This page advises on how to support teens with heart conditions as their relationships change and sexuality begins to develop.
Relationships
When children miss time at school because they are in hospital, their existing relationships with friends or ability to make new friends may be compromised. The same holds true if they cannot participate in the same activities as their peers. Classmates may also feel uncomfortable around peers with medical conditions, and may alienate them if they do not understand their condition. The self-esteem of children and adolescents with a heart condition may suffer as a result since acceptance by others is so important at this stage of life.
Helping your child fit in
Encourage your child, and provide opportunities, to spend as much time as possible with friends. Encourage your child to develop interests and join clubs to meet others. Encourage your child to talk about issues regarding friendships, or a lack of friends. Teach your child how to discuss their heart condition and if they want peers to know about it. Teach your child how to cope with teasing and use humour as a way to diffuse tension, as well as ways to meet people and connect with them. Support groups for teenagers with CHD may also be helpful.
Sexuality
Sexual development
As a parent, you may be wondering about their ability to have children. Or, if your child is entering his teenage years, you may be avoiding thinking about the sexual development of your child. It is important not to ignore this aspect of your child's development. These teenagers need the same information as any developing adult, along with information unique to their situation. Not only will you have questions, but they will too. Studies show that the teenagers are interested and open to sexual health information.
Menstruation
Managing expectations
Studies indicate that girls with CHD tend to start their periods later than expected. Girls with cyanotic CHD also tend to be a little more irregular and their periods vary more in duration than normal. In addition, women with cyanotic CHD may experience more symptoms, or severity in symptoms, before their periods, like muscle aches, headaches, and fatigue. The symptoms resolve once the period arrives. They can also be slightly underdeveloped for their age. All of this is likely to be hormone related.
Treatment
The best thing to do is see a doctor if periods continue to be irregular (or do not occur at all) once the child turns 18. A gynecologist can determine whether a woman is ovulating and will be able to have a child. Also, pre-menstrual medications like Pamprin and Midol are usually safe, though it is best to check with your child’s doctor before taking them.
Sex and contraception
Safe sex and the CHD teenager
Since issues of self-esteem and body image may come into play more often with teenagers who have a CHD, getting involved in a physically intimate relationship may be challenging. There may also be fears that sexual arousal may pose a risk to the heart. Some people worry that if they have sex, they might die. These issues need to be addressed with a health professional in order to facilitate healthy physical and emotional relationships. In general, teenagers with CHD are less sexually active than their healthy peers.
Sexual activity among adolescents with CHD brings about similar issues similar to those faced by typically developing teenagers. Such issues can include when to become sexually active, awareness and prevention of sexually transmitted diseases, and contraception. The same principles governing physical activity among teenagers with various severities of CHDs apply in sexual relations as well.
Young adults with CHD should get information about having sex well before they consider becoming sexually active. It is more than likely that a pediatric cardiologist, rather than an adult cardiologist will be the one to provide this early counselling.
Some heart drugs can cause decreased sexual desire or impotence. To find out more, your teenager should speak privately to their cardiologist about sexual activity, birth control, and risks associated with pregnancy.
Contraception
It is important to speak to the cardiologist about what kind of birth control is best. Oral contraceptives (combined estrogen and progesterone) are safe for most young girls with CHDs; however, they are not appropriate for those with cyanotic CHDs, complex disease, or pulmonary hypertension. The concern with oral contraception is that it increases risk of blood clots, so oral contraception should not be used by those at risk for clotting or with high blood pressure (progestin-only contraceptives may be an alternative.) Oral contraceptives may be used, however, in some women taking anticoagulants. The risks associated with the pill in healthy girls and women still apply to those with CHD, and apply particularly to those who are overweight and who smoke.
Intrauterine devices (IUDs) should not be used if bacterial endocarditis is a risk.
A condom with spermicide is 97% effective if used consistently. The most ideal choice may be contraceptives administered by injection or implanted like Norplant, which is inserted under the skin of the arm and releases a constant level of hormone. If pregnancy is contraindicated, or if a family is complete, tubal ligation is the suggested option to ensure no future pregnancies.