Attitudes Toward the Vaginal Ring and Transdermal Patch Among Adolescents and Young Women

Abstract

Purpose The vaginal ring and the transdermal patch offer important contraceptive options for women at high risk of unintended pregnancy. Little is known about what adolescents and young women think about these methods and why use of the ring has been relatively low compared to the patch. We sought to examine young women’s attitudes and perceptions about the ring and the patch to better understand the relationship between perceptions of these methods and decisions to use them. Methods Sixteen focus groups of young women aged 15–26 years (n=113) from family planning clinics in the San Francisco Bay Area were convened. Data from the focus groups were analyzed using standard content analysis. Results While young women expressed apprehension and doubt about both methods, for the most part women expressed more positive attitudes about the patch. Two related themes for the ring and the patch were identified: “lack of trust in effectiveness,” and “method use concerns. Two themes unique to the ring: “concerns regarding vaginal insertion” and “sexual partner perceptions” and three themes unique to the patch: “ease of remembering”, “visibility issues”, and “perceived health risk” were identified. Conclusions Increased provider education about apprehensions related to the ring and the patch may lead to increased use of the ring and counter recent declines in use of the patch. It would be unfortunate if these safe and effective options for young women are underutilized because negative attitudes and perceptions about these methods act as barriers to adoption.

Adolescents’ Experiences Using the Contraceptive Patch versus Pills

“…Our anecodotal observations that patch users are concerned about the visibility as well as the potential health risks associated with the patch have been substantiated in the literature. 26,45 With regard to the risk of venous thromboembolism which has prompted the FDA to approve label changes for the patch, we concur with other authors that the baseline risk in healthy adolescents is low, and that the patch remains a safe and viable contraceptive option for young women. 45 The findings of our study highlight the fact that, despite apparent advantages of the patch over the pill, the patch does not meet the challenges of achieving perfect and sustained contraceptive use.…”

Acceptability of the Vaginal Contraceptive Ring Among Adolescent Women

“…Recent work indicates that the vaginal ring is an acceptable contraceptive option for adolescent women; 16e18,29 our results align with current trends of the vaginal ring as an underutilized (and potentially underappreciated) form of contraception, as only 3 (1.5%) adolescent women reported use. 16,18,20,21,29 However, over one third of the adolescent women indicated that they were willing to try the vaginal ring after receiving educational materials and healthcare providers were identified as the most important source of information influencing contraceptive choices highlighting the important role of providers in contraceptive decision making for young women.…”

“…30 Our study findings confirm and extend this research that the main barrier to vaginal ring use and acceptability among adolescents is related to method of insertion and being comfortable with their genitals. 17,20,29 In order to use the vaginal ring, adolescent women need to become comfortable with their genitals, thus highlighting the importance of education and practice in clinical and nonclinical settings.…”

“…15e19 However, it remains an underutilized form of hormonal contraception among adolescents since it was approved by the FDA in 2001. Reported vaginal ring use among adolescents has ranged from 0.6% to 6%, 16,20,21 compared to 61% use of oral contraceptive pills and 20% use of the depot medroxyprogesterone (Depo-Provera). 7,22 Accordingly, the purpose of this study was to identify factors that might facilitate the uptake and use of the vaginal ring more broadly by adolescent women.…”

Contraception for Adolescents

“…183 Side effects of the patch are largely similar to other combined methods, with the addition of local adverse effects, such as dislodged patches and hyperpigmentation, 175,176 contact dermatitis and other skin irritation, 184 and concerns about the visibility and appearance of the patch. 185,186 Investigations into the patch' s effect on bone health have yielded inconsistent results, with findings in adults 150,151 more reassuring than those in adolescents. 187 However, this limited work is far from conclusive.…”