1 Sex Ed Carolyn Payne Medical Student University of VermontLarner College of Medicine
2 Goals Student, need your help! Conversation about howDoctors are resources Sexually transmitted infections exist Pregnancies should be decisions Slides are meant to be conversational points, can give you as much or as little information as you want, want to establish: -what you know: mainly about general sex information, STIs, and pregnancy -what you want to know -places where you can get more information -frame it as you are a student, doing school project, need your help. I’ve never done this before and I’m learning how to give this talk. If something doesn’t sound right or you don’t like something or how I say something, then just tell me and I can make it better for the next class. -At the end, I’ll give you a notecard so that you can tell me one thing you learned and one thing you didn’t like about it. We all have a unique upbringing. I grew up in Pittsburgh, 2 older brothers, and in a culture that is unique to my own family. I am still learning about your culture, traditions, values, the way you do things in your communities. Please help me learn more. Tell me if something is not the way you see it or were raised, etc. (-bring notecards to write questions/thoughts -bring healthy snacks for participation)
3 What does your doctor ask you?
4 Questions from DoctorsAre you having sex? What do you use for protection from sexually transmitted infections? What do you use for pregnancy prevention? Do you feel safe at home? In your relationship? Have you ever been sexually harmed? Physically harmed? We ask all our patients, “are you having sex?” Why? -It is important to your health. Just like exercising and eating well. If eat ice cream every day, heart disease, at risk later. Sex, you could get STIs-affect your life in a chronic, life-long way. -Like everything you tell us, all information is confidential-not going to tell anyone else. Our role is to serve as a non-judgemental confidant and resource for you. -should also ask you: -what you know about sex -what your family culture is around sex -if you have interest in males/females -if you have a boyfriend or girlfriend -you are growing up, you will find that you will be attracted to other people. For most people, this will be a member of the opposite sex, for some it will be girls liking girls or boys liking boys. This is okay, lesbian and gay, respectively. Have a partner to support you, and that is okay and important. If you want or need more information, here are the people to talk to about. -if you feel safe in your relationship and at home -if you ever have thoughts of harming yourself or others-that is because those put your health at risk. -consent is very important, don’t have consent, can have PTSD, be in a harmful situation, etc. Questions all doctors should ask you alone. Growing up. Need to become your own advocate for health. Need to be able to have someone to talk to if you ever have any health questions or are ever in trouble. Doctors provide a lot of resources. Not just someone you have to go to. Don’t just administer shots. Doctor also will do a physical exam to make sure your body is changing the way it is supposed to change. Some adolescents’ bodies don’t and it is important to catch that and correct it. Information, especially about sexually transmitted infections: if say that it doesn’t apply to them because they “aren’t supposed to have sex now anyways”, then say, well many in your communities are going to college and you are in America, exposed to american culture where people have sex before marriage. If you are having sex for the right reasons, then it’s okay or at least you are surrounded by people who are taught it is okay. Shouldn’t be shameful about wanting to live your own life, but if you do find your life is moving in a different direction than what you were taught, you need to know more information and if you do have sex, you need to be aware of these things. Can get infections from having sex that can affect you for your entire life, can get pregnant from having sex, your decision affects you, your baby, and the people around you. Pregnancy should be a decision, not an accident. Decide about becoming pregnancy when you are in a situation where you can be absolutely the best parent you can be, that means being substance free during pregnancy, including conception and pregnancy so that the baby can be as healthy as they can be. You need to be able to devote yourself to that completely, likely means not college or intense career at that moment, especially without family, emotional support. The most important time for the baby is with you. They will want and need a lot of your time. Okay to get married and have a baby, just needs to be a decision.
5 Sex Information
6 Data “41% [of high schoolers in 2015] had ever had sexual intercourse30% had had sexual intercourse during the previous 3 months, and, of these: 43% did not use a condom the last time they had sex 14% did not use any method to prevent pregnancy” Important for you to know that not everyone is having sex, that is okay! Only a small percentage have-4/10 of you ever, 3/10 of you in past 3 months. Don’t always believe the people who say they are very sexually experienced! And among those who are having sex-not everyone is having safe sex. Assume don’t know what 50% means, low reading levels. For all of this, assume they don’t know. Then up your level if they seem to be asking more intense questions. Half, that means 4/8 of you. https://www.cdc.gov/healthyyouth/sexualbehaviors/
7 Consent “A 2011 survey of high school students found that 11.8% of girls and 4.5% of boys from grades 9-12 reported that they were forced to have sexual intercourse at some point in their lives” Top perpetrators Intimate partners Family members Acquaintances Felony that follows perpetrator for life Not everyone is having sex. Don’t feel pressured, especially by partner, if you do, you need to tell someone. It is never okay to be forced to have sex with someone. Consent is very important. What does consent mean to you? Communication is key. Ask at every step of the way -Are you comfortable? -Are you okay with…? -Is this okay? -May I? -Do you want to slow down? -Do you want to go further? -Do not make these decisions when under the influence of drugs. Do not feel pressured because partner acts sad, makes you feel guilty for not having sex or saying no, or physically pushes you or ignores what you have said no to. -also, this applies to other parts of daily life. People’s personal space is personal space. Males to males, females to females; friends and heterosexual relationships too; private parts are private and if you touch people under the bathing suit areas, you will get into trouble as you get older, laws against touching inappropriately, felony-follows you every time you want to get a job or rent an apartment, etc. it is a huge impairment to the opportunities you have in the future and will affect your life https://www.ageofconsent.net/laws/vermont/sexual-assault -big deal because so many people, especially women, have been affected by assault Look up state laws. https://www.cdc.gov/violenceprevention/pdf/sv-datasheet-a.pdf
8 Unsafe Sex “Only 10% of sexually experienced students have ever been tested for human immunodeficiency virus (HIV)... Half of the nearly 20 million new STDs reported each year were among young people, between the ages of 15 to 24 Nearly 230,000 babies were born to teen girls aged years in 2015” Those who are having sex are not always safe-no condom, no birth control, even more STI transmission with birth control at this point, may be related to IUD use, contraceptive methods don’t necessarily protect against STIs, 43% no condom, no protection at all against STIs https://www.cdc.gov/healthyyouth/sexualbehaviors/
9 Teen Moms “Pregnancy and birth are significant contributors to high school dropout rates among girls. Only about 50% of teen mothers receive a high school diploma by 22 years of age, whereas approximately 90% of women who do not give birth during adolescence graduate from high school” https://www.cdc.gov/teenpregnancy/about/index.htm
10 Pregnancy Consequences for Children of Teens“The children of teenage mothers are more likely to have lower school achievement and to drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult.” In 2010, teen pregnancy and childbirth accounted for at least $9.4 billion in costs to U.S. taxpayers for increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers. https://www.cdc.gov/teenpregnancy/about/index.htm
11 What do you know about sexually transmitted infections?STIs 3 types of sex: any mucous membrane (wet hole) in contact with private parts/genitals is sex: oral sex, vaginal sex, anal sex. Mouth, penis, labia (outside of vagina), anal, and penis. STIs with any of these things. You can have penis in mouth sex, penis in vagina sex, etc.; (and what are the options for two women, two men…) What are some common STIs? -list How do you prevent them? -condoms -but condoms break, may be incorrectly sized and some, especially HPV and herpes, you can get even if condoms are used correctly working -talk to doctor all the time about sex, but at least a month before you are sexually active -probably say get tested, both of you -start birth control -educate you about how to properly use a condom and birth control, all forms of sex -talk about risks of multiple sexual partners, unsafe practices, and STIs and answer any specific questions you have What happens if you get one? -antibiotics for most things, topical or oral -removal for warts or other things -long-term medications for HIV and Hepatitis -follow up testing -partner or partners testing and treatment -prevention in the future. -decrease number of partners -testing before sex -condoms: oral, vaginal, anal.
12 Sexually Transmitted Infections (STIs)Gonorrhea Chlamydia Human Immunodeficiency Virus (HIV) Human Papilloma Virus (HPV) Herpes Syphilis Trichomoniasis Bacterial vaginosis Hepatitis B Hepatitis C Molloscum contagiosum Pubic lice G and C-very common, infertility, pain HIV-chronic, life-long, wasting illness HPV-genital warts and cervical cancer Herpes-life-long, painful skin lesions Syphilis-really risky for babies Hepatitis-liver failure Pubic lice-crabs
13 STI Prevention Condoms for all forms of sexAnal Vaginal Human Papilloma Virus (HPV) Vaccine Hepatitis B Vaccine -condoms: oral, vaginal, anal: will protect against most but not all, especially common are HPV (genital warts/cancer) and herpes (painful, life-long sores) (also syphillis, public lice, molloscum contagiosum) use correctly. Could still break or be on wrong or wrong size. Make sure using them correctly. So lucky HPV Vaccine-no cancer or hep B-liver failure! All you have to do is get a shot!
14 STI Prevention Safe sex behavior Get testedDecrease number of partners Talk to adults, especially doctors, nurses, counselors Safe sex behavior -always get tested routinely, at least once a year, especially if new partners. get tested together before you have sex. -Reduce number of sexual partners. Monogamous and always using condoms. -talk to doctor, nurse, counselor, adults; not just friends-information friends have not always correct. These other people can teach you how to correctly use condoms, help you get vaccinated and tested, general information Condoms are at top of the list for what we have for physical protection during sex. They don’t protect against everything though. The only thing to do that is to not have sex. And also to get screened by the doctor together. And to know for yourself that STIs are out there and you need to protect yourself.
15 What do you know about pregnancy prevention?How? -need to have penis vagina sex How do you prevent it? -condoms; but condoms break, may be incorrectly sized and some HPV and herpes, you can get even if condoms are used correctly -birth control options. -talk to doctor at least a month before you are sexually active -talk about all the different options and why one would be best for you. -best to come with your partner and make a shared decision, get tested for STIs and educated about safe sex practices, etc. -birth control takes a while to work-best to have a full menstrual cycle on whatever birth control option before you have sex (really about one week active) What happens if you get pregnant? -go to someone you trust and can confide in, good to talk to your doctor, with partner too. -carry and care for the baby -carry and allow for adoption -termination/abortion -pill -procedure (basic suction concept) -chances of complications to your health very minimal
16 Bottom to top least effective to most effective.Bottom not that good: control yourself every time you have sex-break, or don’t succeed -Withdrawal really hard-just experiencing incredible feelings for first time. Very hard to control, even if you have the best of intentions. -condoms-remember, bottom for contraception, but best for STIs. Okay in middle: have to remember to do them: -pill-every day same time -patch-every week -ring-every month -injection-every 3 months Then, best-not up to you to remember. -implant-for 3 years, arm, circulating -IUD-3/5/12 years -copper no hormones at all -no periods NOT sterilization for you, but almost as effective as sterilization. Contraception options. A lot of options and best to talk to your doctor about which one is right for you.
17 Intrauterine Device (IUD)Very effective 0.2% rate of pregnancy with Mirena 0.8% rate of pregnancy with copper Long-term 5 years Mirena 12 years ParaGard Limited side effects Local hormones, progesterone only or none No weight gain Lighter, limited, or no periods for Mirena very effective -long-term form of birth control -limited side effects Very effective-no need to remember to take anything or change something Long-term: put it in and done, overall not very expensive when add up cost of birth control each month, overall covered by insurance right now. Get it right now. Not sure what going to happen in future. Limited side effects-weight gain with others, most others systemic hormones-women don’t like. Lighter, limited or no periods!!!!! If nothing else, outdoors, active, sports-super good. No one knows you have them. popular among female doctors and medical students
18 What happens if you get an STI?What happens if you get one? -antibiotics for most things, topical or oral -removal for warts or other things -long-term medications for HIV -follow up testing -partner or partners testing and treatment -prevention in the future. -decrease number of partners -testing before sex -condoms: oral, vaginal, anal.
19 STI See your doctor if any symptomsOften antibiotics or other medicines will resolve infection or help reduce symptoms Any kind of discharge, irregular bleeding (especially after sex), fever, abdominal pain, change in urination-doctor.
20 What happens if you or your partner become pregnant?-come to someone you trust and can confide in, should be your doctor, with partner too. -emergency contraception, plan b -carry to term and care for the baby -carry to term and allow for adoption -termination/abortion -pill -procedure -chances of complications to your health very minimal
21 Pregnancy Unprotected sex Emergency contraception-Plan BPregnancy test Plan B-up to 72 hours after unprotected sex. Better when taken earlier. High dose of levonorgestrel-progesterone in many birth control, just at a higher dose
22 Pregnancy Pregnant Keep baby Adoption Termination Pill ProcedureSmall chance complications Procedure-basic suction concept
23 Where to go if you need help?A trusted adult, parent, friend, counselor, nurse Your doctor UVM Medical Center Planned Parenthood Help lines Help lines-suicide, sexual assault, pregnancy
24 Helpful Websites https://www.bedsider.org/https://www.plannedparenthood.org/ Good links for teens:
25 Evidence-Based SourcesCenters for Disease Control and Prevention (CDC.gov) National Institutes of Health (NIH.gov) Mayo Clinic (MayoClinic.org) Planned Parenthood (PlannedParenthood.org) U.S. National Library of Medicine (MedlinePlus.gov) More information about public health/general information For you, these are grown up things to talk about, and save this information for you as high schoolers, please don’t talk about this on the bus, on the playground, where younger kids can hear, you are ready for this information, but they are not. It might scare them about the future or be misinterpreted and spread in not the greatest way. Can talk about this with your parents. It is a good thing to do. Have experience and advice for you. Or other adults in the community.
26 References Centers for Disease Control and Prevention (CDC): Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2017). Sexual Risk Behaviors: HIV, STD, & Teen Pregnancy Prevention. Retrieved from: https://www.cdc.gov/healthyyouth/sexualbehaviors/ CDC: National Center for Injury Prevention and Control, Division of Violence Prevention. (2012). Sexual Violence: Facts at a Glance. Retrieved from: https://www.cdc.gov/violenceprevention/pdf/sv-datasheet-a.pdf CDC: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. (2017). About Teen Pregnancy. Retrieved from: https://www.cdc.gov/teenpregnancy/about/index.htm https://www.cdc.gov/healthyyouth/sexualbehaviors/ https://www.cdc.gov/violenceprevention/pdf/sv-datasheet-a.pdf https://www.cdc.gov/teenpregnancy/about/index.htm
27 Effectiveness Only if want more information.CDC. (2011). Effectiveness of Family Planning Methods. Retrieved from: https://www.cdc.gov/reproductivehealth/unintendedpregnancy/pdf/contraceptive_methods_508.pdf Condoms are on bottom of this list for pregnancy prevention, but remember they are the best option we have for STIs (STIs are a hard concept for them). Male form: condom: use correctly every time have sex, 18% chance failure, can be incorrect size, put on wrong, break Female hormones: -Pill, take every day, easy to forget, systemic hormones, risk of clotting (especially if smoke), 1% failure take every day at same time, but more like 9% failure when not taken correctly and forget, a lot of different options, P only options (less risk clotting) -patch-ortho evra-replace every week for 3 weeks, then bleed for a week or don’t, systemic hormones, risk of clotting higher even more E than most pills, 9% failure rate as well., weight gain, skin irritation, doesn’t work as well if more fat tissue -nuva ring-replace once a month (put in, take out after 3 weeks), chance can fall out, sometimes vaginal infection -all can skip last week and not bleed. -Injection-depo-provera, P-only (less risk clotting), every 3 months injection, weight gain up to 20 lbs, IUD, 0.2% chance of getting pregnant/failing-equivalent to most sterilization procedures, but is easily reversible and only local hormones levonorgestrel-releasing: LNG, type of progesterone LNG20-related to dosing Good links for teens: Bedsider https://www.cdc.gov/reproductivehealth/unintendedpregnancy/pdf/contraceptive_methods_508.pdf
28 Contraception OptionsKwok, Alyssa. “Accessible Contraceptive Education in VT.” (2016). Family Medicine Block Clerkship, Student Projects Retrieved from:
29 Contraception OptionsKwok, Alyssa. “Accessible Contraceptive Education in VT.” (2016). Family Medicine Block Clerkship, Student Projects Retrieved from: