SEXUAL HEALTH WHAT WILL WE BE LEARNING ABOUT

SEXUAL HEALTH

WHAT WILL WE BE LEARNING ABOUT? • Making healthy sexual decisions • What are sexually transmitted infections and strategies to stay healthy • Accessing health information for yourself • Strategies to protect yourself and others from potential abuse, exploitation and harm

WHY DO WE LEARN THIS ? • Most people will want to have sex at some point in their lives , whether it is in the next few years, when you get married, or when you want to have children– it is important to understand the health risks so that you can stay healthy. • Sex must be consensual. We must learn what consent means so we can give and ask consent. • You have the right and responsibility to understand how your body works. • Any other ideas?

GROUP GUIDELINES • This is a shame-free learning environment. I will not judge you, laugh at you, or shame you for your questions, views or comments. I expect you to show the same respect to each other. If you are not willing to do this, you will be asked to leave. • I will provide you with information and I will not put you on the spot. Your responsibility is to listen and learn. • We will have a question box for anonymous questions at the end of the unit, however feel free to ask questions as we go as well.

WHAT IS SEX? When we talk about sex, we are talking about a range of activities that fall under four categories: • • Genital to genital sex Anal sex (genitals to anus) Oral sex (mouth to genitals) Digital sex (hand/fingers to genitals) Sex in ANY of these categories can cause infections if proper hygiene and protection are not used.

CONSENT • For people to have sex, there must be consent. Sex without consent is called rape. Consent should be ENTHUSIASTIC. • Someone cannot give consent if: - they are intoxicated (by alcohol or drugs) - they are asleep - they are being threatened or are afraid of saying no To consent to sexual activity means to agree freely. The law requires that a person take reasonable steps to find out whether the other person is consenting.

CONSENT • The legal age of sexual consent in Canada is 16. However, 14 - and 15 -year-olds can have sex with someone who is less than five years older. • A 12 or 13 -year-old can consent to sexual activity with another young person who is less than two years older and with whom there is no relationship of trust, authority or dependency or other exploitation of the young person. • 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 authority, trust or dependency (e. g. , with a teacher, coach or babysitter). • The age of consent laws apply to all forms of sexual activity, ranging from sexual touching (e. g. , kissing) to sexual intercourse.

CONSENT • CONSENT is as simple as tea (video) • https: //vimeo. com/128105683? lite=1

WHAT ARE YOUR VALUES OR BELIEFS ABOUT SEX? On a piece of paper (that you won’t have to show to anyone) answer the following questions: - When and under what circumstances do I want to have sex? (dating, -term relationship, engaged, married, living at home, living on my own, etc. ) long - What are my parents’ beliefs about sex? Do I agree with them? - Do I feel embarrassed talking and learning about sex? - Would I feel embarrassed talking to a doctor about sex? - Would I feel embarrassed talking to my boyfriend or girlfriend about sex?

WHAT ARE YOUR VALUES OR BELIEFS ABOUT SEX? • Depending on how you answered the last questions, you may or may not be ready to have sex for awhile. THAT IS OK. Everyone becomes sexually active at different times, and it should happen when you are ready. • If you are not comfortable discussing sex with a doctor or with your partner, you are not ready to have sex. THAT IS OK. Wait until you are ready.

STAYING HEALTHY • We will be learning about sexually transmitted infections (STIs) in this unit. You can contract an infection anytime that sexual organs make contact. • You can reduce the spread of sexually transmitted infections by: • Visiting a doctor to be tested for STIs, and having your partner do the same BEFORE engaging in sexual activity. If one of you is infected, you don’t want to pass on the infection. You should get tested regularly, especially if you have a new partner. • When you visit the doctor or clinic, it is important to be honest about your sexual history so that they can help you as best they can. Your doctor is not there to judge you. If they seem judgmental, get a new doctor!

STAYING HEALTHY • If engaging in digital sex, hands should be thoroughly washed before touching either partner and washed again before touching the other partner. • Use a condom when engaging in sexual activity. Not only will this reduce the risk of pregnancy, but it will reduce the risk of contracting an STI. Latex condoms are the only form of contraception now available that are highly effective in protecting against the transmission of HIV and other STDs • If you are not comfortable acquiring condoms, you are not ready for sex. Condoms are an investment in your health and should be a normal part of your preparation for sexual intercourse.

STAYING HEALTHY Sexually Transmitted Infections (STIs) • Infectious diseases transmitted through some form of intimate contact • • Genital sex Oral sex Digital sex Anal sex

STAYING HEALTHY Gonorrhea • Caused by a bacteria that usually infects the urethra, genital tract, pharynx, and rectum but may spread to the eyes or other areas of the body via the hands or fluids • Symptoms: white milky discharge with painful, burning urination and/or fever. Some people experience no symptoms.

STAYING HEALTHY Genital Warts • Caused by the Human Papillomavirus (HPV) • The virus penetrates the skin and mucous membranes of the genitals or anus through sexual contact • Can be treated with topical medications or removed by being frozen with liquid nitrogen. • Large warts may require surgical removal

STAYING HEALTHY Syphilis • Caused by bacteria that is transferred only by direct sexual contact as it dies upon exposure to air, dryness, or cold • Primary syphilis • Development of a chancre (painless sore that oozes with bacteria) that disappears in 3 to 6 weeks • Secondary syphilis • A rash or white patches on the skin or mucus membranes of the mouth, throat, or genitals appears along with possible hair loss, lymph node enlargement, fever and headaches • Symptoms again will disappear • Latent syphilis • Organism begins to invade the body’s other organs • Infectious lesions may again reappear • Late syphilis • Heart and nervous system damage, blindness, deafness, paralysis, senility and insanity

STAYING HEALTHY Chlamydia • There are not always symptoms, but symptoms may include: Painful and difficult urination, frequent urination and a watery pus-like discharge from the penis Yellowish discharge, spotting between periods and occasional spotting after intercourse • This infection can damage the cervix or fallopian tubes, causing sterility and can lead to pelvic inflammatory disease

STAYING HEALTHY Pubic Lice (Crabs) • Small parasites that are usually transmitted during sexual contact • They attach to pubic hair where they deposit their eggs • When crab lice feed they can inject saliva into the host, causing itching

STAYING HEALTHY Trichomoniasis • Symptoms include a foamy, yellowish, unpleasant-smelling discharge with a burning sensation, itching, and painful urination • Usually spread by sexual contact, but can also be spread by toilet seats, wet towels, or other items that have discharge fluid on them

STAYING HEALTHY Herpes • Genital herpes is caused by the herpes simplex virus (HSV) • Symptoms include a redness at the site of infection followed by a blister filled with clear fluid containing the virus • The blister will crust over, dry up and disappear and the virus will travel to a nerve in the area and stay dormant until the virus becomes reactivated

STAYING HEALTHY Hepatitis A, B & C • Affects the liver • Hepatitis A spreads via fecal-oral contact, which can occur if there is direct oralanal contact or contact with fingers or objects that have been in or near the anus of an infected person. Sometimes it is spread through food that has been prepared by someone with dirty hands. • Hepatitis B has been found in vaginal secretions, saliva, and semen. It can be spread through sexual contact, and possibly, through deep kissing. • Hepatitis C is transmitted through sexual contact or through contact with an infected person’s blood -- which may be present because of genital sores or cuts or menstruation

STAYING HEALTHY AIDS/HIV • Human immunodeficiency virus (HIV) is the slow acting virus that causes AIDS • Acquired immune deficiency syndrome (AIDS) is a disease that causes the immune system to become inoperative Transmitted through: -Unprotected sex -Sharing needles or syringes -Mother to infant (in the womb or during delivery) -Blood transfusions that have not been properly screened (prior to the 1980 s or in other countries) -Other contact with blood (healthcare workers, etc)

STAYING HEALTHY HIV Symptoms: • A person may go months or years before any symptoms appear • A person may experience infections, colds, sore throats, fever, tiredness, nausea, night sweats and other non-life threatening conditions • Meanwhile, their immune system gradually weakens until they are diagnosed with AIDS Treatment: • Current treatments combine different drugs • Older drugs worked by preventing the virus from infecting new cells • There are many side effects to the different drugs and getting the right combination and dosage is difficult

STAYING HEALTHY Case study: Alex and Janet have been a couple for six months. They were both tested for STIs last month, before having sex. They did not have any infections, so a few times, they had sex without a condom. This morning, Janet noticed a small blister on her vagina. She went to the doctor who told her that she had contracted genital herpes. Janet has only ever had sex with Alex. How did she contract an STI?

STAYING HEALTHY Case study: Two weeks ago, Alex went to a party and had sex with someone that was there. Alex did not use a condom. Alex didn’t tell Janet because Alex feels very guilty about cheating on her and thought that it would be better to just forget it ever happened. Alex contracted genital herpes from this sexual encounter and did not know. Alex then passed it on to Janet. What could Alex have done differently to stay healthy and to keep Janet healthy?

STAYING HEALTHY • In addition to STIs, pregnancy is a possibility any time semen comes in contact with a vagina. Even if a couple does not have genital sex, but engages in other sexual activity, semen may come in contact with the vagina and pregnancy is possible. • There is no method of contraception that is 100% effective, but there are steps that you can take that can reduce the risk of pregnancy if you are engaging in sexual activity. • If you are not ready to be a parent, think seriously about whether you are ready to have sex.

CONTRACEPTION • There are many, many types of contraception (birth control) available. In this class we will review the six most popular methods, but you can ask your doctor about other options. • 1) The Pill (oral contraceptives) • 2) IUD (intrauterine device) • 3) Contraceptive patch • 4) Vaginal Ring (Nuva. Ring) • 5) Condoms • 6) Abstinence

THE PILL The Pill - For it to work, the Pill must be taken daily at the same time every day. Some people find it helpful to set an alarm clock as a reminder. There are two kinds of oral contraceptives, the combined oral contraceptive (COC) and the progestin-only contraceptive (POP). - The combined oral contraceptive (COC) contains two types of hormones: estrogen and progestin. This pill works by preventing the ovary from releasing an egg, thickening the cervical mucus making it difficult for the sperm to reach the egg, and changing the lining of the uterus making implantation difficult. - The progestin-only oral contraceptive contains no estrogen. This pill works by thickening the cervical mucus making it difficult for the sperm to reach the egg, changing the lining of the uterus making implantation difficult, and may sometimes inhibit the release of an egg.

THE PILL Advantages • With proper use, the Pill is 99. 9% effective, making it the most reliable contraception available. However, there is a 3% user failure rate • Does not interfere with intercourse • May reduce menstrual flow and cramps • May decrease premenstrual symptoms Disadvantages • The birth control pill can lead to a higher risk for blood clots, heart attack, and stroke • Must be taken every day, at the same time • May cause irregular bleeding or spotting • May cause breast tenderness, abdominal bloating, acne or headaches • Effectiveness may be reduced by other medications • Does not protect against STIs

CONTRACEPTIVE PATCH - The patch prevents pregnancy primarily by stopping the ovaries from releasing an egg, but it may also thicken the cervical mucus (making it harder for sperm to get into the uterus) and make the uterine lining thin. Its method of action is very similar to the Pill. - Unlike the Pill, which has to be taken every day, each patch is worn on the skin for seven days. One patch is worn each week for 3 weeks. - Effectiveness Like the Pill, the patch is also more than 99% effective at preventing pregnancy when used perfectly, with about a 3% failure rate for typical users. For people who have trouble remembering to take a pill every day, the patch may work better than the Pill.

CONTRACEPTIVE PATCH Benefits to being on the patch include a regular, lighter period, often with less PMS and cramping. It is believed to reduce the risk of endometrial and ovarian cancers and help prevent benign ovarian cysts like the birth control pill because it works in a similar way. It is completely reversible. Once you stop the patch, your body resumes its natural cycle. Disadvantages • The patch does not protect against sexually transmitted infections. • When starting the patch, you may notice side effects such as breakthrough bleeding (between periods), breast tenderness, headaches, or nausea as your body gets used to the hormones. These symptoms usually go away in the first three months. • You may also notice some skin irritation • Users who cannot take estrogen due to a medical condition cannot use the patch or the Pill. See your doctor to decide if the patch is a good choice for you. • It may not be covered by all drug plans.

IUD The IUD is a small, T-shaped device with a copper wire. Inserted into the uterus by a healthcare professional, the copper wire changes the chemistry in the uterus and destroys sperm. Some IUDs also release hormones. Benefits The copper IUD provides up to 5 years of contraception. It fails in only 1 of 100 users per year. The IUD should not alter the timing of your periods. Disadvantages • The copper IUD does not protect against sexually transmitted infections (STIs) or HIV. Condoms should be used to protect against STIs or HIV. • Some users find that their periods get heavier or more crampy. • Complications associated with the IUD are rare but may occur. Possible complications of inserting an IUD include irregular bleeding or spotting, perforating the uterus (making a small hole in the uterus), infection, or expulsion (the IUD falls out).

VAGINAL RING The vaginal ring (Nuva. Ring. TM) is a new birth control method that is now available in Canada. This soft, flexible, clear plastic ring measures 54 mm in diameter and is inserted into the vagina where it slowly releases two hormones (estrogen and a progestin) for three weeks. • The ring comes in only one size, and does not need to be in a particular position in the vagina to be effective. It is held in place by the walls of the vagina and the user usually cannot feel the ring once it is in. The user inserts and removes the ring at home and most users find this easy to do. Remember, the vagina is a closed space and there is no way for the ring to get “lost” or go anywhere else. • The ring is worn inside the vagina for three weeks, followed by a one-week (seven day) ringfree interval. When the ring is removed, the user usually has a period within a few days. At the end of the ring-free week, the user inserts another ring to begin a new cycle.

VAGINAL RING Effectiveness The ring is at least as effective as the birth control pill, and it may be more effective if the user has trouble remembering to take her pill every day. Benefits In addition to preventing pregnancy, the ring has the added benefit of making the user’s periods more regular, lighter, and may reduce cramping. It is completely reversible. When the user stops using the ring, their body resumes its normal cycle and fertility returns quickly. Disadvantages • Uncommonly reported side-effects include headaches, vaginal irritation, discomfort or discharge, nausea, and breast tenderness. • Breakthrough bleeding (bleeding between periods) may occur, especially during the first few months.

EXTERNALCONDOMS The external condom is a latex sheath that is rolled over the penis to prevent secretions (including semen) from entering the vagina. Benefits Condoms are approximately 80% effective when used properly and consistently. Condoms protect you and your partner from unwanted pregnancy. Condoms are inexpensive, easy to use and effective. They’re also your best defence against sexually transmitted infections (STIs) - the only type of birth-control method to offer such protection Disadvantages The condom may slip off during sex. Rough handling may cause the condom to break. Some people may be allergic to latex.

INTERNAL CONDOMS The internal condom is a polyurethane sheath in the shape of a round, upside-down baggie inserted into the vagina before sex. This condom holds in the sperm, preventing it from entering the vagina. • Benefits Used perfectly, the internal condom has a failure rate of 5%. • Disadvantages Some people may have trouble inserting it correctly, and they can be expensive - around $3 each.

ABSTINENCE • Abstinence means NOT having sex • Abstinence is the only method that is 100% effective at avoiding pregnancy • Some people may choose abstinence until they are married, and some people may choose abstinence while they are teenagers, and then use a different method of contraception.

CONTRACEPTION MYTHS The following methods will NOT prevent pregnancy: - Having sex standing up - Peeing after sex - Showering after sex - Having sex while one partner is menstruating - Rinsing with cola (? ? ? ) - Having sex for the first time -What other myths have you heard?

STAYING HEALTHY • Where can I get more sexual health information? • Your doctor • School Counselor • Sexual Health Clinic • www. optionsforsexualhealth. org (you can also email them questions) • 1 -800 -sex-sense

STAYING SAFE • The Criminal Code protects all Canadians, including children, against sexual abuse and exploitation. Children are also protected by child-specific offences in the Criminal Code. • Sexual Interference - no one can touch any part of the body of a child under the age of 16 for a sexual purpose. • Invitation to Sexual Touching- no one can invite a child under the age of 16 to touch himself/herself or them for a sexual purpose. • Sexual Exploitation - no one in a position of trust or authority over a 16 or 17 year old (for example, a teacher, religious leader, baby-sitter or doctor) or upon whom the young person is dependent, can touch any part of the body of the young person for a sexual purpose or invite that young person to touch himself/herself or them for a sexual purpose. • Incest - no one may have sexual intercourse with their parent, child, brother, sister, grandparent or grandchild. • Child Pornography - no one may make, distribute, transmit, make available, access, sell, advertise, export/import or possess child pornography. Child pornography is broadly defined and includes materials that show someone engaged in explicit sexual activity who is, or seems to be, under the age of 18 years;

STAYING SAFE • While it is never the victim’s fault, there are some precautions that everyone can take to help keep themselves and others safe. - Never share sexually explicit photos or videos of yourself or another youth. If the person in the photos or videos are under 18, these materials are considered child pornography. These materials can easily be shared with others, and, once you have shared them, it is impossible to ever be certain that they have been deleted. - If you get to know someone online and are planning to meet them in person, meet them in q public place and let a parent know where and when you are meeting them. Arrange to have a friend check on you awhile. - Remember: If you do not consent to sexual activity, sexual activity should not happen. after

STAYING SAFE • If you have been the victim of sexual assault, abuse or exploitation, there are many resources available to you, and a range of possible actions that you may choose to take. Options include: - reporting the incident to police - calling/texting a support hotline such as Kids Help Phone 1 -800 -668 -6868 - visiting a sexual health clinic - visiting your school counselor - telling a parent or guardian - telling your family doctor - telling a teacher

STAYING SAFE • Look at the statistics on the next slide and answer the following questions: • Why do you think the numbers are so low? • Why wouldn’t someone report sexual assault? • Why would it be so hard to convict someone of sexual assault?

QUESTION BOX • Everyone will receive a slip of a paper. • If you have a question, or several questions, you can ask them confidentially by writing them on the slip of paper. • If you don’t have a question, write down your favorite snack. • I will not answer personal questions about me. • If you have questions that I can’t answer or that you don’t want to ask here, you can call 1 -800 -sex-sense on your own time.