Sex?— A Healthy Sexuality Resource - Government of Nova Scotia

SEX? —A HEalthy Sexuality ResourceThe information contained in this book is up-to-date as of the date of printing.This information is not a substitute for the advice of a health professional. Alwaysconsult a health professional for information on personal health matters.All of theused in this book are direct quotes from youth in Nova Scotia.“Sex?— A Healthy Sexuality Resource” was developed by:Shirley Campbell, (Chair), Health EducatorNova Scotia Department of Health and WellnessJanis Wood Catano, Health Education ConsultantHeather Christian, Coordinator Population Health,Nova Scotia Department of Health and WellnessFrank Covey, Acting Assistant Director, English Program Services,Nova Scotia Department of EducationHelen Farrell, Public Health Nurse, Pictou County Health Authority, ColchesterEast Hants Health Authority, and Cumberland Health AuthorityMaureen Flick, Public Health Nurse, Capital District Health AuthorityLarry Maxwell, Health Educator, Public Health Services, GuysboroughAntigonish Strait Health Authority and Cape Breton District Health AuthorityKaren McMullin, Public Health Nurse, South Shore Health, South West Health,and Annapolis Valley HealthWriter: Janis Wood Catano, Easy-to-Read WritingDesign/Illustration: Derek Sarty, GaynorSartyWhen referring to this resource, please cite it as follows:Healthy Sexuality Working Group. Sex?—A Healthy Sexuality Resource. [Halifax]:Nova Scotia Department of Health and Wellness, 2014.ISBN: 0-88871-851-9© Crown copyright, Province of Nova Scotia, 2004, Revised 2007, 2008, 2009, 2010,2011, 2012, 2013, 2014

?A Healthy SexualityResource

ContentsThis Book is for Everyone!Is this book for me? ............................................................... 5What is sexual orientation? ..................................................... 6•What is gender identity? ......................................................... 8You CAN talk to your parents ................................................. 10Sex, Relationships, and DecisionsWhat is “sex” anyway? ........................................................... 13Making choices about sexual activities .................................... 14Relationships: Happy together? ............................................... 16How healthy is our relationship? .............................................. 18How will I know when I’m ready? ............................................ 20This is confidential, right? ....................................................... 23No commitment: No worries? Think again! ............................. 24YOU decide! .......................................................................... 26•17 Good reasons not to have sex ........................................... 28Clear head, clear thinking....................................................... 30Sexual AssaultSexual assault IS a criminal offence ........................................ 32What IS consent? ................................................................... 36What IS NOT consent? ........................................................... 37•Sexual assault and date rape .................................................. 38Get help if you’ve been sexually assaulted ............................... 39

This Bookis for Everyone!

Is this book for ME?This book is about sexuality, relationshipsand healthy sexual choices.Sexuality is part of being human. It’s a normal and healthy partof everyone’s life, whether you’re straight, gay, lesbian or bisexual,or if you are male, female or transgender. Sexuality is about feelingsand desires. It’s about finding your own way to juggle feelings thatare confusing and scary and exciting—all at the same time. Sexualityincludes sexual feelings and the decisions you make about how you acton those feelings.Healthy sexual choices allow you to:Respect yourself and others•Protect yourself from emotional or physical harm like:- Pressures to have sex- Sexual assault- Sexually transmitted infections (STIs)- Unintended pregnanciesHealthy sexual choices are choicesyou can feel good about.So if you’re looking for information to help yousort out your feelings and make healthy choices,then this book is for you.This Book is for Everyone!Toward the back of this book you’ll find a section calledUseful Information. It has definitions of wordsyou might not know, drawings of the male and female bodies,places to find more information, and lots more.5

This Book is for Everyone!What issexualOrientation?Sexual orientation is your feelingsof sexual attraction toward others.Everyone has a sexual orientation. You could be:• Gay or lesbian—emotionally and sexuallyattracted to people of the same gender.• Straight—emotionally and sexually attracted to people of theopposite gender.• Bisexual—emotionally and sexually attracted to both genders.This book is about healthy relationships and healthy sexual choicesand is useful for everyone—lesbian, gay, bisexual, and straight.6

Having feelings that make you wonder if youare gay, lesbian, or bisexual can be confusingand scary.This is because there is still fear and prejudice against peoplewho are gay, lesbian, or bisexual. These prejudices can makeit difficult for you to accept these feelings and difficult for youto tell other people about them.If you think you are gay, lesbian or bisexual:•You are not alone! There are other youth and adults whoare gay, lesbian, or bisexual. There are people out thereyou can talk to, such as staff at the Youth Project(902) 429-5429.•It’s okay to be yourself. What you are feeling is naturaland normal. Lesbian, gay, and bisexual people havehealthy relationships and lead happy, fulfilling lives withfamily, friends, and community.•Only you will know if you are lesbian, gay, orbisexual. You are who you are and in time you willbecome more comfortable with your sexual orientation. Youdon’t have to come out and tell people until you are ready.•You don’t have to have sex to tell whether you arelesbian, gay, or bisexual. Being gay, lesbian or bisexualis about feelings, relationships, and attraction, not justabout sex.This Book is for Everyone!“It hurts to be judged, teased,hated, excluded.”7

8This Book is for Everyone!What isGenderIdentity?Gender identity is your personal idea ofyourself as male, female, both, neither orsomewhere in between.Most of the time, how you feel inside matches how you lookoutside. But not always. You may feel that you are in thewrong body—that is, you have the body of a girl but you feellike you’re a boy. Or you have the body of a boy, but you feel likeyou’re a girl. If you feel this way, you may be transgender.When you feel that you are in the wrong body, you may find thatpuberty is a particularly difficult time. This may be because yourbody is changing in ways you are not comfortable with.What’s the difference between “sex”and “gender”?Sex is about our biology and ourbodies—the physical things, likehormones and sex organs, that makeus male or female.Gender is about what a societyor culture says is masculine orfeminine—that is, the way men andwomen are expected to act and howwe fit—or don’t fit— into theseexpectations. Gender also includesyour thoughts and feelings aboutbeing male or female.“From a veryyoung age I knewI was not in theright body. Ididn’t know whatthat meant untilI learned aboutbeing transgender.Now I know who Iam and I feelbetter aboutmyself.”

If you think you are transgender:•You are not alone! There are other youth and adultswho are transgender. There are people out there youcan talk to. The Youth Project provides support andinformation for transgender youth. (902) 429-5429.•It’s okay to be yourself. What you are feeling isnatural and normal. Transgender people have healthyrelationships and lead happy, fulfilling lives.•It can be difficult living in a world that is dividedinto “boys” and “girls” when you’re not sure whereyou fit. You may feel more comfortable:- Wearing clothing that matches your gender identity- Asking people to call you “he” instead of “she” orvice versa- Asking people to call you by a different name- Using single-room bathrooms rather than oneslabeled “male” or “female”•You have options. As you get older, you have moreoptions. You can talk to a doctor about takinghormones or having surgery. Some transgenderpeople choose to do this and some don’t. It is yourdecision, but there are people you can talk to.This book is about healthy relationships and healthysexual choices and is useful for everyone—male, femaleand transgender.This Book is for Everyone!It’s okay to be gay, lesbian, bisexual, ortransgender, but it is wrong to treat people badlybecause of their sexual orientation or genderidentity.9

Bringing up these topicsisn’t easy.Pick a time when your parents are relaxedand you’re not likely to be interrupted.Some good openers are...“Today in class, we were talking about_______. Some of it wasreally interesting. Did you know that ...”“I’ve been trying to make up my mind about some things andwould like to hear what you think.”This Book is for Everyone!“I need to talk to you about something that’s important to me.”“I’m confused about ...”Sometimes parents are uncomfortable talking about sex. If theyget upset, tell them that you’re just asking questions and that youhope they can give you some good information. It may help togive them a little time to get used to the idea of talking about sexwith you.Remember that no matter howuncomfortable they feel, your parentswill be very happy that you care what they thinkand that you want to talk to them.11

What is“sex”anyway?Sexual activities are the wide rangeof ways in which people act ontheir sexual or romantic feelings.Sexual activities include everythingfrom kissing to intercourse. At the righttime and with the right person, sexualactivities can be wonderful for bothpartners.Sex comes with risks as well aspleasures. This book focuses onvaginal intercourse, anal intercourse,and oral sex because these are thesexual activities that put you at thehighest risk for STIs (sexuallytransmitted infections) and pregnancy.It’s important to have accurateinformation so you can make safe andhealthy choices about whether, when,and with whom you want to engage inthese activities.In this book,the words “sex” or“having sex” meanvaginal intercourse,anal intercourse,or oral sex.Sexual activities areways to physicallyexpress sexual orromantic feelings andto give and receivepleasure.Sexual activities include:• Kissing• Hugging• Masturbation• Making out• Touching, feeling• Oral sex• Vaginal intercourse• Anal intercourseSex, Relationships, and Decisions13

Making Choicesabout SexualSex, Relationships, and DecisionsActivitiesYou make choices every day. You choose to get up in themorning. You choose what to wear, who to spend time with, andwhat to do with your friends.The people around you, your culture, your religious beliefs, andwhere you are in your life all influence the choices you make. Butin the end, you’re the one who chooses what you’ll do.You are the one who is responsible for theresults of your choices.You make choices about sexual activities, too. And while lots ofthings influence your choices—family, friends, movies, videos—when you’re the one who makes the decisions, you’re the one wholives with the results.14

Sexual feelings are exciting, andit can be easy to let yourself getcarried away. Think ahead aboutthe choices you make.Decide what you feel happy andcomfortable doing. If the whole ideaof sexual activity makes you feeluncomfortable right now, that’s okay.If you feel happy and comfortableholding hands, then that’s enough.If you feel happy and comfortablekissing, then that’s enough.Think before you act.“Be yourself.Don’t doanything youdon’t wantto do.”Sex, Relationships, and DecisionsMost teenschoose NOTto have sex.In 2007, a studyfound that 6 outof 10 teens inNova Scotia havenot had sexualintercourse.The sexual activities you will feelcomfortable with will depend on yourbeliefs, values, and culture. Thinkingcarefully before acting on your sexualfeelings will help you to make choicesyou can be proud of.You matter. Thechoices you makematter, too. It’s yourresponsibility to decidewhat’s right for you atthis time in your life.15

Relationships:Happy Together?Sex, Relationships, and DecisionsRelationships can be healthy or unhealthy.Whether or not you feel happy and comfortable with anykind of sexual activity—from kissing to having sex—depends on whether you feel happy and comfortable withyour partner.In a HEALTHY RELATIONSHIP, you feelsafe, respected, and cared about.•You know, like, andrespect each other. Youaccept each other as you areand don’t try to change eachother.•You trust each other.You enjoy your time togetherand aren’t jealous when youeach spend time with otherpeople.•You’re there for oneanother. You support eachother through good times andbad.•You feel good whenyou’re together. You’rerelaxed and comfortable. Youcan laugh and have fun. You’renot worried about saying ordoing the wrong thing.You can talk about•anything. You can discussyour problems and concerns.You even feel comfortabletalking about sex. You listen toeach other. You’re not afraid tobe honest or to say what youreally think. You can disagreewith each other without gettingmad.16Healthy relationships are about a lot more than sex. They’rebased on self-respect and self-esteem. Healthy relationships taketime—time to get to know, like, and trust one another.

In an UNHEALTHY RELATIONSHIP you feelscared, confused, and insecure.•Your partner constantlycriticizes you and puts youdown. Nothing you do is goodenough. He or she makes youfeel stupid. There are thingsyou’re afraid to talk about withyour partner—for example, yourown feelings, sex or birth control.•Your partner is jealousand controlling. She or hedoesn’t want you to spend timewith your friends or family.•You never know whereyou stand. Your partner playsmind games—he or she will benice one minute and ignoreyou the next. She or he lies toyou. Your partner tells you onething and then does another.•You feel pressured to dothings you don’t want to do.You’re afraid that your partnerwill get angry or leave you if youdon’t do everything he or shewants you to do.•There is a lot of yelling inyour relationship. Yourpartner freaks out when youdon’t agree with what she orhe wants or says. Sometimesyou’re scared of what he or shemight do.Sex, Relationships, and Decisions“Don’t feel obligated to do somethingyou’re not sure you want to do. If youare not comfortable with your partner, you are notcomfortable with your relationship. If you are in arelationship where you are on edge all the time, sexwon’t change it.”17

How healthy isour relationship?Sex, Relationships, and DecisionsYESNOIs this a relationship between equal partners whereneither of us is “the boss”?Are we friends?Do we have fun together?Do we both have other friends and interests so wearen’t jealous about time we spend apart?Are we honest with each other?Do we trust one another?Are we comfortable talking about most things,including sex?Do we listen to each other and respect eachother’s ideas, values, and points of view?Does being in this relationship make me feel goodabout myself?If you answered “no” to any of these questions, yourrelationship could be unhealthy. You might find it helpful totalk with someone you trust about how you feel.18

In a healthyrelationship,you feel goodabout yourself.Sex, Relationships, and Decisions19

How will I knowwhen I’m ready?Sex, Relationships, and DecisionsWhen—or whether—you are ready to havesex is a decision only you can make.Deciding NOT to have sex is anormal and healthy choice.You need to think about whether having sex is a choice both youand your partner will feel happy and comfortable about.20Ask yourself:•Why do I want to have sex now? Is this what I want? Or am Idoing it to please someone else? Am I doing it because I thinkI’m the only one who hasn’t had sex yet?•What does sex mean to me? Does it mean the same thing tomy partner?•Can I talk to my partner about sex? Does my partner carewhat I think?Will having sex now make my life better or worse?•Would I feel embarrassed or ashamed if other people knew Iwas having sex? Or if they knew I was having sex with thisperson?•Do I know how to protect myself and my partner from STIs?From pregnancy?•If I have sex, how will I feel about it afterwards? How will Ifeel if we have sex and then break up?

You MAY be ready when:•You have information about your choices and you understandthe risks.•You’ve thought about it and you know what sex means to you,what you want, what you don’t want, and what’s important toyou. You’re comfortable with the idea of a sexual relationship.•You can talk to your partner about sex. You and your partnertrust each other, listen to each other, and respect each other’sbeliefs and choices.•You and your partner are ready, willing, and able to protectyourselves—from STIs and from pregnancy. This means usingcondoms and birth control.•“The truth is, not all teenagers have sex.”“If you’re having doubts, don’t have sex.”You’re sure this is the right thing for you to do. You feel goodabout yourself and about the choices you’re making.Sex, Relationships, and Decisions“To have safe sex you have to discuss itfirst with your partner. If you can’t talkabout it you shouldn’t be doing it.”21

Sex, Relationships, and DecisionsYou’re NOT READY for sex if :Your partner isn’t ready.You feel pressured.You’re not sure about it.• •You can’t talk about it with your partner.You don’t have a way to protect yourself from STIs andpregnancy.You need to get drunk or stoned to do it.Your partner needs to get drunk or stoned to do it.There is no “right age” for having sex.But one important thing to consider whenmaking your decision is that having vaginal sex at a youngage is risky for a girl. This is because the cells of the cervix arestill developing and are more easily damaged. This puts girls athigher risk for cervical cancer. To find out more see page 100.Sexual activity has physical risks—for example,you could become pregnant or get a sexuallytransmitted infection (STI).Sexual activity has emotional risks, too. You risk getting yourfeelings hurt or your heart broken. You could find that your sexlife is a hot topic for gossip at school or on the internet.Protecting yourself and your partner from both physical andemotional risks is your responsibility when you becomesexually active.22

This isConfidential, Right?If you’re thinking about having sex, it’sgood to get all your questions answeredfirst.Talk to someone you trust, feel comfortable with, and whoyou think will have good information. Talking to friends isgreat, but they don’t always know all the facts.You can talk to:A parent or family member•A nurse—a public health nurse or a nurse in a school, aclinic, or a Youth Health CentreA teacher or guidance counsellorAn adult you trust• A doctorWhen you’re looking for someone to talk to, keep in mindthat not everyone will keep what you say confidential.Doctors and nurses are required by law to keepanything you tell them confidential. This means thatas long as a doctor or nurse believes that you are matureenough to understand medical advice, then he or she cannottell anyone what you say or give anyone information aboutyour health. This includes your parents.There are a few exceptions to this rule to keep you—and others—safe. You’ll find details under “Limits toConfidentiality” on pages 106-107.So, when you see a doctor or nurse, if you want to be sureyour talk remains between the two of you just say, “This isconfidential, right?”Sex, Relationships, and Decisions23

No commitment:No worries?Think again!Sex, Relationships, and DecisionsSex and images of sexuality are everywhere—in movies, in music, in videos.People see someone who looks good, they have sex, and that’sthat. Everyone seems to be having a good time, and no oneseems to be getting hurt. After a while it starts to seem like it’sthe thing to do.Then you chat with someone on the Internet or meet someone at aparty and he or she says, “How about hooking up?”You might think, “Oral sex is safe. It’s not like we’re actuallyhaving sex. I’m flattered that someone wants me, and I’ll be morepopular if I do it. It’s no big deal.”Think again!It is a big deal!24

You can get hurt physically.Oral sex can give you herpes and other STIs.Being alone with a stranger can be dangerous,and having many sexual partnersincreases your risk of getting an STI.You can also get hurt emotionally.Oral sex—or any sexual activity—withsomeone who doesn’t know you or care about youcan leave you feeling sad, bad, hurt, and used.You matter.You are the sum of your heartand mind and spirit.Your sexuality is animportant part of that.Sex, Relationships, and DecisionsYou deserve to be liked, respectedand loved for more than yourwillingness to have sex.If you don’t believe that, talk to acounsellor or someone you trust now.Don’t wait until after youget hurt.25

YOU decide!Sex, Relationships, and DecisionsWhether you are male, female, or transgender, straight or gay, oldor young, no one has the right to pressure you into having sex orinto any kind of sexual activity. These decisions are yours to make.Don’t let anyone else make them for you.•You get to decide how far you’re willing to go. Agreeing to kissor touch does not mean that you have agreed to have sex. Youcan change your mind and say, “Stop” at any point, evenduring sex.•You can say “No” to sex for now. Later on, when you’reready, you can say “Yes.”•Even if you’ve had sex before, you can still say “No” the nexttime.Pressure to have sex can be hard to resist. You don’t have tofeel guilty about saying “No,” and you don’t have to explain why.Your self-respect is more important than doing what someone elsewants you to do.26When in doubt, don’t.Slow down, back up,think it over.

12345 Ways to say“Not now”“You would if you loved me.”“There are other ways to show our love.”“But I love you!”“If you loved me, you’d respect my rightto say no.”“Everybody does it.”“Not everybody. Not me. It’s reallyimportant to me to wait until I’m ready.”“I need you. I have to have you.”“If I can wait, so can you.”Sex, Relationships, and Decisions5“If you don’t, I’ll find someone who will!”“Okay. I’m just not ready for sex yet.”“It would be better to losesomeone who is constantlypressuring you to have sex thanto regret doing it.”27

10 Because you see people having sex in videos andmovies and think you should too1112Because you think that having sex will make the otherperson love you (It won’t. Love may lead to sex, butsex doesn’t lead to love.)Because you think having a baby will be fun andyou’ll be able to move away from homeSex, Relationships, and Decisions13Because you want to prove you’re straight14Because you’re afraid to say “No”15Because you think having a baby will make yourboyfriend or girlfriend stay with you16Because someone gives you money or gifts, or makespromises17Because you want to hurt or get back at someone29

Clear Head,Clear ThinkingSex, Relationships, and DecisionsHaving sex is something to thinkabout carefully before you do it.And it’s a lot better if you do yourthinking while you’re clear headedand sober.In 2002, 35% of grade 7 to 12 students in NovaScotia who had had sex during the previous year saidthat they had unplanned sexual intercourse while theywere drunk or high. Drugs and alcohol can lead tosexual choices you might regret later.It’s a good idea to stay out of situations whereyou might be forced to make an importantdecision when you’re not thinking clearly andaren’t prepared.30

“About twoweeks ago I was outwith my friends and we weredrinking and I drank a littletoo much and we met someguys and I liked one of themand I was pretty much loadedat the time and he tookadvantage of me and I onlyhave a faint recollection ofthis and I’m scared aboutmeeting up with him whenI’m sober. He might thinkI’m like that normally, and Iam not!!”Sex, Relationships, and DecisionsDon’t put yourself in aposition where you startoff kissing and end uphaving sex because you’renot thinking clearly.31

SEXUALASSAULTSexual AssaultIs a CriminalOffenceIt is sexual assault to force someoneinto any kind of sexual activitythat he or she doesn’t wantand doesn’t consent to.

SEXUALASSAULTRead this section carefully!Many people don’t know what sexual assaultis. You may be breaking the law withoutknowing it and that could change yourlife forever.Sexual AssaultAny kind of sexual activity that the otherperson doesn’t consent to is sexual assault.The legal definition of sexual assaultincludes (among other things):oral sex, vaginal sex, anal sex,touching, kissing, grabbing, masturbatinganother person, forcing another personto masturbate you, and masturbatingover another person.If you are sexuallyassaulted, it is never your fault.People who have been sexually assaulted often feelembarrassed or ashamed or that it is somehow their fault.It is not. No one “asks for it.” You are not to blamebecause of the way you look, the clothes you were wearing, orwhere you were. You are not to blame because you weredrinking or high.If you are sexually assaulted, the person who assaults you iscommitting a crime. Crime is the criminal’s fault, not yours.33

Sexual AssaultSEXUALASSAULTSexual assault is a crime.Threatening to sexually assaultsomeone is a crime.Anyone can be sexually assaulted—it makes no difference whetheryou are straight, gay, lesbian or bisexual.Males, females and transgender people can be victims of sexualassault, and males, females or transgender people can commitsexual assault.No one has the right to force another person into having sexor any kind of sexual activity—not a partner, not a date, not afriend, not a relative, not a stranger.Everyone has the right to change his or her mind at any point—even during sex.If you are afraid that you’ll be hurtif you say “No,” talk to someone NOW.SEXUALASSAULTEveryone has the right to say “No.”No one has the right to hurt you.34

SEXUALASSAULTAny kind ofSexual Assaultsexual activitywithoutconsentissexualassault.35

Sexual AssaultSEXUALASSAULTWhat ISconsent?Consent is voluntary agreement.This means that two people agree to docertain things of their own free will.Legal consent means saying “Yes” because youwant to say yes. A person who agrees to sexual activitybecause he or she is pressured, afraid, forced, lied to, orthreatened has not legally consented. This is because theyhave not voluntarily agreed to sexual activity.The legal age of sexual consent in Canada is 16.The exceptions to this are:•A 12-or 13-year-old can consent to sexual activity witha partner who is less than two years older than he or sheis. However, there can be no legal consent if the 12-or13-year-old is dependent on the partner, or if the partner isabusing or taking advantage of the 12-or 13-year-old.•A 14-or 15-year-old can consent to sexual activity witha partner who is less than five years older than he or sheis. However, there can be no legal consent if the 14-or15-year-old is dependent on the partner, or if the partner isabusing or taking advantage of the 14-or 15-year-old.•A 14-or 15-year-old can consent to sexual activity witha partner to whom he or she is married.36

SEXUALASSAULTWhat IS NOTconsent?Sexual AssaultThere are times when consent isNOT legally possible.•A child under age 12 can NEVER give legalconsent to sexual activity.•••There can be no legal consent when a person isdrunk, drugged, asleep, or passed out.There cannot be legal consent when one personis under the age of 18 and the other is in aposition of authority or trust—for example, ateacher, neighbour, parent, older sibling,babysitter, relative, or coach. This is becausethere can be no voluntary consent unless thetwo people are equal. If one person has powerover the other, consent is not legally possible.Unmarried people under age 18 cannot legallyconsent to anal sex.SEXUALASSAULTSexual activity without consentis a criminal offence.37

Sexual AssaultSEXUALASSAULTSexual Assaultand Date RapeNO always means NO. STOP always means STOP.If someone says NO and you do not stop,you are committing a crime.Most sexual assaults are NOT committed by strangers.When a teen is sexually assaulted, 85% of the time it is bysomeone he or she knows. It could be a friend, a date, a relative,or someone you’ve seen around. And most of the time, it doesn’thappen in a dark alley. It happens on a date—in a car or at a partyor in someone’s house. Maybe even in your own house.It’s your responsibility to accept and respect your partner’slimits. It is also your responsibility to ask your partner if what youare doing is okay. You cannot assume that because your partnerdoesn’t say anything, you can just go ahead. For example, evenif your partner says “okay” to kissing and touching, you still needto ask if it’s okay to go further. You can say, “Is this okay, too?”If your partner doesn’t say “yes,” then stop. Silence does notmean consent. Either partner can change their mind at anypoint, even during sex.Drugs and alcohol are often involved in sexual assault. Noone can consent to sex while drunk, drugged, or unconscious.Drugging someone or getting them drunk so you can have sex withher or him is sexual assault. It is a crime.38

SexuallyTransmittedInfections(STIs)?

What are STIs?STIs (sometimes called STDs—sexually transmitted diseases) areinfections that are spread through sexual contact. You can also getsome of these infections from needles used for tattoos or piercing,or for injecting drugs.It makes no difference whether you’re straight, gay, lesbian orbisexual, or if you’re male, female or transgender—anyone can getan STI.Some STIs can be cured if they are found and treated. Others—like herpes—can be treated and controlled, but are never reallycured. There is no cure for HIV/AIDS.STIs often have no symptoms. You can get anSTI and not know it. Years from now you couldstill pass it on to others.Abstinence is the best way to avoid getting an STI.Abstinence means choosing not to have any kind of sexual activitythat leads to an exchange of body fluids. This includes oral sex,vaginal sex, anal sex, and any activity that involves skin-to-skincontact in the genital area.Sexually Transmitted Infections (STIs)Did you know that teens are morelikely to get an STI than adults?In Canada, young people, ages 15-24, have the highestrate of STIs. The rate of STIs is also increasing faster inthis age group than in any other.41

For safer sex...••Always use a male or female condom or an oral damduring anal, vaginal or oral sex.Keep sex toys clean. When sharing sex toys always coverthem with a condom. Use a new condom every time youshare a sex toy.••Avoid oral sex if you, or your partner, have cuts or soresin the mouth or the genital area.Avoid “High Risk” sex activities.Safer sex practices make catching or giving an STI less likely, butthey do not completely eliminate the risk. Condoms and oral damsare NOT 100% effective. They may break or they may not cover allinfected areas.If you have sex, the best thing you can do to loweryour risk of getting—or giving—an STI is to use a maleor female condom or an oral dam the right way,every time.Sexually Transmitted Infections (STIs)High Risk!•Oral sex without a condom or oral dam•Vaginal intercourse without a condom•Anal intercourse without a condom•Sharing sex toys without a condom45

How can I tellif I have anSTI?Sexually Transmitted Infections (STIs)If you have ever had vaginal, anal, or oralsex, you are at risk for STIs.You might have an STI if you have any of these symptoms:•Discharge from your vagina that’s new or that looks or smellsdifferentBleeding between your periodsDischarge from your penisBurning, itching, or pain when peeing•Sores, warts, itching, pain, or swelling anywhere in your genitalareaPainless lumps anywhere in your genital area•Pain or bleeding when you have sex46

STIs often haveno symptoms at all.The only way to know for sure if you have an STI is togo to a doctor or a health clinic and have all STI tests(including HIV testing).Some STI tests are not done routinely, so be sure to ask to haveall STI tests. You don’t have to pay for these tests.After you’ve been tested, if either you or your partner have sexwith a new partner—even once—it puts you both at risk for STIs.You both need to be retested.To be as safe as possible, always use a condom or oraldam. You’ll find information about male and female condoms onpages 70–75. For information about oral dams, see page 51.Anyone can get an STI. It makes no differenceif you are male, female, transgender, straight,gay, lesbian, or bisexual—anyone can get an STI.Sexually Transmitted Infections (STIs)The only way to knowif you have an STI isfor you and yourpartner to be testedfor all STIs.47

When should I get anSTI test?Sexually Transmitted Infections (STIs)Once you become sexually active, youneed a yearly check-up and STI test evenif you haven’t had sex for a while.You also need an STI test:•If you have sex without using a condom or if the condombreaksIf you find out that your current or past partner has an STI•If you find out that your partner is having sex with someoneelseIf you or your partner have piercings or tattoosIf you or your partner have ever injected drugsIf you are having sex with a new partnerIf you or your partner have any STI symptoms•If you have been raped or think you might have beenIf you find out that you have an STI, the sooneryou get treated, the better.It is important that both you and your partner get treated.If only one partner is treated, you will just keep passing the STIback and forth. If either of you has other partners, you’ll pass iton to them, too.48

STIs can spread even when there are nosymptoms. You can have an STI and not know it.Having one STI increases your risk of catching another.There are places you can find out more about these andother STIs—for example, your school nurse, a publichealth nurse, your doctor, or a Sexual Health Centre.Don’t be afraid to ask. They expect questions and arethere to answer them.If you think you should be tested for HIV/AIDSbut are worried about someone finding out, youcan get anonymous testing. This means thatyou can get an HIV test without giving your name.In Nova Scotia, you can be tested anonymously in severalplaces. Just call and make an appointment using only yourfirst name. No one will ask for your full name. Foranonymous HIV testing, call:• Halifax: (902) 455-9696• Sydney: (902) 567-1123• Antigonish: 1-877-597-9255• Port Hawkesbury: 1-877-597-9255Sexually Transmitted Infections (STIs)If you have any reasonto think you might havebeen exposed to an STI,you need to get tested.Early treatment canmake a big difference.49

AvoidingSexually Transmitted Infections (STIs)STIsYou can get an STI from the body fluids of any person whohas a sexually transmitted infection. Body fluids includesemen, vaginal secretions, blood, and sometimes saliva.You can also get some STIs from skin-to-skin contact withan infected person, even when they have no sores or othersymptoms. Anyone can have an STI and not know it.Some sexual activities have higher risks for STIs. You’ll findinformation on “no risk”, “some risk”, and “high risk” sexualactivities on pages 44–45.Safer sex can reduce your risk of getting an STI.Use a condom every time you have vaginal or anal sex.Use a condom or oral dam every time you have oral sex.•Stick with lower-risk sexual activities where no body fluidsare exchanged.50

What’s an oral dam?An oral dam is a thin sheet oflatex. It covers the vagina or anus duringoral sex to block contact with sores, infectedareas, or body fluids.To make an oral dam, unroll a non-lubricatedcondom, cut off the tip and cut up one side.Like a condom, an oral dam can be used onlyonce.You can get STIs fromsharing sex toys.Sexually Transmitted Infections (STIs)Not having sex is one wayto avoid STIs. If you have sex,using a condom or oral damevery time is the mostimportant thing you can doto protect yourself from STIs.51

Sexually Transmitted Infections (STIs)Don’t know how to getcondoms and oral dams?In many communities there are placeswhere you can get inexpensive or freecondoms and oral dams.For example:• Sexual Health Centres• Youth Health Centres• Community AIDS prevention groupsYou can find out how to contact YouthHealth Centres and community AIDSgroups from any Public Health Servicesoffice. You’ll find contact informationfor Sexual Health Centres and forPublic Health Services offices on pages109–112.Be prepared!Carry condoms and oral damswith you. If you don’t needthem, a friend might.52

Protect Yourselfin Long-Term RelationshipsIt’s important to protect yourself and your partner from STIs evenwhen you are in a long-term relationship and having sex with oneperson.People sometimes think that they need condoms or oral dams onlywhen they are in a new relationship or are having sex with morethan one partner.The truth is that, over time, many people have steady relationshipswith more than one sexual partner. And any one of these partnerscould have an STI and not know it or not tell you about it.Sexually Transmitted Infections (STIs)Protect yourself,your partner, and your future.Use a condom or oral damevery time.Breaking up and making up can berisky times for STIs. If either of youhave sex with a new partner—even once—it puts youboth at risk for STIs. When getting back together, alwayshave STI and HIV tests.53

Good answers toexcuses fornot using condomsor oral damsSexually Transmitted Infections (STIs)ExcuseI don’t have one with me.AnswerToo bad. I’ll bring somenext time, but for now,no condom, no sex.Don’t you trust me?This isn’t about trust. It’sabout being safe. Either ofus could have an STI andnot know it. We shouldboth get tested.But you’re on the pill!The pill preventspregnancy. Condomsprevent STI. We’re goingto use both!54

ExcuseI swear I don’t haveAIDS!I don’t like the waythey feel.C’mon, just this once.AnswerNobody knows for surethat they don’t have anSTI. We could bothhave one.I feel better when I’mrelaxed, and I’m a lotmore relaxed when I’mnot worried aboutgetting an STI!Once is all it takes.It’s too risky withoutprotection.Sexually Transmitted Infections (STIs)It spoils the mood.Condoms don’t spoilthe mood, but gettingpregnant or catching anSTI sure would!I’ll pull out in time!That won’t protect usfrom STIs or pregnancy!No matter what your partner says,you can always just say:“I’m a person who uses condoms.”55

PreventingPregnancy

How PregnancyHappensMales produce sperm, more or less constantly.Every time a male ejaculates (or comes), the semen that’s releasedcontains about 500 million sperm.Every month, one of a female’s ovaries releasesan egg. The egg travels down one of her Fallopian tubes towardher uterus.An egg and a sperm have to join for pregnancyto occur. This is called fertilization. Usually, the egg and spermjoin in one of the Fallopian tubes. If the egg isn’t fertilized, itleaves the female’s body, and she has her period. If the egg isfertilized, it moves down the Fallopian tube to the uterus.Preventing PregnancyPregnancy occurs when the fertilized eggattaches itself to the wall of the uterus.“Always protect yourselfwhen having sex. Pregnanciescan happen anytime.”57

Preventing PregnancyHELP!My period is late.I think I might bepregnant!If you are sexually active and your period is 5–7 days late youmight be pregnant and should have a pregnancy test.You can buy a pregnancy test kit at any drugstore and test yoururine at home. A pregnancy test is easy—just follow the directionson the package. Or you can make an appointment with yourfamily doctor or Sexual Health Centre for a pregnancy test.If you are pregnant,you need to see a doctoras soon as possible.“I always use protection now!I wasn’t ready to be a mother.”58

Unplannedpregnancyaffects both partnersPreventing PregnancyIf your partner gets pregnant she has to make some difficultdecisions—Adoption? Raising the baby? Abortion?If your partner gets pregnant, you can support her by:•Listening to her and talking with her about how you feel•Offering to go with her to appointments—for example,doctor, counsellor, etc.•Standing by her whatever she decides to do•Getting more information. Check out the websites and thecontact information in the back of this book (pages 108–112).Support your partner’s decision andfind support for yourself.59

Preventing PregnancyBirthControl:Avoiding PregnancyIt can be surprisingly easy to get pregnant.For every 100 couples who have vaginal sex at least twice a monthwithout using birth control, 85 pregnancies will occur within a year.Not having sexual intercourse is the only sure way to avoidpregnancy. But birth control is very effective and can greatlyreduce your chances of getting pregnant.Condoms—male and female—are the onlymethods of birth control that can also helpprotect you from STIs.But condoms don’t give total protection. They only protect thepart of the genital area that they cover. Some STIs—like herpesor the human papilloma virus—can still be spread by skin-to-skincontact with the uncovered parts of the genital area.60Any method of birthcontrol will work onlyif you use it the rightway and use it everytime you have sex.

True or False?If a male and female have vaginal sex,a pregnancy can happen:•The first time they have sexTrueFalse•No matter what position they have sex inTrue•During the woman’s periodTrueFalseFalse•Even if he pulls out of her vagina beforehe ejaculatesPreventing PregnancyTrueFalse•Even if he doesn’t put his penis inside, butejaculates near her vaginaTrueFalseALL TRUE! The only way to avoid pregnancy is to not havesex or to use a reliable method of birth control every time youhave sex.61

Preventing PregnancyWhat kind ofbirth controlwill work for me?The important thing is to choose a birth control method that youwill be comfortable using every time you have sex. The questionsin this section can help you make a choice. Think carefully and behonest with yourself when you answer.Do my partner and Iagree about birthcontrol?In Canada, thebirth controlmethods youngpeople choosemost often arethe condomand the birthcontrol pill.Any method of birth control works best whenboth of you agree about what you’ll do.Being able to talk about these issues is partof a healthy relationship.Is this method safefor me?Do you have any health problems that wouldmake a particular method risky for you? Thereare health problems that make it risky forsome women to use the birth control pill.Some people are allergic to spermicides or tothe latex in condoms.62

How effective is it?Some methods of birth control are more effective than others.For example, spermicide is between 71% and 82% effective inpreventing pregnancy. The pill is between 92% and 99.9%effective. Any method is effective only if you use it the right wayand use it every time you have sex.Can I afford it?Some methods cost more than others. Depo-Provera shots costabout $40-45 every 12 weeks. Male condoms cost between $8and $10 for a box of 12.Preventing PregnancyCan I get it where I live?Some methods are available everywhere. You can get condomsand spermicides without a prescription in any drugstore.Is this method easy andconvenient for me to use?A male condom needs to be put on right before sex. A femalecondom or sponge can be inserted hours ahead of time. Whichwould be easier and more convenient for you?Will I feel embarrassed using thismethod? Will my partner beembarrassed?Some methods of birth control are used while you’re having sex.If this would embarrass you, choose birth control that is always inplace or can be inserted in advance.63

Preventing PregnancyDoes it fit with my culture andreligious beliefs?A method that goes against your cultural or religiousbeliefs will probably feel “wrong” to you, and you’ll beless likely to feel comfortable using it.“I just want people to be aware ofwhat is out there and what is going on andnot feel afraid or ashamed to talk or ashamed tobuy the condom or something. Because I thinksomebody should feel proud…if they’re going tobe sexually active, to take care of themselves anddo it the right way.”There are lots of kinds of birth control. It’s not alwayseasy to figure out what will work best for you. It can bea big help to talk it over with someone who knows thepros and cons of all the methods, like a nurse, doctor,or counsellor.64

Even if you use anothermethod of birthcontrol, you will stillneed to use a male orfemale condom toprotect yourself andyour partner from STIs.Preventing Pregnancy65

Preventing PregnancyEmergencyContraceptionIf you have had sex without using birth control you can still preventpregnancy by taking ECP—Emergency Contraceptive Pills orMorning After Pills.Even if you use birth control, accidents can happen—for example,condoms can break, or you or your partner might miss several birthcontrol pills.ECP prevent pregnancy. If you are already pregnant, they willnot cause a miscarriage or hurt the baby.ECP work best if you take them within 3 days (72 hours)after having intercourse without birth control. ECP might still workas long as 5—7 days after intercourse, but the sooner you takethem, the more effective they are.You can get ECP from:Drugstores, with or without a prescription.Go to the pharmacy section and ask to speak privately with apharmacist. Say to the pharmacist, “I need ECP.” Thepharmacist will ask you a few questions.The pharmacist willalso give you some important information to help you use ECPthe right way.At a drugstore, ECP costs between $20 and $40.Hospital emergency roomsHalifax Sexual Health CentreThe cost of ECP is $5. Call ahead to find out when they’re open.Some Youth Health Centres66

You do not need your parents’ permission to get ECP.For more information about ECP call toll-free:1-888-270-7444ECP will not protect youfrom STIs. You should still go to a doctor or clinicfor an STI test even if you have taken ECP.Preventing Pregnancy“Pulling out”will notprevent either pregnancy or STIs.•You•You•You“Don’t worry,I’ll pull out in time.”Don’t believe this line!can get an STI from contact with a penis beforeejaculation.can get pregnant from the fluid released from thepenis before ejaculation.can get pregnant even if semen is near the vaginaand not in it.So if he says, “I’ll pull out,” tell himto pull on a condom or no deal!67

Preventing PregnancyBirthControlMethods68Male CondomFemale CondomBirth Control Pill (The Pill)Depo-Provera (The Needle)SpermicideSpongeDiaphragm and Cervical CAPThe PatchThe Ring

This is a very brief introduction tosome common methods of birth control.How well any method of birth control works depends onhow carefully you use it. In this section you’ll find two rates toshow how well each birth control method prevents pregnancy.Preventing Pregnancy• The first shows how well a method works when you follow thedirections exactly and use it every time you have sex.• The second shows how effective the method is likely to be ifyou don’t follow the directions carefully or don’t use it everytime. In this case, birth control will not work as well and youwill be more likely to get an STI or an unplanned pregnancy.You can get more information about any method of birth controlfrom a Youth Health Centre, a doctor, a Sexual Health Centre, yourschool nurse, or a public health nurse.You do not need your parents’ permission, and you do not need tobe a certain age to visit a doctor or a clinic or to use birthcontrol.Whatever method of birth control you choose,READ THE DIRECTIONS CAREFULLY!Every brand is a little bit different.69

Preventing PregnancyMALE CONDOMA condom is a thin cover worn over the penis during sex.Condoms prevent pregnancy by blocking sperm fromentering the vagina.ProsCondoms made from latex or polyurethane are the onlyform of birth control that can protect you from STIs.Condoms are fairly cheap and easy to get. You can buycondoms at any drugstore or grocery store. Condoms cost about$8–10 for a box of 12. For inexpensive or free condoms and oraldams, see page 52.ConsSome people are allergic to latex condoms or to thespermicide in some condoms. If you or your partner notice anyburning, itching, or swelling after using a condom, you may beallergic. Try using condoms made of polyurethane or condoms withno spermicide.Condoms have a “best before” date.Check the expiration date on the package. If thedate has expired, the condom is more likely to break or tear.70Condoms don’t give total protection. They onlyprotect the part of the genital area that they cover.Some STIs—like herpes or the human papilloma virus—canstill be spread by skin-to-skin contact with the uncoveredparts of the genital area, even if you can’t see any sores orwarts.

Do condoms work?Used the right wayand used every time:97% effectiveNot used the right way ornot used every time:86% effectivePreventing Pregnancy• Condoms come in different sizes andthere are many brands. You may need to try outseveral different kinds before you find one that fits welland feels good. It’s a good idea to practise puttingcondoms on before you need to use one for real!• Lubricants can help make condoms feel morenatural and comfortable. Only water-basedlubricants—like Astroglide—are safe to use with latexcondoms. Oil-based lubricants—like petroleum jelly—willdamage the condom very quickly.• Condoms need to be stored in a cool, dry place.Your wallet is too warm. Your glove compartment isn’ta good storage place either—it’s sometimes too hot andother times too cold! Store condoms at roomtemperature. Carry them in a purse, outside pocket,or backpack.If possible, use condoms that don’tcontain nonoxynol-9. N-9 is a spermicide that canirritate the vagina or anus, which can increase the risk ofgetting an STI.71

Preventing PregnancyMALE CONDOMHow to put a condom onPut the condom on your penis as soon as it gets hardand BEFORE it touches your partner’s body.1. Check the expiry date. Open the package carefully.Handle the condom gently so you don’t puncture or tear it.2. Leave about 1 cm (1/2 inch) of space at the tip of thecondom to hold the semen and help keep the condom frombreaking. You can put a drop of water-based lubricant in the tipto make it more comfortable.3. Place the condom on the head of the penis. Squeeze the tip ofthe condom to make sure that no air is trapped and unroll thecondom all the way down the shaft.How to take a condom off721. While your penis is still hard, hold the condom at thebase and slowly pull your penis out of your partner’s body.2. Move completely away from your partner before taking thecondom off your penis.3. Hold the base of your penis and slide the condom off. Becareful to keep all of the semen inside.4. Wrap the used condom in a tissue and put it into the garbage.Do not flush it down the toilet.5. Wash your penis with soap and water. If you can’t wash, don’thave physical contact with your partner after removing thecondom.Use a new condom each timeyou have intercourse.

Guys—Not ready tobe a father?Of all the methods ofpreventing pregnancy,using a condom is theonly one that YOUcontrol.Preventing PregnancyMale and female condomscan’t be used at the sametime because they sticktogether. If you are using amale condom, you don’t needa female condom. If you areusing a female condom, youdon’t need a male condom.73

Preventing PregnancyFEMALE CONDOMThe female condom is a thin polyurethane pouchwith a flexible ring at each end. You put the closedend of the condom into your vagina and the insidering holds it in place. The ring at the open end ofthe condom rests on the vulva outside of yourvagina.The female condom stops sperm from entering yourvagina.ProsFemale condoms are easy to get. You can buy femalecondoms at any drugstore. You don’t need a prescription. A boxof three costs about $10–15.Female condoms are a good choice if you are allergic to thelatex in male condoms.You can insert a female condom up to 8 hours before you havesex.Female condoms reduce your risk of getting STIs aswell as male condoms do, and they are less likely to break.ConsFemale condoms can be tricky to put in. Read the packagedirections and practice until you’re sure you know how to put it in.Many women find it helpful to get advice and counseling on howto use the female condom. You can do this through a Youth HealthCentre or a Sexual Health Centre.74

Do female condoms work?Used the right wayand used every time:95% effectiveNot used the right way ornot used every time:79% effectivePreventing Pregnancy•You might need help to guide your partner’spenis into the condom to be sure it doesn’tslip around the side.•You might need extra lubricant inside thecondom or on the penis to make using thefemale condom more comfortable for bothpartners.•Female condoms are not reusable. Use anew one each time you have intercourse. Afteryou take one out, throw it away.•Male and female condoms can’t be used atthe same time because they stick together. Ifyou are using a male condom, you don’t need afemale condom. If you are using a femalecondom, you don’t need a male condom.75

Preventing PregnancyBIRTH CONTROL PILL(The Pill)The birth control pill (also known as an oralcontraceptive) is a combination of the hormonesestrogen and progestin. It prevents pregnancy bystopping your ovaries from releasing eggs.ProsThe pill gives you very effective, non-stop protection frompregnancy.Taking the pill can make your periods shorter, lighter, lesscrampy, and more regular.ConsThe pill will not protect you or your partner from STIs.You still need a male or female condom even though you are onthe pill.Birth control pills work only if you follow the directionsexactly. The pill’s effectiveness depends on keeping a steadysupply of hormones in your body. Anything that upsets thehormone supply can make the pill less effective. This includesmissing a pill or taking some kinds of medications.Some women have side effects, like headaches,moodiness, nausea, sore breasts, or irregular bleeding. Theseside effects are usually mild and improve with time.76

Do birth control pills work?Used the right way:99.9% effectiveNot used the right way:92%-94% effectiveWhere can I get it and how much does it cost?With a prescription, you can get birth control pills from anydrugstore. You can get a prescription from your doctor orsome Youth Health Centres. The pill costs around $18–25for a month’s supply. It’s a bit cheaper if you buy a 3-monthsupply. You can also get birth control pills from the HalifaxSexual Health Centre for about $14–20 for a month’ssupply.Preventing PregnancyHelp! I forgot my pill!Read the directions that come with your pills.That will tell you what to do to get back on track. Youcould also call a pharmacist or your doctor forinformation.In the meantime: Don’t have sex OR be sure to usea backup method of birth control anytime you havevaginal sex for at least 7 days after you miss a pill.If you have had unprotected sex during a time whenyou have forgotten to take your pills, you may be atrisk of getting pregnant. You need to consideremergency contraception. See page 66 for more infoon ECP.77

Preventing PregnancyDEPO-PROVERA(The Needle)Depo-Provera is a hormone injection given onceevery 12 weeks. You must get another needle every12 weeks to stay protected.Depo-Provera stops the ovaries from releasing anegg each month.ProsOne injection will give you continuous, extremely effectivebirth control for 12 weeks.You don’t have to think about birth control between needles.ConsDepo-Provera does not protect you from STIs. You’llstill need to use a male or female condom.You might have side effects like depression or weight gainor loss.Irregular bleeding is common in the first few months of usingDepo-Provera. After 1 year of use, about half of all womenwill stop having periods. Your periods will gradually startagain when you stop using Depo-Provera.Depo-Provera can affect the health of your bones and makethem weak. Talk to your doctor to find out more about this.78

Does Depo-Provera work?Used the right way:99.7% effectiveNot used the right way:97% effectivePreventing PregnancyWhere can I get it and how much does it cost?You can get Depo-Provera at your doctor’s office or health clinic.Each injection costs about $40–45. The Halifax Sexual HealthCentre gives Depo shots for $30.HELP! I missed my needle!If you are late for your injection, your protectionagainst pregnancy is decreased. Use a backup method ofbirth control until you get your shot.If you are more than 2 weeks late for your injection, and aresexually active, you may have to have a pregnancy test beforeyour next needle.If you’ve had unprotected sex during a time when you haveforgotten to get your needle, you may be at risk of gettingpregnant. You need to consider emergency contraception. Seepage 66 for more information on ECP.79

Preventing PregnancySPERMICIDEA spermicide is a chemical that kills sperm.Spermicides come in many forms—foams, creams,films, suppositories, gels, and tablets. Mostspermicides are put into the vagina right before sex.ProsSpermicides are fairly cheap and easy to get. You can getthem without a prescription at any drugstore or supermarket.They cost between $11 and $20 per package.ConsSpermicides must be left in place for at least 6 to 8 hoursafter you have sex. This means that you should not douche orhave a bath for at least 6 to 8 hours after you have sex. (Youcan wash the outside of your pubic area.)If you have sex more than once in a single night, you need toput in more spermicide before each act of intercourse.Spermicides will not protect you from STIs. Your partnerwill still need to use a condom.Some people are allergic to spermicides. If you or yourpartner notice any itching, swelling, or burning after using aspermicide, go to a doctor or health clinic to get advice onfinding another birth control method or another brand ofspermicide.80

Do spermicides work?Used the right wayand used every time:82% effectiveNot used the right way ornot used every time:71% effectivePreventing PregnancyThere are many kinds ofspermicide on the market.Every brand is a little different.Read the directions carefully!If possible, use spermicides thatdon’t contain nonoxynol-9.N-9 can irritate the vagina,which can increase the riskof getting an STI.81

Preventing PregnancySPONGEThe sponge is made of soft polyurethane foam.It is about 5 cm (2 inches) across and containsspermicide. You insert the sponge into the vaginabefore sex. The sponge blocks the sperm, and thespermicide kills them.ProsYou can insert the sponge in advance. The sponge willwork for 12 hours and must be left in place for 6 hours afterintercourse. This means that you can insert the sponge up to6 hours before you have sex.You can have sex more than once after inserting asponge, but the sponge must stay in for 6 hours after the lasttime you have sex.ConsSome people are allergic to the spermicide in thesponge. If you or your partner notice any burning, itching,or swelling after using the sponge, try another method ofbirth control.A sponge can become dislodged during sex. Read thepackage directions carefully so you’ll know how to put itin correctly and how to check to be sure it stays in place.A sponge will not protect you from STIs. Your partnershould still use a condom.82

Does the sponge work?Used the right wayand used every time:89%-91% effectiveNot used the right way ornot used every time:84%-87%effectivePreventing PregnancyWhere can I get it andhow much does it cost?You can get the sponge at any drugstore.You don’t need a prescription.The cost is about $9 forthree or four sponges.Sponges are not reusable!After you take one out,throw it away.83

Preventing PregnancyDIAPHRAGM & CERVICAL CAPThe diaphragm and the cervical cap are soft latexbarriers that block sperm from entering the cervix.Both are always used with spermicidal jelly. Youinsert the diaphragm or the cervical cap into thevagina before sex.ProsYou can insert a diaphragm or cervical cap as long as 6hours before you have sex. Both must be left in place for 6to 8 hours after having sex.Both the diaphragm and the cervical cap are affordable andreusable.ConsA diaphragm or cervical cap will not protect you fromSTIs. Your partner should still use a condom.Some people are allergic to spermicides. See a doctor ifyou or your partner notice any itching, swelling, or burningafter using a diaphragm or cervical cap.84

Do diaphragms work?Used the right wayand used every time:94% effectiveNot used the right way ornot used every time:80% effectiveDo cervical caps work?Preventing PregnancyUsed the right wayand used every time:91% effectiveNot used the right way ornot used every time:80% effectiveWhere can I get it and how much does it cost?You’ll need to go to a doctor or clinic where you’ll be fitted fora diaphragm or cervical cap and given a prescription. With theprescription, you can get a diaphragm or a cervical cap at anydrugstore. The diaphragm and cervical cap each cost between$55 and $60. You will also need to buy spermicidal jelly to usewith the diaphragm or cervical cap.You’ll need to practise a few times to learn how toproperly insert a diaphragm or a cervical cap. Youwon’t feel either one of them when it is insertedcorrectly.85

Preventing PregnancyTHE PATCHThe patch is about the size of a matchbook andsticks to your skin. You can attach it to your abdomen,buttocks, upper arm, or anywhere on the front or back of yourtorso, except for your breasts. It will not wash off or come offwhile swimming.You put on a new patch each week for three weeksand then use no patch for the fourth week. Each patchis left in place for one week.The patch prevents pregnancy in the same way thepill does. It contains estrogen and progestin that are absorbedthrough the skin. This stops the ovaries from releasing an egg.ProsThe patch provides excellent, continuous protection fromunintended pregnancy.You don’t have to remember to take a pill every day. Youonly need to think about birth control once a week.ConsThe patch does not protect you from STIs. You will stillneed to use a male or female condom.You may have side effects, including headaches, menstrualcramps, nausea, or breast tenderness.86

Does the patch work?Used the right wayand used every time:99.3% effectiveNot used the right way ornot used every time:92% effectivePreventing PregnancyWhere can I get it andhow much does it cost?With a prescription, you can getthe patch at any drugstore. Youcan get a prescription from yourdoctor or some Youth HealthCentres. The Patch costs about$24-28 a month. You can get thepatch at the Halifax Sexual HealthCentre for about $14 for a1–month’s supply.87

Preventing PregnancyTHE RINGThe ring is a soft, flexible plastic ring that you insertinto your vagina. Once you insert it, the walls of your vagina holdit in place and you don’t feel it, even during sex.You insert the ring once a month and leave it in placefor 3 weeks. At the end of three weeks, you remove the ring.Your period usually starts within a few days. Exactly 7 days after youremove the ring, you insert a new one, even if you are still having yourperiod.The ring prevents pregnancy in the same way as thebirth control pill and the patch. It releases the hormonesestrogen and progestin. These are absorbed into your body and stopyour ovaries from releasing an egg.ProsThe ring provides excellent, non-stop protection frompregnancy.You only have to insert the ring once a month. You don’t haveto remember to take a pill every day or change a patch everyweek.The hormones in the ring may make your periods more regularand less crampy.ConsThe ring does not protect you from STIs. You will still needto use a male or female condom.88You may have side effects like headaches, nausea, breasttenderness, or vaginal discharge, discomfort or irritation.

Does the ring work?Used the right way:98%-99% effectiveNot used the right way:92% effectivePreventing PregnancyWhere can I get it andhow much does it cost?With a prescription, you can get the ringat any drugstore. You can get a prescriptionfrom your doctor or some Youth HealthCentres. The Ring costs about $23-26 for a 1-month supply. It’s a bit cheaperif you buy a 3-month supply.You will need to read thedirections carefully or talkto a doctor or nurse about:When to start using the ringHow to insert and remove it•What to do if you forget to takeit out on time•What to do if you forget toinsert a new one on time•What to do if it comes outaccidentally89

1MoreThing

SexualityIs More ThanJust SexOne More ThingSexuality is part of everyone’s personality and everyone’s life. It isa basic need and a part of being human. Sexuality includeseverything in your daily life that makes you a sexual person—your gender, body, mind, spirit, and emotions.Sexuality is about more than what you do. It’s about who you areand how you feel about yourself and your relationships with otherpeople.Sexuality is about what feels right to you. It’s not about livingup to someone else’s ideal or image. Your differences make youunique. They make you special.Your sexuality develops over time and will change as you grow andhave new experiences. So what feels right to you will change, too.You matter. Take care of yourself,think about what is right for you, and enjoyyour developing sexuality.“People need to know that it’s okayto talk about these things.”“Sex is a lot more complicated thansome people might think.”91

UsefulInformation

Words to KnowAbstinence: Choosing not to have any kind of sexual activity that leads toan exchange of body fluids. This includes oral sex, vaginal sex, anal sex,and any activity that involves skin-to-skin contact in the genital area.AIDS: AIDS (Acquired Immune Deficiency Syndrome) is caused by a viruscalled HIV. AIDS occurs when HIV seriously damages the body’s immunesystem. This allows diseases and infections—such as cancers andpneumonia—to develop. There are medications to help treat HIV and AIDS,but there is no cure.Useful InformationAnal sex: Stimulating the anus for sexual pleasure. This can be done withhands, mouth, penis or sex toys. Anal intercourse is when a penis or sextoy is inserted into the anus.Bisexual: A person who is emotionally and sexually attracted to both menand women. Bisexuals are not always equally attracted to each gender.Cervical mucus: Clear, sticky fluid that is produced naturally by thecervix.Circumcision: The surgical removal of the foreskin—the loose skincovering the tip of the penis.Criminal offence: An offence under the Criminal Code of Canada.Come: A slang word for both male and female orgasm.Coming out (as in “coming out of the closet”): The process ofacknowledging and being open about being gay, lesbian, bisexual ortransgender. For example, “I just came out to my parents.” The first personyou come out to is yourself. Coming out to others can be a life-longprocess.93

Useful InformationCum: A slang word that is used to describe the semen released whenmales ejaculate.Dependent: There are many ways that someone can be dependent onanother person. One example of a dependent is a person who relies onanother person for aid or support, such as for food, shelter, money.Discharge: Any fluid, mucus or other substance that is released from yourbody. A discharge from the vagina or penis can be a symptom of asexually transmitted infection.Ejaculation: What happens when a male has an orgasm. Semen, themilky liquid that contains the sperm, is released from the penis.Erection: What happens when a male is sexually aroused. An erectionoccurs when blood rushes into the penis and it becomes erect—larger andharder.Gay: A male who is emotionally and sexually attracted topeople of the same sex. “Gay” can also refer to or include lesbians.Gender: Your thoughts and feelings about being male or female. Gendercan also be about the kinds of behaviour a society or culture defines asmasculine or feminine.Gender identity: Your inner feeling that you are male, female, both,neither or somewhere in between.HIV: HIV (Human Immunodeficiency Virus) attacks and weakens theimmune system of the human body. This makes it hard for the body tofight off diseases and infections. HIV can lead to AIDS (Acquired ImmuneDeficiency Syndrome).94Hymen: A thin membrane that covers the opening of the vagina. Formost girls, this is broken or stretched during normal physical activity, longbefore they have sexual intercourse. However, if it isn’t already stretchedor broken, it may be torn during first intercourse and may bleed a little.

Hysterectomy: Surgical removal of the uterus.Lesbian: A female who is emotionally and sexually attracted to otherwomen.Lubricant: A thick liquid or gel that is used inside or outside male andfemale condoms and oral dams to make sex more comfortable andenjoyable for both partners. It’s important to use only water-basedlubricants—like Astroglide or K-Y Jelly—because oil-based lubricants canvery quickly break down the latex used in condoms.Useful InformationMasturbation: Touching, rubbing or squeezing your genital area, penis,clitoris, vaginal opening, vulva, breast, or anus for sexual pleasure.Masturbation can feel good whether or not it leads to orgasm. It can be asafe and healthy way to learn about your body and your sexuality.Mutual masturbation: Partners masturbate each other—touch eachother for sexual pleasure—by touching, rubbing or squeezing each other’sgenital area, penis, clitoris or other parts of the body. Mutual masturbationcan also mean one or both partners masturbating while their partnerwatches.Oral sex: A form of sexual activity where the mouth and tongue stimulatethe genital or anal area.Orgasm: An intense sensation that happens at the peak of sexual arousalfor both males and females. This is sometimes called “climax.” Males andfemales don’t usually reach orgasm together during intercourse. Malesusually ejaculate during orgasm. Some females also release a fluid duringorgasm.Pap Test: A test to check for changes in the cells of a woman’s cervixthat could be an early sign of cancer. Within 3 years of starting to have sex,or when a girl reaches the age of 21, she needs to start having regular PapTests to check for changes in cervical cells before they become cancerous.95

Useful InformationPelvic Inflammatory Disease (PID): An infection of a woman’s inner sexualand reproductive organs. PID can be very painful and lead to infertility.Respect: Valuing people for who they are, and treating them fairly and equally.Self-esteem: A feeling of pride, confidence, and satisfaction in yourself—thefeeling that you are worthy of respect.Self-respect: Valuing yourself as a person and as an individual and feelingproud of who you are and what you do.Semen: A milky liquid containing sperm that is released through the urethraduring ejaculation.Sex toys: Things, like vibrators and dildos, that people might buy in a storeand use during sex—with themselves or others.Sexual orientation: Your feelings of sexual attraction toward others. Yoursexual orientation could be gay or lesbian (attraction to the same gender);straight (attraction to the opposite gender); or bisexual (attraction to bothgenders).Sterility: Being unable to reproduce. This is also called infertility. For femalesthis means being unable to get pregnant. For males this means that the spermthey reproduce is not able to fertilize a female’s egg.Sterilization: Sterilization is a surgical procedure that makes a female unableto get pregnant. For males, it means that the sperm they reproduce is not ableto fertilize a female’s egg. For males, sterilization surgery is called a vasectomy.For females, it’s called a tubal ligation (getting your tubes tied).Straight: A person who is emotionally and sexually attracted to people of theopposite gender.Transgender: People who feel that their gender identity conflicts with theirsexual anatomy—that is a girl who feels like she ought to have been a boy ora boy who feels like he ought to have been a girl. People who are transgenderoften choose to live the role of the opposite gender.96

Unprotected sex: Sexual activity without using some form of birthcontrol to prevent pregnancy and/or without using protection from STIs—like amale or female condom or oral dam.Vaginal sex, sexual intercourse: Sexual activity during which the penisenters the vagina.Useful Information97

Useful InformationThe Female Body5972 3810 14611981

1234567891011Anus: The opening from which stool leaves the body during abowel movement (BM).Bladder: The organ that holds urine.Cervix: The lower part of the uterus that extends into thevagina.Clitoris: A sensitive, pea-sized organ that is right above theurethra. The clitoris gets a bit bigger and more sensitive whenit’s touched or when a girl has sexual thoughts or feelings.The clitoris plays an important part in sexual arousal andorgasm.Fallopian tubes: Thin tubes that extend out on both sidesof the uterus. The Fallopian tubes carry the eggs from theovaries to the uterus. They are about 10 cm long.Labia: The two folds of skin that cover the clitoris and theopenings of the vagina and the urethra.Ovaries: The two glands, one on each side of the uterus, thatproduce eggs. The ovaries also produce the hormonesestrogen and progesterone.Urethra: The tube through which urine leaves the body. Theopening of the urethra is right below the clitoris.Uterus: The muscular organ (also called the womb) in which afertilized egg implants and a baby grows. When not pregnant,the uterus is about the size and shape of a pear (about 7.5 cmlong).Vagina: The passage that goes from the uterus to the outsideof the body. The vagina is about 9 cm long.Vulva: A woman’s pubic area. The vulva includes thesexual and reproductive organs on the outside of the body—the clitoris, labia, and vaginal opening.Useful Information99

Useful InformationReducing the Risk ofCervicalCancerCancer of the cervix is a serious condition that all girls and womenneed to be aware of. The good news is that a Pap Test can detectchanges in the cervix before they become cancer. When detectedearly, these changes can be treated and cured.The risk for developing cervical canceris increased by:•Having the Human Papilloma Virus (HPV)There are many strains of HPV. Some cause genital warts, otherscause changes in the cells of the cervix that may lead to cancer.HPV is passed from person to person through sexual contact. Youcan now get a vaccination to help protect you from four strains ofHPV, including the two that cause 70% of cervical cancer. If youdidn’t get this vaccine in school, talk to a doctor.•Having sex at a young ageBecause the cells in the cervix are not fully developed, they aremore vulnerable to damage by HPV, the virus linked to causingcervical cancer. This increases the chances of developing abnormalchanges in your cervix.100

•Having unprotected sexHaving sex without a condom or oral dam increases the risk for alltypes of sexually transmitted infection, including HPV.•Having more than one sexual partnerThe more sexual partners, the greater the risk of contracting STIs,including HPV.• SmokingSmoking has been proven to cause lung cancer and is also linkedto cancer of the cervix. Chemicals from cigarettes travel in thebloodstream and have shown up in the Pap tests of smokers.These chemicals can trigger abnormal changes in a cervix that isnot yet fully developed.•Not having regular Pap TestsThis is the biggest risk factor for developing cervical cancer. Ifchanges aren’t detected, abnormal cells may become cancerousand eventually spread to other parts of the body.Useful InformationA Pap test is not the same as an STI test.Even if you have regular Pap tests, you stillneed STI tests if you are sexually active. You’ll find moreinformation about the STI test on page 48.Within 3 years of starting tohave sex, or when a girlreaches the age of 21, sheneeds to start having regularPap Tests to check forchanges in cervical cellsbefore they becomecancerous.101

Useful InformationThe male Body821110 6593147102

123Anus: The opening from which stool leaves the body duringa bowel movement (BM).Bladder: The organ that holds urine.Epididymis: A coiled tube that is attached to the back of thetesticles and connects with the vas deferens. Sperm areproduced in the testicles, mature in the epididymis, and thenmove through the vas deferens to the prostate gland.Useful Information45678910Foreskin: The fold of skin covering the end of the penis.Penis: The male sexual organ. Both semen and urine leavethe body through the penis (but never at the same time!)Prostate gland: A gland that adds fluid to sperm to makesemen.Scrotum: The sack of loose skin just behind the penis. Thescrotum holds the testicles.Seminal vesicles: Two small organs—one on each side ofthe prostate gland—that, with the prostate gland, add fluid tosperm to make semen.Testicles: Two oval glands that hang inside the scrotum.(Testicles are usually a bit lopsided, with one hanging a littlelower than the other.) The testicles produce sperm and thehormone testosterone.Urethra: The tube that carries both urine and semen throughthe penis and out of the body.11Vas deferens: The tubes that carry sperm from the testiclesto the prostate gland.103

Useful InformationHow to check forTesticularCancerTesticular cancer—cancer of the testicles— is the most common kindof cancer in young men between the ages of 15 and 35.It is fairly rare— about 1 in 300 young men will develop testicularcancer at some point in their life.Signs of testicular cancerThe first sign of testicular cancer is usually a hard,painless lump on the testicle. Other signs may include:• Change in the size, shape, feel, or tenderness of thescrotum or testicles• Pain in the testicles or scrotum• A feeling of heaviness or a dull ache in the scrotum orlower abdomen• Soreness or change in the size of the chest around thepectoral muscleHaving one of these signs doesn’t mean you havetesticular cancer. It does mean that you should seea doctor to have it checked out.Most of the time, testicular cancer can be found and treatedbefore it has a chance to spread.104

Useful InformationThe good news is that if it’s found early, testicular cancer canbe treated and cured.The best way to find testicular cancer early is to examine yourtesticles once a month. Testicular Self Examination (TSE) is free,easy, doesn’t hurt, and could save your life.Testicular Self Examination (TSE)The best time to do a TSE is right after a shower or bath whenyour scrotum is warm and relaxed.••Stand in front of a mirror and look for any swelling orchange in the size and shape of your testicles.Feel for any lumps or bumps. One at a time, roll eachtesticle between your thumb and fingers. (It’s normal for onetesticle to be bigger than the other or for one to hang lowerthan the other.) The testicle should feel smooth. Feel for anylumps or bumps. These lumps and bumps could be verysmall—the size of a pea or grain of rice. On the back of eachtesticle, you’ll feel the epididymis (the tube that carries thesperm). It feels soft, rope-like, and a bit tender. This isnormal.•Ifyou feel pain, see any changes in the size or shape ofyour testicles, or feel any lumps or bumps, talk to adoctor right away.105

Useful InformationLimits toConfidentialityYou have a right to confidentiality when youtalk to doctors, nurses, and other professionals.However, there are three exceptions.1Reporting certain STIsDoctors and nurses are required by lawto report to Public Health Services if youtest positive for certain STIs—for example,chlamydia and gonorrhea. They do this tokeep these infections from spreading. If youtest positive for a reportable STI, your doctoror a public health nurse will ask you for thenames of anyone you’ve had sex with. Theydo this because if you have an STI, your sexualpartners need to be told that they have beenexposed so they can be tested. The publichealth nurse will notify them withoutmentioning your name or giving anyinformation about you. If you prefer, youcan tell your partners yourself.?106

2Reporting abuseMany professionals —for example, doctors,nurses, dentists, social workers,counsellors, teachers, principals, youthworkers—are legally required to reportabuse. If you are under age 16, theseprofessionals must report to authorities if theybelieve that:Useful Information• You have been, or are being, abused. Theymust report sexual, physical, emotional, andverbal abuse.• You are being neglected• You are witnessing others being abused3Reporting danger to yourselfor othersDoctors and other professionals arerequired by law to report to authorities ifthey think there is a clear and immediatedanger that you might harm yourself—forexample, commit suicide—or harm others.107

Useful InformationWhere to Gofor More InfoWebsitesThere are hundreds of websites where you can get informationabout sexuality, relationships, birth control and STIs. Here arefew good places to start.http://novascotia.ca/dhwNova Scotia Department of Health and Wellnesswww.sieccan.orgThe Sex Information and Education Council of Canadawww.sexualityandu.caSociety of Obstetricians and Gynecologists of CanadaYouth Sitewww.youthproject.ns.caThe Youth Projectwww.CFSH.caCanadian Federation for Sexual Healthhttp://teenhealthsource.comPlanned Parenthood of Toronto108

Amherst18 South Albion StreetPhone: 667-3319 or1-800-767-3319Annapolis RoyalAnnapolis CommunityHealth Centre821 St. George StreetPhone: 532-0490AntigonishSt. Martha’s Hospital23 Bay Street, Suite 2NPhone: 867-4500 ext 4800Arichat14 Bay StreetPhone: 226-2944BaddeckVictoria Co. MemorialHospital30 Old Margaree RoadPhone: 295-2178Barrington PassageCauseway Shopping PlazaPhone: 637-2430Local Public HealthServices OfficesYou can get more information about healthy sexuality by contactingone of these offices and asking to speak with a public health nurse.BerwickWestern Kings MemorialHealth Centre121 Orchard StreetPhone: 538-3700BridgewaterSuite 200, 215 Dominion StreetPhone: 543-0850CansoEastern Memorial HospitalPhone: 366-2925Chester109 Duke StreetPhone: 275-3581CheticampSacred Heart CommunityHealth Centre15102 Cabot TrailPhone: 224-2410DigbyDigby General Hospital67 Warwick Street, 3rd FloorPhone: 245-2557Useful Information109

Useful InformationElmsdale15 Commerce Court, Suite 150Phone: 883-3500MeteghanClare Health CentrePhone: 645-2325Glace Bay633 Main StreetGround FloorPhone: 842-4050GuysboroughGuysborough HospitalPhone: 533-3502Youth Health Centre27 Green Street(Chedabucto Place)Phone: 533-2250Halifax RegionalMunicipality7 Mellor Avenue, Unit 5BurnsidePhone: 481-5800InvernessInverness Consolidated Hospital26 Upper Railway StreetPhone: 258-1920Liverpool175 School StreetPhone: 354-5737LunenburgFishermen’s Memorial Hospital14 High StreetPhone: 634-4014Middle MusquodoboitMusquodoboit Valley MemorialHospital492 Archibald Brook RoadPhone: 384-2370MiddletonSoldier’s Memorial Hospital462 Main StreetPhone: 825-3385Musquodoboit Harbour7907 Highway 7Phone: 889-2143Neil’s HarbourBuchanan MemorialCommunity Health CentrePhone: 336-2295New Germany#5246, Highway 10Phone: 644-2710New Glasgow825 East River Road, 2nd FloorPhone: 752-5151New WaterfordNew Waterford Hospital716 King StreetPhone: 862-2204110

Port Hawkesbury708 Reeves Street, Unit 3Phone: 625-1693St. Peter’sPhone: 1-888-272-0096(Voice mail only)Sheet HarbourEastern ShoreMemorial HospitalPhone: 885-2470ShelburneRoseway Hospital1606 Lake RoadPhone: 875-2623WindsorWindsor Mall80 Water StreetPhone: 798-2264Wolfville23 Earnscliffe AvenuePhone: 542-6310Yarmouth60 Vancouver Street4th Floor, Building BPhone: 742-7141Useful InformationSherbrookeSt. Mary’s Hospital91 Hospital RoadPhone: 522-2212Sydney235 Townsend Street, 2nd FloorPhone: 563-2400Sydney Mines7 Fraser AvenuePhone: 736-6245TruroColchester East HantsHealth Centre600 Abenaki RoadLevel 1/Wing BPhone: 893-5820111

Useful InformationLocal Sexual Health CentresYou can also get more information about sexuality and birthcontrol by contacting the Sexual Health Centre closest to you.• Sexual Health Centre for Cumberland County—Amherst11 Elmwood DrivePhone: (902) 667-7500Website: www.cumberlandcounty.cfsh.info• Cape Breton Centre for Sexual Health—Sydney150 Bentinck StreetPhone: (902) 539-5158• Sexual Health Centre Lunenburg County—Bridgewater4 Hillcrest Street, Unit 8Phone: (902) 527-2868Website: www.lunco.cfsh.info• Halifax Sexual Health Centre201-6009 Quinpool RoadPhone: (902) 455-9656Website: www.halifaxsexualhealth.ca• Pictou County Centre for Sexual Health—New Glasgow35 Riverside StreetPhone: (902) 695-3366Website: www.pictoucounty.cfsh.info• Sheet Harbour Sexual Health Centre17 Behie RoadPhone: (902) 885-2789Website: www.sheetharbour.cfsh.info112• Yarmouth Centre for Sexual Health —Yarmouth238 Main StreetPhone: (902) 742-0085 or (902) 749-2821Website: www.tricountywomenscentre.org

Thanks!This book is the product of the advice, insight, experience, and support ofmany people. The Nova Scotia Department of Health and Wellness wishesto acknowledge and thank the following individuals for their commitment,energy, and dedication to providing youth in Nova Scotia with theinformation they need to make healthy sexual choices.Healthy Sexuality Working Group• Core Working Group Members- Shirley Campbell (Chair), Health Educator,Nova Scotia Department of Health and Wellness- Janis Wood Catano, Health Education Consultant- Heather Christian, Coordinator, Population Health,Nova Scotia Department of Health and Wellness- Frank Covey, Acting Assistant Director, English Program Services,Nova Scotia Department of Education- Helen Farrell, Public Health Nurse, Pictou County Health Authority,Colchester East Hants Health Authority, and Cumberland Health Authority- Maureen Flick, Public Health Nurse, Capital District Health Authority- Larry Maxwell, Health Educator, Public Health Services, GuysboroughAntigonish Strait Health Authority, Cape Breton District Health Authority- Karen McMullin, Public Health Nurse, South Shore Health, South WestHealth, and Annapolis Valley Health• Contributing Members- Rick Tully, Health and Physical Education Consultant, Nova ScotiaDepartment of Education- Halifax Sexual Health Centre- Youth Representatives- Gerry Brosky, M.D., CCFP, Dalhousie Family MedicineThe Nova Scotia Department of Health and Wellness would like toacknowledge, with thanks, the work of the many people whocontributed to the development and the revisions of this resource.Thanks and Index113

Thanks and IndexFocus Group ParticipantsThe most valuable contributors to this book were the more than 500students from the following schools, universities, and health centreswho (with the support of their school administration) identified the keymessages and provided expert review of thecontent and design of this book.- Amherst Regional High School- Canso Academy- Dalhousie University- Dartmouth High School- École secondaire de Par-en-Bas- Ellenvale Junior High School- Flexible Learning and Education Centres- Forest Heights Community School- Hantsport School- Inverness Education Centre- J. L. Ilsley Teen Health Centre- Malcolm Munroe Junior High School- Memorial High School- Halifax Sexual Health Centre- Prince Andrew High School- Ridgecliff Middle School- Saint Mary’s University- St. Michael Junior High School- Sir Robert Borden Junior High School- South Queens Junior High School- Thorburn Consolidated School- Truro Junior High School- West Kings High School- Yarmouth Junior High SchoolYouth ContributorsA special thanks to the many youth who informally shared theiropinions, ideas and insights as we moved through the process ofdeveloping and revising of this resource.114

ReviewersThe Nova Scotia Department of Health and Wellness would liketo thank the many organizations and individuals who generouslycontributed their time and expertise in reviewing drafts of this book.A special thanks to:Amanda Black, M.D., FRCSC, Society of Obstetricians andGynaecologists of CanadaE. Sandra Byers, Ph.D., Chair, Department of Psychology, UNBDonald Langille, M.D., MHSc, Associate Professor, Community Healthand Epidemology, Dalhousie UniversityAlexander McKay, Ph.D., Research Coordinator, The Sex Informationand Education Council of Canada (SIECCAN)Thanks and IndexAll of the “Quotes from Teens” aredirect quotes from youth in Nova Scotia.They were taken from one of these sources:• Students participating in the focus groups that tested this book.•So Many Bricks in the Wall: Developing Understanding fromYoung Women’s Experiences with Sexual Health Services andEducation in Amherst, Nova Scotia. D. Langille, J. Graham & E.Marshall. Maritime Centre of Excellence for Women’s Health, June1999.• Just Loosen Up and Start Talking: Advice from Nova ScotianYouth for Improving their Sexual Health. M. Agnes. PlannedParenthood Nova Scotia & the Nova Scotia Department of Healthand Wellness, 1996.• The Association between Substance Use, Unplanned SexualIntercourse and other Sexual Behaviours among AdolescentStudents. C. Poulin & L. Graham, Addiction (2001) 96, 607–621.• Promoting A World Free of Homophobia. J.L. Ilsley Gay-Straight Alliance and Peer Health Educators. J.L. Ilsley Teen HealthCentre, 2005.115

Thanks and IndexIndex116abstinence 41, 51, 60, 61, 93abuse, reporting 107ageand contraception 69and legal consent 36, 37and risk of cervical cancer 22, 100AIDS (acquired immunodeficiency symdrome) 93see HIV/AIDS, STIsalcohol and drugs 22, 28, 30and consent to sexual activity 30, 37, 38and date rape 38–39and sexual assault 38–39and unplanned sex 30allergyto latex 62to spermicides 62, 85anal sex 93legal consent for 37risks of STI 13anatomy, female 99–100male 102–103anonymous testing (see HIV/AIDS)anus 99, 103assault (see sexual assault)birth control methods 60–89and cultural/religious beliefs 64and STIs 65, 70, 74, 76, 78, 80, 82, 84, 86, 88choosing method 62cost of 63, 66, 70, 74, 77, 79, 80, 83, 85, 87, 89effectiveness of 63, 71, 75, 77, 79, 81, 83, 85, 87, 89embarrassment using 63emergency contraception 66, 77

methods of 69–89parents’ permission for 67, 69side effects 70, 76, 78, 80, 82, 84, 86, 88where to get it 69-89birth control pill (see pill, birth control)bisexual 5, 6–7, 93bladder 99, 103bleeding 46, 76, 78body fluids, and STIs 41, 44, 50body piercing and STIs 41, 48breaking up and making up 53cancer of the anus 43of the cervix 22, 43, 100of the penis 43of the testicles 104cervical cap 84–85cervical mucus 93cervix 22, 43, 99,100, 101chlamydia 42, 106choicesabout birth control 62–64about sexual activities 5, 14–15, 20, 26, 30about influences on 14, 15about unplanned pregnancy 59circumcision 93clap 42clitoris 99come(s) 57, 93coming out 93commitment (see relationships)condoms 70–75and lubricants 71excuses for not using 54–55female 73–75how to use 72male 70–73Thanks and Index117

Thanks and Indexprotection against STIs 45, 47, 50, 60storing 71where to get 52, 70confidentiality 23, 106-107consent, sexual 32, 36–37contraception (see birth control)come 57, 93criminal offence (see sexual assault)cultural beliefs 15, 64cum 93danger to self or others 107date rape (see sexual assault)decisions (see choices)dependent 94Depo-Provera 78–79diaphragm 84–85discharge 94from penis or vagina 46dose 42drip 42drugs (see alcohol and drugs)ECP (see emergency contraception)egg 57ejaculation 57, 61, 94emergency contraception (ECP) 66–67, 77, 79emotional risks 22, 25emotions and feelings 5, 15, 38, 39, 91about gender identity 8–9about sexual orientation 7feeling good about yourself 19, 21in a relationship 16–19, 22, 25epididymis 103erection 72, 94excuses for not using condoms 54–55fallopian tubes 57, 99feelings (see emotions and feelings)118

female body 98–101female condom 73–75fertilization 57foreskin 103gay 5, 6–7, 94gender 8-9, 94gender identity 8–9, 94gonorrhea 42, 106healthy relationships 16, 18–19, 62, 91help, getting 39, 58, 66, 109–112hepatitis B 42herpesgenital 41-42HIV/AIDS 41, 43, 94anonymous testing for 49hormones 9, 76, 86HPV (human papilloma virus) 43, 100human immunodeficiency virus see HIV/AIDShymen 94hysterectomy 95infertility 42–43, 95information, sources of 10–11, 69, 108–112intercourse 13, see also sexjealousy 17kissing 13, 44labia 99legal consent see consentlesbian 5, 6–7, 95limits to confidentiality 106lubricants 71, 72, 75, 95making up 53male body 102–105masturbation 33, 95medical professionals and confidentiality 23morning after pill 66see ECPThanks and Index119

Thanks and Indexneedle, Depo-Provera 78–79needles and STIs 41, 42, 43, 48nonoxynol-9 71oral contraceptive see pilloral dam, excuses for not using 54–55how to make 51protection against STIs 45, 47, 50oral sex 13, 24, 95risk of STI 13, 25, 42–43, 50see also sexual activityorgasm 95ovaries 57, 99Pap test 95, 100, 101parents, permission for contraception 67, 69talking with 10–11patch, contraceptive 86–87pelvic inflammatory disease (PID) 42, 96penis 57, 72, 103periods 57, 58, 61, 76, 78piercing, and STIs 41, 48pill, birth control 76–77pregnancy 57, 61, 67preventing 57–89preventing after sexual assault 39test 58unplanned 59prejudice 7pressure to have sex 17, 22, 26, 27, 36, 38preventing HIV and pregnancy after sexual assault 39prostate gland 103protecting yourself, against pregnancy see birth controlagainst sexual assault 38against STIs 45, 50, 70against STIs in long-term relationships 53Public Health Services offices 109–111rape (see date rape)120

eadiness to have sex 20–22reasons not to have sex 28relationships 16–19and birth control 62and unplanned pregnancy 59healthy/unhealthy 16–18, 62long-term 51protecting yourself in 53see also pressure to have sexreligious beliefs 15, 64respect 16, 17, 18, 25, 26, 96responsibility 14, 15, 22, 38ring, contraceptive 88–89risksemotional 22physical 22see sexual activitiessafer sex 45see protecting yourselfsaliva and STIs 44saying “no” or “stop” 26, 27, 34, 38scrotum 103, 104self-examination for testicular cancer 105self-esteem 96self-respect 26, 96semen 50, 57, 96seminal vesicles 103sex toys 96and STIs 45, 51sex, definitions 8, 13see safer sexsee also protecting yourselfsexual activities 13, 25, 32legal consent to 35–37making choices about 5, 14–15, 20–22risks of 13, 22, 25, 44, 45Thanks and Index121

Thanks and Indexsee also STIs, safer sex, and protecting yourselfweighing the risks 44-45sexual assault 32–39alcohol or drugs 37and consent 36date rape 38, 39, 48definition 33fault 33, 38medical help after 39protection against 38sexual consent (see consent)sexual health centres 112sexual orientation 6–7, 96sexuality 5, 91sexually transmitted diseases (see STIs)sexually transmitted infections (see STIs)side effects (see birth control methods)skin-to-skin contact and STIs 44, 50smoking and cervical cancer 101sources for ECP 66sources of information 10–11, 69, 108–112sperm 57spermicide 80–81, 84allergy to 62, 70, 80, 82, 84nonoxynol-9 in 71, 81sponge, contraceptive 82–83STDs (see STIs)sterility 42, 96sterilization 96STIs 41–55and birth control 70–89and body fluids 41chart 42–43protection against 22, 45, 47, 50, 51, 60, 70–89symptoms of 41, 46, 47testing for 47, 48, 49122

treatment for 41–43straight 5, 6–7, 96suicide, reporting danger of 107symptoms, of STIs 41, 46, 47of testicular cancer 105syphilis 43talking, about birth control 62, 64with parents 10–11with partner 16–18, 20–22, 62tattoos and STIs 41, 48testicles 103testicular cancer 104tests see HIV, Pap, pregnancy, STIstoys see sex toystransgender 5, 8–9, 96treatment for STIs 41–43trichomoniasis 43unhealthy relationships 17–18unprotected sex 97and emergency contraception 66–67, 77, 79urethra 99, 103uterus 57, 99vaccination 42, 100vagina 99discharge 46secretions 50vaginal intercourse/vaginal sex 97risk of pregnancy 15risks of STIs 15, 42-43, 50see also sexual activitiesvaginitis 43vas deferens 103virus see HIV, HPVvulva 99wartsgenital 43, 100Thanks and Index123

websites for information 108withdrawal 67wrong body 8–9Youth Project 7

TheEnd!11032/NOV13 Rev.12-13novascotia.ca/dhw2014Aussi disponible en français