LOS ANGELES — Teenagers cruising mainstream Web sites can hardly be faulted for thinking that emergency contraception is difficult to obtain, birth control pills will make them fat, and IUDs are meant for older women, not adolescents.
That's because incomplete and inaccurate information abounds on the Internet, even within very well-known Web sites, according to an analysis performed in 2008 by Stanford (Calif.) University researchers.
“We found a lot of myths about IUDs, emergency contraception, birth control, and when women should be getting Pap smears, especially their first one,” said Alisha T. Tolani, a student in the human biology program at the university.
Ms. Tolani and her research mentor, Dr. Sophia Yen of the division of adolescent medicine at Stanford's Lucile Packard Children's Hospital, presented their findings in a poster at the annual meeting of the Society of Adolescent Medicine.
Web sites were selected for analysis based on practitioner recommendations and Google searches of key terms, such as “birth control,” “morning after pill,” and “sexually transmitted disease.” The top 10–15 results for each search term were included. The 35 Web sites examined were assessed for accuracy on 26 topics.
In general, sites provided “fairly accurate” information on STDs, Ms. Tolani and Dr. Yen reported in their poster. For example, 100% of Web sites addressing STDs correctly noted that most sexually transmitted diseases are asymptomatic and that when symptoms are present, they may include burning with urination and discharge.
However, information about transmission was often vague or incomplete. Just 9 of 29 (31%) STD Web sites informed adolescents that herpes can be transmitted by kissing, and 14 of 29 (48%) mentioned skin-to-skin contact as a possible source of transmission.
Some contraception information was uniformly accurate, with Web sites making it clear that withdrawal is not a very effective means of preventing pregnancy, and noting that hormonal contraception does not protect against STDs.
On other topics, however, the information gleaned on Web sites was inaccurate or incomplete. More than half of the Web sites that addressed contraception listed weight gain as a possible side effect of birth control pills, a myth contradicted by 47 randomized, controlled trials. Five Web sites incorrectly stated that the calendar/rhythm method is effective at preventing pregnancy, and three misstated the effectiveness of emergency contraception.
Often, the Web sites omitted important information, considering that approximately a quarter of teens use the Internet to answer “some or a lot” of their questions about sexual health, Ms. Tolani said in an interview.
Although 16 of 34 (47%) Web sites noted that minors need a prescription for emergency contraception, they failed to mention that in many states, minors can obtain those prescriptions directly from authorized pharmacists. Very few sites explained exactly where emergency contraception can be obtained by minors or adults. (The Web sites may soon require more revisions, because a federal judge recently ordered the Food and Drug Administration to allow 17-year-olds to obtain emergency contraception without a prescription, and asked the agency to consider extending the option to younger girls.) Nearly a third of Web sites failed to debunk common myths about emergency contraception by explaining that is not an abortifacient, and making a distinction between emergency contraception and RU-486, mifepristone.
Just 5 of 27 (19%) Web sites dealing with contraception reflected 2007 American College of Obstetricians and Gynecologists guidelines recommending IUDs as a safe means of contraception in adolescents. Many were neutral, failing to mention adolescents and IUDs. But three sites incorrectly stated that IUDs should be reserved for parous women, they found.
Most Web sites offering information on Pap smears were updated in the past few years. Nonetheless, their recommendations for when women should have Pap smears “were all over the place,” with 40% offering advice that contradicted ACOG's 2003 guidelines, which state that women should begin receiving Pap smears at age 21 years or 3 years post coitarche, said Ms. Tolani.
She said adolescents will undoubtedly continue to rely heavily on Web sites to obtain sexual health information, but that doesn't mean physicians can't have a voice. “I think physicians need to specifically debunk the myths that we know are out there.”
Neither Ms. Tolani nor Dr. Yen had any conflicts of interest to disclose.
Recommended Sites for Teens
▸ Go Ask Alice! at
▸ Center for Young Women's Health at
▸ TeenWire at
▸ TeensHealth at
Sources: Ms. Tolani and Dr. Yen
Six Common Myths About Sex on the Internet That Physicians Can Debunk
Myth: Emergency contraception is difficult to obtain.