 From Health Care Provider to Teen: What You Need to Know About Sex and Sexuality

 Objectives  Identify male and female reproductive physiology  Differentiate biological sex, gender identity and expression, sexual orientation and attraction  Discuss different types of sexual activity and risks associated with sexual behaviors  Describe methods of protections against sexually transmitted infections (STIs) and pregnancy

 Outline  Understanding:  Our Bodies  Sexuality  Sex  Pregnancy and Birth Control  Sexually Transmitted Infections  Resources

 Understanding Our Bodies  Genital Anatomy  Reproductive Organs  Reproductive Cells

 Parts That Everyone Has Genitals Nipples Urethra Urethral Opening Buttocks Anus

 Body Diversity  Your body is unique!  There is no right or wrong way for a body to look.

 The Male Body

 Male External Uncircumcised Reprinted with permission from Planned Parenthood® Federation of America, Inc. © 2006 PPFA. All rights reserved.

 Male External Circumcised Reprinted with permission from Planned Parenthood® Federation of America, Inc. © 2006 PPFA. All rights reserved.

 Male Internal Reprinted with permission from Planned Parenthood® Federation of America, Inc. © 2006 PPFA. All rights reserved.

 Male Reproductive Cells  Sperm  Short for spermatozoa  Cells that carry male’s genetic material

 What Is Semen?  A fluid that comes out of the penis during ejaculation  Millions of sperm in each drop of semen  Usually a teaspoon to a tablespoon of semen is released during an ejaculation

 Erections in Males  Blood flows into the penis making it firm  Can occur in sexual and non-sexual situations  Almost all erect penises are around the same size

 The Female Body

 Female External Reprinted with permission from Planned Parenthood® Federation of America, Inc. © 2006 PPFA. All rights reserved.

 Female Internal Reprinted with permission from Planned Parenthood® Federation of America, Inc. © 2006 PPFA. All rights reserved.

 Female Reproductive Cells  Ovum (Egg)  Cells that carry the female’s genetic material  Once a woman starts getting her menstrual period, her ovaries usually release one ovum a month

 Menstruation  Menstruation prepares a female’s body for pregnancy  During a female’s menstrual period, her body sheds the uterine lining  Menstrual blood flows from the uterus through the small opening in the cervix and passes out of the body through the vagina

 The Menstrual Cycle

 Erections In Females  Can occur in sexual and non-sexual situations  During excitement, the clitoris swells and changes position  The size and shape of the clitoris varies in each woman, although its location is pretty much the same for all females

 Understanding Sexuality

 What is Healthy Sexuality? Sexual development and growth is a natural part of human development Healthy sexual expression is different than sexual risk Same-sex sexual behavior is included in the realm of healthy sexuality

 Spectrum of Gender and Sex Biological Gender/Anatomy Male Gender Identity Feminine Male Gender Expression Female Masculine HeterosexualHomosexual Sexual Orientation Female

 When you think of yourself as a person, do you think of yourself as male, female, somewhere in between, or another gender? Questions About Sexuality

 Gender and Sexual Identity

 Gender Identity Includes  Male  Female  Transgender  Both male and female  Neither

 Terminology: What’s in a Name? Transgender = umbrella term for individuals & communities. A person whose identity does not conform unambiguously to conventional notions of male or female gender roles, but blends or moves between them. Gender nonconforming = individuals who do not follow other people’s ideas or stereotypes about how they should look or act based on the female or male sex they were assigned at birth. Cisgender = a person whose gender identity conforms unambiguously to conventional notions of gender, and matches their natal/biologic gender

 Transgender Umbrella  Bi-gendered  Gender bender  Two-spirit  Stud  Gender queer  Cross-dresser  Pre/post-operative  Intersex  Femme queen  Femme boi or Femme boy

 Identities and Transition Transition  Process and time when person goes from living as one gender to living as another gender Identities include but are not limited to: MTF = male to female, transgender woman FTM = female to male, transgender man

 Definitions of Sexual Attraction Females Bisexual/Pansexual Males

 Sexual Attraction Questions  Are you attracted to:  Different sex  Same sex  Both or all sexes  Neither  Not sure yet  How comfortable do you feel with this/these attractions?  Have you told your family or friends about this/these attractions?

 Sexual Orientation Defined Refers to an individual’s pattern of physical and emotional arousal toward other people Heterosexual - straight Homosexual - gay, lesbian Bisexual Pansexual Queer Other

 Understanding Sex

  Increasing your knowledge of healthy and safe sexual behavior can help create a responsible and positive attitude about your sexuality and relationships.  Sex can and should be pleasurable!

 Questions About Sex  Is it normal to be curious about sex?  When you think about sex, what comes to mind?  What does sex mean to you? How do you define it?

 What Are Some Types of Sexual Activity? Sexual Activity Kissing Mutual Masturbation Outercourse Dry humping Genital-to- Genital Contact Masturbation Vaginal Sex Oral Sex Anal sex

 When a Person Becomes Stimulated Males The penis hardens and forms an erection A fluid called pre-ejaculate is released from the penis Females Males and Females Blood rushes to clitoris The vagina becomes wet Nipples become erect

 At Sexual Climax Males Ejaculation: semen comes out of the penis Ejaculation: semen comes out of the penis Not all erections end in ejaculation Females Muscles of the vaginal wall contract Not all females will have a sexual climax during each sex act

 Most Males and Females Have Sex at 17

 Less Than Half of Teens Aged Have Had Sex CDC/NCHS, National Survey of Family Growth, 2006–2010

 Questions About Sex  What if I am curious about sex but not ready to have it yet?

 Masturbation: A Safe Form of Sex  Both males and females can and do masturbate  Causes no physical harm and there is no risk of pregnancy or STIs  Can relieve stress, tension, and sexual desire  Familiarizes you with your body

 Questions About Sex  What if I am interested in someone sexually but not ready to have sex?

 Expressing Sexuality  What are some ways to express yourself sexually?  Hugging  Sexual talk Texting, phone sex, sharing fantasies, etc.  Holding hands  Massage  Dry humping  Mutual Masturbation

 Questions About Sex  What If I think I’m ready to have sex?

 Questions to Ask Yourself Before Having Sex  Am I emotionally ready to have sex?  Am I comfortable with my partner?  How do my religious beliefs, spiritual beliefs, and values affect my choice?  How will I feel after?  Is this something I will enjoy?

 If You Decide You Are Ready to Have Sex…

 Before Having Sex for the First Time, or with a New Partner  Get tested  Discuss past exposure to STIs  Discuss boundaries and consent  Talk to your doctor and develop a pregnancy and STI prevention plan

 What Should You Ask when Making an Appointment?  How much will my visit cost?  Can my partner come with me?  Are services confidential?  Are you going to call my house?  Are you going to mail my test results?

 Tips for Talking to Your Doctor  Be honest  Ask questions  Ask for an explanation

 Pregnancy and Birth Control

 Safety First  Sex is not inherently risky, but some behaviors do carry risks  Awareness of this and access to protection encourages healthy behavior and reduces unplanned pregnancy

 What are the facts? How does pregnancy occur? Understanding Pregnancy Pregnancy Myths

 Types of Sex That Increase Chances of Getting Pregnant  Vaginal Sex  Genital-to-genital contact (only when semen is ejaculated)

 When Can a Woman Get Pregnant?  Can a woman get pregnant during her period?

 When Can a Woman Get Pregnant?  Does a woman have to have an orgasm to become pregnant?

 When Can a Woman Get Pregnant?  Can a woman get pregnant if the guy “pulls out?”

 Some Things to Keep in Mind  Teenagers are very fertile  Sperm can live inside of a woman’s body for up to 5 days  The best protection against pregnancy, other than abstinence, is “Dual Use”  Using condoms with hormonal birth control (or copper IUD)

 Current Contraceptive Options Extremely EffectiveVery Effective Moderately Effective Prevents pregnancy >99% of the time Prevents pregnancy ~91–99% of the time Long Acting Reversible Contraception: Intrauterine Devices (IUDs) Implants Pills Ring Patch Injectable “the shot” Condom Withdrawal or “pulling out”

 What Does Birth Control Look Like?

 Choosing the Best Birth Control for You  Very personal decision  How well each method will work for you?  How effective is it?  How will it fit into your lifestyle?  What are the side effects?  Is it affordable?  Remember: birth control methods do not provide STI protection

 Sexually Transmitted Infections

 Half of New STIs: Ages 15-24

 Types of Sex Increase Exposure to STIs  Vaginal sex  Anal sex  Oral sex  Genital-to-genital contact

 Things That Increase STI Exposure  Having vaginal sex at a young age  Having more than one partner at the same time  Not using condoms or dental dams correctly every time

 How Can You Tell Someone Has an STI?  Many STIs have no symptoms  When there are symptoms, they may include:  Burning when you urinate  Discharge from the penis or the vagina  Bumps or spots

 Often shows no symptoms Most common symptom is discharge Often shows no symptoms Most common symptom is discharge Often shows no symptoms Most common STI in the U.S. Often shows no symptoms Most common STI in the U.S. Curable STIs Chlamydia Gonorrhea

 Treatable STIs Herpes HIV/AIDS Syphilis

 If You Think You Have Been Exposed to an STI  Get tested  STI clinics offer confidential screening  If the test is positive, follow your doctor’s advice for treatment  Talk to your partner(s) and tell them to get tested

 Preventing STIs  Abstinence  Male Condoms, Female Condoms, and Dental Dams

 Things That Will Not Protect You from STIs and Pregnancy  Douching or washing after sex  Withdrawing before ejaculation  Using plastic wrap instead of a condom

 STI Prevention: Condoms and Dental Dams  Most effective means of preventing STIs (besides abstinence)  To be effective, you must use a new condom EVERY time you have sex  For oral sex, use condoms or dental dams to cover the penis, vagina, or anus

 Barrier Methods  Male Condoms Latex Lambskin Polyurethane  Female condoms (polyurethane)  Cervical Cap  Diaphragm

 Using Condoms  Is there a right way and a wrong way to use a condom?

 Things to Remember About Condoms  Always check the expiration date and look for damage to the wrapper or condom before using  Never use a condom more than once  Using two condoms at once does not offer increased protection  You have to use the condom the entire time you have sex

 Other Things to Remember About Condoms  Do not use oils, lotions, or Vaseline anywhere on the condom (either inside or out)  Use lubricants (or lube) specifically designed for use during sex!

 What if…  The condom breaks?  You forgot to take your pill?  Sex was forced?  Is there anything you can do to prevent pregnancy?

 Emergency Contraception, Plan B, “Morning-After Pill”

 What Is Emergency Contraception (EC)?  A safe and effective way of preventing pregnancy in cases of:  When your birth control fails (miss a pill/condom breaks)  No form of contraception used  Unplanned or forced sex  Will not work if you’re already pregnant!

 Branded EC Products in the U.S. Plan B OneStep ® One Pill Can take up to 5 days after unprotected sex OVER-THE-COUNTER for males and females ella ® One Pill Can take up to 5 days after unprotected sex Prescription Only Can order online at kwikmed.comwww.ella- kwikmed.com More effective if overweight

 Generic EC Products in the U.S. Next Choice™ One Dose and My Way® Generic One pill Can take up to 5 days after unprotected sex Over-the-counter for ages 17 & older; prescription required for minors** Levonorgestrel Tablets Generic Two pills Can take up to 5 days after unprotected sex Over-the-counter for ages 17 & older

 In Case of Pregnancy, What Are Your Options? Continue the Pregnancy Adoption Parenthood End the Pregnancy Abortion

 Review of Objectives  Identify male and female reproductive physiology  Differentiate biological sex, gender identity and expression, sexual orientation and attraction  Discuss different types of sexual activity and risks associated with sexual behaviors  Describe methods of protections against sexually transmitted infections (STIs) and pregnancy

 Useful Websites  Planned Parenthood  Sex, Etc.  Go Ask Alice!

 Provider Resources and Organizational Partners  for Youth  Academy of Pediatricians  American Civil Liberties Union Reproductive Freedom Project  College of Obstetricians and Gynecologists  of Reproductive Health Professionals  for Adolescent Health and the Law  Gay and Lesbian Medical Association

  Institute  janefondacenter.emory.edu Jane Fonda Center at Emory University janefondacenter.emory.edu  Morehouse School of Medicine  NARAL Pro-Choice New York Teen Outreach Reproductive Challenge (TORCH)  North American Society of Pediatric and Adolescent Gynecology  for Reproductive Health Provider Resources and Organizational Partners

  Information and Education Council of the United States  for Adolescent Health and Medicine  Planned Parenthood Federation of America  Reproductive Health Access Project  Spence-Chapin Adoption Services

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