experienced students have ever been tested for HIV.

Sexual risk behaviors place adolescents at risk for HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancy:

  • Nearly 10,000 young people (aged 13-24) were diagnosed with HIV infection in the United States in 2013.2
  • Young gay and bisexual men (aged 13-24) accounted for an estimated 19% (8,800) of all new HIV infections in the United States, and 72% of new HIV infections among youth in 2010.3
  • Nearly half of the 20 million new STDs each year were among young people, between the ages of 15 to 24.4
  • Approximately 273,000 babies were born to teen girls aged 15–19 years in 2013.5

To reduce sexual risk behaviorsExternal Web Site Icon and related health problems among youth, schools and other youth-serving organizations can help young people adopt lifelong attitudes and behaviors that support their health and well-being—including behaviors that reduce their risk for HIV, other STDs, and unintended pregnancy.

CDC Issues New Sexually Transmitted Diseases Treatment Guidelines, 2015


These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR–12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.

Click the link for more information…..http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm

STI_STD rates


What are the symptoms of HIV infection?

How can I tell if I have HIV?
Some people who contract HIV experience very strong symptoms, but others experience none at all. Those who do have symptoms generally experience symptoms similar to the common cold or flu: fever, fatigue, and, often, rash. Other common symptoms can include headache, swollen lymph nodes, and sore throat. These symptoms can occur within days or weeks of the initial exposure to the virus during a period called primary or acute HIV infection. Many infections that are not HIV can cause similar symptoms, including mononucleosis, viral hepatitis, other sexual transmitted infections, and viral hepatitis. Stress and anxiety can also produce similar symptoms in some people, even though they do not have HIV.Because of the nonspecific symptoms associated with primary or acute HIV infection, symptoms are not a reliable way to diagnose HIV infection. Testing for HIV antibodies is the only way to know whether you have been infected; however, the HIV antibody test only works after the infected person’s immune system develops antibodies to HIV. During the “window period” between the initial infection and the period in which antibodies are detectable (which can be from 2 weeks to 6 months, but is usually around 3 months), standard HIV antibody testing may be negative, even though a person is infected–it is too early for the antibody test to be positive. However, HIV can be diagnosed during this window period with a test that looks for the HIV virus itself, and not the body’s response to it.

If you are concerned that you may have recently acquired HIV and have symptoms described above, see a health care provider, who can evaluate you for HIV and other possible causes of your symptoms. If early HIV infection is suspected, your provider can test directly for the virus, using a test called “PCR” or a “4th generation” HIV test that looks for the antibody and the virus at the same time), as well as doing the standard antibody test to determine whether HIV is present in the blood.

Once the primary or acute infection is over, most people do not experience any visible symptoms for another 8-10 years. Even though someone may not have active symptoms, they still have the infection and are infectious to others. Left untreated, the immune system becomes increasingly weaker and the disease progresses to AIDS. The next symptoms experienced by individuals infected with the virus are often associated with the “opportunistic infections” that target individuals with AIDS such as pneumonia, fungal infections, and HIV-specific cancers such as Kaposi sarcoma.

How can I tell if someone else has HIV?
There is no way to know for sure if someone else has HIV unless they have an HIV test. Many people with HIV look perfectly healthy. Other people who are sick with HIV may have symptoms that are identical to other common illnesses. You cannot tell by looking whether someone is HIV positive. The only way to know for sure is if someone tells you. It is important to consider how well you know someone and how much you trust them when talking about sex and HIV.
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