Sexual Health Guide

This information is up-to-date and impartial. We hope it provides many of the answers to your frequently asked questions and helps you to better protect your sexual health and your fertility. This web site can only give you basic information about reproductive and sexual health. It is based on currently available scientific evidence and medical opinion.

Family Planning has a resource library that the community is welcome to borrow materials from. Contact us at (509)662-2013 for more information.

You may find books and other resources at the public library. A few suggested titles are listed below:

Teens

We at Family Planning hope that teens in our communities have a strong support system at home, but we realize that some young people might not. Our goal is to provide information and resources to help teens stay healthy and safe.

Suggested Resources

Chill is a website devoted to empowering teens to manage stress. Includes a teen forum, poll, and tips.

Coalition for Positive Sexuality is a website offering straight answers and resources about sexuality. They also have information and resources on other issues including abuse, needle exchange, and teen parenting. Se habla Espanol


4Girls Health
Their mission is to promote healthy, positive behaviors in girls between the ages of 10 and 16. The site gives girls reliable, useful information on the health issues they will face as they become young women, and tips on handling relationships with family and friends, at school and at home.

FUEL Youth Forum Share your stories, essays, ideas, and feedback with others about youth obesity. Learn what youth activists groups are doing to promote health.

gURL.com
This web site is a leading online community intended for girls age 13 and up, built on the principle that information is a positive thing. The site contains stories, games and interactive content dealing with sexuality, body image, emotions, self-destructive behavior, etc.

My Bright Future
This website by the U.S. Dept. of Health and Human Services offers information for young women about physical activity and healthy eating, as well as information on how to reach your personal goals.

iwannaknow.org
This web site is geared toward teens and answers questions about teen sexual health and sexually transmitted diseases. The site also includes a Parent's Guide and a glossary.

Like It Is
This clever, animated web site tells you everything you need to know about sex..."no frills, no judgements, and no holds barred!"

Sex, Etc is a Web site for teens, by teens. In addition to topics regarding sexuality and reproductive health, the site includes information about body image, drugs and alcohol, relationships, teen parenting, and state laws.

Talk About Sex is a new publication from SIECUS designed to provide young people with basic information and reputable website referrals about a range of sexuality topics.

Teen Central.Net
Teen Central Net states is is totally real, totally anonymous, totally yours. It is a place where teens can ask questions, and get information. Check it out!

Teen Health Talk
Teen heath talk is a place where teens can connect with teen-health experts and other teens on a wide range of health, wellness, and reproductive educational issues.

Advocates For Youth
Advocates for Youth helps young people make informed and responsible decisions about their reproductive and sexual health.

Frequently Asked Questions (FAQ)

1. Why do my parents say they will support me in everything I do, but freak out when it comes to the subject of sex?
Choosing whether to have sex, and when, is a very big decision. The choice you make can change the direction of your life, and the lives of other people too. Parents have the advantage of both positive and negative life experiences that you have not yet acquired, which gives them a perspective very different from yours. The bottom line is that parents want to protect you from making a choice that could hurt you and other people. They want you to be safe. They want you to accomplish things that will make you happy. Parents also raise their children with value systems that they hope their children will cherish as much as they do. Your parents may be afraid that the choice to have sex before you are ready will change your life dramatically and risk your opportunities and happiness.

2. I want to date but I am afraid guys will pressure me to have sex before I am ready. How is a girl supposed to handle that kind of pressure?


• Attend events in groups, and stay with the group rather than going off alone with someone


• Stick to public places


• Avoid alcohol and illegal drugs. Impaired judgement leaves you vulnerable to dangerous situations


Someone who truly cares about you won't pressure you to have sex! An estimated 1 in 5 girls in the United States suffers physical and emotional abuse when their companions seek to control and possess them in the dating relationship. Since abuse increases, and usually becomes more violent over time, it is wise to be aware of the following early signs that a person may be abusive:
• Extreme possessiveness and jealousy
• Tries to control what you wear, what you do, and how you act
• Cruelty to animals
• Unable to handle frustration; explosive anger
• Isolates you from spending time with friends, or even family
• Does not respect personal boundaries
• Puts you down, insults you, and says hurtful things as a way to control your behavior
• Won't accept breaking up
• Alcohol and/or drug abuse
• Comes from a home of abuse and accepts the behavior as normal

If you experience any of these warning signs in your relationship, tell someone you trust: your parents, a friend, a counselor, a teacher, etc.
*National Domestic Violence Hotline: 1-800-799-SAFE

3. How old do I have to be to go to Family Planning? What are my rights?
You may access Family Planning services if you are of reproductive age; in other words, if you are able to get pregnant, or to get someone pregnant. Additionally, a minor who is fourteen years of age or older may consent to STD/HIV testing and treatment without prior consent of parent or legal guardian.

4. Why do women have pelvic exams and pap smears?
A pap smear is not required to get started on a birth control method. However, if you are sexually active you need to take care of your sexual health, and having regular pap smears is an important part of that. A pap smear checks for signs of cervical cancer. Pelvic exams are done to check the reproductive organs.

STD checks are an important part of your exam. If you are sexually active, it is a good idea to have screening tests for sexually transmitted diseases. It is not automatically done with your annual pap, so be sure to request the STD screening. If you believe you may have been exposed to an STD, you should schedule an appointment to be tested; don't wait until your pap is due!

5. Do pelvic exams hurt?
It may be a little uncomfortable, but you should feel pressure...not pain. Speak up if it hurts!

6. What does it cost to raise a child to adulthood?
Below are a couple of web sites that will allow you to calculate an estimate of the cost of raising a child.

• Bankrate.com
• BabyCenter

7. What does the law require of a guy if he gets a girl pregnant?
At the very least, you are required to pay child support until the child is 18 years old. Laws vary from state to state.

Characteristics of a Sexually Healthy Adolescent

Courtesy of Advocates for Youth

Self:
Appreciates Own Body

• Understands pubertal change
• Views pubertal changes as normal
• Practices health-promoting behaviors, such as abstinence from alcohol and other drugs, and undergoing regular check-ups

Takes Responsibility for Own Behaviors

• Identifies own values
• Decides what is personally "right" and acts on these values
• Understands consequences of actions
• Understands that media messages can create unrealistic expectations related to sexuality and intimate relationships
• Is able to distinguish personal desires from that of the peer group
• Recognizes behavior that may be self-destructive and can seek help

Is Knowledgeable About Sexuality Issues

• Enjoys sexual feelings without necessarily acting upon them
• Understands the consequences of sexual behaviors
• Makes personal decisions about masturbation consistent with personal values
• Makes personal decisions about sexual behaviors with a partner consistent with personal values
• Understands own gender identity
• Understands effect of gender role stereotypes and makes choices about appropriate roles for oneself
• Understands own sexual orientation
• Seeks further information about sexuality as needed
• Understands peer and cultural pressure to become sexually involved
• Accepts people with different values and experiences

Relationships with Parents and Family Members:
Communicates Effictively With Family About Issues, Including Sexuality

• Maintains appropriate balance between family roles and responsibilities and growing need for independence
• Is able to negotiate with family on boundaries
• Respects rights of others
• Demonstrates respect for adults

Understands and Seeks Information About Parents' and Family's Values, and Considers Them in Developing One's Own Values:

• Asks questions of parents and other trusted adults about sexual issues
• Can accept trusted adults' guidance about sexuality issues
• Tries to understand parental point of view

Peers:
Interacts With Both Genders in Appropriate and Respectful Ways

• Communicates effectively with friends
• Has friendships with males and females
• Is able to form empathetic relationships
• Is able to identify and avoid exploitative relationships
• Understands and rejects sexual harassing behaviors
• Understands pressures to be popular and accepted, and makes decisions consistent with own values

Romantic Partners:
Expresses Love and Intimacy in Developmentally Appropriate Ways

• Believes that boys and girls have equal rights and responsibilities for love and sexual relationships
• Communicates desire not to engage in sexual behaviors and accepts refusals to engage in sexual behaviors
• Is able to distinguish between love and sexual attraction
• Seeks to understand and empathize with partner

Has the Skills to Evaluate Readiness for Mature Sexual Relationships

• Talks with a partner about sexual behaviors before they occur
• Is able to communicate and negotiate sexual limits
• Differentiates between low-risk and high-risk sexual behaviors
• If having intercourse, protects self and partner from unintended pregnancy and diseases through effective use of contraception and condoms and other safer sex practices
• Knows how to use and access the health care system, community agencies, religious institutions, and schools; and seeks advice, information, and services as needed.

Characteristics of an Emotionally Healthy Partner

• Shares in the decision - making with you
• Knows oneself and is comfortable being alone
• Accepts you for who you are, not for how you look
• Has many of the same values as you do
• Is able to express anger without being violent or abusive
• Is able to work through conflict by talking
• Doesn’t expect perfection from you
• Is a good listener and communicates well
• Takes responsibility for what he/she says and does
• Doesn’t rush into the relationship, but moves step by step into being more intimate
• Accepts when you spend time away with your friends
• Asks permission before touching you or being sexual
• Has supportive friends other than you
• Makes and keeps commitments

Sexually Transmitted Diseases/Infections

Please use the list at the bottom of the page if you would like to jump directly to a particular topic. For additional information:
• American Social Health Association
• Centers For Disease Control and Prevention
• CDC en Espanol
• Washington State Department of Health

Sex is a normal and pleasurable part of life, however, it is possible that if one person has an infection it can pass to another person through the close physical contact that happens when people have sex. Infections that are spread in this way are known as sexually transmitted diseases (STD) or infections (STI).

You may not have considered the possibility of getting an infection. Being well-informed about STIs will help you to avoid them. If you feel you need more information then don’t be afraid to ask.

STDs are most commonly passed on through vaginal, oral and anal sex. You don’t need to have a lot of sexual partners to get an STD although having multiple partners increases your risk of infection.

Common symptoms of an STD are:

• Unusual discharge or odor from vagina or penis
• Pain or burning when urinating
• Itching, rash, lumps or blisters around the genitals or anus
• Pain and/or bleeding during sex
• Bleeding after sex and/or between periods
• Abdominal Pain

Note: Symptoms, however, can vary from infection to infection and many STIs show no symptoms at all. It is not uncommon to have more than one infection at the same time.

Some STDs can be completely cured if found early enough and may only require you to take an antibiotic. However, if left untreated infections can be painful and uncomfortable or, at worst, cause permanent damage to your health and fertility.

How to avoid STDs
Of course, the best way to avoid STDs and pregnancy is abstinence (not have sex). If you choose to be sexually active, using a condom (male or female) correctly EVERY TIME you have sex will reduce the risk of transmission of some STDs, including HIV. However, there are also several things that you can do to make sex safer.

Be Prepared

• Discuss with your partner before you have sex how you will both protect yourselves.
• Become familiar with how to use condoms
• Have a supply of condoms ready
• There are lots of choices of condoms so try a different one if you are not happy with the ones you use now
• Learn about how infections are spread, what symptoms to look for, and where to go for help if you are worried
• Have a routine check up at a sexual health clinic
• If you or your partner have symptoms or think you might have an infection seek medical care before you have any more sex
• Tell your partner if you have an infection so they can be treated too
• Do not have sex until treatment or medications are finished.

Chlamydia

What is Chlamydia?
Chlamydia is bacteria that can infect the genitals, urethra and rectum of men and women, but may also affect the throat and eyes.

How is it passed?
It is passed on by unprotected vaginal, oral or anal sex, when sharing sex toys or by a mother to her baby at birth.

Signs and Symptoms
About 60% of men and 80% of women with Chlamydia have no symptoms at all. Often symptoms are very mild and go unnoticed, but typical signs of infection with Chlamydia experienced by men or women include:

• Unusual discharge from the penis or vagina
• Pain while urinating
• Bleeding between periods
• Testicular pain or swelling
• Pain during sex
• Lower abdominal pain

Tests and Treatment
Usually, at FPCD clinics, a simple urine test is done.

Chlamydia is easily treated with antibiotics. To avoid reinfection, sexual partners should also be treated.

If untreated, Chlamydia can spread to other reproductive organs causing serious health problems such as pelvic inflammatory disease, ectopic pregnancy and infertility (unable to have children).

Gonorrhea

What is Gonorrhea?
Gonorrhea is a bacteria that mainly infects the genitals, urethra, rectum and throat of men and women, and sometimes the eyes.

How is it passed?
It is passed on by unprotected vaginal, oral or anal sex, sharing sex toys, or passed from a mother to her baby at birth.

Signs and Symptoms
Many people with gonorrhea, particularly women, show no symptoms. Symptoms can be mild and go unnoticed, but typical signs of infection include:

• Unusual discharge from the penis or vagina that can be thin or watery, yellow or green
• Pain while urinating
• Possible irritation or discharge from the anus
• Lower abdominal pain
• Pain or tenderness in the testicles

Tests and Treatment
Usually a swab is taken from the vagina or tip of the penis or a sample of urine may be taken. The swab may feel a bit uncomfortable but should not be painful.

Gonorrhea is easily treated with antibiotics. To avoid re-infection, sexual partners should also be treated.

If untreated, gonorrhea can infect other reproductive organs in men and women and lead to serious health problems such as pelvic inflammatory disease or ectopic pregnancy, which can affect fertility.

Genital Warts

What are Genital Warts?
Warts are caused by viruses. Genital warts are caused by the Human Papilloma Virus (HPV). This virus affects the genital area.

How are they passed?
Genital warts are passed on through unprotected vaginal or anal sex, by sharing sex toys or direct skin-to-skin contact.

Signs and Symptoms
Not everyone with the virus will develop visible warts but they can still infect others. Genital warts can appear weeks, months, or years after sex with an infected person. When warts are present they are usually painless but may cause some inflammation. Warts can be flat, smooth, small bumps or larger cauliflower-like lumps that occur on their own or in groups.

In women, they can appear anywhere around the vulva and anus, and also inside the vagina or anus, or on the cervix. In men, they can appear anywhere around the urethra, penis, scrotum or anus. They can also appear inside the anus.

Tests and Treatment
Usually warts can be seen with the naked eye. If they are suspected, but not obvious, the area is painted with a special solution to make them more visible.

Warts are easy to treat, but more than one treatment may be needed. Treatment can include covering the warts with a chemical lotion or cream, freezing them off or removing them by laser treatment or surgery.

Genital warts do not cause any serious health problems but the virus always remains in the body. No treatment can remove the virus completely.

Some types of the wart virus are linked to changes in cervical cells which could lead to cervical cancer. These changes can take many years, so it is important women have regular pap smears, whether or not they have had genital warts. Only a few women with certain types of wart virus in their cervix have the kind of cell changes linked with cancer. Men can also have cell changes linked with cancer.

NOTE: Never self-treat genital warts with over-the-counter remedies! Also, some medicines must never be used by pregnant women so be sure to tell your provider if you may be pregnant.

For more information visit the Center for Disease Control and Prevention website.

Genital Herpes

Genital herpes is caused by the Herpes Simplex Virus. There are two types of the virus; Herpes Type 1 causes most oral infections (known as cold sores). Herpes Type 2 causes most genital herpes. But both types can give you sores in either place. Having one does not mean that you can't get the other.

Women and Herpes
Millions of women with herpes have had healthy babies, however pregnant women with genital herpes can give the disease to their babies. It can be very serious when a woman gets herpes for the first time when she is pregnant. It is very important that the doctor and/or obstetrician be told if a woman or any of her partners has genital herpes.

How is it passed?
It is passed on by unprotected vaginal, oral or anal sex, through sharing sex toys or through direct skin-to-skin contact. You can get herpes from people who have the virus even if they have no symptoms.

Signs and Symptoms
Often symptoms don’t show or are very mild and go unnoticed, but typical signs of infection with the virus include:

• Blisters on the genital area or in the vagina, cervix, urethra, rectum, anus or penis that leave painful sores when they burst
• Tingling or itching feeling in the affected area
• Flu-like symptoms such as swollen glands, backache and headache

Tests and Treatment
A swab is taken from one of the sores. The swab may feel uncomfortable but should not be painful. The first outbreak lasts from one or two weeks. Then, the sores begin to dry, form scabs, and heal.

• Herpes can look just like other diseases
• The virus always remains in the body and no treatment can remove it completely
• Some people find that different things can trigger an attack. These can include stress, tiredness, illness, alcohol and smoking.

Although there is no cure for herpes, there are drugs that your doctor can prescribe to help the sores heal faster and reduce the number of outbreaks. If you have sores:

• Keep the area clean and dry
• Don’t touch the sores
• Wash your hands after contact with the sores
• Don’t have sex until the sores are healed and new skin covers the area.
• It is always wise to use condoms

National Herpes Hotline: (919)361-8488

Scabies and Pubic Lice

Scabies and pubic lice are caused by tiny mites or lice. There are 3 kinds of lice that can live on humans – head lice, body lice, and pubic or crab lice.

Pubic Lice (Crabs)
Compared to other kinds of human lice, pubic lice move slowly. If you have sexual contact with a person who has crabs, you will almost certainly get them too; however people can get pubic lice without direct contact. Sometimes the lice or their eggs land on beds, towels or clothing when pubic hairs fall out. The crabs live in coarse body hair such as pubic and anal hair, chest, thigh and underarm hair. They sometimes live in eyebrows or eyelashes but NOT on head hair.

Scabies
Scabies is a skin infestation caused by tiny mites. It takes only 3 minutes for a female mite to burrow under the skin, where she lays her eggs. The mites can occur in any part of the body, but are generally seen in creases such as between fingers, on hands and wrists, underneath the buttocks and breasts, the genitals, skin folds and toes. Scabies is passed through close physical contact. Mites can live for a couple of days in fabric and dust and can be passed to others even if you don’t have any symptoms of infestation.

Signs and Symptoms
Scabies causes an itchy rash in the body’s skin creases, which may also be accompanied by tiny spots. Scabies can look exactly like other skin rashes.

Pubic lice can be accompanied by itchy skin. Black powder may appear in the underwear caused by mite droppings; tiny blood spots may be present as well. White eggs can be found on affected hair.

Tests and Treatment
For both scabies and pubic lice, the skin will be examined and a skin flake may be taken to test for mites or lice.

Scabies requires a prescription treatment. Talk to your medical provider or pharmacist about treatments that are safe for you, particularly if you are pregnant or if you are treating a small child. To avoid re-infection, close contacts or sexual partners should also be treated.

There are special ointments used for lice in brows and lashes.

For washable clothing, bedding, towels, rugs, and toys use the HOT cycle of the washer and dryer. Dry cleaning also works. Things that cannot be washed in hot water may be wrapped in plastic bags and sealed for 3 to 4 weeks.

Syphilis

Syphilis is a very serious disease. It is a bacteria that infects the vulva, urethra, or cervix in women and the penis or foreskin in men.

How is it passed?
It is passed through unprotected vaginal, oral or anal sex, by sharing sex toys, direct skin-to-skin contact with someone who has syphilis sores or rashes, or from a mother to her unborn child.

What are the symptoms?
Primary Stage
Ten to ninety days after sex (usually 21 days) a painless single sore appears in the area where contact was made. The sore, called a chancre, usually feels hard at the edges. It does not hurt. The sore is full of germs. After 2 to 6 weeks, the sore goes away.

Secondary Stage
Six to eight weeks later, the secondary stage begins and lasts from 2 weeks to 6 months. Symptoms include swelling of lymph nodes, rashes, and a flu-like feeling. There may be sores on the hands or feet that look like flat, grayish warts, or white with red borders. The sores can spread the disease. After a couple of weeks, the sores disappear. At this point, serious damage that can’t be seen or felt affects the heart, nervous system, kidneys, eyes and brain.

Latent Stage
There may be no visible signs during the slow latent stage. While the disease is not usually spread during this period, silent damage goes on until treatment or death.

Tests and Treatment
There are blood tests to detect the bacteria that cause syphilis. The sores can also be tested. If you have had sex with a person who has syphilis you must be treated right away. Tests are usually repeated, and everyone treated for syphilis must return for tests.

There is a cure for syphilis. Penicillin is the drug of choice and is given by injection. Other antibiotics are also available if you are allergic to penicillin. The antibiotics can be given at any stage to prevent further damage. After you have been cured you can get syphilis again if you have sex with an infected person.

Women and Babies
Moms are tested for syphilis and other STDs during their prenatal care. Both mom and baby can be treated and cured during pregnancy.

Trichomoniasis (Trich)

What is Trichomoniasis (Trich)?
Trich is a common STD caused by a microscopic parasite that lives in the wet areas (urethra and vagina) of infected men and women.

Trich is passed through unprotected vaginal, oral or anal sex, possibly by sharing sex toys, or from a mother to her baby at birth.

Signs and Symptoms
Sometimes there are no symptoms, or they are so mild they go unnoticed. If there are signs they usually come 4 to 20 days after contact with an infected partner; however the signs can come 6 months or even years after infection.

Typical signs include:

• Women may experience a heavy yellow-green discharge, an unpleasant odor, itching, and/or an irritation in the vagina
• Pain in lower abdomen
• Men may have a discharge from the penis
• Pain while urinating, and/or during sex

Is there a test?
Yes. A swab is used to take fluid from the vagina or penis; the sample is observed under a microscope. A culture can be taken, but often takes longer and is more expensive. Sometimes trich is found around cells taken for a Pap smear. Male semen can also be checked for trich.

Is there a cure?
Trich is easily treated with an antibiotic called Metronidazole (Flagyl). To avoid re-infection, sexual partners must also be treated, even if they show no signs of infection.

Is it serious?
Women with trich may be more likely to have babies who are premature or are born too small to be healthy. In men, trich can irritate the prostate gland. For both men and women, inflammation of the genitals can make it easier to get other STD infections. If you have trich or any other STD, get treatment right away.

HIV/AIDS

• El VIH y su transmisión

HIV (human immunodeficiency virus) is the virus that causes AIDS. It is passed through blood, semen, vaginal fluids and breast milk. You risk getting the virus if you:


• Have sexual contact with an infected person
• Share needles and/or syringes (primarily for drug injection) with someone who is infected

Babies born to HIV-infected women risk getting the virus before or during birth or through breast-feeding after birth. Currently there are medications that an HIV-infected pregnant woman can take to lower the chance of passing HIV to her infant before, during or after birth. Getting tested for HIV, and early entry into prenatal care can significantly reduce the risk of passing the virus to your baby.

HIV may also be passed through transfusions of infected blood, however it is very rare in countries where blood is screened for HIV antibodies. Hospital blood supplies have been tested and protected from HIV since 1985. Blood donation centers use clean needles once and then carefully dispose them.

Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV. Casual contact through closed-mouth or "social" kissing is not a risk for spreading HIV. However, because of the possible contact with blood during "French" kissing, the Center for Disease Control and Prevention(CDC) recommends against it with an infected person.

Be aware that you or your partner may have HIV and not know it. It can be months or years before an infected person will feel sick or have any serious signs of the virus. However, you can still pass it to others.

Family Planning is currently offering free HIV tests. Contact us at (509)662-2013 for more information and to set up an appointment.

Note: About one quarter of HIV-infected persons in the United States are also infected with hepatitus C virus (HCV). HCV is one of the primary causes of chronic liver disease in the United States.

Frequently Asked Questions:

Can I get HIV from getting a tattoo or body piercing?
You are at risk of HIV if instruments contaminated with blood are either not sterilized or disinfected, or are used inappropriately between clients.

Can I get HIV from mosquitoes?
There is no evidence of HIV transmission from mosquitoes or any other insects.

Can I get HIV while playing sports?
There is no risk of transmission during sports activities where bleeding does not occur. If someone is bleeding, they should not participate until the the wound stops bleeding, and is antiseptically cleaned and securely bandaged.

Are health care workers and patients at risk for HIV?
It is possible but rare. Health care workers are trained to practice infection control procedures and universal precautions which includes using protective barriers such as gloves, masks, aprons, gowns and protective eyewear.

Links
The CDC Info numbers below are available 24 hours a day, 7 days a week in English and Spanish:

• CDC Info: 1-800-232-4636, 1-888-232-6348 TTY, E-mail: cdcinfo@cdc.gov
• Centers for Disease Control and Prevention
• Centros para el Control y la Prevencion de Enfermedades