iv. Knowledge-Building Info Sheet: Healthy Sexuality

Sexuality is an important part of girls and young women’s lives but is often unaddressed in conventional settings. There are many aspects that make up “healthly sexuality” and it may differ for one person to the next depending on the context. Access to information and resources; knowing oneself and desires; sexual orientation; and interpersonal and communication skills are just some of the factors that make up healthy sexuality.

 

Sexuality is a central aspect of a girl’s sense of self as well as an important dimension of girls’ health. We offer this information to counter stereotypes, to offer options amidst very narrow messages about girls’ sexuality found in the media, and to spark new dialogue. We hope you will draw on this information as questions arise. Use them as a springboard for ongoing learning and empowerment.

 

Sexual Health

Self-advocacy

• Educate yourself.

• Demand that relevant resources, prevention measures, information and health care be available and accessible to you and your partner(s).

• Focus on practising communication skill, not just sharing facts about safe sex. Young women are most likely to say that they need more information about negotiation and communication skills and how to deal with the emotional consequences of being sexually active.ⁱ

• Help to implement peer education programs, such as the Sense Project by Head and Hands.ⁱⁱ

• A recent Canadian study showed that the majority of teenage girls will first go to their peers for advice if they think they have a sexually transmitted infection instead of asking a parent, teacher or doctor for help.ⁱⁱⁱ

• Peers are well placed to model positive social behaviours, establish new norms for sexual health, and refer youth to professionals they might not otherwise approach.^iv

• Peer counsellors produce greater attitude changes in teens’ perception of personal risk of HIV infection, and improve teens’ inclination to take steps to prevent transmission than adult-led education programs.^v

• Approach talking and learning about sex from a sex-positive perspective.

• A World Health Organization review of 35 sex-education programs around the world documented the relative ineffectiveness of abstinence-only education in stemming the spread of STIs.^vi

• Abstinence-only programs are detrimental to LGTBQ youth. These programs largely ignore homosexuality except as a context for HIV transmission.^vii

• Studies have shown that youth in gay-sensitive sex-education tend to engage in risky sexual behaviours less frequently than youth in abstinence-only programs.^viii

• Consider the factors of what makes HIV/AIDS prevention programs for youth effective:

1. The program must be based on a theory of learning and behaviour change.

2. Incorporate community or cultural aspects of the group.

3. Include skills training on topics such as negotiation and communication.

4. Address systemic barriers such as racism, sexism and poverty.^ix

 

 

Sexuality and desire

• Self-respect, consent, and open communication are some great foundations for sexual health and healthy relationships.

• Most people are sexual and it is normal and healthy for women to have sexual desires.^x

• North American popular culture gives women and men very mixed messages about sex. We are often taught that we must be in love to have sex. We may also be taught that having sex is an important part of being an adult or that sex proves we are desirable. Sex can be about all of these things or it may not involve any of them.

• Sexual desire is often traditionally seen as male, while girls are supposed to seek love and romance. Girls are consistently directed and educated away from sexual self-interest.^xi

• Some women don’t experience orgasm during sexual activities with a partner. Few women will orgasm through vaginal stimulation alone; stimulation of the clitoris is usually needed. Some women are able to have several orgasms in a row.^xii Sexual satisfaction is very personal and will vary drastically from one person to the next.

• A woman's current or past experiences with sexual assault or domestic violence may have effects on her sexual relationships. A woman’s sexual responses may be inhibited if she doesn’t trust her partner or if she and her partner can’t communicate effectively.^xiii

• By 14 or 15 years of age, 10% of boys and girls have had sexual intercourse.^xiv

 

 

Some guidelines for healthy sexuality

 

Sex partners should always:

 

• Have one another's consent

• Be able to talk honestly to each other

• Treat each other with respect

• Care about their partner’s pleasure

• Protect each other against physical and emotional harm, unwanted pregnancy, and sexually transmitted infections

• Accept responsibility for their actions^xv

 

 

Know the facts

 

Sexually Transmitted Infections (STI):

 

• The term STI (Sexually Transmitted Infection) is now commonly used in the place of STD (Sexually Transmitted Disease). STI is more encompassing, including infections that may not show signs or symptoms.^xvi

• An estimated 4% of 15- to 24-year-olds who have had sexual intercourse reported having been diagnosed with an STI.^xvii

• Rates of Chlamydia cases among males and females aged 15–19 increased from 623 to 802 per 100,000 youth between 1991 and 2002.^xviii

• The highest rates and increases of STIs in Canada are in people between the ages of 15 and 24.^xix

 

Human Papilloma Virus (HPV)

We are including discussion of human papilloma virus here specifically because it is a common infection and because it has become such a big topic of debate in Canadian health research.

 

HPV is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own. The viruses can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina) or anus, as well as the linings of the vagina, cervix, or rectum.

 

Some of these HPV viruses are called “high-risk” types and will show up through abnormal Pap tests. They may also lead to cancer of the cervix, vulva, vagina, anus or penis. Others are called “low-risk” types and they may cause mild Pap test abnormalities or genital warts.^xx

 

• HPV is estimated to be one of the most common STIs in Canada and around the world.^xxi

• A vaccine is available to help prevent infection with some types of HPV and offers protection against some HPV types responsible for approximately 70% of cervical cancers.^xxii

• Since the HPV vaccine does not protect against all types of HPV, you are still at risk for infection with other types of HPV even if you are vaccinated.^xxiii

 

There is currently a controversial campaign to “immunize” girls as young as nine-years old for some of the strands of HPV through school-based vaccination programs. The campaign is controversial because of the lobbying by Merck Frosst (the company that manufactures Gardasil vaccines) that took place prior to the federal government’s $300 million announcement of the immunization program and because it is felt that the public does not have full information to make an informed decision. For example, the long-term effects, such as the duration of immunity of this vaccine are not known. Gardasil is not a “vaccine against cancer,” and it has not been adequately proven that it will “prevent 70% of cervical cancers.”^xxiv Research may later show that the HPV vaccine does help prevent cervical cancer, but for now it is felt by many that the data do not merit a mass vaccination program.

 

In Quebec, among other places, groups are calling for those administering the vaccine to stop the vaccination program. They question the disproportionate burden in the prevention of HPV infection that is being placed on girls. They are urging that the millions of dollars be instead put aside for a campaign that is directed toward improving access to health care for women, promoting awareness, prevention and sex education, in particular for adolescent girls.^xxv

 

Human Immunodeficiency Virus (HIV)

HIV is a retrovirus that can lead to Acquired Immunodeficiency Syndrome (AIDS), a condition in humans where the immune system begins to fail, leading to life-threatening opportunistic infections.^xxvi

 

• Socio-cultural and physiological factors increase girls’ and young women’s risk to HIV infection. A physiological example includes girls’ vaginal lining being more susceptible to tearing than in adult women, which increases the risk of the virus entering the bloodstream.^xxvii As a result, “When a guy and a girl have unprotected sex, she’s twice as likely to get HIV as he is.”^xxviii

• Young women globally, and in Canada, are experiencing higher rates of HIV infection. Among positive HIV tests for all males and females in 2001 in Canada, females in the 15 to 29 year range accounted for 44.5% of all positive HIV test reports, an increase from 41% in 2000.^xxix

• Heterosexual contact and injected drug use are the two main risk factors for HIV transmission in women.^xxx

• Young people know less about HIV/AIDS today than they did fifteen years ago.

• Youth feel less susceptible to HIV/AIDS today than they did in 1989.^xxxi Recent surveys conducted in fifteen countries around the world found that 50% or more of girls aged 15 to 19 do not know that someone who looks healthy can be HIV+ and transmit the virus to others.^xxxii

• 30% of Aboriginal HIV^xxxiii are in youth (20–29 years old), compared to only 20% in the non-Aboriginal populations of Canada. Socio-economic factors like colonization, residential schools, racism, and poverty are socio-economic factors that increase their vulnerability to HIV.^xxxiv

 

 

 

Safer Sex

Queer, lesbian, bisexual and questioning girls and young women and safer sex

• Your sexual orientation doesn’t make you immune to sexually transmitted diseases. In fact, a recent survey of 504 lesbian and bisexual respondents, 26% of women reported having been previously diagnosed with an STI.^xxxv That’s one in four women.

• Lesbian and bisexual women may not receive regular gynaecological and medical care because they fear homophobic responses from health care providers.^xxxvi

• If a woman only has sex with other women, she does not need birth control, but she is still at risk of some sexually transmitted diseases.

 

The following infections may result from sex between women:

• Herpes

• Genital warts

• Crabs

• Trichomonas

• Bacterial vaginosis

• Yeast infections

• Very rarely, HIV may also be transmitted from one woman to another

• Sharing needles to inject drugs also increases a woman's risk of infection, regardless of her sexual orientation^xxxvii

 

Talking about sexuality and safer sex

Here are some tips for ways to approach talking about sexuality and safer sex when trying to foster safer, anti-oppressive and empowering spaces:

• Do not assume everyone in your group is heterosexual

• Present safer sex information for a diversity of sexual acts (including sex between women, between women and men, and between men and men)

• Demystify sexual acts by describing them. This is a good way clarify slang words and new terminology without making assumptions about the kinds of sexual activities people engage in. For example instead of saying “You should use a condom during sex,” you may want to say something like, “When having penetrative vaginal sex, whether with fingers, toys or a penis, using a condom can lessen your risk of transmitting STIs; and also unwanted pregnancy for penis in vagina sex.”

• Talk about safer sex practices on a continuum of risk. Some practices are safer than others and the idea is to be as safe as you can to protect you and your partner(s). For example, having unprotected penetrative sex with fingers carries less risk than unprotected penetrative sex with a penis.

 

Here are some sexual acts, their risk, and ways to engage in them with less risk

Oral sex

Unprotected oral sex can put you at high risk for STI infection and may carry a low risk of HIV infection. If you’re having oral sex (oral contact with a partner’s vagina, penis or anus) try to use a dental dam, a condom or another latex barrier, such as an unlubricated condom cut down the middle. A dental dam is a square piece of latex about five inches on each side available at dental and medical supply stores. Since it can be hard to find dental and medical supply stores, you can also use plastic wrap, available at your local grocery store. Use the non-microwaveable kind, since it doesn’t have tiny holes.

 

Manual sex or touching

If you’re touching someone’s genitals with your hands, be aware of tiny scrapes and cuts on your hands. These cuts allow infections to enter your body. You can lower the transmission of body fluids by using a latex barrier like surgical gloves (you can buy these really cheaply at a drug store). You can also cut the fingers off the glove, and use just the finger part (called finger cots) if you only have cuts on your fingers.

 

Vulva-to-vulva rubbing or humping

To lower the risk of STI transmission you can use a large piece of latex in between you and your partner’s vaginas. Using lube on either side of the latex will increase sensations. Make sure to always run up against the same side of the latex. If you have lost track, get a new piece of latex. You can also make underwear with the crotch cut out and a piece of latex in place instead! Be creative!

 

Sex toys

If you're sharing sex toys with your partner(s), such as a dildo, make sure to put a condom on the toy, and change condoms in between partners. Or, if you have a toy made of silicone, you can boil it for three minutes to sterilize it in between partners.

 

Penis in vagina or anus penetration

Condoms are the best way to prevent STI transmission and unwanted pregnancy when having penis-vagina penetration. According to statistics, about one in four young people who reported multiple sexual partners did not use a condom the last time they had sexual intercourse.^xxxviii

 

• The penis should be covered with a condom, or, alternately, female condoms can be inserted in the vagina. Female condoms are available without a prescription where male condoms are sold. In Canada, the female condom is a strong, soft, clear sheath made of polyurethane. It is placed inside the vagina before sex and protects against pregnancy and STIs (including HIV).^xxxix

• When having anal sex (a penis or toy in anus or the butt hole), use a condom to prevent the transmission of STIs.

• If switching from vagina to anal sex during a romantic encounter, make sure to change condoms. Going from the anus to the vagina can cause serious infections even if partners do not have any STIs.

 

Birth control

More common forms of birth control can be broken down into the following categories: barrier methods, hormone therapy, intrauterine devices, and emergency contraception. You will find more information about each method below.

 

Barrier methods (DO protect against STIs and HIV)

These work by creating a protective barrier preventing exchange of bodily fluids between partners.

 

Condoms
Male and female condoms, when used properly, are highly effective in protecting against STIs, HIV and unwanted pregnancy.

• Male condom is a latex or polyurethane shield that fits over the erect penis. Condoms are often free at clinics and are available at a pharmacy. They do not need to be prescribed by a doctor and are approximately $11 for a pack of 12.

• Female condom is a polyurethane shield in the shape of baggy or pouch that’s inserted into the vagina. Female condoms are available at a pharmacy and do not need to be prescribed by a doctor. They are approximately $16 for a pack of 4.

 

Cervical barriers (DO NOT protect against STIs and HIV)
These work by creating a protective barrier inside the women’s cervix.

 

Diaphragm

A diaphragm is a silicone or latex reusable dome that is used with spermicide and is inserted into the vagina. Diaphragms are fitted by a physician to determine the correct size and once fitted are available at a pharmacy. The cost is approximately $40.

 

Cervical cap

A cervical cap is a silicon cap that is used with spermicide and is inserted into the vagina, like diaphragms they need to be fitted by a physician. The cost is approximately $40.

 

Hormone therapies (DO NOT protect against STIs and HIV)

These work by changing hormone level in you body, usually estrogen and progesterone, to control your menstrual cycle and prevent pregnancy. All hormone methods must be prescribed by a doctor.

 

Oral contraception

Commonly known as the pill, it is a small pill that is taken daily and comes in either 21-day or 28-day packets. The pill controls hormone levels in the body and is available at a pharmacy once prescribed by a doctor. The cost is approximately $15 to $20 per pack, per month.

 

The patch

This is a small square patch that sticks to your skin and is applied once a week starting on the first day of your menstrual cycle. Over a four-week period, the patch is changed on the same day every week for a total of three weeks and on the final and fourth week it is not worn. Altogether you wear the patch everyday except for the seven days at the end of your menstrual cycle. It works similarly to the pill but hormones are released into the bloodstream via the patch instead of orally. The patch is available at a pharmacy once prescribed by a doctor. The cost is approximately $25 per month.

 

Depo Provera

This is an injection of progestin given by a doctor every three months. Depo Provera works by preventing a woman’s ovaries from releasing eggs. After six to twelve months, many women stop menstruating altogether.^xl The cost is approximately $40 per injection.

 

Intrauterine devices (DO NOT protect against STIs and HIV)

 

IUD (intra-uterine device)

This is a small device that is inserted into the uterus by a physician. The IUD is small, T-shaped and is made out of copper and plastic. It can be left in place for two to five years. The cost is anywhere from $100 to $400.

 

Emergency contraception or hormone therapy (DOES NOT protect against STIs and HIV)

 

Emergency contraception

Emergency contraception (commonly called the morning after pill) is an oral contraceptive that is used after unprotected sex or after failure of another form of birth control method (for example, your condom breaks). Emergency contraception can be used three to five days after unprotected sex, but it is advised to be use it as soon as possible. The pill is available at clinics and some pharmacies, although often is more expensive when purchased at pharmacies because they often require a consultation, which costs an additional fee. Not all pharmacies will carry or sell emergency contraception. The cost is approximately $16–$40.

 

Some additional information:

• Pregnancies among women under the age of 20 fell from 45.5 pregnancies for every 1,000 women in 1974 to 30.6 in 2001.^xli

• It has been reported that lesbian teens are twice as likely as their heterosexual peers to experience unwanted pregnancy. Self-identifying as lesbian does not mean that someone will not have sex with men. Young lesbians are in the unusual position of often needing to educate their doctors about their reproductive health needs.^xlii

For more information on Healthy Sexuality please consult our Online Resource Centre