【赫芬顿邮报】加拿大儿科协会建议将子宫内避孕器作为青少年女孩避孕的首选 [加拿大媒体]

-------------译者：翀翀麻麻-审核者：龙腾翻译总管------------



【Depending on the particular type copper-based IUDs may not need to be replaced for five to 10 years.】

【取决于特定的类型，铜制避孕器（IUDs）在未来5-10年内不用更换。】

TORONTO — Teen girls who are considering contraception should look to intrauterine devices as their first-line choice as they provide the greatest protection against an unplanned pregnancy the Canadian Paediatric Society recommends.

多伦多报道——加拿大儿科协会（CPS）建议那些考虑避孕的少女，将宫内避孕器作为首选，因为这是避免意外怀孕的最好保护措施。

The position statement the CPS's first on the issue was set to be released Thursday during the organization's annual meeting in Quebec City.

加拿大儿科协会关于这一问题的第一份立场申明，定于周四在魁北克市举行的组织年会上发布。

Known as IUDs or IUSs the small and often T-shaped devices are placed inside the uterus and are more than 99 per cent effective in preventing pregnancy compared to 91 per cent for birth-control pills and 82 per cent for condoms the CPS says.

加拿大儿科协会声称，众所周知，宫内避孕器是被安放于子宫内的一个小T型装置，其避孕的有效率高达99%，而避孕药和避孕套的有效率则分别为91%以及82%。


    

IUDs or intrauterine devices typically incorporate copper in their design which is toxic to sperm; IUSs or intrauterine systems release a small amount of hormones over time. Both act continuously over the course of several years but can be removed at any time by a health-care provider.

铜制的宫内避孕器（IUD）典型的作用原理是杀死精子（对精子有毒），宫内节育系统（IUS）则是随着时间的推移缓慢释放少量的激素。两者的作用都能持续几年，但是都可以在医护人员的帮组下随时将其取出。

"Intrauterine contraception and the long-acting reversible contraceptives in general ... those should be your first line because they're the most effective" said Dr. Giosi Di Meglio a co-author of the paper and an adolescent medicine specialist at the Montreal Children's Hospital.

蒙特利尔儿童医院青春期研究医学专家这篇论文的合着者Giosi Di Meglio博士称，“一般来讲，宫内避孕器和长效（可恢复生育能力的）避孕药.................这些应是你避孕的首选，因为它们更有效。”

That doesn't mean that young women shouldn't choose the pill or other forms of birth control like a skin patch or injectable contraceptive she said in an interview from Quebec.

在魁北克的一次采访里她还说，这并不意味着年轻女性不可以选择药物或者其他形式（如避孕贴，避孕注射针剂等）的避孕方式。

"What we're saying is this should be an option and this should be something that we think about that leads our list of options."

“我们想表达的是，这应该是一种选择，是一件我们要考虑的事情，它将引领我们的避孕选择列表。”

-------------译者：翀翀麻麻-审核者：龙腾翻译总管------------

Di Meglio said that depending on the particular type copper-based IUDs may not need to be replaced for five to 10 years while the protective lifespan of IUSs ranges from three to five years depending on the make.

Di Meglio说，取决于避孕器的类型，铜制宫内避孕器5-10年内可能都不需要更换，而宫内节育系统的使用寿命依据做工而定则是3-5年。

The devices do carry a small risk of tissue perforation during insertion through the vagina and doctors also monitor patients for possible bacterial infection for a few weeks after the device is implanted. But Di Meglio said such an occurrence is rare and can be treated with antibiotics.

这些装置在插入阴道时确实有很小的组织穿孔风险，而且医生也会在植入该装置几周后对患者进行潜在的细菌感染监测，但是Di Meglio说这种情况发生几率很小，而且可以给予抗生素治疗。

Studies suggest that intrauterine devices are not a direct conduit for infection and there is a theoretical possibility that IUSs may actually decrease the risk of infection she said.

她称，研究表明，宫内避孕器并不是直接的感染渠道，理论上来讲，宫内避孕系统实际可能会减小感染的风险。

Still the idea of having a device inserted may cause anxiety for some teen girls and Di Meglio concedes the procedure can initially be somewhat uncomfortable.

装置植入的想法仍然可能会引起一些少女的焦虑。Di Meglio承认这一过程开始可能会有一点点不舒服。

"You get a few pretty intense cramps but nothing more than you would have with a really bad period" she said. "It subsides pretty quickly and then for the next few days you might have a few cramps on and off."

她表示，“你会有几次非常严重的抽筋，但是没有什么比你处在一次非常疼痛的经期要更严重难受的了。它很快就会减弱，接下来的几天你会断断续续有几次抽筋。”

Di Meglio said a girl can get an IUD or IUS any time after getting their first period and ideally prior to becoming sexually active. By age 17 about half of Canadian youth are having sex the CPS says.

Di Meglio说，女生在第一次例假到来后，就可以在任何时间装上宫内避孕器，最好是在性生活频繁之前。加拿大儿科协会声称，大约有一半的加拿大青年在17岁的时候会有性行为。

"We're not recommending that this be used the minute the kid has their first period but there are certain benefits in using the hormonal IUS — one of them being that it can reduce the amount of bleeding or also reduce cramping a lot" she said.。

她说，“我们不是建议孩子在第一次来例假的时候就使用它，但是使用激素IUS是有一定的好处的，其中一点就是它可以减少出血量或者减少抽筋次数。”

"We have even used it for that reason instead of for contraception in kids who have not even had sex."

“我们甚至是出于那些原因提供它，而不是给那些还没性行为的孩子提供避孕措施。”



【Percentage of women using each form of contraception:

女性使用各种避孕方式的比例：

No contraception：36.4%——无避孕：36.4%
other：9.6%——其他：9.6%
injectible：4.6%——避孕注射剂：4.6%
Male condom：7.7%——男用避孕套：7.7%
The pill：8.8%——药物：8.8%
IUD：13.7%——宫内避孕器：13.7%
Female  sterilization：19.2%——女性绝育：19.2%】

-------------译者：翀翀麻麻-审核者：龙腾翻译总管------------

Up-front costs higher

前期成本更高。

Andrew Townsend of Planned Parenthood Toronto welcomed the CPS recommendation saying the clinic gets a lot of questions from young people who "still view the pill as the first kind of birth control that they should start on or that they have to start on.

多伦多计划生育协会的安德鲁·汤森德（Andrew Townsend）对加拿大儿科协会的建议表示欢迎，他说，诊所遇到很多年轻人的问题，那些年轻人仍然认为避孕药是他们应该开始或者不得不开始的第一项避孕选择。

"Something like IUDs being a recommended option is great because different people have different needs" he said adding that a growing number of clients being seen in the clinic are opting for the implanted devices. The program provides information and health-care services to those aged 13 to 29.

他说：“把一些像宫内避孕器作为避孕的推荐选项这是非常好的，因为不用的人有不同的需求。”他补充说，越来越多的客户在诊所里选择在宫内植入避孕器。这个项目给这些13-29岁的人提供了信息和保健服务。

While intrauterine contraception may be the most effective means of preventing unplanned pregnancy the up-front costs of the devices are high compared with the pill and other methods said Di Meglio.

然而，宫内避孕器可能是最有效的也意味着，和避孕药以及其他方法相比，该装置的前期成本会更高，Di Meglio表示。

One hormone-releasing IUS that lasts five year costs the Quebec government's prescxtion plan about $325 while copper-based IUDs run from about $60 to $100 she said. For those not covered under private insurance the provincial plan covers 65 per cent of the cost of birth control pills and IUDs.

她说，一个可以持续5年释放激素的宫内节育器将要花掉魁北克政府处方药计划约为325美元，而铜制避孕器只需要60-100美元。对于那些没有私人保险的人，省级计划报销65%的避孕药和铜制避孕器的费用。

Coverage by public insurance plans varies across the country. In Ontario for instance long-acting reversible contraceptives are fully covered for women under age 25 along with the physician's fee for implanting one of the devices.

全国各地的公共保险覆盖范围各不相同。例如，在安大略省，长效可逆性避孕药对25岁以下的女性是全保，与此同时，植入装置的医疗费用也在保险范围。

Di Meglio said that over time IUDs and IUSs are actually more cost-effective than most other birth-control methods because of how long they last before needing to be replaced.

Di Meglio说随着时间的推移，实际上铜制避孕器（IUD）和释放激素的宫内避孕器（IUS）的价格比其他的避孕方法更划算，因为在被更换之前，他们持续的时间更长。

The CPS statement also recommends that practitioners adopt a collaborative approach that empowers youth to make informed decisions about their birth control options weighing the benefits risks side-effects and suitability of each method based on individual preference.

加拿大儿科协会声明还建议从医人员采取合作的方式，使青少年能根据自身喜好，在权衡每种方法的益处、风险、副作用以及适用性后，能对他们的避孕方式做出明智的决定。

"At the end of the day we just want to facilitate whatever contraceptive they choose" Di Meglio said.

Di Meglio称“不管最后他们选择哪种避孕方式，最终我们只是想要起到帮助作用。”

-------------译者：翀翀麻麻-审核者：龙腾翻译总管------------

Yvonne Peters4d Leader 3likes
From what I understand the design has changed somewhat to cause less pain and side effects but some of the women I know who have used it in the past have reported terrible pain and other side effects that made them regret using it. Others have had good experiences with it though. I am all for giving teen girls tools to avoid pregnancy but am not sure this would be ideal for all girls. I think it's up to the individual and their level of comfort. I would love to see something more that boys can do as well besides using condoms.

据我所知，（宫内避孕器）设计进行了改良以减少疼痛感和副作用，但是我认识的一些曾经使用过它的女性表示，因为强烈的疼痛和其他副作用让她们很后悔使用。虽然另一部分人体验感很好。我很支持提供避孕方法给少女们，但是我不确定这对所有女生来说都是理想的选择。我想这取决于个体自身以及她们的舒适程度。我非常愿意看到男生们除了使用避孕套，还可以做点其他事情。

Nicky GriffinLeaderYvonne Peters4d 1 Like
As soon as I read this article I imagined having this conversation with my daughter who is all grown up along with my ex-husband. It would not have been easy but would have greatly reduced the fear and anxiety we suffered as we raised our headstrong fiery redhead. Getting her into sports early and repeating the mantra “your body is not a playground” helped but many of her friends were not so lucky.

我一读到这篇文章就在想我和我的女儿谈这个问题时的场景，她是跟着我前夫长大的。这不是件容易的事情，因为我们养大的那个红发女孩任性又火爆，但是这装置可以大大减少我们所承受的恐惧和焦虑。让她提早开始运动，并且用不断重复“你的身体可不是任人玩乐的游乐场”的咒语来帮助她，但女儿的很多朋友们就没这么幸运了。

Rebecca RossiniLeaderYvonne Peters4d 2likes
I would love to see something more that boys can do as well Yvonne.  I have two grandsons four granddaughters and do not want all the responsibility to ladies only.  My grandkids would agree.

我和网友Yvonne一样，希望看到男孩们可以做更多。我有两个孙子以及四个孙女，不希望所有责任都由女士们承担。我的孙子们认同我的这种想法。

George Rudolfo Leader 4d 2Likes
Don’t anyone tell Doug Ford about this. He’ll have a heart attack.

别告诉道格·福特（Doug Ford）这个，他会心脏病发作的。

Melita Vega4d Leader 2 Likes
It's astounding how backwards North America is when it comes to IUDs. The issues with the infamous Dalkon Shield were due to faulty design back in the 1970s. Even the first round of the Pill in the 1960s was known for its severe side effects. Today's formulations and designs have vastly improved. Of course not everyone will adjust to the IUD or even the Pill which is why these discussions should be had with a gynocolgist (not a family doctor). In Latin America and Europe IUDs are far more common and are often the first method of contraception recommended by doctors - especially for young women and teenagers.

令人震惊的是，北美在宫内避孕器方面这么落后。早在上世纪70年代，臭名昭着的“达尔康盾”事件起因是其错误的设计。甚至19世纪60年代出现的第一代避孕药也是因为其严重的副作用而广为人知。如今的配方和设计都有了极大的改善。当然并不是每个人都适合宫内避孕器或者避孕药，这也是为什么要和妇科医生（非家庭医生）讨论这个问题。在拉丁美洲和欧洲，宫内避孕器非常常见，而且它也是医生首先推荐的避孕方式——特别是对年轻女性以及青春期女孩。



（如图：节育环史上的冷血杀手“达尔康盾”诞生于七十年代，其上面带有侧尖峰和尖锐的尾部。它是从一种成功率很低的节育环发展而来，而其独特的侧尖峰和尖锐的尾部（看起来像只会带来不祥之兆的螃蟹）是为了增加成功率，然而这一设计却会使得“达尔康盾”刺入子宫壁，在造成感染时极难取下。 事实上，在第一次实验时，使用“达尔康盾”的女性里，有百分之六十的人选择了中途放弃，但这一重要情况却未被记录进最后的研究报告，于是“达尔康盾”被投入生产，为250万美国女性所使用。随后，18名女性死于其造成的并发症，超过二十万女性因此严重感染，甚至失去生育能力。最终，美国食品药品监督管理局在1974年召回了该产品，而“达尔康盾”的设计者也收到了来自受害人将近一万两千多起诉讼。因为这个事件，节育环的名声一落千丈，很长一段时间在市面上销声匿迹了。）

Jean RoyLeaderMelita Vega4d 3 Likes
Never forget that USA is the most primate country in the world  towards sex due to their over zealous religious  beliefs towards sex. They can kill children in schools due to gun problems but dont you dare talk of simple condoms or birth control.

不要忘记美国是世界上对性最开放的国家，因为他们对性有着狂热的宗教信仰。他们可以在校园内枪杀学生，但是你敢谈论简单的避孕套或者节育试试看。

Rebecca RossiniLeaderJean Roy4d 2 likes
So true.

的确如此。

-------------译者：翀翀麻麻-审核者：龙腾翻译总管------------

Jake Roberts3d Leader 1 Like
The Condom should be the first recommendation imo.

在我看来，避孕套应该作为首选。

Mike NikeLeaderJake Roberts3d
Some people would rather drive off a cliff eating a dirt sandwich...than wear a condom.  They are uncomfortable.

一些人宁愿吃着脏的三明治开车掉下悬崖，也不愿意戴套，他们觉得不舒服。

Carey Finding 3d
Jesus.. I had one of these torture devices put in.  I've broken my leg been bucked off horses blown out both my knees and taken a slapshot to the crotch - NONE of them hurt as bad as having this thing put in.  I actually went into shock felt nauseous and was so dizzy I had to remain lying down for almost a half hour afterwards.  If you haven't had a child having one of these things pushed into your cervix is PAINFUL.  Not only that I had what can only be described as debilitating cramps for months afterwards and bled for almost four months straight.  When I complained to my ob/gyn I was told 'it's normal' while your body adjusts to the thing.  NO. That is not normal.

上帝啊...我体内曾装过这样一个折磨人的装置，而我曾经从马上摔下过、摔断过腿、双膝碎掉过、腰部被一记重击过，但是这些都没有安放这个东西那样疼。实际上我直接休克过去了，感觉恶心，头很晕，以至于我不得不躺了半小时。如果你没有生过小孩，把这个放入你的子宫颈是非常疼的。不仅仅是这些，那之后我还经历了几个月的让人虚弱的抽筋，并且连续4个月一直在流血。当我向我的妇产科医生抱怨时，我被告知“这是正常的”，你的身体正在适应这个东西。不！这并不正常。

Maybe that was just my experience with an IUD but I will never have another and would never recommend them to anyone who hasn't had a child.

可能这也仅仅是我使用宫内避孕器的个人经验，但我绝不会向那些没有生过小孩的人推荐它。

Mike Nike 
As a male I would like a "few hours before" pill so I can control my own reproduction and take the choice away from females.  I can't wear a condom.  I Can't orgasm wearing one.  Have tried many times.

作为一位男性，我愿意吃一片“几小时前服用”的避孕药，这样我可以控制自己的生殖能力，让女性不用做选择。我不能戴套，戴着会让我无法高潮。我已经试过很多次了。

Mark Boyle
Makes sense. Tough to forget to use these once they're in.

挺合理的。进入的时候很难忘记使用这些。

Pamela Farber Leader 1 Like
While I can respect that sure it would be a great solution unfortunately the main factor for me is the percentage of women/youth that cannot have one. That's $500 down the toilet when you need an emergency removal due to unimaginable pain it can cause if your body is not the ideal structure. When I was in the emergency room for the 4th time (as general ER doctors will not remove it) the nurses made plenty of remarks about their concern for how frequent this is happening. Its not an exact science.

我可以尊重这个选择，确实是很好的一个解决办法，但是很不幸，对我而言，主要因素是不能使用这个的女性/青少年的比例。当你的身体结构因不适合这个装置，带来了无法想象的疼痛，而需要紧急取出它的时候，丢弃在厕所的可是500美元啊。当我第四次在急诊室时（一般的急诊医生不会取出），护士们对这种手术的发生频率做出了很多评论。这并不是一个严谨的科学。

Jean RoyLeaderPamela Farber4d
Guess nothing is perfect.

我猜这世上没有什么事情是完美的。

-------------译者：匣漆-审核者：龙腾翻译总管------------

Garbriel Longfordo Leader 4d 2 Likes
Considering the long history of IUDs causing damage to women's reproductive systems you would have to be out of your damn mind putting one of those things in your teen daughter. I have yet to ever hear of a condom that shreds the wall of a cervix.

考虑到宫内节育器长期以来损伤女性的生殖系统，你一定是疯了才会把这玩意儿给你青春期的女儿装上。我还从未听过避孕套会割破子宫颈壁。

Nicky GriffinLeaderGabriel Longfordo4d 6 Likes
I don't know where you get your information or if the words "toxic to sperm" triggered you but if anything can reduce the chances of teen pregnancy I would consider it.  Too often we hear them saying: "but it was just one time" before their lives are ruined at 15 or 16 and never get a chance to finish high school.  Can you imagine boys having to pay child support at that age?

我不知道你从哪得来的信息，或者是“对精子有毒”这个词刺激了你，但是，只要能够减少青少年怀孕的机会，任何办法我都会考虑。我们经常听到他们说“但是就只有那一次而已啊”，然后他们的人生于在五六岁时就被毁掉了，之后再也没有机会从高中学业。你能想象男孩们在那个年纪就要支付宝宝的抚养费吗？

Tim HindsonLeaderNicky Griffin4d 4 Likes
Anything that can safely reduce the cases of unwanted pregnancies are something that I wholeheartedly support as they also result in the reduction of medical costs associated with medically terminated pregnancies as well as the stress that accompanies them.

任何可以安全减少意外怀孕情况发生的东西我都全力支持，因为这还可以减少流产相关的医疗费用并减轻随之而来的压力。

Nicky GriffinLeaderTim Hindson4d 1 like
And that's the other angle.

这是另一个思维角度。

Ian Monteith  LeaderGabriel Longfordo4d 6 Likes
You may be thinking of the old Copper T which was a very bad design. Today's devices are far safer. They also don't rely on the cooperation of a hormonally lobotomized teen boy to function.

你可能会回想起那设计糟糕到底的旧式铜制节育器。现在的设备要安全得多。这些设备不需要那些激素猛增（下半身冲动上脑）的青春期男生们（为避孕而克制自己）的合作。

tbLeaderGabriel Longfordo4d 4 Likes
Yeah 'history' being the main word here. These have changed a lot in the past few years. My wife recently had hers removed and she is now pregnant with our first child. No harm to the cervix defintely didn't 'shred the wall of a cervix' as you politely put it.

你这里的关键词是“历史”啊。过去几年（宫内节育器技术）变化很大。我的妻子最近移除了节育器，现在已经怀上我们第一个宝宝。针对你委婉提出的问题，（节育器）一点都没有伤到子宫颈，更别提“割破子宫颈壁”了。

Melita VegaLeadertb4d
Congrats! You've touched upon another reason why IUDs are a good option: they don't mess with a woman's fertility like the Pill does (specifically the copper IUD). Assuming the woman is in good health and has no pre-existing conditions that would hinder her fertility pregnancy after an IUD removal is fairly easy.

恭喜（反讽）！你谈及了宫内节育器为何是个不错选择的另一个原因：它们（特别是铜制节育器）不会像避孕药那样紊乱女性的生殖功能。假如一位女士身体健康并且没有预先存在的妨碍她生育的条件（指其他不孕因素），那么在摘掉节育器后怀孕是很容易的事儿。

Lauraine Howatt4d 1 like
No No.  A child would not know how to manage the thing inside of them. Copper is toxic to sperm.  What happens to that toxicity in her body over time?

不不，一个孩子怎么可能知道要如何管理体内的这东西（指宫内节育器）。铜对精子有毒性。试想下一旦时间长了，万一毒素在她体内发生什么变化可咋办？

Melita VegaLeaderLauraine Howatt4d 3 Likes
There is nothing to manage. I had my first IUD implanted at 19 and I've had 4 replacements over the last 20 years. I've never even felt it in my body. The one I'm on now will last me until menopause and there have been no adverse side effects with the copper. I just went to see my gyno today and have a clean bill of health. The Pill does far worse damage.

（宫内节育器）没啥要打理的。我在19岁时植入了第一个宫内节育器，在过去20年里又换过4次。我根本感觉不到它在我体内。我现在装着的这个会一直持续用到更年期，且铜没有任何不良副作用。我今天才去看过妇科，身体完全健康。避孕药的危害更严重。