Sexuality

Human sexuality encompasses many things. The subject has personal biological implications, social implications, and moral implications. Sexuality involves how people view themselves and behave sexually as well as how their bodies function sexually.

It is important to note that sexuality is viewed differently in different cultures. Certain practices and standards vary from country to country, religion to religion, and culture to culture. Other factors affecting the perception of sexuality, and how people react to it, include age and gender.

In this chapter, sexual development for both boys and girls will be explained, as will physical attraction and the urges and actions that accompany sexual development. Other issues related to sexuality, such as pregnancy, birth control, and sexually transmitted diseases, will also be addressed.

TALKING ABOUT SEX: IS IT TABOO?

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What is the difference between sex and sexuality? The word sex can refer to gender, meaning whether an individual is male or female. It can also refer to the physical act of having sexual intercourse with another person. But sexuality encompasses much more. Sexuality includes how people learn to define themselves as sexual beings in the world. It includes desires, wishes, and dreams as well as relationships with others. It is a lot more than the physical act of sex.

Sexuality is often a difficult topic for many people to discuss, and talking openly about sexual feelings or the changes one's body is going through can make some individuals uncomfortable. Sometimes, due to a lack of open communication, young adults may receive negative or confusing messages concerning sexuality. It is important to remember that sexuality, and all of the thoughts and changes that develop as a result of growing up, are all very natural, and that everyone has questions and worries about this topic. Many teens think, "I'm the only one in the entire world with zits," or "My breasts haven't started growing yet, and I feel like an outcast," or "All the other guys in gym class seem to have bigger penises than I do," or "Why do I masturbate?" The common theme among all of these questions is, "What's wrong with me? Am I normal?" The fact is, however, that most teens are normal. They are not weird for wondering, nor are these thoughts unique to any young adult.

Sexuality is an individual experience, but the fear and frustration adolescents may feel is quite common. It's all a part of the process of growing up. Parents, teachers, and older siblings experienced many of these very same feelings, and they managed to survive the growing-up process. Armed with the proper knowledge and outlook, most teens are capable of surviving, too.

PUBERTY

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Puberty is simply the time during which the secondary sexual characteristics, such as boys' voices deepening or girls' breasts growing, develop and a sign that the body's reproductive organs are becoming fully functional. Puberty occurs in boys roughly from ages thirteen to sixteen and in girls roughly between the ages of twelve and fifteen. However, this time certainly doesn't feel simple to those going through it. It is probably the first time in a person's life that he or she will have the opportunity to be truly aware of his or her own biological changes.

The experience of puberty will be new and different for both boys and girls. It is not something that happens overnight, though, but rather it is a process that occurs in stages and at different ages for different people. It is perfectly normal, for example, for one person to have already started developing while his or her best friend has not.

WHAT HAPPENS TO BOYS?

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Pubescent boys can have a really hard time feeling like they fit in. That's because of the huge variation in the rate of development in boys. Two fourteen-year-old boys can look very different from one another physically. For instance, one fourteen-year-old boy can have lots of body hair, a deep voice, and be very tall, while his classmate might still be short, have no chest and other body hair, and still have a childlike voice. So why and how do boys change into men? The answer is in the hormones. Even in the womb, a male fetus contains small amounts of the "male" hormone—testosterone.

Male Anatomy

The male reproductive system has three parts: the testicles, scrotum, and penis. The testicles are where sperm cells are produced. At the start of puberty, the hypothalamus, pituitary, and pineal glands signal to the testicles to begin producing testosterone, the most important male hormone. Testosterone triggers male secondary sex characteristics, like the deepening of the voice, thicker body hair, facial hair, and enlargement of the genital organs. The testicles look like two small eggs in a sac. This small sac of skin that hangs under the penis is called the scrotum. It's perfectly natural for one testicle to hang lower than the other. In fact, in 70 percent of men, the left hangs lower than the right. This has a very good biological purpose: if the two testicles hung at the same length, they would both get a lot of friction from the legs.

The Journey of the Sperm

The sperm cells are created in a series of chambers in the testicles. They grow and travel through the second part of the male reproductive system, which consists of the ducts for storage and transportation of sperm. The epididymis is a long, coiled canal that lies over each testicle. The next stop for the sperm is the vas deferens, a shorter extension of the epididymis. This takes the sperm from the scrotum to the abdominal cavity, passing to the back of the bladder and joining the seminal vesicles, and forming the ejaculatory duct where sperm is stored. The prostate gland lies against the bottom of the bladder and secretes the seminal fluid. Fluids from the seminal vesicles combine with this and carry the sperm out from the body. The prostate gland gets much bigger when males reach adolescence. (Taking care of the prostate gland by eating a healthy diet starting in adolescence can help prevent prostate problems that develop in many men later in life.) There are two tiny structures on either side of the urethra, called the cowper's glands, that produce a clear, sticky fluid that is thought to coat the urethra for passage of sperm. This is not seminal fluid, but it may contain sperm.

The third part of the male reproductive system is the penis. During arousal, the penis gets solid and erect and may eventually release the seminal fluid. The fluid is called ejaculate. This final stage of arousal is called orgasm or ejaculation. There is usually about one teaspoon full of ejaculate emitted. Not all sexual excitement ends in orgasm, though. Sometimes the penis may become flaccid (soft) without having ejaculated after arousal. This is perfectly normal.

Facts about the Penis

There is a lot of folklore and misinformation about the penis. There are racial stereotypes about penis size and often an unspoken competition between boys about the size of their penises. Many young men are very concerned about having a large penis. They are worried that when they start having sex, their penis will be too small to please a woman sexually or that they will be made fun of by other men. Size of the penis is not the most important factor in terms of pleasurable intercourse for a woman. There are many other aspects of sex, such as caring feelings between the sex partners, that play a more important role than penis size.

Penises come in all shapes, sizes, and shades. Some boys have birthmarks on their penises, just like people have on other parts of their body. (If there is any mark on the penis that wasn't previously noticed or some mark has changed in size, color or texture, a physician should be consulted.) Some penises, while erect, point over to the left or right, and some point up.

The penis is actually made up of spongy tissue and large blood vessels. When males become sexually excited, the blood vessels expand and more blood flows to the penis, making it erect. Although the penis is hard at this time, the skin around it stays loose to allow for expansion during erection.

ERECTIONS. Males have erections all through their lives. Even babies can have erections. Erections can also accompany the urge to urinate, and are quite common upon waking from a night's sleep. In fact, erections can seem to happen for no reason at all. However, they also occur with sexual stimulation, or when a person is sexually aroused.

NOCTURNAL EMISSIONS. Sometimes males will wake up after having ejaculated during their sleep. This is called a nocturnal emission, or the slang term "wet dream," and it is a natural occurrence. Wet dreams usually start during puberty and can happen throughout a man's life. While having a wet dream may cause a boy to feel embarrassment, it is a normal occurrence and happens to most males at some time or another.

The Stages of Development: Boys

As stated earlier, all boys have different rates of maturation. Puberty can start as early as age eight and end as late as fifteen. Boys should not be nervous if their friends start changing before they do, or if they themselves are the first to start changing. There is no rhyme or reason to development; the body develops as it is genetically programmed to do so. What, then, happens to the male body at puberty? According to The New Teenage Body Book, British physician Dr. J. M. Tanner identified the stages of puberty for boys as follows:

• Stage One: (approximately between ages nine and twelve)

No visible signs of development occur, but, internally, male hormones become a lot more active. Sometimes a growth spurt will begin at this time.

• Stage Two: (approximately between ages nine to fifteen)

Height will increase and the shape of the body will change. Muscle tissue and fat are developing at this time. The aureole, the dark skin around the nipple, will darken and increase in size. The testicles and scrotum will grow, but the penis probably won't. A little bit of pubic hair will begin to grow at the base of the penis.

• Stage Three: (approximately between ages eleven and sixteen)

The penis will finally start to grow during this stage. It will tend to grow in length rather than width. Pubic hair is getting darker and coarser and spreading to where the legs meet the torso. Also, boys will continue to grow in height, and even their faces will begin to appear more mature looking. The shoulders will broaden, making the hips look smaller. Muscle tissue increases and the voice will start to change and deepen. (This is because the larynx is enlarging.) Finally, facial hair will begin to develop on the upper lip.

• Stage Four: (approximately eleven to seventeen)

At this time, the penis starts to grow in width, too. The testicles and scrotum are also continuing to grow. Boys shouldn't be alarmed if hair begins to grow on the anus; this is perfectly normal. The texture of the penis is beginning to look more adult. Underarm and facial hair increases as well. Skin will get oilier, and the voice will continue to deepen.

• Stage Five: (approximately fourteen to eighteen)

Boys will be reaching their full adult height. Pubic hair and the genitals will look like an adult man's would. At this point, too, shaving may become a necessity. Some young men continue to grow past this point, even into their twenties.

Most important to remember in understanding the stages of development is that everyone has their own, individual pace. Age may vary from the approximate ages in each stage. There's no reason to worry. Inevitably, virtually everyone develops into an adult in due time.

WHAT HAPPENS TO GIRLS?

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Girls usually start and finish puberty before boys. However, since their bodies are changing, too, girls have a lot of the same concerns as boys. Many girls are confused and scared of the changes they are experiencing emotionally, as well as physically. Girls often wonder if their friends and classmates are developing faster than they are. Some might be concerned because they are developing breasts faster or slower than their peers. Still others might feel uncomfortable because they are the tallest in their class. All of these feelings and changes are normal for pubescent females.

Female Anatomy

The vulva is the proper word for the entire area between a girl or woman's legs. (A common misconception is that this area is called the vagina. The vagina is actually just one part of the vulva.) There are two sets of vaginal lips. The first is the labia majora, or "big lips." This area is covered with hair in the more advanced stages of development. The outer lips protect the rest of the vagina. Under-neath the labia majora are the labia minora, or "small lips" (although they aren't always small). The labia minora can vary distinctly in color, size and shape. They may be pink or brown, wrinkled or smooth. The labia minora don't have fat or padding. Instead they have blood vessels, oil glands, and scent glands. At the point where the labia minora connect lies the clitoris. The clitoris is very small but quite sensitive. It is a very important part of the experience of sexual arousal in girls and women but it may be hard to find because it is hooded with skin. Below the clitoris is the urethra (the urinary opening). Below that is the vaginal opening. The hymen, a fold of membrane at the vaginal opening, may cover it.

The vaginal opening connects the inner and outer genitalia. It is possible to feel inside the long, moist canal beyond the vaginal opening. This is the actual vagina. It is even possible to feel all the way to the back of the vagina to touch the cervix. The cervix is dimple-shaped and might feel like the tip of one's nose. Beyond this dimple is the opening of the cervix, called the os. During menstruation, the flow passes through the uterus and out of the os into the vaginal canal and then out the vaginal opening.

The uterus is small and shaped like a pear. It is comprised mostly of muscle tissue, and can expand tremendously during pregnancy. Right above the uterus are the fallopian tubes. They are passages from the uterus to the ovaries, where egg cells are found. During every cycle (about a month), an egg cell is released from one of the two ovaries. This is called ovulation. During ovulation, it is possible to become pregnant if one of the eggs is fertilized by a sperm cell. This is called conception. The window for ovulation is twenty-four to seventy-two hours. This is a female's most fertile time. Sexually active women should always use protection at this time to avoid pregnancy. Women who are trying to get pregnant often chart their cycles so they know the best times to have sex. Usually during ovulation the egg that is released is unfertilized and disintegrates. The menstrual flow is made up of this tissue and the endometrial tissue that has been building up in anticipation of a new life to nourish.

The Stages of Development: Girls

Every girl matures in her own, individual way. Each person's "biological clock" is unique. Just because one person's development begins before another's has started doesn't mean that either one is abnormal. Just as it is for boys, sexual development for girls really begins in the womb. Baby girls are born with thousands of immature ova (eggs) in their ovaries. When a girl hits the age of eight, behind-the-scenes hormonal changes start to take place. Estrogen, the most important female hormone, begins to be produced by the ovaries. This starts when the brain tells the pituitary gland to begin to produce follicle-stimulating hormone (FSH). This FSH stimulates the ovaries to make estrogen. This initiates the process of puberty for females. According to The New Teenage Body Book, British physician Dr. J. M. Tanner identified the stages of puberty for girls as follows:

• Stage One: (approximately between the ages of eight and eleven)

The ovaries are enlarging and hormone production is starting, but external development is not yet visible.

• Stage Two: (approximately between the ages of eight and fourteen)

The first external sign of puberty is usually breast development. At first breast buds develop. The nipples will be tender and elevated. The area around the nipple (the aureole) will increase in size. The first stage of pubic hair may also be present at this time. It may be coarse and curly or fine and straight. Height and weight increase at this time. The body will get rounder and curvier.

• Stage Three: (approximately between the ages of nine and fifteen)

Breast growth continues and pubic hair gets coarser and darker. During this stage, whitish discharge from the vagina may be present, signaling that the vagina is self-cleansing. For some girls, this is the time that the first menstrual period begins.

• Stage Four: (approximately from ages ten to sixteen)

Some girls will notice that their aureoles get even darker and separate into a little mound rising above the rest of the breast. (Some girls never get this.) Pubic hair may begin to look more like the adult triangular pattern of growth. If it didn't happen in Stage Three, menarche (first menstruation) should start now. Ovulation might start now, too. But it won't necessarily occur on a regular basis. (It is possible to have regular periods even if ovulation is not occurring every month.)

• Stage Five: (approximately between ages twelve and nineteen)

This is the final stage of development. Full height should be reached by now, and young women should be ovulating regularly. Pubic hair should be filled in, and the breasts should have developed fully for the body.

Menstruation

Menstruation, or "getting your period," is the monthly shedding of blood and uterine lining that occurs when the female egg cell is not fertilized. Menstruation normally begins during the onset of puberty in females; however, as with everything else, "normal" is different for everyone. In general, a menstrual cycle is 28 to 30 days in duration (in other words, a girl can expect her period every 28 to 30 days). A period can last from 3 to 7 days. Healthy menstrual periods should at least:

• Come regularly. It's normal to skip one or two periods when first menstruating. But for girls who've been regular for a few years and suddenly start missing periods, a gynecologist should be consulted.
• Have a normal flow—not too heavy. Girls bleeding through a tampon in less than an hour are probably bleeding too much. This can make a girl overly tired from iron loss. Again, if this happens, one's doctor should be told.
• Have a normal flow—not too light. When a girl first starts to menstruate, light periods are common. But those experiencing consistently light or brief periods should not assume everything is okay. A gynecologist can help determine if this is a symptom of a more serious problem.

Premenstrual-Syndrome (PMS)

PMS is a common complaint of young and older women alike. For years, PMS was thought of as something that women "made up" to explain their feelings—physical and emotional—around the time of their menstrual cycles. Today, PMS is accepted in the medical community as a real phenomenon that may or may not affect some women. That means girls and women can have a whole list of symptoms, or just one, or none. Some girls suffer to such an extreme that they seem to experience all the pain and symptoms of PMS. Others do not exhibit any symptoms of PMS.

PMS includes headaches or migraines; abdominal, leg, and lower-back cramps; acne; depression; anxiety; bloating; fatigue; heart palpitations; confusion; breast swelling and pain; cravings; and even proneness to accidents. Most PMS sets in at ovulation. That means up to two weeks of every month can be filled with the above symptoms.

HEALING PMS. Girls can start to come to grips with PMS by writing all of their feelings about menstruation in a journal. They can record and reflect on all the symptoms they have, and try to figure out if the symptoms happen at the same time each month. This is the first step to healing.

The next step is addressing the symptoms themselves. One of the major causes of PMS is poor diet. What are the worst culprits? Processed foods, caffeine, sugar, dairy and meat. Sometimes simply eliminating or cutting back on these foods will cure the symptoms, but that is easier said than done. Girls seeking to beat PMS should think about eating a healthy diet based on whole foods: fruits, vegetables, soy products and whole grains.

Pharmacies also sell over-the-counter products that may help with some of the symptoms of PMS, such as reducing bloating and providing mild pain relief.

Cramps (Dysmenorrhea)

Dysmenorrhea, commonly known as cramps, may be experienced by some females during menstruation. Over-the-counter painkillers can offer a quick fix for cramps, while some women prefer to use painkillers specially formulated to also reduce bloating. (Another dietary way to prevent bloating is to reduce salt intake and drink lots of water.) Chamomile tea is a great natural muscle relaxant. However, to prevent cramps from starting in the first place, eliminating unhealthy foods from one's diet is a good thing to keep in mind. Another approach is exercise. Regular exercise will keep hormones flowing properly through the body and regulate periods, and often eliminate cramps. Doing yoga is a good way to eliminate cramps (and other symptoms of PMS as well). There are even some yoga poses that can be done which will ease the pain of cramps immediately.

If cramps and/or PMS are incapacitating, a physician should be consulted. Getting rid of cramps and PMS doesn't happen overnight. It will definitely be a process of trial and error. So if someone has PMS or even a mom, best friend, sister, or girlfriend has it, let the P stand for patience. Boys need to understand PMS too, so they are kind and compassionate to the girls and women they know who go through it.

KISSING, DATING AND PHYSICAL ATTRACTION

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Crushes

Everyone gets crushes on other people at some point in their lives. The truth is adults and even little kids can get crushes. But due to the rush of hormones that seem to "take over" young adults, crushes get really intense at the start of puberty. A crush is simply the feeling of really admiring, being attracted to, or liking someone. Both boys and girls have crushes; crushes are a fun and safe way for young people to explore their emerging sexuality, even though it doesn't always feel fun when feelings for another person are not returned. That's why they are called "crushes." The crushee can feel crushed if his or her feelings don't lead to a real romantic relationship.

There are a lot of different kinds of crushes. People get crushes on their teachers, movie stars, or people in older grades at school. People get crushes on friends of their older brothers or sisters. What do all of these kinds of crushes have in common? The objects of the crush are unattainable. That means that they are out of bounds, or aren't actual possibilities for dating because of a significant age difference or, in the case of movie stars, someone the crushee might never meet. Crushes on unattainable people are healthy

and normal. As long as a crush doesn't become an obsession (thoughts that occupy the mind continually), people should enjoy their secret feelings.

Dating

Dating is when two people take a romantic interest in one another and spend time together going to movies, or to dances, or any number of places. Some kids and teens, and even some adults don't always like to use the term "dating" because it sounds too formal. Instead of dating, it may be referred to as people just kind of "hanging out" with each other. A girl might like a boy and then find out that he likes her, too. Then, she might spend time or talk on the phone with him and get to know him better. Over time, they might become boyfriend and girlfriend. If they go somewhere together, like to the movies or to dinner, they might consider that a date, but the whole process usually isn't treated as formally as it was in the past.

Kissing

Kissing is fun and, as with many things, can be perfected with practice. Lots of teens are terrified that they will end up being bad kissers, but by relaxing and doing what comes naturally most teens find that there is no such thing as a "bad" kisser. French kissing is kissing with an opened mouth and exploring one's partner's mouth with the tongue. Kissing is a great way for two people to show their feelings toward one another without going too far. In fact, some people feel kissing can often be more intimate than the act of sexual intercourse.

Petting

Petting is another term for "fooling around" or "hooking up." This is what happens when couples go beyond kissing. Petting is touching one's partner's body but not having intercourse. Clothes may be kept on during petting. However, heavy petting can advance to the stage when clothing is removed. Such petting can include oral sex and touching of the genital area and the breasts. It can arouse very strong sexual responses, including orgasm. As always, consent (permission or agreement) between the two people is really important. If one person has any reservations about progressing, something should be said. It's better to say Stop than to regret going too far.

Intimacy

Intimacy, or closeness, can be shared with someone without sharing a physical relationship. Really liking someone doesn't necessarily mean that a physical relationship is possible or even necessary. Emotional intimacy—being able to share personal feelings and thoughts—should go hand-in-hand with sharing physical intimacy. Anyone who is uncertain about taking a relationship to a physical level shouldn't do so. Often, people can share a deeper connection and more true intimacy by keeping their clothes on and finding out about a person through communication.

Homosexuality

Homosexuality, or being gay, is when a person has sexual feelings for someone of the same sex (heterosexuality is the term used for those who have sexual feelings for people of the opposite sex). It is perfectly normal to have a crush on someone of the same sex, particularly in the teen years. Many people have feelings for people of the same sex. Boy or girl, it's normal to feel deep affection for friends. For example, many females are very affectionate with one another. Does this mean that they are gay? Not necessarily. Many teenagers have anxiety about being gay. This is probably because homosexuality is often viewed negatively in American society. It's common to have sexual feelings or sexual dreams about people of the same sex. Many young people panic when this happens and wonder if they are gay. Consistent sexual feelings about people of the same sex and attraction can indicate homosexuality. These are normal feelings, too.

Bisexuality

Bisexuality is defined as attraction to and/or engaging in sexual relations with people of both sexes. Many people experiment sexually with people of both sexes. Experimenting or the temptation to do so does not necessarily make a person bisexual or homosexual. Rather, this is merely an indication of curiosity.

Some people think that those who define themselves as bisexual are just extremely open-minded and sexually free. But many bisexuals themselves often disagree. They say that they are bisexual not by choice, but because of their biology. Bisexuality is often harder to figure out, at least for young people, than homosexuality. Any teen who has such concerns should talk openly with a trusted friend, relative, or counselor to help them sort out their feelings.

SEX

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Times have changed a great deal since a few decades ago. People are experimenting with sex at younger and younger ages. American culture is saturated with sexual imagery; however, sex is often presented in a taboo (forbidden) light. Often times young adults are drawn to engaging in activities that are considered taboo to them. On the other hand, abstinence, a conscious choice to abstain from sex, is gaining favor with young people. More and more teens are choosing to remain virgins until marriage. This includes boys and girls. Ideally, sex should be based on loving and tender feelings for a partner. Many people have sex based on lust rather than love. There is nothing wrong with this, if both partners consent to and enjoy the sex, but it's usually even more fulfilling if it's based on a loving union.

Intercourse

Sexual intercourse can occur when a man is sexually aroused and his penis is erect. He slides his penis into the vagina of a consenting partner. The aroused female will produce vaginal secretions that will make it easier for the man's penis to enter her. He will move his penis in and out of her vagina in a rhythmic fashion until he ejaculates (reaches orgasm, the highest point, or climax, of sexual excitement).

Women often have orgasms during sex as well. Women usually have clitoral orgasms, but they can have vaginal orgasms, too. (For many women, it takes practice to learn to orgasm from sexual intercourse.) It is important that there is open communication between the partners so that each can share desires with the other. It's hard for both women and men to orgasm if they are tense and nervous.

Choosing to enter into a full-fledged sexual relationship that includes intercourse should never be done lightly. Both the man and woman should be mature enough and responsible enough to discuss birth control and protection from sexually transmitted diseases (see sections below) before taking that step. It is also essential to discuss one's expectations as well as how a pregnancy will be handled (see section on pregnancy) if one occurs.

Oral Sex

Oral sex is often practiced as an alternative to intercourse. Oral sex includes fellatio (pronounced fell-AY-shee-o) and cunnilingus. Fellatio is the stimulation of a man's genitals with the mouth of a partner. Cunnilingus is the stimulation of a woman's genitals with the mouth of a partner. Oral sex does not carry with it the risk of an unplanned pregnancy, as sexual intercourse does. However, it does not protect against sexually-transmitted diseases (STDs), including AIDS, because there is contact with a person's bodily fluids. When engaging in either form of oral sex, both partners should take precautions to protect themselves from STDs by using either a condom (for men) or a dental dam (a rubber shield that dentists use to isolate a specific tooth when doing work on it; used to practice safe oral sex on women).

Masturbation

Masturbation is the safest kind of sex. It is pleasuring oneself, or solo sex. It is totally natural and healthy. Most people do it, but they don't like to admit it because of the negative portrayal put upon it by society. Girls can masturbate by stimulating their clitoris or putting their fingers inside of their vaginas. Boys can masturbate by stroking or rubbing their penis. Some people believe that masturbating too often is dangerous. This is a myth. As long as something feels good, is carried out in private, and doesn't involve hurting anyone or anything, masturbation is a healthy way to explore and indulge sexual fantasies and impulses without the risk of unwanted pregnancy or STDs.

BIRTH CONTROL

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Birth control has had a dual purpose in recent times, specifically where condoms are concerned. Preventing an unwanted pregnancy goes hand in hand with preventing the spread of sexually transmitted diseases, including HIV. There are many forms of birth control, or contraception, available but none offer 100 percent protection against STDs, including condoms. Ideally, both partners should be tested for HIV and STDs before engaging in a sexual relationship so that their options for birth control widen and are not limited to the condom.

Condoms

A condom is a sheath that fits snugly over the penis. The reservoir at the tip of the condom collects the semen that is ejaculated, thus preventing it from entering the vagina. Condoms are the easiest, safest, and most commonly used form of birth control. Latex condoms that are spermicidally lubricated are the most effective. Spermicidal lubricant, such as Nonoxynol-9, kills any sperm that might leak out of a condom. Some people have latex allergies; for those individuals, condoms are available in other compositions; however, they are not as effective in preventing pregnancy or the transmission of STDs as latex condoms.

Condoms are widely available, at drug and convenience stores and even supermarkets. Both sexes can purchase them; this helps both partners share responsibility for birth control. Condoms are a good way to ensure that one is always prepared (in terms of birth control) for a sexual encounter.

It is a myth that condoms lessen sexual pleasure. If one or both partners are uncomfortable using condoms, each should be tested for STDs, including HIV, and then discuss other birthcontrol options with a counselor or physician.

The female condom, which is similar to traditional condoms, is also available. It is placed inside a woman and it lines her vagina and blocks her cervix.

The Pill

Another common form of contraception is the birth-control pill. There are several types of birth-control pills, available by a physician's prescription only. Most common is the combination pill (which employs a combination of different

hormones). This type of birth-control pill works by inhibiting the development of the egg in a woman's ovary. In other words, the ovaries remain somewhat inactive, which is similar to how a woman's body behaves when she is pregnant.

Birth-control pills are the most effective form of birth control (aside from abstinence) and are used by millions and millions of women throughout the world. However, the pill does not offer protection against sexually transmitted diseases (STDs), which leaves many women at risk for HIV and other diseases like herpes. Furthermore, the dangers of taking the pill (such as heart attack, stroke, or embolism—a sudden obstruction in a blood vessel) can be intensified by family and personal health histories and lifestyle. (It is advised that smokers over the age of thirty-five should not take the pill.) Always discuss possible side effects with a doctor. Most experts agree, however, that the possible dangers involved with an actual pregnancy and delivery outweigh the possible dangers presented by the pill. For most people, in consultation with a doctor, the pill is considered safe.

Some women have other issues with the pill, including nausea from the increased hormones, weight gain, irritability, migraines, depression, and a reduced sexual desire. These side effects usually decrease after a few monthly cycles of taking the pill. As with any prescription product, some have a great deal of difficulty with the pill while others experience no difficulty at all.

There are many pros and cons to taking birth-control pills, and these should be weighed carefully against a woman's lifestyle and health before deciding to use them.

Diaphragm

A diaphragm is a soft, round, rubber cup that fits over the cervix. It works by keeping the sperm out of the uterus. A doctor must measure a woman's cervix and prescribe the proper size diaphragm for her.

Diaphragms are used in conjunction with spermicidal jelly and are inserted thirty minutes prior to intercourse. The diaphragm must be left in place for several hours afterward. Many women enjoy diaphragms as they offer the freedom that is similar to pill usage. However, some women find diaphragms to be messy (because of the spermicide) and difficult to insert. Furthermore, the effectiveness rate is not as high as that of the pill and, unlike the condom, diaphragms offer no protection against STDs and HIV.

Cervical Cap

A cervical cap looks like a thimble with a rim. It fits over the cervix just like a thimble fits over a finger. It comes in four different sizes, and must be fitted to the user by a doctor. The cervical cap works as a diaphragm does, blocking the cervix.

Drawbacks to the cap are that it does not allow free flow of cervical fluid, which can lead to odor and infection in certain wearers. Also, like the diaphragm, the cervical cap can be difficult to insert and remove and it offers no protection against STDs, including HIV.

Intrauterine Device

Intrauterine devices (IUDs) are small devices placed in the uterus to prevent pregnancy. Though it is not known how IUDs work precisely, it is believed that they prevent fertilization. Usually comprised of plastic (copper IUDs are no longer common), most contain a synthetic hormone, often progesterone, that helps prevent pregnancy if the IUD exists in the body at a constant rate throughout a woman's entire cycle. IUDs are decreasing in popularity and are controversial as they have been known to affect fertility (the ability to become pregnant) and cause other health problems, such as rejection of the device by the body and damage to the uterus. Another drawback to IUDs is that they must be implanted and removed by a physician. Furthermore, IUDs offer no protection against STDs and HIV.

Norplant

Norplant is a contraceptive device that involves a set of thin, match-size capsules containing hormones that are implanted just under the skin of a woman's upper arm. Effective for approximately five years, Norplant has a high success rate in preventing pregnancy. Since it is implanted in the woman's arm, the woman is protected twenty-four hours a day and there is no chance of forgetting birth control (as with the pill, condoms, or the diaphragm). However, it offers no protection against HIV and other STDs; further, Norplant has many risks associated with its use, including irregular menstruation, headaches, weight gain or loss, benign (noncancerous) ovarian cysts, depression, and acne. Smokers or women with a history of certain health problems should not use it. Finally, Norplant is a very costly method of birth control (it can cost hundreds of dollars for insertion and removal is also expensive).

PREGNANCY

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A planned pregnancy between two mature adults can be a beautiful experience. Ideally a pregnancy occurs between loving partners who will share the responsibility of the pregnancy. A healthy pregnancy should be free of stress. If a woman is even a little bit unsure about whether having a baby is right for her, it can affect the course of her pregnancy.

Unplanned Pregnancy

An unplanned pregnancy can be terrifying for anyone, but especially for a teenager. It can make a person feel totally out of control, especially if the parents are not emotionally connected to one another. (This is why it's so essential to practice safe sex; see box on page 81). If a girl is sexually active and using protection but misses a period, she should not assume that she isn't pregnant. There is no single form of birth control that is 100 percent effective.

For girls who are sexually active and menstruate on a relatively regular basis, if a period is late (that is, beyond the usual 28- to 30-day cycle) by even a week or two, it is best to take a pregnancy test. Pregnancy tests are administered at local clinics, such as Planned Parenthood, or at a physician's office. Home pregnancy tests are available at most pharmacies and even many supermarkets. Home pregnancy tests have drawbacks, however. First, they are not 100 percent accurate. Second, clinics and physicians provide more than just accurate results; they are qualified to discuss what options there are for dealing with a pregnancy.

A good approach to this situation is to share concerns with a trusted adult or friend, who may offer advice and comfort and ease feelings of isolation.

Choices

Going to a clinic or a physician comes with the added benefit of having all options for addressing an unexpected pregnancy explained by qualified individuals. A couple or a woman alone may choose to carry the pregnancy to term and raise the child. Adoption is also another alternative. Finally, the pregnancy may also be terminated through abortion.

ABORTION. Abortion remains a very controversial issue, and the choice to proceed with one depends on personal belief as much as the legalities of abortion in a particular state. While abortion was made legal in the United States through the Roe v. Wade Supreme Court case in the 1970s, many states have legislation in place requiring parental notification, something that makes abortion an undesirable or impossible choice for many minors.

Abortion is the termination of a pregnancy before the embryo or fetus is capable of surviving outside of the womb. Someone desiring to terminate her pregnancy can usually find help through a local Planned Parenthood clinic. Planned Parenthood will be familiar with area clinics and physicians that offer abortion services. The organization is also familiar with any restrictions that exist in a particular state concerning abortion.

Most abortions are performed in the first trimester (first three months) and early second trimester of the pregnancy. Having a procedure in a clinic or a hospital is an ambulatory procedure (meaning that patients are sent home the very same day). After undergoing an abortion, most women are issued antibiotics to prevent infection and given birth-control counseling. Follow-up visits to a physician are required and recipients must also abstain from sexual intercourse and wearing tampons for several weeks. Discomfort, cramps, and bleeding are common in the days following an abortion, as is emotional pain.

Some women may not be emotionally affected at all by an abortion, while others may address feelings of regret or sadness years later. Choosing abortion is not simple or easy; in fact, it can be terrifying and traumatic. However, for many women, young and older, it is still the best choice for them personally.

ADOPTION. Some young women who find themselves pregnant are opposed to abortion for moral or religious reasons. Yet for any number of reasons,

they feel they are not able to raise a child on their own. For such people, carrying a child to term (until it is born) but placing the baby for adoption after the birth is a viable solution.

Adoption can be a very complicated legal process, but put very simply, when a woman or couple decide to place their baby up for adoption, they legally give up parental rights to the child so that another person or couple can legally become the child's parents. The biological parents, or birth parents, are the people who conceived and gave birth to the child. The adoptive parents have legal custody of the child and are the people who care for and raise the child as their own.

Giving up a child for adoption is never easy. Many women that have experienced pregnancy bond with the baby inside them on a very deep level. It's not easy to let go after nine months of closeness. Often, a birth mother or birth father will wonder about that child for the rest of their lives. Stories, positive and negative, about birth parents reconnecting with children they've given up for adoption years earlier are prevalent in the media. People considering adoption must make careful choices and be certain that they are willing to face the likelihood that they will never see their birth child again. People need to be honest with themselves when considering adoption and all parties should consult with attorneys experienced in such matters. However, for many people, adoption is the best choice for them personally.

SEXUALLY TRANSMITTED DISEASES

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Sexually transmitted diseases (STDs) include an array of diseases, some treatable and some not, that are transmitted primarily through sexual activity. The best way to almost completely reduce the risk of catching a STD is to abstain from sexual activity. Another method to reduce the odds of becoming infected is getting tested, along with one's planned sexual partner, for STDs, including and especially for HIV.

HIV/AIDS

Human Immunodeficiency Virus (HIV) infection is an immune system disorder (the immune system helps the body resist infection by diseases) that can be contracted through sexual activity as well as other types of contact. HIV is often labelled as an STD because of the high number of cases that emerge as a result of sexual activity, but it is important to note that HIV is not always contracted through sexual activity.

HIV can lead to the development of full-blown Acquired Immunodeficiency Syndrome (AIDS), which is also an immune system disorder. People catch HIV through sexual contact or by exposure to contaminated blood (such as through sharing dirty needles or a blood transfusion). People cannot contract HIV from sharing a meal, swimming in a pool, hugging, casual kissing, holding hands, or even sharing a toothbrush. Furthermore, there are no documented cases of transmission of HIV through French kissing. HIV can remain in the systems of the body for many years without leading to the development of AIDS; however, HIV can easily be detected with a blood test.

Many myths about AIDS have circulated since it was first discovered in the early 1980s. The first, and most fatal myth to women and heterosexual men, is that AIDS is only a "gay person's disease" or a syndrome limited to intravenous drug abusers who share needles with other users. The disease did devastate the gay community in the 1980s, but gay communities around the United States quickly took up a campaign of awareness and activism that led to a sharp decline in HIV-infection rates in that population. (These numbers, however, are going up again and are a big concern in the gay and lesbian community.) The strongest growing populations currently being infected with HIV include heterosexual women and teens. Specifically, young black heterosexual females are the fastest growing group of new cases.

Anyone who has sex is at risk for catching and/or spreading HIV. This is why practicing safe sex is imperative to everyone's health.

Chlamydia

Chlamydia is the most common sexually transmitted disease. It is caused by a virus and is spread during sexual intercourse with an infected person. Girls often have no symptoms. Males are more likely to have symptoms, including irritation or burning during urination and a milky discharge from the penis in the morning. For females, the only indication of being infected with chlamydia may be vague, lower abdominal pain. As a result, women's reproductive organs may be damaged by Pelvic Inflammatory Disease if chlamydia is not treated in a timely way. Therefore, it is really important to get tested if one has had unprotected sex. The virus can be treated with antibiotics.

Gonorrhea

Gonorrhea is a STD caused by bacteria. It can occur in the cervix, penis, throat and rectum. Symptoms usually appear only in the male, similar to chlamydia. Two to nine days after infection, males will experience painful urination and a thick, yellow discharge from the penis. Boys experiencing these symptoms must inform any and all sexual partners so that those individuals can get tested and receive treatment. Gonorrhea can render women sterile (unable to have children) without treatment. It is treated with highdose antibiotics.

Herpes

Herpes is another very common STD. Genital herpes affects 10 to 40 million Americans. The Herpes Simplex 2 virus causes it; this is the same virus that causes cold sores in and around the mouth. The herpes virus can be spread from the mouth to the genitals during oral sex. Two to twenty days after exposure, symptoms appear. Small, painful, pus-filled blisters appear on the labia, around the vagina, on the penis, and around the anus in both sexes. Swollen lymph glands, aching muscles and fever are some other symptoms. The symptoms subside after a few weeks, but the virus stays dormant in the body and can flare up regularly. It can also never flare up again. Even if there aren't any symptoms present, a person can still transmit the disease to another.

Compromised immunity and emotional stress can trigger symptoms. Sexually active individuals should be tested for herpes and all STDs even if no symptoms are present. At this time, there is no cure for genital or oral herpes. Treatment includes acyclovir, which can reduce symptoms and is available in topical and oral forms. A healthy diet and avoiding stress also are important.

Syphilis

Syphilis is a STD caused by a very small, corkscrew-shaped spirochete (bacterium). It is spread by sexual contact and can be transmitted from a sex organ to an open cut on the skin of another person. Ten to ninety days after infection, a small, painless sore can appear on the genitals. After it goes away, weeks or months later a rash can appear all over the body, and swollen glands accompanied by flu-like symptoms may occur. Untreated syphilis does not go away. The disease can remain dormant for years and reappear when it is too late. The third stage of the disease may include nervous, brain, and circulatory system damage, and possibly death. Once detected, syphilis can be treated with penicillin.

Genital Warts, or Human Papilloma Virus

Genital warts (also known as Human Papilloma Virus) is the third most common STD. The warts are extremely contagious, and can appear on the vagina, cervix, penis, and rectum or in the urethra in the male. They are white-colored and cauliflower-shaped growths. They appear a few months after exposure. A physician can remove them with podophyllin, a medication, or by nitrogen freezing or laser treatment.

Crabs, or Pubic Lice

Crabs or pubic lice are spread by sexual contact with an infected partner or even by sharing of bedding, clothing, towels and toilet seats. Crabs cause intense itching and sometimes pain where the parasites have burrowed under the skin. A prescription drug called Kwell is the most effective treatment. Over-the-counter medications are also available. Washing bedding and clothing in hot water is essential follow-up for someone infected with crabs.

SEXUAL HARASSMENT AND ABUSE

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Sexual harassment and abuse have always been in existence, but have gotten a lot of exposure especially over the past few years. Sexual harassment includes almost all unwanted and unsolicited sexual advances, talk, and behavior. Sexual abuse includes all levels of sexual contact against anyone's will. Sexual abuse may include, but is not limited to, inappropriate touching or kissing, incest (sexual relations between closely related people), rape, and date rape. A perpetrator's motives for victimizing another are usually based around issues of power; the power is derived by having another person at his or her mercy, sexually or verbally. Sexual abuse and harassment can happen anywhere and at almost anyone's hands, from peers to a trusted adult to a total stranger.

Many people that are being harassed or abused are sometimes afraid to admit it. There are a lot of reasons for this. Sometimes the person harassing another threatens the victim, forcing him or her to promise not to tell anyone else, or threatens to harm the victim's family or that the victim might lose a job or favor with the perpetrator. Sometimes people are afraid that they are responsible for what has happened to them, so they want to keep it a secret. Young people are often manipulated into thinking that they will get into trouble if they tell an adult about the situation.

If anyone, an adult or another teen or child, touches anyone else inappropriately or threatens another person sexually, one should immediately tell a trusted adult or law-enforcement professional. Sometimes, the abuser or perpetrator is someone that, in normal situations, should be trusted. In this case, it is often hard to speak up, especially if that person is a classmate, a boss, or even a family member. If a victim is scared that he or she won't be believed, a neutral party should be consulted (a guidance counselor, a neighbor, a friend's mother or father) so that they can act on the victim's behalf.

The only way to stop abuse and harassment is to expose it.

FOR MORE INFORMATION

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Books

Ditson, Mary, Caesar Pacifici and Lee White. The Teenage Human Body Operator's Manual. Ore.: Northwest Media Inc., 1998.

Harris, Robie H. It's Perfectly Normal: Changing Bodies, Growing Up, Sex & Sexual Health. New York: Candlewick Press, 1996.

Jukes, Mavis. It's A Girl Thing: How To Stay Healthy, Safe and In Charge. New York: Alfred A. Knopf, 1996.

McCoy, Kathy and Charles Wibbelsman. The New Teenage Body Book. New York: The Body Press/Perigee Books, 1992.

Web sites

The American Foundation for AIDS Research. [Online] http://amfar.org (Accessed October 25, 1999)

Centers for Disease Control and Prevention. [Online] http://www.cdc.gov (Accessed October 25, 1999)

Planned Parenthood. [Online] http://www.plannedparenthood.org (Accessed October 25, 1999)

Teen Challenge World Wide Network. [Online] http://www.teenchallenge.com (Accessed October 25, 1999)