[Contraception in adolescence: knowing is not enough].

: Sexuality is the source of the biological, psychic, and social changes of adolescence. Contraception, by modifying some aspects of sexuality, can change the usual course of adolescence. Sexuality is a new experience for adolescents and is submerged in the same confusion and uncertainty as other areas of their lives. The experience of health personnel in contraception over the years has been gained in prescription for adults, who unlike adolescents are members of stable couples who have found their places in society. Women seeking contraception have usually experienced pregnancy and verified their fecundity, thereby consolidating their identities, unlike the adolescent who is still unsure of her femininity. Contraception for adolescents, by blocking 2 stages in the life of a woman (proving fecundity and experiencing maternity) is an obstacle to the total achievement of adulthood. The connection between sex and pregnancy is recognized by a 13-year-old in a theoretical way, but is not always integrated as a practical reality. Many adults have difficulty accepting the contraception requests of adolescents because they do not feel it is morally right for adolescents to have direct sexual experiences rather than daydreams. The reality of adolescent sexual lives is quite different from what most adults adults imagine it to be. Mental integration of contraception for an adolescent requires acceptance of the link between sex and pregnancy and a mental representation of oneself and one's behavior in which sexuality is considered a possibility. Many adolescents believe that they are too young to become pregnant, or are unable to make the link between sex today and pregnancy in the future, or do not perceive a possible pregnancy in negative terms. After they perceive the need for contraception and develop a desire to meet the need, adolescents must gain knowledge of the different methods available. Choice of a method will be influenced by the degree of efficacy of the method, its cost, facility of use, the frequency of intercourse, secondary effects, social or religious prohibitions, desire to keep contraceptive use secret, and the possibility of involving the partner. Failure to use the chosen means may be caused by such external factors as absence of a nearby family planning center or lack of money, or by internal factors. THe presence of an adult at the contraception consultation may be perceived by the adolescent as a means of control. The consultation may signify to the adolescent a demand for recognition of the reality of his affective and sexual life, a rite of passage, a means of transgressing parental prohibitions, and an indication of acceptance of the dissociation of sexuality from fertility. The presence of the girl's mother can complicate the consultation. Very often the health care professional confuses the role of parent with the medical role, feeling a moral responsibility beyond helping the adolescent avoid pregnancy or abortion. The best course is to be available to listen to the adolescent without prejudice in order to permit the establishment of room for reflection and maturation.