Transplantation is a chance to obtain a normal life after acute or chronic organ dysfunction. What few teens realize is that after organ transplantation, it is still possible to have a normal sex drive (libido), to become pregnant, and to contract sexually transmitted illnesses. This article represents the second in a three-part series on special health issues related to family planning and reproductive health maintenance. Here some questions that most young adults ask about puberty and contraception after undergoing transplantation:
Will I grow and develop normally after I have received a transplant?
Puberty and reaching adult height is usually delayed by one to two years more than the general population in transplant recipients. This is due to a person’s overall health before transplant, what kinds of medications are used after transplant, and the timing of the transplant in proximity to puberty. Girls can expect to begin having periods by age 14-15, and boys and girls can expect to have gained their adult height by as late as 19 years of age. For those young adults who were already having periods, by one year post-transplant, most have resumed menstruating.
 | The transplant team can review your medical profile with you and help you understand the impact of various types of birth control on your health. Carly Bhave, R.N., M.S., C.R.N.P. speaks with a patient about sexual health issues. |
If I am sexually active with the same person, do I need to worry about sexually transmitted diseases?
Yes. Even if your partner has not changed, you should always protect yourself against disease. In a report done by the National Transplant Pregnancy Registry most respondents reported using the coitus interruptus method only, known as "pulling out", which is a highly unreliable way to try to prevent pregnancy. It does not prevent individuals from contracting sexually transmitted diseases. The biggest risk of unprotected sex is getting a sexually transmitted disease such as HIV (the virus that causes AIDs), Gonnorhea, Chlamydia, or Hepatitis. These diseases are extremely difficult to treat in transplant recipients. Furthermore, these diseases have dangerous lifelong health consequences, and some can result in death. Kidney transplant recipients should especially be aware of this because these infectious organisms can easily travel to the bladder and the transplanted kidney.
Why should I worry about pregnancy if my periods are not normal?
It is still possible to ovulate even though the periods are not normal, which will make pregnancy possible. For many reasons, pregnancy is dangerous for the baby and the young adult, especially for a young adult who is close to the time of transplant. During periods of high doses of anti-rejection drugs, most teens are susceptible to certain viruses such as EBV and CMV (see box below) that are harmful to a developing fetus. Pregnancy can also spur a rejection because anti-rejection drug levels can plummet as the blood volume of the mother literally triples. Most teens in general who become pregnant have more limited resources than adults and their bodies are not fully developed yet. For this reason, most of those pregnancies result in premature babies, which jeopardizes the baby’s and the mother’s health.
What is the best way to prevent pregnancy for me?
There are choices to prevent pregnancy that should be discussed with every sexually active young adult and the transplant team during routine clinic visits. The absolute safest alternative is abstinence or the use of a condom. Condoms are recommended even when using oral contraceptives -"the pill"- in order to prevent disease. Low-dose birth control pills with estrogen and progesterone combinations are now well-tolerated in post-transplant recipients. Birth control pills can have very serious increased risks such as blood clotting, high blood pressure, and an increased risk in breast and cervical cancer, however, the risks are relatively low. The new forms of birth control such as the patch, the shot given every three months, and cervical rings may also be options to prevent pregnancy. Thus, this does not mean that transplant recipients have to shun birth control methods. It simply means that before deciding on any type of birth control method (or any medication that has been prescribed), transplant recipients should discuss their options with their transplant team.
In conclusion, transplant recipients do grow and function normally. Young adults who are influenced by peer pressure must consider that they carry the same risk as their peers for pregnancy and sexually transmitted diseases. Pregnancy and birth control are best when they are planned in collaboration with the transplant team to avoid health problems. By making these issues the topic of a routine clinic visit, you can maintain better health and think responsibly about your romantic relationships.
- Carly Bhave, R.N., M.S., C.P.N.P.
Pediatric Transplant Coordinator
