You`ve Decided to Have Sex: STIs, HIV and Contraception Options

You’ve Decided to Have Sex: STIs,
HIV and Contraception Options
Erica Thomas, MS
October 15, 2015
Agenda
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Warm Up
Review of Last Month’s Session
Contraception/Birth Control Options
STIs and HIV
Safe Sex
Sexual Identity
Resources
What is Your Comfort Level?
On a scale of 1 – 10, what is your comfort level when
talking about sex, sexuality, sexual behaviors, etc.?
Warm-Up Activity
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True or False
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True or False
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True or False
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True or False
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True or False
You can use Vaseline or baby oil on a
condom for lubrication
A woman can’t get pregnant when she
is on her period
You can’t get pregnant if you have sex
standing up
You can’t get pregnant the first time
you have vaginal sex
You can’t get pregnant if you don’t have
an orgasm
Warm-Up Activity
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True or False
True or False
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True or False
True or False
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True or False
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True or False
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Douching is a form of birth control
You can’t get pregnant if you have sex
in the water
You can't get STIs from oral sex
You'd know if you (or your partner)
had an STI
If you get a STI once, you can never
get it again
You can get a STI from a tattoo or
piercing
Are You Ready to Have Sex?
Review of Last Month’s Session
Questions to Ask Those You Support
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Are you ready (I mean really ready) to have sex?
How will you feel after you have sex?
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Are you doing this for the right reasons?
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Happy
Guilty
Slutty
Are you being pressured into sex?
How do you plan to protect yourself and your partner
from sexually transmitted infections or pregnancy?
How are you going to feel about your partner
afterwards?
It’s All About You
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The best way to prepare for the decision to have sex is
to be comfortable with communicating your needs
If you do not feel right about something, say so!
Anyone who challenges your choices about whether or
not to have sex is not giving you the respect that you
deserve
Pay attention to your feelings, and don’t let anyone make
you feel guilty for making decisions that are right for you
Always Remember…
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Only you can decide if you are ready to have sex
No one ever has the right to pressure you into having
sex.
If you’re not ready--even if you and that person have had
sex before--remember that you are the only person who
should have control over your body.
You might feel badly about hurting someone else’s
feelings, but you always have the right to say "no."
Yes or No?
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Go over the following questions with the people you
support:
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Is ok to have sex with a staff member? Why or why not?
Is it ok to have sex with a family member? Why or why not?
Is it ok to have sex with a child? Why or why not?
Is it ok to pay someone for sex? Why or why not?
Who can you have sex with? Why?
Contraception/Birth Control
Options
Test Your Knowledge
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Take out the “Contraception Table”
Fill out the chart with what you know about each
contraceptive method
Think About It…
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When helping those you support to choose a birth
control method, make sure they think about the following:
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Overall health
How often the person is having sex
The number of sex partners the person has
If the person wants to have children someday
How well each method works to prevent pregnancy
If the method protects against HIV and STIs
Possible side effects
The person’s comfort level with using the method
Continuous Abstinence
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The best form of birth control
No sex (vaginal, anal, oral, etc.) at any time
It is the only sure way to prevent pregnancy and protect
against sexually transmitted infections (STIs), including
HIV
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Natural Family Planning/Rhythm
Method
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This method is when you do not have sex or use a
barrier method on the days you are most fertile (most
likely to become pregnant)
To have success with this method, a woman needs to
learn about her menstrual cycle and learn to predict
which days she is fertile or "unsafe“
To learn about your cycle, keep a written record of:
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When you get your period
What it is like (heavy or light blood flow)
How you feel (sore breasts, cramps)
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Natural Family Planning/Rhythm
Method
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Checking your cervical mucus and recording your body
temperature each day
You can talk with your doctor or a natural family planning
instructor to learn how to record and understand this
information
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
My Days App for Cell Phone
Barrier Method
Put up a block, or barrier, to keep sperm from reaching the egg
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Contraceptive sponge
Diaphragm, cervical cap, and cervical shield
Female condom
Male condom
Contraceptive Sponge
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This barrier method is a soft, disk-shaped device with a
loop for taking it out
It is made out of polyurethane foam and contains the
spermicide nonoxynol-9
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Spermicide kills sperm.
Before having sex, wet the sponge and place it, loop side
down, inside the vagina to cover the cervix
The sponge is effective for more than one act of
intercourse for up to 24 hours
It needs to be left in for at least 6 hours after having sex to
prevent pregnancy
It must then be taken out within 30 hours after it is
inserted
Women who are sensitive to the spermicide nonoxynol-9
should not use the sponge
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Diaphragm
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A shallow latex cup
A woman needs a doctor to "fit" her for one
Before having sex, add spermicide (to block or kill
sperm) to the diaphragm
Then place it inside the vagina to cover the cervix
The diaphragm must be left in place for 6 to 8 hours
after having sex to prevent pregnancy
The diaphragm should be taken out within 24 hours
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Cervical Cap
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A thimble-shaped latex cup
A woman needs a doctor to "fit" her for one
Before having sex, add spermicide (to block or kill sperm)
to the diaphragm
Then place the cap inside the vagina to cover the cervix
The cervical cap must be left in place for 6 to 8 hours
after having sex to prevent pregnancy
The cervical cap should be taken out within 48 hours
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Female Condom
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This condom is worn by the woman inside her vagina
It keeps sperm from getting into her body
It is made of thin, flexible, manmade rubber and is
packaged with a lubricant
It can be inserted up to 8 hours before having sex
Use a new condom each time you have intercourse
Do not use it and a male condom at the same time
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Male Condom
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Male condoms are a thin sheath placed over an erect penis to keep
sperm from entering a woman's body
Condoms can be made of latex, polyurethane, or "natural/lambskin“
Natural condoms do not protect against STIs
Condoms work best when used with a vaginal spermicide
Use a new condom with each sex act
Condoms are either:
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Lubricated, which can make sexual intercourse more comfortable
Non-lubricated, which can also be used for oral sex
It is best to add lubrication to non-lubricated condoms if you use them for
vaginal or anal sex
Use a water-based lubricant, such as K-Y jelly
DO NOT use oil-based lubricants like massage oils, baby oil, lotions, or
petroleum jelly. They will weaken the condom, causing it to tear or break
Keep condoms in a cool, dry place. If you keep them in a hot place (like
a wallet or glove compartment), the latex breaks down. Then the
condom can tear or break.
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
How to Use a Male Condom
Hormonal Methods
Prevent pregnancy by interfering with ovulation, fertilization, and/or implantation of the fertilized egg
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Oral Contraceptives aka “The Pill”
The Patch
Shot/Injection
Vaginal Ring
The Pill
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The pill contains the hormones estrogen and progestin
It is taken daily to keep the ovaries from releasing an egg
The pill also causes changes in the lining of the uterus and
the cervical mucus to keep the sperm from joining the
egg
Many types of oral contraceptives are available
A woman can talk to her doctor about which is best
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
The Pill
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Your doctor may advise you not to take the pill if you:
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Are older than 35 and smoke
Have a history of blood clots
Have a history of breast, liver, or endometrial cancer
Antibiotics may reduce how well the pill works in some
women
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
The Patch
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Skin patch is worn on the lower abdomen, buttocks,
outer arm, or upper body
It releases the hormones progestin and estrogen into the
bloodstream to stop the ovaries from releasing eggs in
most women
It also thickens the cervical mucus, which keeps the
sperm from joining with the egg
You put on a new patch once a week for 3 weeks
You don't use a patch the fourth week in order to have a
period
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Depo Shot
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The birth control shot often is called by its brand name DepoProvera
With this method a woman get injections, or shots, of the
hormone progestin in the buttocks or arm every 3 months
The birth control shot stops the ovaries from releasing an egg
in most women
It also causes changes in the cervix that keep the sperm from
joining with the egg
The shot should not be used more than 2 years in a row
because it can cause a temporary loss of bone density. The loss
increases the longer this method is used. The bone does start
to grow after this method is stopped. But it may increase the
risk of fracture and osteoporosis if used for a long time
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Vaginal Ring
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This is a thin, flexible ring that releases the hormones
progestin and estrogen
It works by stopping the ovaries from releasing eggs
It also thickens the cervical mucus, which keeps the
sperm from joining the egg
It is commonly called NuvaRing, its brand name
You squeeze the ring between your thumb and index
finger and insert it into your vagina
You wear the ring for 3 weeks, take it out for the
week that you have your period, and then put in a new
ring
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Implantable Devices
Devices that are inserted into the vagina and left in place for a few years
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Implantable rod
Intrauterine devices or IUDs
Implantable Rod
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This is a matchstick-size, flexible rod that is put under the
skin of the upper arm
It is often called by its brand name, Implanon
The rod releases a progestin, which causes changes in the
lining of the uterus and the cervical mucus to keep the
sperm from joining an egg
Less often, it stops the ovaries from releasing eggs
It is effective for up to 3 years
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Intrauterine Device - IUD
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An IUD is a small device shaped like a "T" that goes in your
uterus. There are two types:
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Copper IUD — The copper IUD goes by the brand name
ParaGard. It releases a small amount of copper into the uterus, which
prevents the sperm from reaching and fertilizing the egg. If
fertilization does occur, the IUD keeps the fertilized egg from
implanting in the lining of the uterus. A doctor needs to put in
your copper IUD. It can stay in your uterus for 5 to 10 years.
Hormonal IUD — The hormonal IUD goes by the brand name
Mirena. It is sometimes called an intrauterine system, or IUS. It
releases progestin into the uterus, which keeps the ovaries from
releasing an egg and causes the cervical mucus to thicken so sperm
can't reach the egg. It also affects the ability of a fertilized egg to
successfully implant in the uterus. A doctor needs to put in a
hormonal IUD. It can stay in your uterus for up to 5 years.
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Permenant Birth Control
Methods
For people who are sure they never want to have a child or they do not want more children
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Sterilization implant (essure)
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Surgical sterilization
Sterilization Implant (Essure)
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Essure is the first non-surgical method of sterilizing women
A thin tube is used to thread a tiny spring-like device through
the vagina and uterus into each fallopian tube
The device works by causing scar tissue to form around the
coil
This blocks the fallopian tubes and stops the egg and sperm
from joining
It can take about 3 months for the scar tissue to grow, so it's
important to use another form of birth control during this
time
A woman will have to return to her doctor for a test to see if
scar tissue has fully blocked her tubes
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Surgical Sterilization
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For women, surgical sterilization closes the fallopian tubes by
being cut, tied, or sealed
This stops the eggs from going down to the uterus where they
can be fertilized
The surgery can be done a number of ways
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A woman having cesarean birth has the procedure done at the same
time, so as to avoid having additional surgery later
For men, having a vasectomy (vuh-SEK-tuh-mee) keeps sperm
from going to his penis, so his ejaculate never has any sperm in
it
Sperm stays in the system after surgery for about 3 months
During that time, use a backup form of birth control to
prevent pregnancy
A simple test can be done to check if all the sperm is gone; it
is called a semen analysis
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Emergency Contraception
Used if a woman's primary method of birth control fails. It
should not be used as a regular method of birth control
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Plan B One-Step
It is also called the "morning after pill”
Plan B One Step or “Morning After Pill”
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Emergency contraception keeps a woman from getting pregnant
when she has had unprotected vaginal intercourse
”Unprotected" can mean that no method of birth control was used
or can also mean that a birth control method was used but it was
used incorrectly, did not work (like a condom breaking), or a
woman may have forgotten to take her birth control pills
She also may have been abused or forced to have sex
Emergency contraception can be taken as a single pill treatment
It works by stopping the ovaries from releasing an egg or keeping
the sperm from joining with the egg
For the best results, take the pill as soon as possible after
unprotected sex - within 72 hours
A single-pill dose or two-pill dose of emergency contraception is
available over-the-counter (OTC) for women ages 17 and older
Note: If the woman is already pregnant, it will not abort the baby
https://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.html#conabs
Other Forms of Birth Control
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Breastfeeding as Birth Control
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Outercourse
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Spermicide
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Withdrawal (Pull Out)
Breastfeeding as Birth Control
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Sometimes called LAM (Lactational Amenorrhea
Method)
A natural way to prevent pregnancy after giving birth
Lasts for up to six months after giving birth
The baby does not drink anything besides breast milk
The act of breastfeeding naturally changes a woman's
hormones so that she does not become pregnant
While a woman is continuously breastfeeding, her
body does not make a hormone that is necessary for
ovulation — the release of an egg from an ovary
Pregnancy cannot happen if an egg is not released
http://www.plannedparenthood.org/health-info/birth-control/breastfeeding/
Outercourse
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Sex play that keeps sperm out of the vagina to prevent
pregnancy
For some people, outercourse is any sexual
activity without vaginal intercourse
For others, it's sexual activity with no penetration at all
— oral, anal, or vaginal
Outercourse prevents pregnancy by keeping sperm out of
the vagina
Pregnancy cannot happen if there is no sperm present
http://www.plannedparenthood.org/health-info/birth-control/outercourse/
Spermicide
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A substance that prevents pregnancy by stopping sperm from
moving
Spermicide is a birth control method that contains chemicals
that stop sperm from moving
Spermicides are available in different forms, including creams,
film, foams, gels, and suppositories
Spermicide can be used alone, or it can be used with other birth
control methods to make them more effective
It is always used with the diaphragm and cervical cap
Spermicides prevent pregnancy by keeping sperm from joining
with an egg
Spermicides are inserted deep into the vagina shortly before
intercourse
They block the cervix, so sperm cannot reach an egg keep
sperm from moving, so they cannot join with an egg
When used alone, spermicide is not very effective
http://www.plannedparenthood.org/health-info/birth-control/spermicide/
Withdrawal (“Pull Out”)
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Withdrawal or the "pull out method"
Something you can do during vaginal intercourse to
prevent pregnancy
A man who uses withdrawal will pull his penis out of the
vagina before ejaculation
Withdrawal may be the world's oldest way to practice
birth control
Of every 100 women whose partners use withdrawal, 4
will become pregnant each year if they always do it
correctly
Pregnancy is also possible if semen or pre-ejaculate is
spilled on the vulva
http://www.plannedparenthood.org/health-info/birth-control/withdrawal-pull-out-method/
Excuses, Excuses…Conversation Cards
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You have a stack of yellow “Conversation Cards”
Theses are excuses people have used so they don’t have
to use protection
Pick an excuse and share it with a partner
Your partner has to convince you to do the right thing
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What advice did your partner give?
This happened to someone you support – says it or it is
said to the person. What is your reaction?
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What will you say?
How can/will you help?
Choosing the Appropriate Birth Control
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How can you support your folks in choosing appropriate
birth control?
How do you know what birth control to suggest?
How will you ensure it is used and taken properly?
What resources will you provide as learning tools?
STIs and HIV
A Night to Remember
The Facts
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You cannot tell if a person has a STI/HIV by looking at
him/her
If you get a STI or HIV, you might not have symptoms
The more partners you have, the higher your risk of
getting a STI or HIV
If you use drugs or get drunk often, your chances of
getting a STI or HIV increase
Intravenous drug use increases your risk of getting a STD
and HIV
What are STIs?
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Sexually transmitted infections are passed from an
infected person through sexual activity that involves
the anus, vagina or penis
How are they spread?
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Body fluids including blood, semen, and vaginal secretions.
These fluids can be passed from partner to partner during
vaginal, anal, or oral sex.
Skin-to-skin contact. This can happen when rubbing genitals, or
when one person touches another’s genitals and then touches
his/her own.
STIs/HIV
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Common STIs
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Chlamydia
Gonorrhea
Genital warts
Genital herpes
HIV/AIDS
Signs and symptoms
Can they be cured
Protecting yourself and your partner
Getting tested
Who to talk to
Examples of STDs
Chancroid
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Chancroid (SHANG-kroid) is a type of bacteria that is
transmitted through sexual contact
A sexually transmitted disease (STI)
Common symptoms include sores on the genitals
Treatment is available – it can be cured
Easily spread
Condoms reduce your risk of infection
Ahhh What Beautiful Flowers…
Chlamydia
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Chlamydia (klah MIH dee ah) is an infection caused by a
kind of bacteria that is passed during sexual contact
A common sexually transmitted disease (STI)
Often has no symptoms
Easily treated – it can be cured
Easily spread with or without symptoms
Condoms offer good protection
Genital Warts
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A common sexually transmitted disease (STI)
Spread easily by skin-to-skin contact
Treatment available for genital warts symptoms
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There is no cure
There are ways to reduce your risk of getting genital
warts
Gonorrhea
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Gonorrhea (gon-o-RHEE-a) is an infection caused by a
kind of bacteria that is passed during sexual contact. It
can infect the penis, vagina, cervix, anus, urethra, or throat.
Sometimes it is called "the clap" or "the drip."
A common sexually transmitted disease (STI)
Often has no symptoms
Easily treated – it can be cured
Easily spread with or without symptoms
Condoms offer good protection
What Lovely Mountains…
Hepatitis B
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A kind of liver infection
Often has no symptoms
No cure, but the infection often goes away on its own
Many states require the hepatitis B vaccine for school
children
Can be spread during sex play
Easily spread with or without symptoms
Condoms offer good protection for people not
vaccinated
Herpes
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A very common sexually transmitted disease (STI)
Can affect the mouth (oral herpes) or genitals (genital
herpes)
Easily spread with or without symptoms
Treatment available for herpes symptoms
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There is no cure
There are ways to reduce your risk of getting herpes
Pubic Lice (Crabs)
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Often called "crabs"
Common symptoms include intense itching
Treatment is available and shampoos and soaps can get
rid of the pubic lice
Easily spread through close contact, including sex play
Beautiful Fall Colors…
HIV/AIDS
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HIV is the infection that causes AIDS
HIV has few or no symptoms for up to 10 years or more
before symptoms of AIDS develop
There is no cure for HIV/AIDS, but treatment is available
HIV can be spread during sex play
Latex and female condoms offer protection against HIV
Safe Sex
Lowering Your Risk of Getting a STI
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Only have one partner who has no sexually
transmitted infections, and no other partners than you
Get tested for STIs regularly
Sex that does not spread STIs
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Masturbation
Mutual masturbation
Online sex or "cybersex"
Phone sex
Sharing fantasies
http://www.plannedparenthood.org/health-info/stds-hiv-safer-sex/safer-sex/
Risk
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High risk spread of STIs
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Vaginal intercourse
Anal intercourse
Low risk spread of STIs
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Kissing fondling
Manual stimulation of one another
Body-to-body rubbing, or "dry humping," or "outercourse"
Oral sex (safest with a condom, Sheer Glyde dam or other
barrier)
Playing with sex toys
http://www.plannedparenthood.org/health-info/stds-hiv-safer-sex/safer-sex/
Vaginal or Anal Intercourse
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Intercourse without a condom poses a high risk for
passing:
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Chancroid
Chlamydia
Genital Warts
Gonorrhea
Hepatitis B
Herpes
Human Immunodeficiency Virus (HIV)
Human Papilloma Virus (HPV)
Pelvic Inflammatory Disease (PID)
Pubic Lice
Scabies
Syphilis
Trichomoniasis
http://www.plannedparenthood.org/health-info/stds-hiv-safer-sex/safer-sex/
Oral Sex
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Oral sex with out a condom poses a high risk for
passing:
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Gonorrhea
Hepatitis B
Herpes
Syphilis
HPV
http://www.plannedparenthood.org/health-info/stds-hiv-safer-sex/safer-sex/
Skin to Skin
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Skin to skin sexual contact without sexual
intercourse poses a risk of passing:




Herpes
HPV
Pubic lice
Scabies
http://www.plannedparenthood.org/health-info/stds-hiv-safer-sex/safer-sex/
Sexual Identity
What is Your Comfort Level?
On a scale of 1 – 10, what is your comfort level when
talking about sex, sexuality, sexual behaviors, etc.?
Resources
DC DOH STD Info

Sexually Transmitted Disease Services


SE STD Clinic Directions


http://doh.dc.gov/service/se-std-clinic-process
STD Basics


http://doh.dc.gov/service/se-std-clinic-directions
SE STD Clinic Process


http://doh.dc.gov/service/sexually-transmitted-disease-services
http://doh.dc.gov/page/std-basics
STD Data and Reports

http://doh.dc.gov/service/std-data-and-reports
DC DOH Resources (HIV)

HIV Services In the District of Columbia


Living with HIV


http://doh.dc.gov/service/condoms-and-condom-information
Getting Involved – HIV


http://doh.dc.gov/service/living-hiv
Condoms and Condom Information


http://doh.dc.gov/page/hiv-services-district-columbia
http://doh.dc.gov/service/getting-involved-hiv
HIV/AIDS Information DC DOH

http://doh.dc.gov/node/143002
STD Online Resources

STD Fact Sheets – CDC


STD Invaders (Interactive online game)


http://www.avert.org/std-pictures.htm
Video: How to use a condom


http://stdpictures.org/std-videos/
STD Pictures/Images


http://www.stopthinkbesafe.org/games/#
STD Pictures and STD Videos


http://www.cdc.gov/std/healthcomm/fact_sheets.htm
https://www.youtube.com/watch?v=gXlcEJhYVuc
Quizzes and Online Games

http://www.thinkcontraception.ie/Quizzes-Games-Events.98.1.aspx
Take Charge!

Guide for Women with Disabilities
https://www.accessliving.org/1410ga304

It's sponsored by Access Living, and was created by the
Empowered Fefes, a support and advocacy group for
young women with disabilities.
(http://empoweredfefesanddivas.blogspot.com/)

The guide is written at about an 8th grade level and
addresses reproductive health, making connections with
your doctor, rights and accommodations, violence and
abuse and mental health