A young woman (23) walked into my clinic after missing her periods for almost three months. She had earlier been diagnosed with polyendocrine metabolic ovarian syndrome (PMOS), so she was not alarmed about the delay. When I asked whether she was sexually active, she refuted immediately. But gentle prodding later, when she felt she would not be judged, she admitted the truth. A positive pregnancy test and inquiry revealed a nearly two-month pregnancy. What unsettled her most was not just the result, but her belief that had brought her there — that having PMOS meant spontaneous conception is difficult. In PMOS, ovulation may be irregular, but pregnancy can still take place.
Safe-sex days: This is another widely believed misconception that certain days of the menstrual cycle are completely “safe”. This is a misleading belief, particularly when cycles are unpredictable. Many young women have landed with an unplanned pregnancy after following this unpredictable method. If pregnancy is not desired, contraception must be planned rather than left to misinformation.
Emergency contraceptive pills can fail: Another young woman came to my OPD after several months of unusual bleeding. She had unprotected intercourse some months earlier and had taken an emergency contraceptive pill. When she bled afterwards, she assumed the pill had worked. The bleeding, though stayed scanty and irregular, unlike her regular cycle, but she continued to interpret it as menstruation. By the time she sought medical help, an ultrasound showed that she was into her fifth month of pregnancy. Sadly, the intermittent bleeding had extended her false reassurance.
Frequent use of emergency pills can temporarily alter menstrual bleeding patterns, making periods less predictable. These pills can fail and any bleeding after taking the pills does not mean that pregnancy has been stopped. A pregnancy test three weeks after unprotected intercourse is a sensible precaution when chances of pregnancy are high.
Emergency contraception is a key safeguard, but it is not a regular contraceptive strategy. The commonly used and accessible over-the-counter emergency pill (levonorgestrel) works by delaying or preventing ovulation; it does not terminate an established pregnancy. It is most effective when taken promptly, ideally within 72 hours, while some other emergency options like intrauterine devices can be used up to five days after intercourse.
Why planning contraception is vital
Condoms can break, intercourse may happen without protection, and situations involving sexual coercion or assault may arise. In such circumstances, timely access to emergency contraception is valuable. What matters is understanding when to use emergency contraception and when a dependable ongoing method like oral contraceptive pills is preferable. Condoms remain especially important because most other contraceptive methods do not reduce STI (sexually transmitted infections) transmission.
Oral pills are safe and do not cause much weight gain: Oral contraceptive pills (OCPs), when appropriately prescribed and taken correctly, are safe and highly effective. Contrary to popular belief, modern combined (a combination of hormones) oral contraceptive pills do not cause significant weight gain or even future infertility. On the contrary, these are quite beneficial and helpful as these can make menstrual bleeding predictable and most important reduce period-related discomfort. Bleeding also remains controlled, making it beneficial for anaemic women. Fertility usually returns around some months after stopping them. Nevertheless, underlying conditions like PMOS may become apparent once more.
Consequences of misinformation
The consequences extend beyond an unexpected test result. When a woman mistakes spotting for a normal period, she may lose valuable time to understand her options and obtain appropriate antenatal or other medical care. What matters is not simply whether bleeding has happened, but whether it resembles a usual period or not. A delayed period, unusually light bleeding or persistent pregnancy symptoms should prompt a test rather than ‘reassurance’ based on guesswork.
STIs are silent, can happen to anyone: Preventing pregnancy is only one part of this conversation. I meet many young individuals who assume that a sexually transmitted infection (STI) has obvious symptoms like discharge, pain, sores or itching. In reality, STIs like chlamydia, gonorrhoea and HPV can be silent. An apparently healthy partner may still transmit an infection. Some untreated infections can cause pelvic inflammatory disease and impact fertility.
What is sexual contact: There is also confusion about what counts as sexual contact. Oral sex can transmit infections, including gonorrhoea, herpes and syphilis. Deep kissing can spread oral herpes, while syphilis may spread through direct contact with an infectious oral sore. HIV is generally not transmitted through kissing. These distinctions matter because exaggerated fear is no more helpful than false reassurance. Condoms and other barriers curb risk, and HPV and hepatitis B vaccination offer extra protection where signalled.
An STI test is not a verdict on someone’s character. It is a clinical decision based on the type of contact, timing and possible exposure. Depending on circumstances, testing may involve urine, blood or swabs, including a throat swab after oral exposure. Testing too early can miss an infection, so follow-up may sometimes be needed. After a potential HIV exposure, urgent assessment is vital because post-exposure prophylaxis must be commenced within 72 hours.
Half-truths and misinformation
We live in a time when teenagers and young adults can google anything within seconds. Yet, the details they get about sex, pregnancy and infections is often a confusing mixture of facts, half-truths and ‘confident misinformation’. They may know the names of contraceptive pills without knowing when or how to use them. They may have heard of STIs without understanding that an infection can be present without symptoms. Friends, viral reels or anonymous online answers frequently becomes their first source of details, which necessarily may not be accurate or applicable in their case.
Young individuals deserve medically accurate, age-appropriate education about contraception, consent, healthy relationships and STIs. They also need to know where they can look for help without humiliation. Perhaps, it is time we stop asking why the young are making uninformed choices and start asking why, despite having so much details around them, they are still afraid to ask the right questions.
The real threat is not that teenagers are learning about sex. It is that they may be learning everything about it from wrong sources. And when a young woman has an unintended pregnancy, the most useful question is not “Why did you do this?” but “What could we have told her earlier that might have prevented her from reaching this point?”
— The writer is a consultant gynaecologist & clinical sexologist
