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The more you know the facts about the changes you're experiencing, the easier your life is going to be. Whether you're just beginning your teen years or about to finish them, it's important to understand how your body has changed in the past, is changing now and will change in the future. This leaflet presents information you need to know.
YOUR SEXUAL ANATOMY
Learning about sexual anatomy will help you understand sexual development. While most teens may think they already know the facts, many don't. Many don't even know the correct names for parts of their own bodies. Being ignorant about your body will probably contribute to your confusion, anxiety, fear and embarrassment about sexuality. Take the time to become sexually literate. Read this leaflet and don't be afraid to ask questions about things you don't understand.
A person's external genitals are located in the front of the body between the legs. The entire area of the external female genitals is called the vulva and is illustrated in Figure 1. You can see the clitoris and hood of the clitoris. The head of the clitoris can often only be seen when a fold of skin (hood) is gently pushed up. Not much of the clitoris is visible because it is covered by the labia and extends inside the body. Stimulation to this highly sensitive area can provide a lot of pleasure.
Just below the clitoris is the very small urinary opening known as the urethra and below that is the opening of the vagina. The anus, through which the bowels empty, is still lower. You'll also notice the labia majora and labia minora. The labia majora, often called the "outer lips," extends from above the clitoris down to below the vaginal opening. They include a fold of skin on each side which usually meet and cover the urinary and vaginal openings. The labia minora or inner lips are inside the outer lips and extend from just above the clitoris to below the vaginal opening. While they are called "inner lips," it is not unusual for them to protrude beyond the outer lips.
A female's vagina connects her external genitals to the internal reproductive system (see Figure 2). The cervix is at the top of the vagina and is the neck of the uterus. The uterus, or womb, is a cavity whose purpose is to hold a fetus until birth. Two fallopian tubes lead from the uterus and connect it to the ovaries which produce both eggs, or ova, and female hormones.
The male external genitals, which are easier to see than the vulva, are illustrated in Figure 3. The penis hangs away from the male's body. The glans is at the tip of the penis. Sometimes it is covered by the foreskin and sometimes it isn't. When it isn't, chances are it was removed soon after the baby was born in an operation called "circumcision." The scrotum is a sac which hangs beneath the penis and contains two testicles.
The testicles are part of the internal male reproductive system, which is shown in Figure 4. They produce male reproductive cells called sperm as well as male hormones. The vas deferens is a duct that carries sperm away from the testicles. Two glands, the seminal vesicles and the prostate, produce a milky fluid called semen which carries the sperm through the urethra and out the end of the penis. The urethra also is connected to the bladder and carries urine, though never at the same time as it carries semen and sperm.
PUBERTY
While you've probably heard people use the term "puberty," you may not know exactly what it means. Puberty refers to gaining the ability to reproduce and includes a variety of physical, psychological and social changes.
Our bodies produce chemicals called hormones which guide the physical changes we experience during puberty. Two hormones, estrogen in girls and testosterone in boys, direct the sexual development of young women and men.
It's important to realize that not everyone reaches puberty at the same time. Puberty can begin as early as age 8 or as late as age 15. Girls generally reach puberty earlier than boys. The age at which puberty begins is affected by the age your parents reached puberty, nutrition, percent body fat and a host of other factors.
Many teenagers worry that they are developing too slow or too fast. They become anxious and embarrassed about their bodies. What's important to realize is that it's normal for everyone to be different when it comes to growing up. Learning about the stages of sexual development can help you become more comfortable with the changes taking place in your body. Knowing what's happening to your body and what to expect can lessen your worries.
FEMALE SEXUAL DEVELOPMENT
The physical changes females experience during puberty can be outlined in four stages. These stages are best thought of as guidelines since all girls do not follow the same identical pattern or develop at the same rate.
| Sometime between ages 8 and 11. Hormones signal the ovaries and other
internal reproductive organs to start growing. This increases the amount of
estrogen produced.
Sometime between ages 9 and 15. The darker area around the nipple known as
the areola and then the breasts increase in size and develop a more rounded
shape. While still sparse, pubic hair, which grows between the legs, becomes
darker and coarser. Body fat continues to round body contours as growth in
height continues. Normal vaginal discharge becomes noticeable. Acne may
appear as sweat and oil glands become more active. The vagina becomes longer
and the labia more pronounced as both internal and external reproductive
organs and genitals grow.
|
Sometime between ages 10 and 16. Both the areola and nipples grow. Pubic
hair begins to take a triangular shape and underarm hair appears. The first
menstrual flow or period occurs. As internal organs continue to develop, the
ovaries may begin to produce mature eggs that are capable of being
fertilized. Growth in height occurs more slowly.
|
Sometime between ages 12 and 19. Breasts approach adult size and shape and
pubic hair spreads to the top of the thighs. The voice may deepen slightly
and menstrual cycles gradually become more regular.
|
It's normal for females to experience increased sexual desires, dreams,
fantasies and arousal during puberty. As a female becomes sexually excited,
her vagina becomes wet. When she becomes very excited, she has an orgasm.
Orgasm occurs when sexual tension reaches its peak and is suddenly
discharged. This extremely pleasurable, involuntary response lasts a few
seconds. | |
MENSTRUATION
Beginning menstruation is one of the most significant events of puberty for young women and usually begins between the ages of 10 and 16. It's important to understand why and how it occurs.
The ovaries usually produce one egg each month. After the egg is released, known as "ovulation," it travels down one fallopian tube towards the uterus which has been preparing for pregnancy by becoming full of extra blood and other tissue to support a developing, fertilized egg. If the egg and sperm join together in the fallopian tube, fertilization occurs. Pregnancy then begins if the fertilized egg attaches itself to the lining of the uterus.
Most of the time this doesn't happen, however. The egg does not meet a sperm and it begins to break apart before it gets to the uterus. In this case, the tissue and blood which line the uterus aren't needed and they flow out the uterus, through the cervix and vagina and out of the body. This is what is known as menstrual flow or "having a period."
One of the most important things for girls to understand is that menstruation is normal and healthy. While blood is a sign of injury or disease in other circumstances, in this case, it's a sign they are growing up. It's also important for girls to realize that they can manage their menstrual flow without disrupting other aspects of their lives such as school athletics and social events.
Sanitary pads or tampons are used to absorb the menstrual flow. Pads stay in place by an adhesive strip that sticks inside the underwear. A tampon, on the other hand, fits inside the vagina and is held in place by the vaginal walls. The tampon has a string that hangs out of the vagina and it is easily removed by pulling the string. Pads and tampons are available in drugstores and supermarkets and come with instructions on how to use them.
Teenagers should not be surprised if their periods vary in how long they last or how far apart they occur. It's normal for young women to have an irregular pattern of menstrual cycles when they first begin menstruation. In fact, it's not unusual for three to six months to go by between periods. It can take up to seven years for young women to establish their regular, more predictable cycles when they probably will have a menstrual flow every four or five weeks.
While most women and girls do not have severe problems with menstruation, some do have cramps the first day or two of their periods. A girl who has bad cramps or a menstrual flow that seems unusually heavy should talk to her parents, a school nurse, doctor or teacher. Medicine can be taken to reduce the pain of menstrual cramps.
In addition, some females may experience physical or emotional discomfort before their periods begin. This is known as "premenstrual syndrome" (PMS) and is due to hormonal changes that occur the week or so before their periods begin. Eating a healthy diet and engaging in moderate exercise reportedly reduce the symptoms of PMS for some. Since PMS is a treatable physical problem, it's a good idea to talk to a doctor if symptoms continue.
MALE SEXUAL DEVELOPMENT
The physical changes that males experience during puberty can be outlined in four stages. Think of the stages as guidelines. Not all boys follow the same identical pattern or develop at the same rate.
| Sometime between ages 9 and 15. The first noticeable change occurs when
the testicles begin to grow, the scrotum becomes redder and coarser, and a
few pubic hairs appear at the base of the penis. Body shape changes as the
hormone testosterone causes muscle mass to develop and height increases. The
circle of darker skin around the nipple (areola) grows larger and darker.
Sometime between ages 11 and 16. The testicles and scrotum continue to
grow and the penis becomes longer. Pubic hair becomes both coarser and more
curled and spreads to cover the area between the legs. The body increases in
height, the shoulders broaden and the hips narrow. The voice begins to
deepen as the voice box or larynx becomes larger. Sparse facial and underarm
hair appear.
|
Sometime between ages 11 and 17. The testicles continue to increase in
size and the penis begins to increase in circumference as well as in length.
Growth of underarm and facial hair increases and shaving may begin. The
internal reproductive organs mature enough to produce the first ejaculation
of semen and sperm.
|
Sometime between ages 14 and 18. The body nears its final adult height and
the genitals achieve their adult size and shape. Pubic hair spreads to the
thighs and upward towards the stomach. Chest hair appears. Shaving becomes
more frequent as facial hair reaches its full growth. Height, body hair,
muscle growth and strength continue to increase into the twenties for some
young men. | |
Males, like females, experience increased sexual desires, dreams, fantasies and arousal during puberty. As a male becomes sexually excited, his penis fills with blood and gets hard and erect. When he becomes very excited, he too has an orgasm and a sticky liquid spurts out the end of his erect penis. This pleasurable experience is also called ejaculation or "coming." The sticky liquid is semen or "cum" and contains sperm which were made in the testicles. Usually, about a teaspoon of semen is released at a time. Every drop of healthy semen contains millions of invisible sperm. Even the semen that oozes out of the penis before ejaculation contains sperm and can cause pregnancy.
Most boys and men have erections and ejaculate in their sleep. This often occurs when they have sexual dreams and is called a "wet dream." While they may come as a surprise to a male who is not prepared for them, wet dreams are healthy, cannot be controlled and should not be a cause for concern.
Young men also often have erections in nonsexual situations or for no reason at all. While they can be embarrassing, it's important to realize that they are normal and a sign of good health. They usually go away in a few minutes if you stop worrying about them. A hard penis will become soft again even without an orgasm or ejaculation.
ACCEPT YOUR BODY
Some teenagers react to all the changes going on in their bodies by becoming very anxious and self-conscious. They don't like the way they look or worry that the changes they are experiencing are not "normal."
Young women are particularly likely to worry about their breasts. They worry about breasts that are too big, too small or don't match. These women should try to accept their breasts as they are. They shouldn't judge themselves against the bodies they see in magazines or on television. Breasts, like all body parts, naturally come in a wide variety of shapes and sizes. In fact, more than half of all women have visible size differences between their own two breasts. Regardless of shape or size, a woman's breasts can give her sexual pleasure when they are touched. Because they are mammary glands, they produce milk after the birth of a baby. The size of a woman's breasts does not affect the amount of milk she produces.
Similarly, young men are likely to be worried about the size of their penises and testicles. They often worry that they are too small. These males need to simply accept themselves as they are. There is no magical "normal" size. There simply is a variety of sizes and shapes. Although it can be shorter or longer, the erect penis usually varies from four to eight inches long. About six inches is average, regardless of size when not erect. Penis size does not determine the sexual enjoyment of either a male or his sexual partner.
If you're concerned, anxious or worried about the way your body looks, try to understand that being masculine, feminine, cute, attractive or sexy depends far more on personality than the size and shape of any part of your body. How you think about yourself, take care of yourself and treat other people are far more important than any physical characteristic.
FEELING GOOD ABOUT SAYING "NO"
Some of the toughest decisions you have to make involve intimate relationships and sexuality. You may feel surrounded by sexual talk and images. You may be experiencing strong sexual feelings. At the same time, you've got the task of deciding what is "right" for you. In addition to deciding what is right, you also need to decide how to do what is right for you. In other words, you need to live your values. That isn't always easy.
CHOOSING ABSTINENCE
One thing to keep in mind as you make your decisions is that saying "no" is a valid option. Contrary to what you may hear, everyone is not "doing it." Many teens choose abstinence, which means not engaging in sexual intercourse.
There are a variety of good reasons to choose abstinence. The best, and simplest, reason is because you think it is the right thing to do. If your ethical or moral beliefs prohibit sex at a young age or outside of marriage, abstinence is the choice for you. Using your own values to guide your sexual decision-making is a sign of sexual integrity and is something you should feel good about.
Not being ready for sex is another good reason to choose abstinence. Before having sex, you should be willing to take responsibility for your own sexual behavior. There are a number of ways to tell if you're not ready for sex. You are not ready if:
| You're not willing and able to take on the responsibility of parenthood if
you or your partner becomes pregnant and has a child.
You cannot talk to your partner about sex.
|
You're too afraid to ask your doctor for birth control or to purchase it
yourself.
|
You're too embarrassed to talk to your partner about the necessity of
using a condom.
|
You're not sure how you feel about your partner or how your partner feels
about you.
|
You're not thinking of the well-being of your partner and how having sex
will affect your relationship.
|
You just want to have sex to get it over with.
|
You're not really sure you should do it. | |
Don't think that not being ready for sex is a sign of immaturity. On the contrary, realizing you aren't ready for something as complex as sex and avoiding it is a sign of maturity. It is something you should feel good about.
Another good reason to choose abstinence is the fact that it is a "safe" decision. The risk of an unwanted pregnancy which could alter your educational or career plans is real. The risk of contracting a sexually transmitted disease which could threaten your health, if not your life, is real. While practicing "safer sex" greatly reduces these risks, it does not totally eliminate them. Abstinence is the only completely safe behavior and is, therefore, something you should feel good about.
It's important to realize that it's never too late to choose abstinence. Even if you've had sexual intercourse in the past, you can choose not to continue this practice in the future.
LIVING YOUR VALUES
Practicing abstinence is not always easy. Teens face a lot of pressure to have sex. If abstinence is your choice, you need to think about the sources of that pressure and how to avoid or resist it.
Under the right circumstances, sexual passion may override your best intentions. Those circumstances may be as innocent and ordinary as time alone with the person you are in love with. The best way to avoid stumbling into sex is to make sure you are adequately prepared. Anticipate the circumstances you may find yourself in and rehearse what you will say and do. Consider the following suggestions:
| Find enjoyable, sex-free activities and ways to express your love for a
romantic partner.
Acknowledge your partner's feelings. Say, "I understand you have
strong sexual urges, and that's ok, but that doesn't mean we have to have
sexual intercourse."
|
Explain your position. Tell your partner that you care for him or her but
you don't want to have sex and that you'd appreciate it if he or she would
respect that decision.
|
Say, "No, I don't want to have sex." Say it firmly and with
feeling. If necessary, say it repeatedly. Say, "If you really loved me,
you wouldn't keep asking."
|
If your partner threatens to break up with you because you won't have sex,
don't try to stop him or her. Say, "I'm sorry you feel that way, but
that won't make me change my mind." A partner who won't respect your
wishes isn't worthy of your affection.
|
If your verbal refusals are not sufficient to stop his or her advances, be
prepared to take other action. Be prepared to get out of a car stopped at an
intersection. Be prepared to approach strangers, police cars or unfamiliar
houses on an unfamiliar street to seek help. While such actions require
courage and involve risks, living your values is worth it.
|
Avoid alcohol and other drug use. In addition to other drawbacks, their
use can impair your ability to make sound decisions. | |
SETTING LIMITS
There are many forms of sexual behavior that vary in degree of intimacy from kissing and intimate touching to intercourse. While we've been focusing on intercourse, you need to think about other forms of sexual expression as well. You need to think about whether you consider them right for you. That's a decision you have to make based upon your own values, and it is important because it sets your sexual limits. The suggestions for living your values discussed above can help you avoid and resist the pressure to go beyond those limits.
No discussion of alternatives to sex with a partner would be complete without considering masturbation. Masturbation involves stimulating one's own body, usually the genitals, for sexual pleasure. Since some people consider masturbation to be wrong and there are many myths about it, masturbation is a sensitive topic many people feel uncomfortable discussing. How you personally feel about masturbation is something else you have to decide yourself based upon your own values. You do need to know the facts, however. The most important thing to know is that masturbation is quite common among both males and females and that it does not cause any kind of physical or mental harm. It's also safe. You can't get yourself pregnant. You can't get a sexually transmitted disease from yourself.
SAYING "KNOW"
Just because you've decided not to be sexually active at this time doesn't mean you shouldn't be informed about sexuality. Just as you receive training and learn many job-related skills long before you ever become employed, you need to learn accurate information about sexuality long before becoming sexually active.
A person should understand sexual development and functioning and have accurate information about sexually transmitted diseases and how to prevent their spread before becoming sexually active. Heterosexuals also should know how reproduction takes place. That includes knowing the effectiveness of various contraceptive or birth control methods and how to use them correctly.
If you've decided to say "no" to sexual intercourse, you can use this period of your life to acquire the type of accurate information that will enable you to continue to make responsible sexual decisions that are right for you. Other leaflets in this series titled "Sexual Integrity for Teens" provide such information. Obtain and read them. Saying "no" to intercourse and "know" to sexuality should go hand-in-hand. Both can be signs of sexual integrity.
If you decide that you do not want to become a parent at this time, the information contained in this leaflet will provide some of the information that will help you make an informed decision about the strategy for controlling birth that is "best for you."
Since discussions of birth control involve the topics of sex and relationships with intimate partners, many ideas of what is right or wrong and good or bad are involved. Some people's moral and religious values will lead them to view some of the alternatives as being unacceptable. How you view them and whether you practice them is your own personal decision. Being informed about the options will help you decide what you want to do.
NOT HAVING INTERCOURSE IS AN OPTION
The surest way to avoid pregnancy is not to have sexual intercourse. For many unmarried young people, this is the only viable option since they believe either that they are not ready to have intercourse or that sex outside of marriage is wrong. If this describes you, make up your mind to say "no" and stick with it. Remember that acting out your values is a characteristic of sexual integrity.
Whether or not abstinence is the best option for other groups of young people depends on a variety of factors such as the nature of their intimate relationships or their marital status.
Despite what you may have heard, everyone is not "doing it." When considering abstinence, it's important to remember that just because you've had sex in the past doesn't mean you have to continue this practice. It's possible to say "no" at any time.
IF YOU ARE SEXUALLY ACTIVE
If you are sexually active, knowing key facts about the most common methods of contraception can help you make informed decisions. As you consider each method, ask yourself the following questions:
| Will I have trouble using this method correctly?
Will I have trouble remembering to use this method?
|
Does this method require cooperation from my partner? If so, is that a
problem?
|
Is this method too expensive? | |
Thinking about these questions can be confusing and embarrassing. That is normal, but you need to make yourself think about contraception if you are having, or plan to have, intercourse and do not want to become pregnant.
You also need to talk about these issues with your sexual partner. If you don't feel comfortable discussing contraception with your partner, ask yourself, "Should I be having sexual intercourse with someone I cannot talk to?" Contraception works best when a female and male choose and use it together.
THE BIRTH CONTROL PILL
"The pill" is among the safest and most effective forms of contraception for young women. Combination birth control pills, the kind most commonly prescribed, contain two hormones an estrogen and a progestin. Mini-pills contain progestin only. Both types of pills must be prescribed by a doctor or health care practitioner after a physical exam and risk evaluation.
When using birth control pills, you must take one every single day. It is best if you do this at the same time each day. When used correctly, the pill is a highly effective form of birth control. The lowest expected failure rate is less than 1 pregnancy per 100 users per year. On average, there are about 3 pregnancies per 100 users per year. The mini-pill is slightly less effective.
While the risks from the pill are slight, there are a few side effects like slight weight gain, breast tenderness, and light spotting between your menstrual cycles. In most cases, these are not serious and usually go away. When considering your options, it is important to realize that the pill, or any other form of contraception, is safer than the risks associated with an unplanned pregnancy. The pill does not, however, protect you from sexually transmitted diseases.
DIAPHRAGM OR CERVICAL CAP
The diaphragm and cervical cap are quite similar. A diaphragm is a shallow rubber cup stretched over a flexible ring. A sperm-killing cream or jelly (spermicide) is applied to it and it is inserted into the female's vagina to cover the opening to the uterus (cervix). A cervical cap, on the other hand, is a small thimble-shaped cup made of soft latex rubber that fits over the cervix inside the vagina. It too is used in conjunction with spermicidal jelly or cream. Diaphragms and cervical cups must be fitted by a clinician because women's vaginas vary in size. In addition, if a woman gains or loses considerable weight or gives birth, a refitting is necessary if she is using a diaphragm.
Both devices must be inserted before intercourse and provide protection in two ways. They block sperm from reaching the uterus while the spermicide kills sperm. The diaphragm can be put in the woman's vagina six hours before intercourse and left in for twenty-four hours. The cervical cap can be left in her vagina for up to forty-eight hours. After these devices are removed, they should be cleaned and stored. Directions on how to care for and store them are provided when they are purchased.
The lowest expected failure rate for diaphragms and cervical caps is about 3 to 5 pregnancies per 100 users per year. On average, there are about 18 pregnancies per 100 users per year. Users can get better protection by checking each time they have intercourse to make sure the diaphragm or cap covers the cervix and by having their partner use a condom. Also, reapplying the spermicide for repeated sexual encounters will increase the effectiveness.
NORPLANT
Norplant consists of six flexible capsules filled with progesterone that are inserted in a fan-like pattern beneath the skin of a female's upper arm. Once inserted they are only slightly, if at all, visible. A tiny amount of progesterone is released every day and works by inhibiting ovulation, thickening of the cervical mucous, and/or decreasing the thickness of the uterine lining. The procedure for inserting the Norplant device is not painful and can be performed during a 30-minute routine office visit.
Norplant is a very effective means of contraception. The lowest expected failure rate is significantly less than 1 pregnancy per 100 users per year. On average, there is less than 1 pregnancy per 100 users per year. Norplant is effective for five years. At the end of that period, or sooner if the user desires, the Norplant device is removed in a manner similar to that of the insertion procedure. If desired, a new set of capsules may be inserted at the same time the old set is removed.
DEPO PROVERA INJECTIONS
Depo Provera is a contraceptive injection or "shot" of long-acting progestins. Like the pill and Norplant, it keeps a woman's body from producing eggs. A woman using Depo-Provera goes to a doctor or clinic to be injected every three months. The first shot is given within the first seven days of a menstrual cycle (within seven days from the first day of bleeding). Since it does not become effective immediately, a woman should use an additional contraceptive method for two weeks after her first injection.
Like Norplant, Depo Provera is very effective. Its lowest expected and actual failure rates are significantly less than 1 pregnancy per 100 users per year. Unlike other hormonal birth control methods, the shot is safe for women who have just had a baby and can be used safely by women who are breast-feeding.
While Depo Provera is a good choice for many women, there are certain women who should not opt for this method. Women who want to become pregnant within the next two years should choose another birth control method since a return to fertility is sometimes delayed.
INTRAUTERINE DEVICE (IUD)
While you may have heard of intrauterine devices, they are not recommended for young women who have never had children. An IUD is usually made of soft flexible plastic in the shape of a "T" and come in various sizes. It is worn inside the uterus after insertion by a doctor or other clinician. While there are a number of theories, we are not completely sure how IUDs work. The lowest expected failure rate is about 1 to 2 pregnancies per 100 users per year. On average, there are about 3 pregnancies per 100 users per year.
MALE CONDOMS
The male condom, also called a "rubber" or "prophylactic," is an over-the-counter method used by men. You can buy it without a prescription. It is shaped like the finger of a glove and is made of latex rubber or animal tissue. The condom is rolled onto the erect (hard) penis before the penis comes into any contact with the vagina. It works by catching ejaculated semen (come), thus preventing sperm from getting inside the woman's vagina.
Those using a condom should be careful to leave a little space at the tip to catch the sperm and help prevent it from bursting. The male also should withdraw, while holding the base of the condom, before his erection subsides in order to keep the condom from slipping off. A new condom should be used for each act of intercourse. In addition, avoid storing condoms in warm places and using Vaseline or petroleum-based lubricants that weaken latex.
The male condom's lowest expected failure rate is about 2 pregnancies per 100 couples using condoms per year. On average, there are about 12 pregnancies per 100 couples per year. When used in conjunction with a vaginal spermicide, such as a jelly or foam, failure rates are significantly lower.
Use of latex condoms by those who are sexually active is the most effective way to prevent the spread of sexually transmitted diseases, including AIDS. Using a spermicide containing Nonoxynol-9 along with a condom results in even safer sex.
FEMALE CONDOMS
One of the newer over-the-counter birth control methods is the female condom. Made of polyurethane, which is a thin plastic, it covers the cervix and the vagina. There are flexible rings both at the opening and at the bottom of the device. The closed end is inserted near the cervix while the outer ring stays outside the vagina and holds the condom open.
The female condom works by catching the male's semen as he ejaculates (comes). It can be inserted up to eight hours before intercourse and is usable during a woman's period. Each condom should be used only once. The lowest expected failure rate is about 5 pregnancies per 100 users per year. On average, there are about 21 pregnancies per 100 users annually. Using the female condom helps prevent sexually transmitted diseases, including AIDS.
SPERMICIDES
Other over-the-counter birth control methods for women include contraceptive foams, creams, jellies, suppositories, films and sponges. All contain chemicals called "spermicides" and are inserted deep into the female's vagina before sexual intercourse. They work by blocking the entrance to the uterus and killing sperm.
Foams, which come in aerosol cans, and creams and jellies, which come in tubes, have plastic applicators. Suppositories and film are inserted by hand. Sponges come in one size and are made of polyurethane foam which contains the spermicide. They must be moistened with water before use and also are inserted by hand. Sponges have a nylon loop so they can be easily removed.
These methods are not as reliable as medical methods but they are easy to obtain and use. Some offer some protection against certain sexually transmitted diseases. Their lowest expected failure rate is about 3 to 5 pregnancies per 100 users per year. On average, there are about 18 to 21 pregnancies per 100 users per year. However, if the female's partner also uses a condom, failure rates are significantly lower.
FERTILITY AWARENESS
Fertility awareness, also called "natural family planning" or "rhythm method," is not very effective with young people. The female attempts to pinpoint the days of the month when she is fertile. She monitors daily changes in her body temperature, vaginal discharge, and/or keeps track of her menstrual periods on a calendar. This information is used to pinpoint which days she is most likely to get pregnant. Couples then can avoid intercourse during that time.
The lowest expected failure rate for fertility awareness is 2 to 10 pregnancies per 100 women per year. On average, there are about 24 pregnancies per 100 women per year.
While fertility awareness has no health risks or side effects, it is among the least effective methods of contraception. If your moral or religious values make this the only acceptable method for you to use, however, realize that it is more likely to work if careful records are kept and if both partners have a high degree of self-control.
METHODS THAT DON'T WORK
There are many wide-spread myths about sexuality that result in people relying on methods to control births that simply don't work. Ineffective methods include:
| douching after intercourse (no matter what you choose as a douche);
having sex while menstruating;
|
having sex in a standing, sitting or other varied position; and
|
withdrawal (male withdraws penis from female's vagina before he ejaculates
or "comes"). | |
MAKING YOUR CHOICE
It should be obvious by now that there are many choices for controlling births. The first decision you have to make is whether or not you are going to have sexual intercourse. If you decide not to, you don't have to worry about controlling births. If, on the other hand, you are sexually active and don't want to become a parent, you need to practice one or more of the contraceptive methods discussed in this leaflet.
Deciding which method or methods to use is not easy. While some of the methods like condoms, contraceptive foams, creams, jellies, suppositories and sponges do not require you to see a medical professional and are readily available in local stores, some of the most effective methods must be either prescribed or fitted by a medically qualified person. Therefore, it's a good idea to talk with someone trained in helping others make contraceptive choices. Visit your private doctor, your county health department's family planning clinic, or a Planned Parenthood affiliate. These caring medical professionals can help you make the type of informed, responsible choice that characterizes those who act with sexual integrity.
STDs strike teens in our smallest towns and biggest cities. They strike teens from our richest and poorest neighborhoods. They strike females and males. In other words, they can strike teens like you and your friends. The best way to protect yourself is to become aware of STDs and how to reduce your risk of contracting one.
THE CAUSES AND EFFECTS OF STDS
STDs are illnesses that are passed from one person to another by sexual intercourse or other intimate contact. As such, they are infectious diseases. That means they are caused by organisms that invade the body.
Many common STDs such as syphilis, gonorrhea and chlamydia infections are caused by different types of bacteria. Viruses are responsible for several other types of STDs including genital herpes, genital warts and AIDS, which is caused by the human immunodeficiency virus (HIV).
STDs can permanently damage a person's health. Females who aren't treated and cured may never be able to have children. Certain STDs can be passed to the fetus during pregnancy and birth. Some STDs can cause a lifetime of health problems or even death.
CAN STDS BE CURED?
Many STDs can be cured, but others cannot. Antibiotics are very effective against STDs caused by bacteria. A few others caused by fungi and parasites also respond well to treatment. On the other hand, STDs caused by viruses can't be cured. Current treatments can only help control symptoms or prevent recurrences.
AVOIDING STDS
The only way to be absolutely sure you won't contract a STD is to abstain entirely from sex. You simply won't catch a STD if you don't have sex.
Waiting to have sex until you're older can reduce your chances of contracting a STD. One reason for this is obvious. The longer you postpone becoming sexually active, the longer you avoid any risk. There are other reasons, however. There may be a buildup of resistance over time so that older women may be less susceptible to certain STDs like chlamydia. In addition, some of the more severe complications of STDs in women such as fallopian tube infection and infertility are less common after age 20 than in the teen years.
If you are sexually active, you can't completely eliminate the risk of contracting a STD. There are a number of things that substantially reduce the risk of infection, however. One of the most important ones is to know that your partner is free of STDs. Then the two of you must maintain a mutually monogamous relationship. That means neither one of you has sex with anyone else.
One of the simplest and most important rules for avoiding STDs is to limit the number of sexual partners you have. The more partners you have, the more likely you are to come into contact with an infected partner and the more likely you are to become infected yourself.
It's also important to know which sexual activities create the greatest risk of contracting a STD and to avoid them. If you're going to be sexually active with anyone other than a faithful partner who's not infected, study the "Safer Sex" box and avoid the risky activities. Notice the importance of using latex condoms for every type of sexual intercourse. When used with the spermicide nonoxynol-9, they offer good protection against most serious STDs.
| SAFEST SEX (NO SEXUAL INTERCOURSE) | SAFER SEX | RISKY SEX | RISKIEST SEX |
|---|---|---|---|
| masturbation, mutual masturbation, touching, massage, kissing, deep kissing without biting, oral sex on a man with a condom, oral sex on a woman with a dental dam (A dental dam is a small square piece of thin latex that is held over the vaginal opening or anus during oral sex) | vaginal intercourse with a condom, anal intercourse with a condom | deep kissing and biting with bruising, oral sex on a woman without a dental dam, oral sex on a man without a condom | vaginal intercourse without a condom, anal intercourse without a condom |
KNOW AND LOOK FOR SYMPTOMS
If there's even the slightest chance you could have been exposed to a sexually transmitted disease, you need to be aware of and look for the symptoms. Symptoms of some of the most common types of STDs are listed in the chart at the end of this leaflet. Some of the most common symptoms are sores and blisters on or near the sex organs or mouth; unusual discharges from the penis or vagina; itches, rashes and bumps on the sex organs and other parts of the body; and burning pain during urination. But symptoms of some STDs are mild and may go unnoticed.
IF YOU SUSPECT YOU HAVE A STD
If you have the slightest suspicion that you or your partner have a STD, seek medical attention immediately. When diagnosed early and dealt with promptly, most STDs can be treated. Contact your personal doctor, county health department or a Planned Parenthood affiliate. Don't let embarrassment prevent you from seeking prompt treatment. Minors can be checked without parental consent.
You can also call the National STD Hotline at 1-800-227-8922. The hotline provides basic information about STDs and can refer you to the closest public health clinic for diagnosis and treatment.
If you are diagnosed with a STD, you'll need to do the following:
| Tell your sexual partner(s) to get tested immediately.
| If you don't want to do it yourself, ask your health-care professional to
contact them.
| Abstain from all sexual activity until your health-care provider says it's
safe.
| Follow instructions and prescriptions exactly. Be sure to have a follow-up
examination to see if the treatment is working. | |
INTEGRITY AND STDS
As you can see, STDs are a serious problem for American teens. Teens like yourself can be part of the solution. You can begin by sharing the information in this leaflet with your friends. You can abstain from sex. You can avoid those sexual activities that place both you and your partner at risk. Don't be embarrassed to do these things. They are a sign that you are acting responsibly. They are a sign of sexual integrity.
| STD | SYMPTOMS | TREATABLE? | |||||||||
| Chlamydia | No symptoms; or pain and burning when urinating, discharge | Yes | |||||||||
| Crabs | Severe itching | Yes | Cytomegalovirus (CMV) | No symptoms; or fever, fatigue; or damaged immune systems | Yes | Genital herpes | Pain and burning when urinating, red bumps/blisters in genital area | Yes, but can't be cured | |||
| Genital warts | Bumpy warts on/near genitals | Yes, but can't be cured | |||||||||
| Gonorrhea | Pain or burning when urinating, yellow discharge | Yes | |||||||||
| Hepatitis B | Nausea, vomiting, stomach pain, yellow skin | Yes, but can't be cured | |||||||||
| HIV/AIDS | Recurrent fever, unexplained and rapid weight loss, swollen lymph glands, fatigue, diarrhea, appetite loss, white spots or unusual blemishes in mouth | Yes, but can't be cured | |||||||||
| Syphilis | Chancre sore, rash, genital ulcers | Yes | |||||||||
| Trichomoniasis | Itching in/around vagina, strawberry-colored rash | Yes |
Choices should be made carefully. American teens are experimenting sexually at a younger age today than ever before. If you have reached the point that you are considering or already having sexual intercourse, you need to know the facts about HIV/AIDS. In addition to learning the facts, there are questions you need to ask your partner and there are steps you need to take to prevent contracting HIV/AIDS. Not taking the necessary precautions can be fatal to both you and your partner. AIDS is becoming one of the leading causes of death among teens.
WHAT IS HIV/AIDS?
HIV stands for human immunodeficiency virus. HIV attacks the body's immune system. The immune system is a collection of cells and chemicals that protect the body from anything foreign. Our immune system has no protection against HIV. A person can contract HIV and continue a normal healthy life for several years. A person can be HIV positive and not be aware that they are a carrier of the virus. There is a period of up to six months after HIV has entered the blood stream that it may not appear in a test for the virus. A person may be HIV positive for as many as ten years before HIV goes into full-blown AIDS. It's important to realize that you can contract HIV through a single sexual contact with an HIV positive partner.
AIDS, which stands for acquired immunodeficiency syndrome, is caused by HIV. AIDS develops when the immune system can no longer protect itself from life-threatening diseases. There is no known cure for AIDS. The life expectancy of an individual with AIDS is three years or less.
HOW IS HIV SPREAD?
HIV is spread four ways:
| By having vaginal, anal or oral sex with someone who is infected with HIV.
| By sharing needles or syringes with an HIV positive person.
| From an infected mother to her baby during pregnancy, childbirth or, in
rare cases, breast-feeding.
| Through blood transfusions. However, people in the United States are very
unlikely to contract HIV this way today. Since 1985, all donated blood and
plasma has been tested for antibodies to HIV and people who are at risk of
being infected with certain germs, including HIV, are not allowed to give
blood. | |
HOW IS HIV NOT SPREAD?
You cannot get HIV through casual contact or everyday activities. Unlike other viruses, it is not spread through the air or water or by:
| Handshakes
| Hugs
| Coughs or sneezes
| Sweat or tears
| Pets
| Mosquitos or other insects
| Eating food prepared/served by someone else
| Attending school
| Being around an infected person
| Toilet or shower facilities
| Forks, knives, spoons and cups
| Chairs, desks or bus seats
| Phones or computers
| Drinking fountains
| Swimming pools
| Sports and gym equipment | |
You also cannot get HIV by giving blood in the United States. All blood collection equipment goes through a special cleaning and screening process.
WHAT CAN I DO TO PROTECT MYSELF FROM HIV?
You can avoid contracting HIV by:
| Not having sex. Remember that you can get infected from just one sexual
experience.
| Not shooting drugs.
| Not sharing needles or syringes.
| Not using alcohol or other drugs. These substances can keep you from
thinking clearly and cause you to make unwise decisions. | |
See also the box at the end of this leaflet.
WHAT IF I DO HAVE SEX?
If you choose to have sex, you can lower your risk of HIV infection if you:
| Have sex with a partner who is not infected, who has sex only with you and
who does not shoot drugs or share needles or syringes. (Keep in mind that it
is difficult to know all these things about another person.)
| Always use a latex condom for any kind of sex vaginal, anal or oral. It's
possible you won't know if your partner is infected.
| Learn how to use a condom correctly before you have sex.
| Avoid contact with your partner's blood, semen or vaginal fluid. | |
Latex condoms are the only safe condoms to use. "Lambskin" and other "natural membrane" condoms are unsafe because they contain many very small holes through which the virus can travel. The spermicide nonoxynol-9 is also recommended as an additional protection against HIV. Remember, if condoms are exposed to excessive heat they lose their protective quality. This can happen if you store them in your wallet or purse or the glove compartment of your vehicle.
WHAT ABOUT HIV AND SPORTS OR PHYSICAL ACTIVITIES?
Remember the ways you can become infected with HIV. If someone gets an open wound through sports or some other physical activity, normal first-aid procedures should be followed. When handling towels, t-shirts or other blood-saturated clothing, always wear protective latex gloves. If gloves are not available, use plastic bags or other protective materials to create a protective barrier between you and the clothing. Contracting HIV through everyday physical activities is most unlikely.
WHAT ABOUT KISSING?
A kiss on the cheek is very nice and safe. The skin is a very good protector from HIV. Kissing on the mouth also is safe. Although HIV has been detected in saliva, the only known way you can become infected by kissing is through open sores or bleeding gums of an HIV-positive individual.
WHAT CAN I DO IF A FRIEND HAS HIV OR AIDS?
Be supportive. Show them that you care. Spend time with them. Let them know that there are support groups available for them. Make yourself available to listen when they want to talk. There is a direct relationship between people's emotional outlook and how they respond to being HIV positive. The following can help them maintain a healthy outlook:
| Support of family and friends
| Companionship
| Love
| Access to social, educational, religious and recreational facilities. | |
The best way to protect yourself from HIV/AIDS is abstinence. If you are sexually active or feel that you are ready to become sexually active, however, you should talk with your partner about your sexual histories and expectations. Sex will be safer if the two of you use a condom every time you have sex. It also will be safer if the two of you are monogamous. That means neither one of you has sex with anyone else. For many teens, a monogamous relationship means they have only one sexual partner this month. A true monogamous relationship is one that lasts a long time, if not a life-time.
Ultimately, you have to make your own sexual choices. Make those choices wisely and communicate with your partner. If you cannot talk with your partner about your sexual histories, sexual practices, condom use and other ways to protect yourselves, you simply are not ready for sexual intimacy.
AIDS does not discriminate. We all are at risk. It only takes one sexual act with an infected partner to contract HIV.
Considering the number of sexual messages they receive, you'd think today's teens wouldn't have any trouble talking about sexuality. But that's usually not the case. Many teens have a lot of trouble communicating effectively about it.
Effective communication about sexuality involves being able to share one's desires, doubts and other feelings on a one-to-one basis with another person. It also involves feeling comfortable when asking questions and using the correct words for physical anatomy and sexual activities. Communicating effectively about sexuality provides teens with both the information and the human support necessary for developing values for sexual decision-making and responsible sexual behavior. In other words, talking about sexuality plays a key part in being able to act with sexual integrity.
LANGUAGE IS IMPORTANT
The words or terms we use for objects and activities influence how we experience and feel about them. This is particularly true when it comes to sexuality. The terms people use for sexual intercourse provide a good example. A person who uses the phrase "making love" will undoubtedly think of the act of intercourse differently than a person who uses one of the many derogatory "slang" expressions.
Besides affecting how we think and feel about sexuality, the language we use affects how others respond to what we say because words have different meanings. Words not only have a "dictionary" definition or meaning, but also a "connotative" meaning. The later refers to the personal associations and emotional responses a person has to a word. Since connotative meanings are personal, the same word may have different connotative meanings to different people.
If you use words that arouse strong emotions, people sometimes respond to the words you use rather than listen to the content of what you're saying. This usually results in miscommunication. You can often avoid problems by being aware of and sensitive to the connotative meanings that others attach to the words you use. It's generally better to avoid words with strong negative connotations when talking about sexuality. You can minimize problems by learning and using the correct words for physical anatomy and sexual activities.
Just as you need to be aware of the language you use, you also need to be sensitive to the language others use when talking about sexuality. If they use emotionally charged slang terms, don't immediately react to their words without trying to really listen to what they're saying. When you do respond, use the communication techniques we discussed. Who knows? Those around you may begin to view you as a positive role model for talking about sexuality.
TALKING WITH PARENTS
Talking with your parents about sex may seem like one of the most embarrassing things you could ever do. Most teens think of their parents as being "old-fashioned." They can't imagine them ever being interested in sex.
If you feel this way, you may want to re-evaluate your thinking. Talking about sexuality with your parents can be an enlightening experience. Remember that your parents were young once and had the same type of questions and feelings about sexuality you're having now. Also remember that your parents are sexual beings, as we all are throughout our entire lives. Just because they're older doesn't mean your parents don't understand the sexual issues and the feelings you may be struggling with.
Your parents can help you understand your feelings and find answers to your questions. Because they care for you, they probably would welcome the opportunity to talk about sexuality. If they seem reluctant, however, realize that they may feel uncomfortable. While they want to talk, many parents don't know how to start. They may have been raised in a family where sexuality was seldom, if ever, discussed. If they didn't talk about sexuality with their parents, they may not know what they should say to their teens or how they should say it.
You don't have to make talking to your parents about sexuality a big deal where you sit down to "talk about sex." Consider using everyday experiences as "triggers" for communication, such as commenting on the sexual content of a television program and asking your parents what they think. Talking in this way is valuable in two ways. First, you and your parents can learn what each other thinks. Second, you're laying the foundation for future talks. If you ever come to the point where you do need to sit down and talk about a major sexual issue, decision or problem, it's going to be a lot easier if you're already in the habit of discussing sexuality than if you've never talked about it.
There are many issues for teens to explore with their parents. Some questions you may want to talk about are:
| How do you know when you're really "in love?"
When should young people start dating and what activities are appropriate
for them?
|
What do you think about masturbation?
|
When is it okay to have sex?
|
When is it okay not to have sex?
|
When, if ever, is contraceptive use appropriate and which methods are
best? | |
If these questions seem too embarrassing to discuss with your parents, rephrase them or make up your own. The specific topic you discuss isn't nearly as important as the simple fact that you're talking with your parents about sexuality.
TALKING WITH YOUR PARTNER
If you're dating, seeing or going out with someone, it's important for the two of you to talk about sexuality. Both of you need to communicate your feelings about sexuality and what sexual behaviors you feel are appropriate. As you do, respect your partner's viewpoints and decisions. Don't pressure your partner to do anything he or she doesn't want to do. Likewise, don't let your partner pressure you. Clearly communicate your own sexual standards and resolve to stick to them.
If you and your partner are sexually active or think you may become so, continued communication is absolutely essential. The two of you need to discuss ways to avoid an unwanted pregnancy and protect yourselves from sexually transmitted diseases. Responsible sexual partners take the initiative in discussing sexuality-related issues. Don't leave it up to the other person to take the lead.
It's difficult for many teenage couples to have the kind of frank discussions about sexuality we're talking about here. While it's not easy, it is well worth the effort. Even if the two of you don't always agree, communication in a nonjudgmental atmosphere will reap benefits. In the long run, it's easier to talk now than to deal with the misunderstandings and hard feelings that often arise when communication doesn't take place or is not effective.
TALKING WITH FRIENDS
Many teens want to or need to talk about sexuality with someone other than their partner or parents. They need someone who will listen as they share their feelings, anxieties and uncertainties. In such cases, they often turn to friends who can be very supportive. Confiding in a friend and sharing your feelings can be comforting. Friends can provide new insights into what you're experiencing. It's important to remember two things, however. There's a lot of misinformation about sexuality that gets passed from person to person. There's no guarantee that everything your friends say about sexuality is absolutely true. You also need to remember that you need to make your own decisions. Don't let friends convince you to do something you think is wrong.
Talking with friends is a two-way street. Just as there are times when you will approach friends, there will be times when they will come to you to discuss sexuality. Be a good listener, try to pass on accurate information and encourage them to make responsible sexual decisions.
TALKING WITH MEDICAL PROFESSIONALS
Doctors, nurses and other health-care professionals are an important source of information about sexuality. If you have questions about how your body is changing or functions, don't be afraid to ask them. If you have questions about contraception or STDs, ask them. They're concerned about your sexual health and will be happy to talk with you. You can either make a special appointment to discuss your concerns or you can simply ask your questions during a routine check-up or appointment.
Don't be surprised if your doctor doesn't wait for you to ask about sexuality during a routine physical examination. He or she may ask if you're dating, if you're sexually active, or if you know about birth control and sexually transmitted diseases. Don't be offended or embarrassed and refuse to talk. Doctors who ask such questions care about you and are competently doing their jobs. Take advantage of the opportunity to talk with and learn from them.
WHO ELSE?
It's impossible to cover all the people teens might want to talk with in a short leaflet like this. Think about who they might be. Is there a former teacher you'd feel comfortable talking with? A leader of a youth group? A minister, priest or rabbi? A favorite aunt, uncle or other relative? A school counselor? If there is, take the initiative. They'll probably be flattered you thought of them and happy to talk with you.
TALKING IS IMPORTANT
As you can see, being able to talk openly and honestly about sexuality is important. It helps you sort out your feelings, develop your sexual standards, understand the viewpoints of others and obtain the information you need to make responsible sexual decisions. Effective communication is a critical part of acting with sexual integrity.
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This website was built as an assignment for a class and includes information and links from www.nnfr.org/adolsex/fact and will not be a permanent webpage. |
