Teenagers' misconceptions

Mother and daughter Ruth and Steph Chambers tell you how to help dispel the myths some teenagers have about sex

The proportion of teenagers who become pregnant is higher in the United Kingdom than in other European countries. In England alone nearly 90 000 teenagers became pregnant in 1998-9; 7700 girls were under 16 and of these 2200 were aged 14 or younger.¹ About three fifths went on to give birth, the rest either miscarrying spontaneously or having their pregnancies terminated. The rates in Wales, Scotland, and Northern Ireland are similar. The high rates of teenage conception are attributed to young people's low expectations, ignorance of contraception and knowing what is involved in forming relationships and parenting, and the mixed messages they perceive--namely, that sex is the norm but contraception is illegal.²

Many teenagers are at unnecessary risk from unprotected sexual activity out of ignorance. Incorrect information circulates around their peer group and is commonly believed across teenage society. Too few young people have access to reliable sources of accurate information.

As medical students or doctors you need to know what misconceptions about sexual behaviour and fertility young people may have, so that you can give out correct information. You will probably have to initiate the interaction. Many young people find it difficult to talk to professionals, as Paul Greaves described in his recent student soapbox article about a 14 year old teenage girl whose 19 week pregnancy was presented as a "missed period." ³

Commonly believed misconceptions about pregnancy
There are many commonly circulating myths such as, "You can't get pregnant first time," or "You cannot get pregnant from having sex while standing up," or "If you have a bath straight after sex then you can't get pregnant."⁴ These and other similar sayings have become clichés, repeated by generations of young people. For people who lead educated lives it may seem incredible that such myths are so commonly believed.

For young people, the physical basis of the misinformation often seems to support the myths. For instance, it may seem plausible that the hymen of a virgin is a physical structure forming a barricade to sperm at first ever sexual intercourse, or that the sperm cannot ascend into the uterus against the force of gravity when the couple are standing vertically. Young people may visualise bath water washing all the sperm out of the uterus before it reaches the egg, not realising how rapidly those millions of sperm travel and that bath water gives no protection.

Other commonly held myths are:

• "I can't fit into a condom." This is a common excuse given by boys who do not like wearing condoms or do not know how to put a condom on properly. Girls may not realise that condoms are designed to stretch up to 5ft and fit all shapes and sizes of penis and may be falsely reassured by the boy's "I'll be careful."
• "I'm too young to get you pregnant." Some girls mistakenly think that if a boy does not have pubic hair then his sperm will not be able to impregnate them. There is no fixed age when boys and girls become fertile--most GPs can readily recall 12 and 13 year old patients who have become pregnant.
• "I can't get pregnant when I'm just off my period." It may be slightly less likely than at other times of the cycle but is still possible. Young people may be unaware that sperm can live for several days inside the uterus.
• "I'll withdraw before I ejaculate." This is thought to be an adequate form of contraception among teenagers today, and although better than no contraception at all in an emergency it has a high failure rate. Young boys may withdraw before they ejaculate but many find such control difficult and afterwards some will re-enter the vagina.
• "You can't get pregnant if your partner is a heroin addict." So a 16 year old teenage mum thought before she conceived.
• "I didn't sleep with him. I stayed awake" is another example of how ambiguous words can mislead teenagers.
• "If you have sex just before the girl's period then it will all get washed out," but real life is not like that.

Commonly believed misconceptions about sexually transmitted infections
There is misinformation about perceived safety from sexually transmitted infections (STIs) too. A common misconception among young people (and quite a few adults for that matter) is that the contraceptive pill protects the woman against STIs.

Rebutting such misconceptions or myths is only scratching at the surface compared with influencing the other factors that affect the chances of unplanned teenage pregnancies occurring. Teenagers' concerns about lack of confidentiality and poor communication from professionals are deeper, more important issues that need to be tackled. Teenagers should be allowed to make informed choices about protecting themselves from pregnancy and infections, and whether they are sexually active at all.

Poor communication
Poor communication can result in pregnancy--for example, where there are misconceptions about emergency contraception. Many young people believe that they can take the emergency contraceptive pill only on the morning after the episode of unprotected sex instead of up to 72 hours later because it is known as "the morning after pill." Few teenagers know of the existence of an alternative emergency contraceptive, the intrauterine device (IUD) or coil. Nor do they know of the guidelines that apply to the use of the coil as an emergency contraceptive up to five days after the unprotected sexual intercourse or up to day 19 for a woman with a regular 28 day cycle.

Perceived lack of privacy and confidentiality
Sexual activity is regarded as private by young people and concerns about confidentiality deter some from seeking help. As many as a quarter of adolescents believe that their parents will be informed about their consultations in general practices.

Many teenagers attending young people's clinics do not consent to information about their consultation being passed on to their own GPs. They do not believe that the information will be kept confidential. They have doubts about family planning clinics too--quite a few give false names or dates of birth or refuse to give their addresses.

We will debunk the teenagers' misconceptions only by tackling their social culture and educating young people through reliable sources that are easily accessed and cater for the needs of teenagers as a whole. Gaining information from the internet may avoid embarrassment, but there is no way that the young person knows whether the information provided is true or not. A breakdown in communication between adults and teenagers may create new misconceptions and make it difficult for teenagers to ask for the information they want. As young doctors you have a real opportunity to connect with teenagers and so help dispel any myths and give the correct information that they so badly need.

Steph Chambers, teenage school pupil in Newcastle under Lyme

Ruth Chambers, GP and professor of primary care development, Staffordshire University


studentBMJ 2001;09:305-356 September ISSN 0966-6494

1. Office for National Statistics. Population trends 99. London: Stationery Office, 2000.
2. Department of Health. Teenage pregnancy. Social Exclusion Unit. London: Department of Health, 1999.
3. Greaves P. Student soapbox: teenage pregnancies. studentBMJ 2001;9:247.(July.)
4. Chambers R, Wakley G, Chambers S. Tackling teenage pregnancy. Oxford: Radcliffe Medical Press, 2001.