Birth Control and Sexually Transmitted Infections

Birth Control and Sexually Transmitted Infections
Interior Health 2017 This PPT was originally developed by Erin Taylor, PHN, Interior Health. This modified version includes contributions from Erin Taylor, as well as Brenda Marsman and Valerie Pitman, Interior Health Knowledge Coordinators. These two presentation take about an hour each to present with room for discussion. They can be presented together or separately. Speaking notes and activity suggestions are included. It is recommended that you obtain free copies of the Sex and HPV Its time to Talk booklet from the sexandu.ca website to support and accompany this PPT. These are available from: (available in English and French, bundles of 25, max order at one time is 8 bundles, or 200 booklets). This information is current as of May 2017 Birth control teaching kits may be available for loan from public health centres. Speak with your school PHN. It is important to set the tone for these presentations, set up ground rules, for example: This is a safe environment to learn and ask questions. We need to respect each other. Ask questions as they come up and we will also have a question period at the end of the class. Remember there are no bad questions. I may not always know the answer to your questions but I will get back to you. NOTE: if you see a security warning to enable content, please do so as this will help allow video links to work once you are connected to the internet

Why????? Part of the curriculum
Important information to help you make informed decisions about your health The ability to talk openly about sex is an important part of having a healthy relationship BC Adolescent Health Survey Results and poster Notes for speakers: For this presentation We encourage you to become familiar with the McCreary Centre Adolescent Health Survey provincial and regional data: see sexual health of youth in BC full report here Surveys are e done every 5 years in BC.. 1. Summary of data from the 2013 BC Adolescent Health Survey of youth in grades 7-12 in public schools across BC (report released in 2015): Majority of kids are not having sex, youth who did have intercourse are waiting longer to do so compared to previous surveys 3 out of 4 youth had not had oral sex or any other type of sex 23% report having oral sex, down from 26% in 2008 19% of students reported having sex (other than oral sex or masturbation) down from 24% in 2003 so 81% of the who completed the survey have never had intercourse 69% of students who are sexually active used a condom the last time they had intercourse. Students were less likely to use a condom or barrier with oral sex (17%) As students get older rates increase for both sexual intercourse and oral sex 3% if students who had ever had sexual intercourse reported an STI 1% report ever being pregnant 24% report using drugs or alcohol before the last time they had sex 2. Regional reports (with more local data) can be found here:

Am I Ready For Sex? Everyone has feelings about relationships, dating, intimacy and sex. Only you can decide what is right for you,... Speakers notes: These are questions you need to ask yourself: Do I want to have sexual intercourse? Am I feeling pressured to make a decision about having sex? Am I afraid of anything? Will I feel good about myself if I have sex now? Will I be glad I had sex with this person if our relationship ends? Have my partner and I talked about having sex? About birth control? Am I willing to risk getting /causing a pregnancy or risk getting an STI? Have my partner and I been honest about our feelings? Is this right for me right now? Optional Activity: Consider handing this pamphlet (Am I Ready for Sex) out, available from Interior Health, (soon to be uploaded on the interiorhealth.ca website) plus the sex sense booklet available free from Options for Sexual Health (1 800 Sex – Sense).

Quick Anatomy Reminder
See pages of the Sex and HPV Its Time to Talk booklet for a review of male and female reproductive systems, and a matching activity

Objectives Learn about Sexually Transmitted Infections (STIs)
Find out which STIs are bacterial versus viral infections Understand the risky behaviours that can lead to STIs Learn how to prevent STIs Learn the signs and symptoms of STIs Discover how testing can be easy, and where to get it See the Sex and HPV Its Time to Talk booklet, pages 3-4 Use the activities in the Sex and HPV Its Time to Talk booklet on pages 16,17, 18, 20,21, 23 to support this section

Lesson One: Sexually Transmitted Infections
Herpes Hepatitis B Trichomoniasis Chlamydia Recommended activity to start the STI presentation: GAME: DON’T PASS IT ALONG Time: approx min What you need: small pieces of scrap paper and pens - 2 pieces will have the letter “I” written in the corner. This stands for “infection” - 5 pieces with have the letter “C” written in the corner. This stands for “condom” - 5 pieces will have the letters “NC” written in the corner. This stands for “no condom” - 5 pieces will have the letter “OC” written in the corner. This stands for “outer course” - 5 pieces will have the letter “CB written in the corner. This stands for “condom Broke” - 5 pieces will have the letters “NS” written in the corner. This stands for “no sex” Adjust these numbers to suit the class size (must have 2 with “I”) and at least 2 of all the others).Works best with a class size of 20 or more How to play: - Give each person in the class a piece of paper. Do not tell them what the letters stand for. - Have them move around the classroom and shake hands with three different people – encourage them to find someone that they may not normally speak with. Each time they shake hands with someone they will write that persons name on their paper.(must have 3 names on paper for game) - When they have 3 names they will return to their seat. - Have the 2 people who have the letter “I” on their paper stand up and read off the names on their paper. If your name is read off then you stand up and read off the names on your paper. At the end all of the students in the class should be standing. Then start sitting people down: - Explain that the letter I stands for Infection (i.e. Chlamydia – those people need to remain standing) Make sure that they are not made to feel ashamed and thank them for pretending to have Chlamydia - The letter C stands for Condom – those people can sit down - The letter CB stands for Condom Broke – these people remain standing - The letters NC stand for No Condom – these people remain standing - The letter NS stand for No sex – these people can sit - the letter OC stands for Outer course – These people can sit as they did not have any skin to skin or fluid exchange - There should be more people standing than when you started. - Count the number of people now standing Talking Points: This game shows how infections can move through a group of people. Even though you didn’t “talk” to the person with the infection you may have “talked” with someone who “talked” with someone who “talked” with the infected person. When you have unprotected sex you expose yourself to all of the germs that your partner has been exposed to. You cannot tell who may be infected as people are often asymptomatic Pelvic Inflammatory Disease T cells Human Papilloma Virus

Sexual Transmitted Infections (STIs) – what are they?
a sickness that is passed from person to person during sexual activity, but the person that is passing it on may not know they are sick (many STIs do not have symptoms) See the Sex and HPV Its Time to Talk booklet, page 3 Think of sexually transmitted infections, or STI for short, as a sickness that is passed from person to person during sexual activity, but the person that is passing it on may not know they are sick (many STIs do not have symptoms) There are 4 different families of STIs—viral, bacterial, parasitic, and fungal. Each family has many types. Some have minor consequences while others have lifetime consequences. Bacterial infections are usually cleared up by the use of prescription medication , parasitic and fungal infections are usually cleared up by the use of over-the counter or prescription medication. Viral infections are the most problematic because they are chronic (lifelong) infections which usually require ongoing treatment. Infections can be transferred through exchanges of body fluids like blood, semen, vaginal secretions, and breast milk. Different types of sexual activities that transfer infections include oral, vaginal, or anal intercourse, as well as just skin-to-skin contact. You can catch some STIs just by touching or kissing an infected area. Infections can also be spread while getting a tattoo or piercing from an unsterile needle, or sharing items used for sex play. In Canada, some of the highest rates for STIs are amongst youth ages Another great resource for this STI information is a free booklet available online here: The important thing is for students to be aware of what is normal for them and recognize when something is different, and know where to seek help. For more detailed information on each infection please see BCCDC’s Smart Sex Resource at Please note that this PPT does not include an exhaustive list of STIs, but does outline the more common ones.

Bacterial STIs: can be treated with antibiotics
Chlamydia (LGV) Gonorrhea Syphilis see the following background information. You do not have to go through each infection symptom by symptom. The important thing is for students to be aware of what is normal for them and recognize when something is different, and know where to seek help. BACTERIAL STI’s: can be treated with antibiotics. Untreated STIs like chlamydia and gonorrhea can cause pelvic inflammatory disease (PID) in women Chlamydia: - most common reportable infection in BC - majority of cases are asymptomatic and, if symptoms do develop, it can take days after sexual activity for them to appear - if untreated can lead to complications such as PID in women and epididymitis in men (PID: Pelvic Inflammatory Disease is an infection of a women’s reproductive organs, including the uterus, fallopian tubes, and ovaries. It happens when bacteria travel up from the vagina into the reproductive organs. Some complications include pelvic pain, infertility, tubal pregnancy. Epididymitis is an inflammation of the tube that joins the testicle with the vas deferens. It’s caused by bacteria that travel from the urethra or the bladder to the epididymis. It can cause swelling and pain in the scrotum, fluid from the urethra, pain/burning with peeing, fever, infertility, abscess in the scrotum. women are more likely to be diagnosed (routine testing performed during visits for other things i.e. PAP’s, contraception, pregnancy). It is treated with antibiotics LGV is short for lymphogranuloma venereum and is caused by a certain type of chlamydia bacteria. Gonorrhea: - Often asymptomatic, if symptoms do appear it can take 2-7 days - 2nd most common reportable STI - if untreated can lead to PID in women and epididymitis and prostatitis in men - treat with antibiotics Syphilis: - 3 stages - less common than chlamydia and Gonorrhea but rate have been steadily increasing in BC over the last 15 years - Complications from syphillis include damage to the brain and heart, dementia, hearing loss, vision changes, balance problems, death - passed by skin to skin contact with open syphilis sores during anal, oral or vaginal sex - Most infectious during the primary, secondary and early latent stages Reportable NOTE: Bacterial Vaginosis - not sexually transmitted but more common in females that are having sex (multiple partners or new partner, same sex female partners), smokers, douching (douching is not recommended for any women), or if you have an IUD (intrauterine device) - imbalance of bacteria normally found in the vagina - symptoms include white or grey discharge, pain, itching or burning and foul (fishy) odour - usually asymptomatic or resolves on its own but if it persists can be treated with antibiotics For more detailed information on each infection please see BCCDC Smart Sex Resource at

Viral STIs: Can be treated with medication, but NOT cured
Herpes Simplex Virus (HSV) Human Papilloma Virus (HPV) Hepatitis B Human Immunodeficiency Virus (HIV) see the following background information. You do not have to go through each infection symptom by symptom. The important thing is for students to be aware of what is normal for them and to recognize when something is different, and know where to seek help VIRAL STI’S: Can be treated with medications, but not cured. Some may stay in the body forever or resolve on their own. Herpes Simplex Virus (HSV): - One of the most common STI’s - most people will have one form of HSV in their lifetime - HSV 1 is most commonly found on the mouth and commonly known as cold sores - HSV 2 is commonly found in the genital area - spread through skin to skin contact - you can pass HSV1 to the genitals and HSV 2 to the mouth through oral sex - most likely to pass it on when sores are present but there is a small risk when no sores are present - outbreaks are triggered by stress, lack of sleep, sun exposure, alcohol use, skin irritation - primary outbreak is usually more severe and lasts longer than future outbreaks - can be managed with an antiviral medication but it is not a cure Human Papilloma Virus(HPV): - over 100 types (40 or more involve the genitals!) - 75% of sexually active people will have an HPV infection at some time in their life - Most of the time it is not serious and will resolve on it’s own, however it can cause cancer and genital warts - easy to pass because it often has no symptoms or symptoms are hard to detect - some types of HPV cause bumpy or flat genital warts that DO NOT cause cancer and are low risk and usually benign, but are unsightly - other types of HPV cause cancer of the cervix, penis, vulva, anus, and throat - routine Pap tests are done to screen for cervical cancer (see “testing” slide for more info on PAP test) - HPV vaccine helps to prevent 70% of genital cancers and 90% of genital warts. You need to have the vaccine before you are exposed to the virus. That is why it is offered in grade 6 to all girls (starting September 2017, in Interior Health, all boys as well) If you are female and under 26 and you have not yet been vaccinated, you are still eligible - spread by skin to skin contact - complications include bleeding during intercourse, cancer - most HPV infections clear on their own or they can be frozen off. You need to remember that even if the warts clear, either by treatment or on their own, you may still have the virus in the body and can still pass it on. It can take a few months to a couple of years for the virus to clear. can treat with liquid nitrogen (cryotherapy – freezing) Hepatitis B: - spread though blood and body fluids, mom to baby during birthing - complications include liver scarring (cirrhosis) in Chronic Carriers which can lead to liver cancer, and in rare cases Hep B can cause liver failure and death - Most adults get Hep B for a short time and then get better. Some adults will become Chronic carriers – this is a long term infection and they can pass it on to others - children and babies who are infected with the virus are more likely than adults to become chronic carriers there is no treatment to cure long term infections. You can make lifestyle choices that help manage your Hep B such as rest, drink lots of water, avoid alcohol and drugs, eat healthy foods - Getting vaccinated is the best prevention. All children and some adults in British Columbia are eligible for free Hepatitis B vaccine. Prevention also includes using condoms, not sharing drug equipment, avoiding exposure to other people’s blood. - reportable HIV: Human Immunodeficiency Virus found in semen, blood, breast milk, vaginal and anal fluids can be passed through unprotected sex, sharing drug equipment, and from mom to babe (medications taken pregnancy can prevent mom from passing virus on to babe) Sero-conversion illness (going from being HIV negative to HIV positive) symptoms usually occur 2-4 weeks after infection and can include fever, sore throat, headache, muscle aches and joint pain, swollen glands - HIV does not live long outside the body and cannot be passed through casual contact such as kissing or sharing drinking glasses - there is no cure but medication can help decrease the amount of virus in the body and this helps you to stay healthy - Without treatment, HIV damages the immune system and may become AIDS or Acquired Immunodeficiency Syndrome - HIV is a chronic illness and With proper treatment and support, people can be very healthy. Treatment can also decrease the risk of spreading HIV to other people. - If you have other STI’s your chance of getting HIV increases (lowered immune system from other STI’s) For more detailed information on each infection please see BCCDC Smart Sex Resource at

Other STIs: Parasites and Fungus
Trichomoniasis Pubic Lice Scabies Yeast see the following background information. You do not have to go through each infection symptom by symptom. The important thing is for students to be aware of what is normal for them and recognize when something is different, and know where to seek help Trichomoniasis: “trich” -a microscopic, single –celled organism - more commonly found in women - passed through unprotected vaginal sex - itchy, frothy (off-white or yellowish-greenish) vaginal discharge, discomfort when peeing - men usually have no symptoms - can increase chance of getting other STI’s, affect fertility, caused pelvic inflammatory disease in women and , in pregnancy can cause early labour - only tested for in women but male partners receive treatment as well if a women tests positive Pubic lice: also known as “crabs” - tiny bugs that live on body hair, usually in the genital region, but occasionally will be on hair on the leg, armpit, beard etc. - spread by close personal contact, sharing towels, bedding - require treatment with special shampoo sheets, towels, clothes should cleaned in hot water Scabies: also known as “mites” -parasites that burrow beneath the surface of the skin, to lay eggs, prefer warmth found on folds of skin on elbows, wrist, buttocks, knees, waist, breasts, penis etc. -transmitted through close contact, scabies can live for 3 days on clothing, bedding, towels -symptoms include itchiness, reddish rash on fingers, wrists, armpits, waist, nipples -treated with over the counter creams and lotions Yeast: fungal - both men and women - overgrowth of yeast already present in the body - symptoms include itchy vagina, dryness, pain and increased clumpy, white discharge in women. In men can appear as red raised rash, may be itchy, may have cheesy, white discharge, swelling of the foreskin, flaky - over the counter treatment For more detailed information on each infection please see BCCDC Smart Sex Resource at

Myth: If I use a condom, I can’t get HPV(human papilloma virus) or any other STI.
See the Sex and HPV Its Time to Talk booklet, page 10 Condoms can protect against most STIs including HIV/AIDS, but do not provide complete protection against HPV (human papilloma virus) . The virus can spread through skin to skin contact with infected areas of the skin not covered by the condoms (such as the scrotum, anus or vulva). More on prevention in the coming slides.

Is There A Cure? Some STIs are treatable with antibiotics
STIs caused by viruses cannot be cured and may stay in your body forever STIs are highly PREVENTABLE and it is your responsibility to PROTECT YOURSELF See the Sex and HPV Its Time to Talk booklet , page 4 STI’s that can be cured with Antibiotics: Chlamydia, Gonorrhea, Syphilis, Trichomoniasis Pubic lice and scabies can be treated with over the counter lotions and shampoos STI’s that cannot be cured – Hepatitis B, HIV, Herpes, Human Papilloma Virus (HPV) STI’s that MAY go away on their own – HPV, Hepatitis B. Everyone is different and there is no way to know ahead of time if your body will be able to “clear’ them or not. STIs that you can be vaccinated against include Hepatitis B and HPV

How Can I Protect Myself?
Use condoms and dental dams every time you have any kind of sex Limit the number of partners that you have Don’t have sex when you are drunk or high Get vaccinated Get tested regularly See the Sex and HPV Its Time to Talk booklet, pages 8-9 Free condoms and lube are available from most public health units Vaccination: - Currently all students in BC are eligible for Hepatitis B vaccine. - HPV vaccine is routinely offered to girls in Grade 6; women who were not immunized in school and are age 26 and under; and a small cohort of boys. In the 2017/2018 school year HPV vaccine will be available to ALL grade 6 student! Hooray! Vaccines are a safe and effective way to help prevent disease. You do not need parental permission to get vaccinated. For more information regarding HPV and Hepatitis B vaccine please go to HealthLinkBC File: Or

Dental Dams Hard to find Easy to make your own using condoms
1. Start with an unlubricated or flavoured condom. 2. Remove the condom from the package and unroll it all the way. 3. Cut off the tip of the condom and the bottom band using a pair of sharp scissors. 4. Cut down one side of the cylindrical latex tube that remains. You now have a latex dam click on the condom image or words “latex dam” to play this link: It is almost impossible to buy dental dams, however, they can easily be made using condoms or gloves. This is a good demo video from the teaching sexual health website. How to Make a Dental Dam: 1. Starting with an unlubricated or flavored condom, check the expiration date on the package to make certain that the condom is still good, and then feel for the air bubble to make certain that the condom hasn't been damaged. 2. Carefully remove the condom from the package and unroll it all the way. 3. Cut off the tip of the condom using a pair of sharp scissors and throw the tip away. You may also want to cut off and discard the bottom band of the condom if you find it awkward or difficult to unroll. 4. Cut down one side of the cylindrical latex tube that remains. You now have a latex dam Dental dams can also be made out of gloves. The easiest way to make a glove into a dental dam is to cut the four fingers off the top of the glove and then cut a slit down the side of the glove, leaving the thumb intact. If you do this, you can use the thumb to insert your tongue or finger into your partner while still practicing safe oral sex. Another way to make a dental dam using a glove is to cut off the three middle fingers and then slit the glove along the palm side from the wrist to where the middle finger used to be. This gives you a square with two handles where you can insert your thumbs to make the dental dam easier to manipulate Tips for DIY Dental Dams: Use flavoured or unlubricated condoms when making a dam. Do not reuse dental dams. Saran wrap and other plastic wraps can also be used as barriers for oral sex, but there is little to no research about their effectiveness, which means they may not be effective at all. The main advantages are cost and the ability to tear off a piece that is as large as you need. Lubricant on the side of the dental dam that is touching skin keeps the latex from sticking, and it also makes the sensations more enjoyable and more like having unprotected oral sex. Where can Dental Dams be Purchased? They can be purchased online or at stores that sell safe sex supplies. You may also be able to find them at medical supply stores; however, dental dams are not generally available at major chain drug stores. Other Visual Resources:

Risky Behaviours… Unprotected sex
Multiple sex partners or a partner who has had multiple partners Blood or body fluid exchange Drinking alcohol Drug use Sharing sex toys Cold sores Anal sex IV needle use and sharing of pipes Sexting Internet dating/Apps to meet up NOTE: this slide uses animations when in slideshow mode, so keep clicking for the list of all risks to appear IV Drug use and sharing of glass pipes – can lead to bad decision making and also put you at risk for HIV, Hep B, and Hep C if there are any burns or open wounds on the mouth where there could be a blood exchange Sexting: once pictures are posted they are not private, and there is potential for them to be circulated more widely. Internet Dating/Apps: make sure you have someone who knows where you are going and where you are meeting up for your own safety

Myth: You cannot get an STI from giving or receiving oral sex.
See the Sex and HPV Its Time to Talk booklet, pages 6-7 The majority of common STIs can be spread through either giving or getting oral sex! (chlamydia, gonorrhea, herpes, syphilis, HIV and HPV just to name a few) Although oral sex is considered a lower-risk sexual activity, there is still some risk. There is no such thing as 100% safe sex and oral sex is no exception. Using a condom or dental dam during oral sex will help to lower the risk. Dental dams can be hard to purchase, but are easily made using condom. Ask your public health nurse for more information.

What Do STIs Look Like? Abnormal Discharge Blisters
Lower Abdominal Pain Burning with Urination Pain with Sex Bleeding with Sex Warts Epididymitis Painless Sores Miscarriage Itchy skin Rash Foul Smell Yellow Skin Tone Flu-like Symptoms Blindness Bumps, Lumps, Growths Swollen Glands Sore Throat NO SYMPTOMS It is important to know what is normal for you. You can have one, several or no symptoms from this list and have an STI For Males: - only urine or semen should be coming out the end of the penis. Anything else may be considered abnormal and needs to be checked - know what kind of bumps are normal for you and recognize when something is out of the ordinary i.e. ingrown hairs testicular exams should be done monthly it is important to get checked regularity for STIs once you become sexually active For Females: -normal vaginal discharge can have a musty odour. Discharge will change through your menstrual cycle so it is important to recognize what is normal for you - if you shave/wax your pubic region you may be prone to ingrown hairs or bumps - use a mirror and have a look at your anatomy and see what it looks like so you can recognize any changes - some symptoms such as blisters, warts, discharge may be up on the cervix or in the vagina. You may not see anything but you may “feel” something i.e. bleeding between periods, pain with intercourse, abnormal bleeding, bleeding after intercourse, that is why it is important to get checked regularity once you become sexually active

When Should I Get Tested?
Anytime you think that you’ve had a “risk” If you have multiple partners and are having unprotected sex If your partner has multiple sex partners If you are using drugs or alcohol and having sex If you are entering into a new sexual relationship If you feel that you are at risk for an STI Yearly See the Sex and HPV Its Time to Talk booklet on page 6-7 Get tested regularly, once a year if you are sexually active is recommended

Where Do I Go For Testing?
Family Physician Walk In Clinic Health Outreach Nurse Options for Sexual Health Clinics or Youth Clinics Get Checked Online in Nelson and Kamloops, Vancouver and Vancouver Island These services are confidential! However, if you test positive and the disease is a reportable one, anonymous contact tracing has to be done. See your local Doctor or Nurse Practitioner. Or go to a walk-in clinic if you have one. Interior Health has a Health Outreach Team of registered nurses - offices are located in Cranbrook, Kamloops, Rutland, Nelson, Penticton and Kelowna, and Vernon – These nurses cover a large territory and may travel to your community regularly - for more info: Options for Sexual Health: - Check the Options website to see where the closest clinic is Youth Clinics in Interior Health are located in Chase, Kamloops, Lillooet and Merritt, newer clinics are starting to be located in some high schools BCCDC Get Checked Online - - Available in Nelson and Kamloops (interior Health) at Life Labs and other locations in the province in Vancouver and Vancouver Island - Sign up, print a lab requisition, give sample to the lab and get results online - You can be tested for chlamydia, gonorrhea, Syphilis, HIV, and Hepatitis C

What Does Testing Involve?
Health History Urine Testing Speculum Exam Swabs/Smears Blood Testing Results Contact Tracing Treatment See the Sex and HPV Its Time to Talk booklet, page 5 Physical exam: HPV, Trichomoniasis, pubic lice, scabies, Herpes Urine Test: Chlamydia and Gonorrhea (Trichomoniasis for women) Speculum Exam: This is a good opportunity to talk about Pap tests: Pap tests screen for cervical cancers which is caused by HPV. Only needed if you are a female >25 years of age and having any type of sex. The screening interval is every 3 years. Please see BC Cancer Agency Guidelines for more information: See the Sex and HPV Its Time to Talk booklet on page 12 Swab/smear: Chlamydia, gonorrhea, syphilis, genital herpes, trichomoniasis, yeast infection, HPV Blood Test: syphilis, Hepatitis A, B, and C, HIV, Herpes (usually a swab as the blood test does not differentiate between HSV1 and HSV2 i.e. if you get cold sores your test will be positive) Results: If you test positive for certain infections – Chlamydia, Gonorrhea, Syphilis, HIV, Hepatitis B – your health care provider will have to report them to the BC Centre for Disease Control. These infections are deemed to have potential long term consequences if untreated and require contact tracing and follow up. You will be asked to tell all of your sexual partners that you have tested positive for a STI so that they have the opportunity for testing and treatment. This can also be done anonymously by a nurse. Treatment: dependant upon the disease Use the quiz activities in the Sex and HPV Its Time to Talk booklet on pages 16,17, 18, 20,21, 23 to support this section

References and the Sex and HPV Its Time to Talk booklet from the SOGC (has great information on STIs and contraceptives) has fact sheets and information and operates the sex sense line sex sense McCreary Centre, Adolescent Health Survey, 2013 has survey result from school districts all across BC including a report of youth and sexual health Smart Sex Resource from BCCDC HealthLink BC or 811 to speak with a RN Interior Health's Public Website pages on Sex Health Canada’s Source for HIV and Hepatitis C information (CATIE) The Sex and HPV booklet that would be a great accompaniment to this PPT can be ordered for free from this web site: Sexual health of youth in BC 2013 report is found here in addition there is an infographic of key findings The smart sex resource site from BCCDC HealthLinkBC: Whether you or your family member has a specific health concern or if you are looking for information about a health topic you saw on TV, you have come to the right place. In this section, we have easy-to-understand health topics. HealthLinkBC Files are easy-to-understand fact sheets on a range of public health and safety topics including disease prevention and immunizations. 811: Registered Nurses Registered nurses at HealthLink BC can help you with non-emergency health concerns, to discuss symptoms and procedures, and to recommend whether you should see a health care provider in person. At any time of the day or night, every day of the year, you can call to ask a registered nurse your health questions. Learn more about Nursing Services at HealthLink BC. CATIE ordering Centre for Schools STI booklet, cat # ATI-24801, 2015 from the Public Health Agency of Canada Note: some more appropriate photos could not be included in the PPT as permissions were not given or photos were not available from the Interior Health selection. All images used in this PPT are owned by Interior Health

Lesson Two: Consent and Birth Control Options
Lesson 2 speaks to consent and birth control methods It is recommended to obtain free copies of the Sex and HPV Its time to Talk booklet from the sexandu.ca website to support and accompany this section: (available in English and French, bundles of 25, max order at one time is 8 bundles, or 200 booklets). This information is current as of May 2017. Use the quiz activities in the Sex and HPV Its Time to Talk booklet on pages 19, 20, to support this section

Why????? Part of the curriculum
Important information to help you make informed decisions about your health The ability to talk openly about sex is an important part of having a healthy relationship BC Adolescent Health Survey Results and poster This slide is a repeat from the presentation on sexually transmitted infections, useful in the event that this presentation is being used first, or the other one is not being used, please feel free to skip if this is a repeat for your presentation. Notes for speakers: For this presentation We encourage you to become familiar with the McCreary Centre Adolescent Health Survey provincial and regional data: see sexual health of youth in BC full report here Surveys are e done every 5 years in BC.. 1. Summary of data from the 2013 BC Adolescent Health Survey of youth in grades 7-12 in public schools across BC (report released in 2015): Majority of kids are not having sex, youth who did have intercourse are waiting longer to do so compared to previous surveys 3 out of 4 youth had not had oral sex or any other type of sex 23% report having oral sex, down from 26% in 2008 19% of students reported having sex (other than oral sex or masturbation) down from 24% in 2003 so 81% of the who completed the survey have never had intercourse 69% of students who are sexually active used a condom the last time they had intercourse. Students were less likely to use a condom or barrier with oral sex (17%) As students get older rates increase for both sexual intercourse and oral sex 3% if students who had ever had sexual intercourse reported an STI 1% report ever being pregnant 24% report using drugs or alcohol before the last time they had sex 2. Regional reports (with more local data) can be found here:

Am I ready for sex? Everyone has feelings about relationships, dating, intimacy and sex. Only you can decide what is right for you,... Note: this is a repeat slide from the STI presentation on sexually transmitted infections, useful in the event that this presentation is being used first, or the other one is not being used, please feel free to skip if this is a repeat for your presentation. Speakers notes: These are questions you need to ask yourself: Do I want to have sexual intercourse? Am I feeling pressured to make a decision about having sex? Am I afraid of anything? Will I feel good about myself if I have sex now? Will I be glad I had sex with this person if our relationship ends? Have my partner and I talked about having sex? About birth control? Am I willing to risk getting /causing a pregnancy or risk getting an STI? Have my partner and I been honest about our feelings? Is this right for me right now? Optional Activity: Consider handing this pamphlet (Am I Ready for Sex) out, available from Interior Health, (soon to be uploaded on the interiorhealth.ca website) plus a sex sense booklet available free from Options for Sexual Health (1 800 Sex – Sense). Lets talk about your options, so you can decide what is right for you See page 2 in the Sex and HPV Its Time to Talk booklet

Quick Anatomy Reminder
Note: this is a repeat slide from the STI presentation on sexually transmitted infections, useful in the event that this presentation is being used first, or the other one is not being used, please feel free to skip if this is a repeat for your presentation. See pages of the Sex and HPV Its Time to Talk booklet for a review of male and female reproductive systems, and a matching activity

Objectives Understand the importance of consent
Learn about taking responsibility for your sexual health Learn about the different methods of birth control and the importance of using dual methods Learn about emergency contraception Learn about birth control effectiveness Learn where to obtain birth control When we talk about birth control we can also use the word contraception, they are the same thing Dual protection means using a condom with any other form of birth control to protect against STIs and to increase the effectiveness of the method you are using

Consent: its like a cup of tea
Lets start off by talking about consent: (note, there are different versions of this video, this one is a “clean” version) You have to be connected to the internet for this video to play! (and content must be enabled) “Consent for any sexual activity must be freely given. Consent cannot be given by someone who is intoxicated, unconscious, or otherwise considered incapable of giving their consent. Consent can also not be freely given if it follows from threats to personal safety, or threats to harm others.” From The criminal code of Canada states that having sex with a person who is passed out or too impaired to give voluntary consent is sexual assault. Summary: You can only consent for yourself. You actually have to be able to give consent. That means you have to be awake, conscious, and sober enough to make a clear decision. People in positions of trust, power or authority can’t abuse their position to get sexual activity. If you imply no through your words or behaviours that’s just as good as saying “NO”. You have the right to change your mind and stop anytime for any reason during sexual activity. More information about the age of consent can be found: -in the Sexual Health of Youth in BC report here: -Options for sexual Heath : -Sexandu.ca consent: and

Age of Consent in Canada
Age of consent also known as age of protection refers to the age at which a young person can legally consent to sexual activity. All sexual activity without consent, regardless of age is a criminal offense. The age of consent laws apply to all forms of sexual activity, ranging from touching (e.g. kissing) to sexual intercourse. The age of consent for sexual activity in 16 years in Canada However, the age of consent is 18 years where the sexual activity “exploits” the young person when it involves prostitution, pornography, or occurs in a relationship of trust (e.g. with a coach). Also, age difference is part of the laws. The age of consent for anal sex in Canada is 18 years of age. “close in age” exceptions: For example, a 14 or 15 year old can consent to sexual activity with a partner as long as the partner is less than five years older and there is no relationship of trust, authority or dependency or any other exploitation of the young person. This means that if the partner is 5 years or older than the 14 or 15 year old, any sexual activity will be considered a criminal offence. The Criminal Code protects 16 and 17 year olds against sexual exploitation, where the sexual activity occurs within a relationship of trust, authority, dependency or where there is other exploitation. 16 and 17 year olds cannot consent to sexual activity that involves prostitution or pornography. From: Summary: Under age 12: are unable to consent under any circumstance. Ages 12-16: some flexibility for “close in age” and peers. 16 is the official age of consent. Young people under 18 years old are protected from exploitation.

What are my options? When it comes to sexual activity and birth control you have a few options: Be abstinent Hope and pray that nothing “bad” happens Chance it…and have an oops that might result in a pregnancy Educate yourself: learn about your options, about contraception, and STI prevention Readiness to have sex is very individual. Everyone has feelings about relationships, dating, intimacy and sex. Only you can decide what is right for you, and what works with your values. We all come from a different place and we need to respect one another’s decisions. Lets talk about some options, so you can decide what is right for you See page 2 in the Sex and HPV Its Time to Talk booklet Note for speakers: If you have not done this already, share the results from the McCreary Centre Adolescent Health Survey provincial and regional data: see sexual health of youth in BC full report here Surveys are done every 5 years in BC. 1. Summary of data from the 2013 BC Adolescent Health Survey of youth in grades 7-12 in public schools across BC (report released in 2015): Majority of kids are not having sex, youth who did have intercourse are waiting longer to do so compared to previous surveys 3 out of 4 youth had not had oral sex or any other type of sex 23% report having oral sex, down from 26% in 2008 19% of students reported having of sex (other than oral sex or masturbation) down from 24% in 2003 so of the survey respondents, 81% have never had intercourse 69% of students who are sexually active used a condom the last time they had intercourse. Students were less likely to use a condom or barrier with oral sex (17%) As students get older rates increase for both sexual intercourse and oral sex 3% if students who had ever had sexual intercourse reported an STI 1% report ever being pregnant 24% report using drugs or alcohol before the last time they had sex 2. Regional reports (with more local data) can be found here:

Abstinence – what is it? “Can mean a number of things but in terms of birth control, abstinence means not allowing sperm near the woman’s body below the waist. In terms of STI protection, abstinence also means no oral-genital, anal- genital, or intimate skin to skin contact.” - Options for Sexual Health Fact Sheet, FS- 420 Rev 03/09 What does it mean for you? Abstinence refers to not having sex. There are many forms of sexual abstinence, but in terms of using this as a method of contraception, it means avoiding vaginal intercourse. This type of abstinence can be effective for preventing unwanted pregnancy, but it also has a significant failure rate. How it works: Basically you choose not to have sex. It takes a very high level of self-control and agreement. Both partners must make sure to avoid any contact between the penis and the vagina and also be cautious not to have the pre-ejaculate or ejaculate, come in close contact with the vagina This includes on fingers. How effective is it? Total abstinence is 100% effective in preventing pregnancy. In practice, however, abstinence is not particularly effective, particularly when alcohol or drugs are involved. Abstinence education programs have not been found to reduce the risk of unplanned pregnancy, nor reduce STIs. Activity: Ask class to come up with advantages and disadvantages of this method (ideas below) Advantages Free and available to all Effective against pregnancy and disease Can be started at any time in ones life Encourages relationship building in ways other than through sex There are no hormonal or medical side effects Theoretically the most effective method of contraception Safe Disadvantages Can be challenging over time Partners may be unprepared if a change of mind suddenly occurs (what's the back up plan?) Requires both partners to be fully committed to using the method Choosing abstinence does not mean that your sex drive goes away and you may need to find other healthy ways to redirect your sexual energy.

Birth Control: Hormonal Methods
Combined Hormonal Contraceptives Patch Pills Ring Progesterone only Shot (Depo Provera) intrauterine device (IUD) Hormonal birth control methods may contain the hormones estrogen and progesterone or just progesterone by itself. They are very effective birth control methods for preventing pregnancy, when used consistently and correctly. Activity: use birth control kit (may be borrowed from some health units) to demonstrate what these different methods look like See pages of the Sex and HPV booklet there is also a quiz on page 19 and 22

Combined Hormonal Contraceptives: The Pill, The Patch, The Ring
Uses two hormones – estrogen and progestin – that are similar to the ones normally produced in your body Prevent pregnancy by stopping ovulation, changing the lining of the uterus and thickening the cervical mucous For typical users 8 out of every 100 women/year will experience an accidental pregnancy. Combined hormonal methods ( see page 14 of the Sex and HPV Its Time to Talk booklet) Pill: taken daily and can be taken continuously to prevent your period from happening for a significant event (i.e. grad) How it works: The pill works by preventing the ovary from releasing an egg, and by thickening the cervical mucus making it difficult for the sperm to reach the egg, and changing the lining of the uterus making implantation difficult. It must be taken every day, ideally close to the same time each day. Most pills are set up on a 28 day formula with hormone pills taken for three weeks, followed by a “placebo” or “sugar pill” . Newer pill options have adjusted the number of hormone pills and placebos to provide effective contraception with lower doses of hormones and as little as two days of placebo to minimize hormone variations and side effects. Patch: changed weekly The contraceptive patch is has been available in Canada since January It is a 4 x 4 cm beige patch that sticks to a woman’s skin and continuously releases the hormones estrogen and progestin into the bloodstream. The patch prevents pregnancy in a way that is similar to the birth control pill. Each patch is worn for seven days. One patch is worn each week for 3 weeks (21 days). The patch should be changed on the same day each week. The fourth week is patch-free, allowing a period to occur. Following the seven patch-free days, a new cycle is started when you apply a new patch. The patch can be worn on the buttocks, stomach, back or upper arms, change the location each week. The patch should be applied to clean, dry skin. You should not use any creams or lotions near a patch you’re already wearing, or where you’ll be applying a new one. The patch is very “sticky”. You can exercise, shower, swim or go in a sauna or hot tub and it still sticks 98% of the time! Ring: changed once a month The vaginal ring is a soft, flexible, clear plastic ring that measures 54 mm in diameter. It is inserted into a woman’s vagina where it slowly releases the hormones, estrogen and progestin, for three weeks/ 21 days. The ring works similar to the way the pill works. The ring comes in only one size. It is held in place by the walls of the vagina and cannot be felt ring once it is in place. The ring is worn inside the vagina for three weeks, followed by a 7 day ring-free interval allowing a period to occur. At the end of the ring-free week, a new ring is inserted. A woman inserts and removes the ring herself. If she can use a tampon, she can use the ring. Costs vary depending if these are purchased through a non-profit clinic (like Options for Sexual Health, a youth clinic) or by prescription at a drug store. Some drug benefit plans cover the cost of birth control methods. Generally, if you do not have drug coverage and have to pay for yourself, clinics are less expensive ($ for one month supply) otherwise it is at least twice that amount through a drug store.

Progesterone Only Contraceptives
Thickens the cervical mucous Hinders ovulation or fertilization Changes the lining of the uterus Progesterone only (see page of the Sex and HPV Its Time to Talk booklet) contain only the one hormone. Progesterone only pills MUST be taken at the same time each day and are suitable for women who cannot take estrogen Injectable contraception, or “the shot”, is highly effective and reversible. An injection is given four times a year, and can be a good choice for women who have trouble following a daily, weekly, or monthly routine. How it works: The injection is given by a nurse/Dr in the upper arm or buttocks, of a woman, every 12 to 14 weeks (four times a year). The progestin hormone prevents the ovaries from releasing an egg. It also thickens the cervical mucus making it difficult for sperm to reach the egg and changes the lining of the uterus making implantation difficult. Intrauterine contraceptives (IUCs) are long-acting reversible contraceptive (LARC) methods They are the most effective forms of birth control available (as there is no human error involved once they are inserted). IUCs are small T-shaped devices (about the size of a quarter) that are inserted in the uterus by a trained Dr or Nurse Practitioner. There are two types of intrauterine contraception: the Copper intrauterine device (Cu-IUD) and the progesterone-releasing intrauterine system (LNG-IUS). (NOTE: the IUD shown above is a copper IUD, IUC’s are similar in size and design) How it works: All IUCs prevent pregnancy by making the uterus hostile to sperm and eggs. In a LNG-IUS, the tiny cylinder on the device contains the hormone, which is slowly released over several years. The lining of the uterus becomes thinner and the cervical mucus becomes thicker which makes it harder for sperm to enter the uterus. As well it tends to eliminate ovulation Both types of devices are inserted by a health professional. The procedure is fairly simple, does not require anaesthesia, and only takes a few minutes. Depending on the device chosen, the IUC can remain inserted for 3-10 years, before needing to be replaced. Copper (hormone free) version cost about $80. while the version with hormones can be $300 or more.

Myth: a guy can’t get a girl pregnant if he doesn’t have an orgasm
(page 6 of the of the Sex and HPV Its Time to Talk booklet) Males often release a small amount of semen (cum) before they ejaculate. Sometimes this is called pre-cum, this may contain sperm and can cause pregnancy STRESS that this important to consider when putting on condoms. If you start to put a condom on and it wont roll down, you cant turn it over and use it as pre-cum may now be on the outside of the condom.

Non-Hormonal Methods from the Drug Store
Sponge Spermicide Condoms Drug store methods (see page 5 and 15 of the Sex and HPV Its Time to Talk booklet) These are methods that can be purchased without a prescription and are generally less effective in preventing pregnancy if used alone. Using them together with a condom raises their effectiveness rates. The contraceptive sponge is a small, disposable, foam device that is placed in the vagina. The sponge contains a spermicide, which helps to absorb and trap sperm. How it works: The contraceptive action of the sponge is primarily provided by the spermicide it contains. The spermicide absorbs and traps the sperm and destroys the sperm cell membrane. The sponge itself also provides a physical barrier to prevent sperm from entering the cervix. The sponge can be inserted into the vagina up to 24 hours before intercourse. One side has a loop to make removal easier. It comes in a one size fits all. Protection begins immediately when inserted and lasts for 24 hours even with repeated acts of intercourse. It should be left in the vagina for at least 6 hours after sex, and should not remain in the vagina for more than 30 hours total. For a woman who has not had children, it is 68% effective in preventing pregnancy (based on 100 women using this method for a year) Spermicides should be used along with another method of contraception, such as a condom, because alone they are not highly effective. (currently there is no health Canada approved contraceptive gel, however this is a spermicide “substitute”) By inserting spermicide in front of the cervix, in the vagina, it works to destroy sperm on contact. How does it work? Nonoxynol-9 is a surfactant that destroys the sperm cell membrane. Spermicides are available at pharmacies without a prescription, in the form of cream, gel, foam, film, or suppository. Spermicidal film must be inserted into the vagina at least 15 minutes before intercourse. It will melt and disperse. If more than 3 hours have passed before intercourse, another film must be inserted. Spermicidal foam is inserted into the vagina using an applicator. It is effective immediately and for up to one hour after insertion. It must be applied again for each act of intercourse. Failure rate is 29% with typical use (so in a 100 women using this method for a year 71 did not get pregnant with typical use). Spermicides should always be used with another barrier method of contraception Can be purchased in film, foam and suppository (and sometimes gel) form More on condoms in upcoming slides No prescription or doctor’s visit needed

Female/Internal Condom
Soft disposable sheath Available free from some health units Insert in vagina before sex, use with lubricant (lube) Lines the vagina and prevents direct genital contact and exchange of body fluids This condom is a soft, loose-fitting, seamless casing containing two flexible rings, one at each end. It is inserted into the vagina before sex and works by holding in the sperm, preventing sperm from entering the vagina. How it works: The internal condom is a barrier contraception method The ring at the closed end of the condom is inserted into the vagina and helps to keep it in place The external ring at the open end of the condom sits outside the vagina The sheath is coated on the inside with a silicone-based lubricant. It can be placed in the vagina up to 8 hours before sexual intercourse. A new condom should be used for each repeated act of sexual intercourse They can be a bit “noisy” and require some practice to use correctly There are often available free from your local health unit

Male/External Condom Disposable sheath that fits over an erect penis
Available in different sizes, shapes, colours, and flavours Latex and non-latex available Available free from health units, some schools etc. Easy and reliable method of birth control Very effective in preventing disease Most condoms are made of latex, but non-latex condoms are also available in polyurethane and polyisoprene. These types of condoms are also effective for preventing most sexually transmitted infections Condoms come in different sizes and flavours. Flavoured condoms are not just for oral sex. How it works The condom is placed over the penis before sexual activity. It must be put on before any skin-to-skin genital contact occurs. It acts as a barrier preventing direct contact between the penis and the vagina and prevents the exchange of body fluids and trapping sperm. A new one must be used for each time you have sex. It is good to practice putting condoms on before you plan to be sexually active There are often available free from your local health unit as well as in some schools and from some organizations that offer youth services.

Condom Demo Suggestion:
Give all students a condoms (free condoms may be available from your local Public Health Centre), in Interior Health consider having your school become part of the condom pilot project and obtain free condoms from our website here: Storage · Condoms should be kept at room temperature in a dry location. · If you keep condoms in your pocket, wallet or backpack replace them often as they may get damaged (check if they still have an air pillow). Talking About Condoms With Your Partner, its important! · Talk with your partner about using condoms before you have sex, even if it feels awkward. Practice how you’d like the talk to go. · Explain that this is important to you and that you want to protect both of you. · If your partner does not want to use a condom suggest a low risk activity like massage instead. · Use condoms every time you have sex to prevent STIs and pregnancy. · Condoms are the best protection available against sexually transmitted infections (STI) except for not having sex. · Condoms can be 85-98% effective in preventing pregnancy if used correctly every time you have sex. It is better to use 2 different methods of birth control, (dual methods) like condoms & the pill to avoid a pregnancy. · Never use 2 condoms together, as rubbing can cause the condoms to break. Use condoms every time you have vaginal, anal or oral sex, whatever your gender or sexual orientation. Optional Activity 1 Review steps: Condoms should be put on a hard penis before vaginal, anal or oral sex. Putting condoms on right takes practice! And one way for males to practice is with masturbation, before trying them for the first time with intercourse. · Check the expiry date, and for an “air pillow” in the package push the condom to one side and open the package carefully with your fingers. · Hold the condom by the tip to push out air and leave space for the semen. · The condom should look like a Mexican hat and roll down easily. If the condom is placed upside down it will not unroll. This condom will have pre-cum on it, so start over with a new condom. · Unroll the condom all the way down the penis (for practice, consider using a banana, or 2 fingers) , remember to keep the tip pinched to leave space for the semen · Apply lube. After sex hold the condom in place as the penis is pulled out, to prevent spillage. **Used condoms go in the garbage. Do not flush down the toilet, and do not litter with them, as small children may mistake them for balloons. A condom demo video supported by the BC Centre for Disease control has been linked to the above picture and can be found here: Optional Activity 2: Condom Line up Game (from Alberta Health Services) This game will require you to print off cards. They will last a long time if you laminate them. You can find the full lesson plan and the cards here: You don’t have do the whole lesson as you will have already addressed many of the points covered, you can just print the cards. How to Play 1. Divide group into two (or more) teams. 2. Each team is given a set of cards. 3. Each person on the team takes one card (or more if necessary). 4. Have each person read their card to their group. 5. As a team, the group decides which card is the first step in condom use. The person holding that card begins to form a line. 6. The group then decides which card goes next. The person holding that card takes the next place in line. 7. This process continues with each person lining up with cards in the correct order. 8. The first group to stand with their cards correctly in order wins. 9. The order may change depending on group discussion/decision. This game can also be played by taping the cards in order if the game is being played in a small space. The same rules apply. Line up the cards in correct order and tape to a board so everyone can see. This game can also be played individually or in pairs by using small versions of the cards and laying them out on a table.

Myth : a female can’t get pregnant the first time she has sex
(page 7 of the Sex and HPV Its Time to Talk booklet) A woman who is ovulating can get pregnant the very first time having intercourse regardless of her age or sexual history. Ovulation is the time during a woman’s menstrual cycle when she is most likely to get pregnant. Conception can occur when sexual intercourses takes place during the fertile window, from 5 days before to 1 day following ovulation.

Other Non-Hormonal Methods that Require a Clinic Appointment
IUD (copper) Surgical options (permanent) Barriers (cervical cap/diaphragm) Non- hormonal methods available from your Doctor (see page 15 of the Sex and HPV Its Time to Talk booklet) How it works: Copper IUDs (Cu-IUDs) do not contain any hormones and the copper acts as a natural spermicide. The presence of the IUD itself creates a hostile environment leading to prevention of a pregnancy. The IUD is inserted by a health professional, in a clinic. The procedure is fairly simple, does not require anaesthesia, and only takes a few minutes. Depending on the device, the IUD can remain inserted for 3-10 years, before needing to be replaced. Copper IUD’s (hormone free) cost about $80. They are the most effective forms of birth control available. Male sterilization or vasectomy is a permanent surgical procedure to close or block the tubes that carry sperm to the penis (these tubes are called the vas deferens). This is permanent. Compared to a tubal ligation, vasectomy is safer, more effective, less expensive, and less invasive. How it works: Under local anaesthesia, a Dr. will reach the vas deferens either by making a small incision on the skin of the scrotum (conventional vasectomy) or by making a small puncture on the skin of the scrotum (no-scalpel vasectomy) the vas deferens is partially removed or blocked, so that no sperm is released. Another form of contraception is required until a semen analysis shows no sperm (about 6 weeks). Female sterilization by tubal ligation is a permanent surgical procedure where the two fallopian tubes, which transport the eggs from the ovaries to the uterus, get disconnected. Female sterilization by tubal occlusion is a permanent procedure where a micro-insert is placed into each of the fallopian tubes, these work with your body to form a natural barrier that keeps sperm from reaching the eggs, preventing pregnancy. It involves surgery and there are a few different ways it can be done: Tubal ligation: Laparoscopy – using a general anesthesia, the doctor will make small incisions over the abdomen and either clip, burn or remove the fallopian tubes. Abdominally – during a caesarean section, a gynaecologist can access the fallopian tubes to either clip or remove them. Tubal occlusion: Hysteroscopy – using only local anesthesia, a gynaecologist will put micro-inserts in your fallopian tubes through a vaginal approach. It takes 3 months for this method to be effective, at which time a confirmation test (x-ray or ultrasound) is done to make sure the tubes are fully blocked. The cervical cap is a deep silicone cap that fits against the cervix and prevents sperm and bacteria from entering. Current version available in Canada is the Fem cap. While it can be ordered online, it requires a prescription The cervical cap serves as a physical barrier between sperm and the cervix. It comes is different sizes depending if you have never been pregnant, been pregnant but not delivered vaginally or if you have had a vaginal delivery. Effectiveness rates vary It should always be used with a spermicide gel ( and the problem is that there currently is no Health Canada approved gel, the gel forms a physical cellulose barrier in front of the cervix and lowers the pH of the vaginal fluid, thereby inhibiting sperm motility.) The cap can be inserted into the vagina up to 2 hours before having sex. More spermicide gel is needed for each repeated act of intercourse or after 2 hours has passed. It should be left in the vagina for at least 6 hours after intercourse but should not remain in the vagina for more than 48 hours total. Cervical caps can be purchased online and should be replaced every year. The diaphragm is a barrier, made of latex or silicone and nylon, that covers the cervix and prevents sperm and from entering. The diaphragm should always be used with a spermicide gel (and the problem is that there currently is no Health Canada approved gel, the gel forms a physical cellulose barrier in front of the cervix and lowers the pH of the vaginal fluid, thereby inhibiting sperm motility) which is placed inside the diaphragm to immobilize or kill sperm. The diaphragm serves as a physical barrier between sperm and the cervix. It should always be used with a spermicide gel (and the problem is that there currently is no Health Canada approved gel). (The gel forms a physical cellulose barrier in front of the cervix and lowers the pH of the vaginal fluid, thereby inhibiting sperm motility.) The diaphragm can be inserted into the vagina by the women using it up to 2 hours before having sex. The diaphragm should be left in the vagina for at least 6 hours after intercourse but should not remain in the vagina for more than 24 hours total. If there is repeated intercourse within the first 6 hours, more gel should be inserted with an application (the diaphragm should not be removed). DATA is Lacking on the effectiveness of the diaphragm with the gel that is currently available in Canada. Previous studies based on diaphragm use with spermicidal gel ( which is no longer available in Canada, instead there is a “spermicide substitute) have shown that the diaphragm has a higher failure rate compared to other types of contraception The Caya diaphragm Caya is the brand of a diaphragm that does not need to be fitted but may require a prescription. Caya can be ordered online, although the Canadian website is not always functioning so it is hard to get information on cost. According to the website, effectiveness rates are said to be that women out of 100 may get pregnant per year using this method, and if you have sex 3 or more times a week, it may be less effective. It needs to be replaced every 2 years.

Withdrawal Withdrawal as a method of birth control is not a great choice. Withdrawal, also known as pulling out, is an attempt to avoid having any sperm ejaculated into the vagina or on the vulva during sex. How it works: During sex, the male pulls his penis out of the vagina and away from the vulva prior to ejaculation. This can be difficult to time just right. Both partners have to be really careful as right before ejaculation, there is some fluid released from the penis that contains sperm Effectiveness Withdrawal is risky. About 27 out of 100 women who use this method will become pregnant in a year. Advantages It is considered a natural method Safe Convenient Readily available No cost No prescription required No hormone side effects Disadvantages It’s not easy, it takes a lot of self-control It is risky Does not protect against STIs

Emergency Contraception (EC)
“Morning After Pill” aka Emergency Contraceptive Pill The emergency contraceptive pill (ECP) is a high dose of progesterone Must be taken within 5 days of unprotected sex, weight can be a factor in effectiveness No prescription needed (unless you want Ulipristal acetate) It is not an abortion pill The Copper Intrauterine Device (IUD) must be inserted by a Dr. within 7 days of unprotected intercourse There are two types of emergency contraception to choose from in Canada: “morning after pills” and the Copper intrauterine device (IUD) See page 13 of the Sex and HPV Its Time to Talk booklet Morning after pills or Emergency Contraception Pills (ECP) Can be purchased over the counter at drug stores without a prescription. You have to ask the Pharmacist for it. Cost varies (from $30-50 or more dollars), also available from some doctors, walk in clinics, Youth Clinics, Options for Sexual Health clinics, emergency departments and some public health offices. (free, or $10-20 dollars). Emergency contraceptive pills are intended for occasional use only, not as a regular method of birth control. ECP work best if taken as soon as possible after unprotected sex. (within 72 hours) Not the same as the abortion pill The effectiveness of ECP is highest when taken within 24 hours of unprotected sex and declines the later they are taken; but they can be taken up to five days later. The pills contains synthetic progesterone and mimics how the natural hormone works, interfering with ovulation in the early stages of the egg's development, preventing fertilization and preventing implantation. It depends where a woman is in her menstrual cycle as to how they work. ECP will not harm the fetus, should it not be able to prevent the pregnancy. A high body weight (a body mass index (BMI) greater than 25) may decrease the effectiveness of these pills. A second morning after pill, UPA-EC (Ulipristal acetate), is now available in Canada, currently by prescription only (according to sexandu.ca) It is recommended for its greater effectiveness over a longer period of time after unprotected sex (up to 5 days) and appears to be equally as effective for those who have a higher BMI/weight. It works by delaying ovulation until the egg is released from the ovary (cost estimate $100 plus) Copper intrauterine device (IUD) The most effective method of emergency contraception is a copper intrauterine device (IUD), which is inserted by a trained doctor or nurse practioner within 7 days of unprotected intercourse. The copper IUD provides ongoing birth control for 5 years or more. Cost is about $ Suggested Classroom Activity: Ask the class for some of the reasons that emergency contraception may be used: Missed birth control pill, patch, or injection No contraception was used Withdrawal didn’t work Sexual assault The condom slipped, broke, or leaked Error in the calculation of the fertility period

Contraceptive Success Rates
Method Actual Use Perfect Use (but who is perfect?) Pill, Patch ,Ring 92% 99.9% IUS (progesterone) IUD (copper) 99.2% 99.4% Shot (Depo Provera) 97% 99.95% Male/external condom 85% 98% Female/internal condom 79% 95% Withdrawal 73% 96% No method 15% Actual use takes into account human error and other non ideal factors Perfect use are rates of how well a method works when it is used correctly and when all other conditions are ideal (So as none of us are perfect, or live in a perfect world, it is safer to go by actual use rates) Adapted from Contraceptive Technology Today 19th Revised Edition, Hatcher et al (New York: 2007) based on 100 couples using the method for 1 year, and shows the percentage of women who did not get pregnant while using this method for 1 year Also see the Options for sexual health website under birth control (relative effectiveness) for a more comprehensive chart that can be printed Suggested classroom activity: ask students to find a more comprehensive list of effectiveness rates, see references on next slide for suggested places to look Or Use the activities in the Sex and HPV Its Time to Talk booklet on pages 19, 20, 21 22 Remind students that dual protection helps to prevent unwanted pregnancy and STIs (page 5 of Sex and HPV Its Time to Talk booklet )

References and the Sex and HPV Its Time to Talk booklet from the SOGC (has great information on STIs and contraceptives) has fact sheets and information and operates the sex sense line sex sense McCreary Centre, Adolescent Health Survey, 2013 has survey result from school districts all across BC including a report of youth and sexual health Smart Sex Resource from BCCDC HealthLink BC or 811 to speak with a RN Interior Health's Public Website pages on Sex Health spx The Sex and HPV Its Time to Talk booklet that would be a great accompaniment to this PPT can be ordered for free from this web site: Sexual health of youth in BC 2013 report is found here in addition there is an infographic of key findings The smart sex resource site from BCCDC HealthLinkBC: Whether you have a specific health concern or you are looking for information about a health topic you saw on TV, you have come to the right place. HealthLinkBC Files are easy-to-understand fact sheets on a range of public health and safety topics including disease prevention and immunizations. 811: Registered Nurses Registered nurses at HealthLink BC can help you with non-emergency health concerns, to discuss symptoms and procedures, and to recommend whether you should see a health care provider in person. At any time of the day or night, every day of the year, you can call to ask a registered nurse your health questions. Learn more about Nursing Services at HealthLink BC. 1 800 Sex Sense line provides free and confidential information. Note: some more appropriate photos could not be included as permissions were not given or photos were not available from the Interior Health selection. All images used in this PPT are owned by Interior Health

Birth Control and Sexually Transmitted Infections

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