Preventive Care and Preventive Care and Sexual Health Sexual Health

Information for Tweens Information for Tweens and Teensand Teens

Developed by: Developed by:

ACOG District XII ACOG District XII

Health Care for Underserved Women CommitteeHealth Care for Underserved Women Committee

General Risk Factors General Risk Factors for Tweens and Teensfor Tweens and Teens

• Poor Diet• Lack of Exercise• Smoking/Drugs/Alcohol• Early initiations of Sexual Activity

When Should You See When Should You See an Ob/Gyn?an Ob/Gyn?

• Ideally BEFORE there is a problem• The American College of Obstetricians

Gynecologists (ACOG) recommends young women see a obstetrician/gynecologist (Ob/Gyn) between the ages of 13-15 years

What to Expect from What to Expect from an Initial Visit?an Initial Visit?

• History and Physicalo History on menstrual (period) cycle o Examine physical developmento Screen for emotional and behavioral conditionso Discuss/obtain immunizations

• Generally does not involve a Pelvic Exam• All females aged 10-18 should receive

annual screening• Annual screening should focus on:

o Healthy eating habitso Regular exerciseo Tobacco/drug useo Sexual activity

What is a Pap What is a Pap Smear????Smear????

• It is not a pelvic exam• Use of a speculum to look at the cervix to screen

for pre-cancer and cancer cells• Exams should begin at age 21

Just the Facts……..Just the Facts……..2002 Center for Disease Control (CDC)

National Survey of Family Growth

•11% of girls sexually active by age 13•24% of girls sexually active by age 15•40% of girls sexually active by age 16•70% of girls sexually active by age 18•Every 10 seconds, a teen loses their virginity

Every Every 10 10 secondsseconds a teen a teen

loses their loses their virginity!virginity!

CDC Trends in Sexual CDC Trends in Sexual Début Girls, Ages 15-Début Girls, Ages 15-

1919

More facts…….More facts…….• 12 million NEW Sexually

Transmitted Infections (STIs) cases per YEAR• 3 million of them are TEENS• 9,000 teen STIs per DAY

STI FactsSTI Facts• Herpes Simplex Virus (HSV)- 20 million active cases

• Human Papilloma Virus (HPV)- 24 million active cases

• Human Immunodeficiency Virus (HIV) More than 1 million active cases

HIV in FloridaHIV in Florida• Florida #3 nationwide• 1999: 5,424 new cases• 22% of new cases are female• 12 % ages 15-24

Chlamydia in Florida Chlamydia in Florida (2008 Data)(2008 Data)

• Total cases= 75,000 people• 389.1 cases/100,000 people

Gonorrhea in Florida Gonorrhea in Florida (2000 Data)(2000 Data)

• Total cases: 25,000 people• 127.8 cases/100,000 people

Teen PregnancyTeen Pregnancy

• 1997-183,324 births to 15-17 year olds in USA

• 1997-305,886 births to 18-19 year olds in USA

• 35% of all teen pregnancies are aborted• ADD TEEN PREGNANCY RATES IN

FLORIDA

Teen PregnancyTeen Pregnancy• 8 out of 10 teen moms live

below the poverty level for 10 years• 9 out of 10 teen moms never

finish college

Consequences of Our Consequences of Our Choices……Choices……

• Emotional affects• Physical affects• Future Fertility (pregnancy)• Possibility of Cancer (HPV)• Consequences and affects on

loved ones

Pregnancy PreventionPregnancy Prevention• Communicate with parents,

counselors, trusted adults, partner• Daily involvement• Commit to your decision• Date those that share your views• Avoid alcohol• Safe sex?• Think of YOUR future

Invasive Cervical Invasive Cervical CancerCancer

• 12,360 cases in the USA/year• 4,020 deaths in the USA/year• 16% of reproductive tract

cancers

Cervical Cancer is Cervical Cancer is caused by HPVcaused by HPV

Risk Factors for Contacting HPV the cause Risk Factors for Contacting HPV the cause

of of

Cervical CancerCervical Cancer

• #1 Highest Risk=HPV• Number of partners• Age at loss of virginity• Smoking• HIV infection

Prevalence of HPVPrevalence of HPV• Sexually active female college

students baseline 26% positive for HPV

• Check every 6 months 60% positive at least once over 3 years.

Sexual DebutSexual Debut• 62% 12th graders sexually active…• ½ their mothers are unaware

Role of the Pap Smear Role of the Pap Smear in Cervical Cancer in Cervical Cancer

PreventionPrevention• Age 21 • Responsible for 70% decrease in

cervical cancer deaths.• Results 3% Low grade• 1% High grade• 0.1% Cancer

When Should My When Should My Daughter see a Daughter see a

Ob/Gyn?Ob/Gyn?• Recommended first visit age 13-15• Annually to check for STIs

(gonorrhea and chlamydia) testing if sexually active

• Problems with period• Discussions about sexual activity

What is the What is the HPV HPV

Vacccine?Vacccine?

Quadrivalent HPV VaccineQuadrivalent HPV Vaccine• Protects against four strains of the virus

o 6,11,16,18• Approved by CDC in 2006• CDC/ACIP in mid-2006 after FDA approval• Recommended for females ages 11-26

o Vaccine may be given to females as young as 9 years old

How Safe is the HPV How Safe is the HPV vaccine?vaccine?

• Vaccine was studied for a period of over 10 years

• Included 25,000 people • 1,124 adolescent girls age 9-14• Vaccine against a virus particle• Rare complications noted from 5 year

Scandinavian study

How Do I Get the How Do I Get the Vaccine?Vaccine?

• Vaccine is dispensed in 3 doseso 1st-dose at visit, o 2nd dose at two months o 3rd dose at six months

• Through the Florida Department of Health- Vaccine for Children (VFC) Program

Is the Vaccine Is the Vaccine Effective?Effective?

• HPV 16 and 18 responsible for 70% of cervical cancers

• State of Florida- 10 cases cervical cancer per 100,000 women

New DevelopmentsNew Developments• Gardasil was FDA approved for

young men ages 9-26 in October 2009

• Cervarix is an additional FDA approved HPV vaccine FDA approved for ages 9-25

o Only covers HPV strains 16 and 18o Does NOT prevent HPV associated warts

New DevelopmentsNew Developments• New vaccine in development that covers 9 different HPV types

What we have done..What we have done..

With only a 33% vaccination in US girls, and 10% vaccination rate in US boys, rate we have decreased the incidence of HPV by 56% in girls

ages14-19!!!

We can do better…We can do better…• 80% adolescent girls vaccinated in Rwanda• 33% US girls vaccinated• 25.3% eligible Florida adolescent girls vaccinated

We can prevent close to 33,000 cases of HPV linked cancer cases annually with

the HPV vaccine

QUESTIONS?QUESTIONS?

ResourcesResources• ACOG Pamphlet AP073 Human Papillomavirus (HPV)

Infection Jan 13• ACOG Pamphlet AP167 Human Papillomavirus Vaccines Feb

2014• cdc.gov/vaccines/teens • cancer.gov/cancertopics/factsheet/Prevention/HPV-vaccine• The initial reproductive health visit. Committee Opinion No.

598. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:1143–7.

• Human papillomavirus vaccination. Committee Opinion No. 588. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:712–8

• www.ImmunizationforWomen.org/HPV  

References References CDC. Human papillomavirus vaccination coverage among adolescent girls, 2007–2012, and postlicensure vaccine safety monitoring, 2006–2013—United States. MMWR 2013;62:591–5.

CDC. Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices. MMWR 2007;56(No. RR-2):1–24.

Markowitz, L. Hariri,S .Lin.C.,Dunnel,E. Steinau,E. McQuillan,G and Unge,E. Education in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 2006–2010J Infect Dis. June 2013.

ACOG pratice Bulleton Number 131, November 2012 Screening for Cervical Cancer.