Vous êtes sur la page 1sur 61

Proyecto Diversex: Salud para todo el mundo

Diversex Project

What is sexuality?

Your body, their body

How to prevent pregnancy

How to use condoms

Sexually Transmitted Diseases Aids, does it affect me?

Dont believe everything they say

Page

Diversex Project

INDEX
1. What is this thing called sexuality? .............................................................. 3 2. Dont believe everything they say ................................................................ 4
2.1. About female sexuality .............................................................................. 4 2.2. About male sexuality ................................................................................. 8

3. If you want your relationship to be successful, dont forget that ............. 12 4. Our body.................................................................................................... 14
4.1. Male sexual external parts ...................................................................... 14 4.2. Male sexual internal parts ....................................................................... 14 4.3. Female sexual external parts .................................................................. 15 4.4. Female sexual internal parts ................................................................... 16 4.5. Your menstrual cycle............................................................................... 16
A. Facts about menstruation ................................................................................ 17 B. What is the menstrual cycle? ........................................................................... 17 C. In what moment of the cycle is there a risk of pregnancy? ............................... 19 D. What changes do I experience every moment? ............................................... 19

5. Contraceptive and STI prevention methods............................................... 20


5.1. Barrier methods....................................................................................... 21
- Male condom..................................................................................................... 21 - Female condom................................................................................................. 23 - Diaphragm......................................................................................................... 25 - Cervical cap ...................................................................................................... 26 - Spermicide: complementary to barrier methods ................................................. 27

5.2. Hormonal mixtures .................................................................................. 28


- The pill .............................................................................................................. 29 - Vaginal ring ....................................................................................................... 31 - Intra-muscular shots .......................................................................................... 32 - Patches............................................................................................................. 33 - Implants ............................................................................................................ 34

5.3. Intra-uterine methods .............................................................................. 35


- IUD.................................................................................................................... 35

5.4. Surgical methods .................................................................................... 36


- Vasectomy ........................................................................................................ 36 - Tubal ligation..................................................................................................... 37

5.5. Natural methods...................................................................................... 38


- The calendar method......................................................................................... 39 - The temperature method ................................................................................... 40 - Billings or cervical mucus method ...................................................................... 41 - The breast-feeding method................................................................................ 42

Page

Diversex Project

5.6. Emergency contraception........................................................................ 43


- The morning after pill....................................................................................... 43

5.7. Not considered contraceptive methods ................................................... 45


- Withdrawal ........................................................................................................ 45 - Vaginal rinsing................................................................................................... 45

6. Abortion ..................................................................................................... 48 7. Sexually Transmitted Infections (STI) ........................................................ 50


7.1. How to detect an STI............................................................................... 50 7.2. Main STIs................................................................................................ 51

8. The Aids virus ............................................................................................ 52 9. Sexual Rights............................................................................................. 55 10. Useful resources ...................................................................................... 57

Page

Diversex Project

1. What is this thing called sexuality?


It is a way of sharing emotions and feelings. It is something you can use to express yourself with your partner. It is showing you care in an intimate way. It is something useful to have children. It is a physical need. It is a way to obtain pleasure. It is something useful to feel your own body and know yourself better.

These were answers given by some boys and girls like you. As you see, each person lives and understands sexuality in a very different way. Your childhood, your relationships, vital experiences that youve had so far have made you experience and understand sexuality the way you do. WHAT IS SEXUALITY FOR YOU? There are so many ways of expressing sexuality as of understanding it. Many people think sexuality is a matter of behaving just one way: having intercourse (sex with penetration). However, there is a bunch of ways you can be sexual with someone, as many as there are in your imagination. Many young people feel guilty when they think about or have sex, as if sex was something dirty or wrong. This is due to the way they have been brought up or to their cultural traditions, which judge peoples behaviour as right or wrong. Dont forget that what might be wrong for one culture might be accepted by another. For example, in Spain it is ok to be sexual with somebody without the aim of having children, just for fun.
Page

Diversex Project

2. Dont believe everything they say


Rumours, myths and false beliefs about sexuality exist everywhere, in all cultures and have existed in all times. These arise as a result of ignorance. In order to avoid confusion, here there are some of them:

2.1. About female sexuality


"Its indecent for girls to take the first step..."
Sometimes people take the first step. When this happens, they are sure about what they like, what they need and what they want. They know themselves, they are self-confident, they are not afraid of getting what they deserve, enjoy what life offers them, stand up for their rights, decide by themselves.

"Girls who carry a condom in their bag are slots..."


Dont get it wrong; girls who carry a condom in their bag are responsible, love themselves, take care of themselves and protect their health and their sexual partners.

"When you have your period its better for you not to do certain things such as bathing, touching plants, making mayonnaise, playing sports, having sex"
Having your period shouldnt have to affect your daily life at all only in cases in which it causes pain, might women modify their normal activity.

Page

Diversex Project

Carrying out the activities above mentioned when you have your period is not harmful at all. There is only a greater risk of getting sexually transmitted infections when you or your sexual partner have one. In that case, use a condom to prevent getting infected (see pages 21-24).

"If you dont have a hymen it means youre no longer a virgin"


The hymen is a membrane in the opening of the vagina. It can be different from a woman to another in size, consistency and shape. A virgin is a person who hasnt had sexual intercourse. A woman might be a virgin and not have a hymen because its been stretched open as a result of a brusque movement while playing sports or doing any other activity.

"Women should wait for men to make them feel an orgasm"


In a sexual relationship, those involved can help each other find pleasure. One of the best ways to do this is touching yourself and showing your partner where you like to be touched, the right movements for you, the right rhythm, etc. Not every woman or man likes the same thing. There are many women who have never reached orgasm with somebody else because their sexual partners dont know how to turn them on and how to give them pleasure. Likewise, there are many girls who dont know themselves because they have never explored their body. Some even think they are frigid, that is to say, they dont have the capacity to feel pleasure. How can
Page

Diversex Project

one teach somebody what they want when they dont know themselves? That is why it is so important that YOU KNOW YOUR BODY and TALK WITH YOUR PARTNER ALL THE TIME! As much as your partner loves and understands you, he does not always know what you need.

"The first time a woman has sex, she bleeds and feels pain"
This is not necessarily true. When it does happen it is because the woman needs lubrication, she is tense and therefore she contracts the vaginal muscles, making intercourse painful. When the female body gets excited it prepares for intercourse getting lubricated with more vaginal fluid. In this way the female genitals get humid. The body instinctively prepares for penetration. For this to happen the woman needs to get excited and being nervous doesnt help. Generally speaking, the female body needs to be more stimulated than the males to get excited. Thus, it is important to be ready, convinced, relaxed, instead of fearful or pressured. It is recommendable that, previous to penetration, there are other sexual behaviours alternative to intercourse, which allow to explore what you both like and to get familiar with your bodies, such as masturbating each other, kissing, caressing, massaging each other, touching, licking, playing, etc. Use your imagination!

Page

Diversex Project

"There are two types of female orgasm: vaginal and clitoral"


Until proven otherwise, women can only reach orgasm through the clitoris (see pages 15-16, female sexual biology). When they reach it through intercourse, it is because there is a vibration or touch (although indirect) of the clitoris due to the movement during intercourse. Women can have orgasms that may be different in intensity and duration. Knowing that women reach orgasm through the clitoris helps us understand why many of them do not reach orgasm through penetration and they do through masturbation. Likewise, it should encourage couples to extend their range of sexual behaviours and not to link sexuality to intercourse only. There are sexual relationships that provide a lot of pleasure and are very satisfactory in which there is no penetration. By associating sexuality to intercourse only, you are limiting your sexuality a lot!

"Girls do not masturbate"


Girls do masturbate, but they dont say so because in many cultures it is still wrong that women use their sexuality as a means to obtain pleasure, leaving aside the reproductive function. Both men and women have genitals that provide pleasure. These genitals should be used without remorse, dont you think?

Page

Diversex Project

Masturbating is not harmful at all. It is even helpful to fight stress and insomnia, eliminate tension and know oneself better. The only harmful aspect is feeling guilty about it and thinking that women dont have the right to feel pleasure with their own body. If you masturbate, that does not mean you are immature. Those who are married or in a long-term relationship also masturbate, and that doesnt mean their relationship doesnt work.

It just isnt true that...


Women with larger breasts feel more pleasure than those with small ones. Men with a larger penis get more pleasure and give more pleasure than those with a small one.

2.2. About male sexuality


"Men are always sexually ready; they have more desire and get turned on by any sexual situation"
Generalisations are never quite true. Like girls, boys do not always want the same, nor are they always on the mood, nor are they turned on by the same thing... A man might not get turned on by his partner one day because he is tired, worried or a thousand more reasons and that doesnt mean that he doesnt find his partner attractive any more or that he has sexual problems.

Page

Diversex Project

"Boys know more about sex; thats why they should be the ones to take the first step"
The fact that boys talk more openly about sex doesnt mean that they know more about it. Likewise, the fact they were traditionally the ones to take the first step doesnt mean that it should continue to be like this.

"Men shouldnt cry, nor express their feelings"


Why do we think that if a man cries is less of a man and therefore, homosexual? Because traditionally men have been attributed some characteristics and functions that define his manliness, and everything that means differently is abnormal. Behaviours and preferences do not determine our sexual orientation! (so, somebody might feel sexually attracted to people the same sex homosexual and/or the opposite sex heterosexual). Being homosexual is neither a deviation nor an illness nor a genetic problem, nor a bad habit. You dont choose to be a homosexual or a heterosexual. Accepting a sexual orientation that does not coincide with the vast majoritys is not easy. If you need help to accept this situation, you should know that there are professionals and associations of gays and lesbians who have been through this and can help you. (Look up on the resource guide at the end of this manual.) If your sexual orientation coincides with most peoples, you should accept diversity: respect different options!

Page

Diversex Project

"A sexual contact finishes when the man ejaculates"


We cant always reach orgasm at the same time as our partner (orgasm is an intense feeling of pleasure both for women and men, which lasts for a few seconds) since it would be necessary to have control over our body and a good communication with our partner. It is neither true that women take longer to reach orgasm nor that if both reach orgasm at the same time it is more pleasurable than at different moments. Unlike women, once men ejaculate, they need some time to recover for another orgasm to take place. This stage is called resolution and after a state of relax, the body goes back to its nonexcited state (diminishing of sexual desire, non erection of the penis). Girls do not always need this resolution phase and may have several orgasms without having to stop their sexual activity. If the man has ejaculated, he can do some other things to give the woman pleasure without having to use his penis. Oral sex, masturbation, kisses, caresses, there are a thousand options for women to reach orgasm (that is, in case they want to, since orgasm should not always be the aim of a sexual contact. There are many couples that prefer to enjoy the whole process and do not have orgasm as the final aim of their sexual relationships). When sex is shared it involves two, doesnt it?

"If you masturbate you get spots on your face and can become impotent or even go blind"
Masturbation is not harmful. It doesnt cause any of the above.

Page

10

Diversex Project

"It is not common to fantasize about somebody who is not your partner and even less so to have same-sex fantasies"
Many people have sexual fantasies about other people and that doesnt mean that they dont feel attracted to their partner or that their relationship is not working. Its just fantasies and they do not necessarily will come true. They do not depict reality either, so somebody who might have same-sex fantasies is not supposed to be a homosexual.

Page

11

Diversex Project

3. If you want your relationship to be successful, do not forget that...


P Sexuality is a matter of discovering; it is something we build and experience during our lives: we all have to learn about it. Take your time and dont set limits; just enjoy yourself. P Sexuality includes behaving sexually in a multitude of ways, as many as there are in our imagination. A sexual relationship has nothing to do with good or bad, right or wrong, normal or abnormal, as long as those involved agree and dont feel forced to do anything they dont feel like doing. Although it is nice to give pleasure to your partner, your happiness comes first. Be consistent and listen to your inner voice. P Respect your own decisions and choose whats best for you, avoiding unsafe situations. For example, drinking alcohol can diminish your capacity of judgment. P Try to make your sexual relationships fun. The less risk there is, the more you will enjoy them. Take care of yourself: Protect yourself from Sexually Transmitted Infections or unintended pregnancies. And remember: this responsibility should be shared equally by those involved in the relationship, shouldnt it? P Talk with your partner about what you like, what you need or what worries you about your relationship. P Treat your partner with the same care and respect you would like to be treated. P Learn to know and accept yourself. Do the same about your partner: respect the difference.

Page

12

Diversex Project

P Respect peoples sexual intimacy. P Respect the word NO. When somebody says "no" it doesnt mean that they dont like to be seduced or that they are playing it tough.

WARNING
Sexual harassment is not a joke. If you think someone is pressuring you into some kind of sexual activity, state clearly that this behaviour displeases you. If it doesnt stop, you can register all the details of every incident (date, hour, place, witnesses, and facts) in a notebook that you can keep it in a safe place. And remember that your silence is what allows this abusive behaviour to continue. Share your situation with a parent/guardian or trusted adult; they might help you. Sexual abuse is not allowed and there are laws and professionals that protect the victims. (For further information, have a look at the end of this guide for different resources.) Dont get it wrong! Being jealous is not a sign of love, but of insecurity. It is only you who can take best care of yourself. Remember that a love relationship shouldnt be one of possession.

Page

13

Diversex Project

4. Our body 4.1. Male sexual external parts


Foreskin: soft and flexible skin that covers the glans. Scrotum: The pouch of soft skin that holds the testicles. Its main function is to keep a constant temperature of the testicles. Glans: erectile tip of the penis. Penis: it serves as the external male organ of urination and reproduction. In its inner side it contains several cavities that fill with blood during sexual excitement making an erection possible.

4.2. Male sexual internal parts


1 1

Urinary bladder: it is the organ that collects urine.


Seminal Vesicles: They are a pair of glands connected to the ductus deferens. They secrete a significant proportion of the fluid that ultimately becomes semen. Ductus deferens: muscular tubes that carry the semen from the epididymis. Epididymis: It is a narrow, tightly-coiled tube in which semen is stored.

2 6

2 3

5 7

Testicles: their main function is to produce sperm and sexual hormones. They are covered by the scrotum. Prostate: walnut-size gland situated below the urinary bladder. Its function is to secrete a clear fluid to feed and maintain the sperm. This nourishing stuff also serves as a vehicle for sperm to come out when ejaculation takes place. Urethra: it is a tube that connects the urinary bladder to the outside of the body through which urine and semen are expelled.

Page

14

Diversex Project

4.3. Female sexual external parts


Mons Pubis: the fleshy pad of skin situated above the pelvis, which gets covered with hair from puberty. It protects the internal genitals and softens the sexual contact between male and female during intercourse.

Clitoris: organ that can be very sensitive to touch. Its known unique function is to provide sexual pleasure.

Outer lips: they are an extension of the skin that covers part of the vulva. The external part is covered with hair.

Urethra: tube-like organ situated between the clitoris and the vagina through which urine comes out.

Inner lips: they are situated in the inner side of the outer lips, although sometimes they might stick out. They are very sensitive to touch. They dont have pubis hair.

The Vulva comprises all the external genital parts.


Do you know all the secret places of your body? Have a look at it with the help of a mirror.

Page

15

Diversex Project

4.4. Female sexual internal parts


Uterus or womb: hollow organ 5-7cm wide. Its function is to keep the baby during pregnancy.

Fallopian Tubes: Once an egg is released, it travels down the fallopian tube into the uterus.

Cervix neck of the womb: the bottom part of the uterus that extends down into the vagina. Ovaries: their function is to release the ovum or eggs and sexual hormones. Vagina: tube-like opening between the inner lips, which extends down 10cm into the pelvis. It is made of a flexible stuff that gives off a slimy fluid during sexual excitement, which facilitates penetration.

4.5. Your menstrual cycle


Why do I feel sad a few days before having my period? Is it ok to bathe when having my period? Can I get an infection if I have sex when having my period? When I have my period, is there less risk for me to get pregnant?

Page

16

Diversex Project

A. Facts about menstruation


The period or menstruation is the discharge of blood and tissue that happens for the first time between 9 and 16 years of age and is the outward proof that a girl is becoming a woman: The womans reproductive years begin and indicate she is physically able to become pregnant. Your period is part of one of the different phases in the menstrual cycle, which regulates the human beings reproduction. Although many women may experience some unpleasant symptoms when having their period, they should be able to carry on with their normal daily life activity. Keeping a good personal hygiene is important: you can bathe normally and have sexual relationships, as long as you have a wash before and after intercourse. When having your period there are more chances you get a sexually transmitted infection.

B. What is the menstrual cycle?


Your menstrual cycle is the period of time between the first day of your period and the first day of the following one. Depending on each woman this cycle is repeated every 25, 30, or even 40 days. Normally a cycle lasts 28 days and includes the whole process by which the womans body prepares to receive a new life. Its phases are as follows:

Page

17

Diversex Project

The egg matures in the Fallopian tubes. At the end of this phase, if it has been fertilized it travels to the uterus in order for a foetus to form. If not, it will be expelled, together with the endometrium, during menstruation.

Menstruation happens when the ovum or egg that hasnt been fertilized is expelled through the vagina. The bleeding of menstruation indicates that a pregnancy hasnt occurred that month.

During 9-10 days after menstruation an egg matures into the socalled follicle thanks to the luteinizing hormone.

Ovulation. On day 14 the follicle liberates the egg that will travel to the Fallopian tubes. During that day the probability that the egg is fertilized by a sperm cell is maximum. Given that the life of a sperm cell can last for up to 3 days before and 1 after ovulation, they are also considered high risk for pregnancy to take place. If on that day the egg is not fertilized by a sperm cell, it will end up dying and pregnancy wont happen until another egg is released the following month. In this phase, the levels of sexual hormones (estrogens) are at their highest peak.

Page

18

Diversex Project

C. In what moment of the cycle is there a risk of pregnancy?


It is necessary that during the ovulation, one of the eggs (female reproductive cells) is fertilised by a sperm cell (male reproductive cell that is found in sperm or semen). If all the menstrual cycles were equally regular, it could be stated that there is only a period of risk of pregnancy in each cycle, which coincides with ovulation, and that during menstruation there is no risk whatsoever. However, it is well known that in many cases womens cycle is altered and ovulation takes place at a different period of time and even more than once every cycle, so we could say that the risk of pregnancy exists during the whole menstrual cycle.

D. What changes do I experience in each phase?


Each phase of the cycle is regulated by the increase and reduction of several hormones. The way these hormones function can cause a series of specific physical and emotional changes in each phase. For example, a few days before menstruation, there can be some symptoms such as sadness, tiredness, anxiety, mood swings, bloating, greasy skin and hair, tender breasts, headache, acne, changes in the sexual interest, backache, etc.

Page

19

Diversex Project

5. Pregnancy and Sexually Transmitted Infections prevention methods


How can pregnancy be prevented?
There are some methods by which pregnancy can be prevented. Effectiveness of each method mostly depends on using them correctly. Every method has its particularities. Each person will feel more comfortable using one or another depending on their lifestyle and needs. The decision of using contraceptives concerns both members in the relationship. Talk to your partner! These are the characteristics of the most commonly used contraceptive methods.

STI Prevention
The only methods that protect from these infections are male and female condoms and abstinence. You should use them from the first time, since there are some infections that are transmitted through the mere slight touch of the genitals (for further information about how to use them, look up on pages 21-24). Remember that it is you and your partners responsibility to get protection from possible risks.

Page

20

Diversex Project

5.1. Barrier Methods


WHAT IS A BARRIER METHOD? Barrier methods stop the sperm from going into de vagina, so that the sperm dont meet the eggs.

Male Condom
It is a sheath made out of latex, polyurethane, or lambskin (natural) worn over the penis when it is erect. Together with the female condom, it is the only contraceptive method that also protects against aids and other sexually transmitted diseases.

Protection against Sexually Transmitted Infections Protection Pregnancy Advantages

Yes 84 to 98% effectiveness - Available without prescription. - No important side effects. - Easy to get. - No medical control needed. - Some people experience allergy to latex, but they can get condoms made of other materials such as polyurethane. - It sometimes reduces spontaneity of the sexual relationship. - It might slightly reduce the sensation of the penis inside the vagina. - There always has to be one at hand.

Disadvantages

Page

21

Diversex Project

How to use it
Before opening it, always check the expiring date on the package and if the condom has the quality control symbol (EC symbol). It is important to store it in a cool, dry place. Open the package carefully, but never use scissors, knifes, or teeth! Be particularly careful with long or jagged fingernails so as not to rip the condom. To put it on, it is necessary that the penis is erect. Press the air out of the tip of the condom and put it on the head of the penis. It is important to leave the tip of the condom emptylooking, since if we dont, with ejaculation the condom could break. With the other hand, unroll the condom over the ERECT penis until it is completely unrolled and/or the entire penis is covered.

After ejaculation hold the base of the penis (which should still be hard) before removing it from the vagina or anus to help prevent the condom from coming off or spilling. Remove the condom by holding the base of the penis and sliding it off. Once out of the vagina, it is recommendable you make sure theres no breakage. In case it was broken or stayed inside the vagina, you may go to a medical centre before 72 hours to take the morning after pill (see page 43) although its better not to put it off a lot. Important: Never use the same condom twice! Never use 2 condoms at the same time! There is a higher risk they break. If you want to increase sensitivity you may use water based lubricants on latex condoms, such as glycerine. Oil based lubricants such as Vaseline or baby oil can
damage the condom.

Putting the condom on should be one more erotic part of having sex.

Page

22

Diversex Project

Female Condom

It is similar to a male condom, but it is the woman who puts it on inside the vagina. The female condom is made of latex or polyurethane, it entirely lines the vagina and it can provide greater protection against STDs than male condoms. You might put it on before starting sexual intercourse. Although it may seem very bulky, it is a very safe method, easy to put on and can be very erotic! To put it on, pay attention, girls! Before opening it, check on the expiring date and look for the EC quality control symbol. It is important to store it in a cool and dry place.

Protection against Sexually Transmitted Infections Protection Pregnancy Advantages

Yes

75 to 85% effectiveness - Available without prescription. - It is not necessary to wait until the penis is erect to put it on. - Its not necessary to take it out after the ejaculation, and its easy to use. - Its more expensive than the male condom. - It is not very nice looking, since it is a bit bulky.

Disadvantages

Page

23

Diversex Project

How to use it

It is wider than a male condom. At each end of the condom there is a flexible ring, which is inserted into the vagina to hold the female condom in place. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina.

Squeeze the inner ring with thumb and middle finger (so it has the shape of an 8) and then insert the inner ring and sheath into the vaginal opening.

Make sure the condom is inserted straight, and is not twisted inside the vagina. After ejaculation, when the penis has been removed, twist the outer ring gently and then pull the condom out keeping the sperm inside. Throw it away. Do not put it into the toilet.

The condom is disposable. It is not recommendable to use it twice. It can be used any moment and any day of the month.

Page

24

Diversex Project

Diaphragm
It is a flexible ring covered in latex that is inserted together with a spermicide cream into the vagina preventing the sperm cells to go through to the uterus. The diaphragm might be put on a few hours before intercourse. After sex it has to remain inside the vagina for at least 6 hours, to make sure the spermicide is acting against all the sperm cells that might have stayed there. If during that time there are more sexual relationships more spermicide has to be introduced in the vagina without removing the diaphragm. After using it, the diaphragm should be washed with neutral soap, dry it and store it in its original package, since one diaphragm can be used many times (approximately for 2 years). It is the Doctor who determines the appropriate size of the diaphragm for each woman and show how to put it on. It can be used at any time, and it has no negative effects on your health.
Protection against Sexually Transmitted Infections Protection Pregnancy Advantages No 80 to 91% effectiveness - No side effects. - It helps preventing certain infections. - It can be put on before starting the relationship. - It requires learning to use it and medical revisions. - The size can vary due to weight changes, pregnancies. - It might move during intercourse.

Disadvantages

Page

25

Diversex Project

Cervical Cap
It is a thimble-shaped latex cap made of soft rubber. The cap is like a mini diaphragm, but it only covers the cervix and it can be left in place longer. The cervical cap comes in several sizes. Doctors recommend using it together with spermicide. The cervical cap has to be filled with spermicide in one or two thirds of its capacity. The cap is inserted putting its ends together and sliding it through the base of the vagina. It is then pushed against the cervix. The fingers should be used to check the edges of the cap in order to make sure the cervix is perfectly covered and also touch the cap to feel the cervix through the rubber. The cap can be introduced approximately 6 hours before intercourse and it shouldnt be removed until at least six hours after intercourse. Taking showers should be avoided during that period of time. It can remain inside 24 hours after intercourse, but after that time it must be removed.
Protection against Sexually Transmitted Infections Protection Pregnancy Advantages Disadvantages No 75 to 91% effectiveness - No side effects. - No need for further applications of spermicide although additional sexual acts occur. - High reported failure rates. - Generally speaking, its use is not recommended for women with deformation of the cervix due to cysts, or pregnancies. - Some women or their sexual partners could experiment allergy to spermicides or rubber. - It might be difficult to insert it properly. - It can slip out of place during intercourse, which may considerably reduce its effectiveness.

Page

26

Diversex Project

Spermicide (complementary to barrier methods)


Spermicides come in different consistencies: creams, jellies, foams, suppository and sponges. They contain substances that block the movement of the sperm cells, thus preventing them from reaching the uterus and fertilising the egg. They can be put on at the moment of intercourse, as a complement of the diaphragm or the cervical cap. DO NOT FORGET! One application of spermicide is only for one intercourse. It must be applied immediately before intercourse; otherwise, it might be ineffective. Water or soap cant go into the vagina for 6 hours after intercourse. They can be bought at the chemist without prescription.
Protection against Sexually Transmitted Infections Protection Pregnancy Advantages No

Disadvantages

50-80% effectiveness - Available without medical prescription. - They dont have any known side effects. Additionally, some couples enjoy the extra lubrication that spermicides provide. - Allergy or sensitivity. - Not very effective as a contraceptive method used alone. - Sometimes spermicides can cause irritation in the genitals. - Because of their unpleasant taste, the use of vaginal spermicides might stop some couples from practising oral sex.

Page

27

Diversex Project

5.2. Hormonal mixtures


The following methods are based on synthetic hormones that imitate the natural hormones in our body. Basically, the ones used are gestagen and estrogens separately or combined. Gestagen acts in three ways in the female reproductive system: inhibiting ovulation, thickening the cervical mucus, preventing the sperm cells from entering, causing changes in the endometrium (narrowing), making it to fail to have the appropriate conditions to receive the egg. Taking estrogens causes menstrual bleedings to be regular. Additionally, it makes menstruation less abundant because estrogens increase the blood clotting factors (reduced bleeding).

Page

28

Diversex Project

The Pill

The pill is taken daily and contains hormones that prevent ovulation from happening, thus eliminating the possibility of fertilisation. One pill is taken daily during 21 days in a row. The pills must be taken in the exact order indicated in the package every day approximately at the same time. Any further set of pills will be started after a 7-day rest, during which menstrual period appears. The bleeding often starts 2-3 days after taking the last pill, and it is possible that it isnt finished when the next set of pills has to be started. The pill must be prescribed by a doctor, who, after making a blood test will determine which is the best pill for every woman (some women can take none at all!). Since it must be taken daily, there is the risk you forget to take it, which considerably reduces its effectiveness. In case of forgetting to take it once, two things can happen: * That you remember to take it within the following 12 hours after you forgot. In this case you must take the pill you missed and on the following day you must carry on with the treatment as normally. * If more than 12 hours passed from the time you should have taken the pill, birth control effectiveness cant be guaranteed. Dont take the pill missed but take the following one as normal.

Page

29

Diversex Project

You should use a barrier method (such as condoms) during the rest of the cycle, until you start a new pack. The same applies if you vomit within the 3-4 hours after you have taken the pill.

Protection against No Sexually Transmitted Infections 99% effectiveness Protection Pregnancy - Very effective method during the whole Advantages menstrual cycle, as long as it is used correctly. - It reduces the unpleasant symptoms of menstruation, both cramps and menstrual flow. - It is a reversible method: if a woman wants to get pregnant she only has to stop taking the pill and its effects will stop immediately. - As all medicines, the pill can have side effects Disadvantages such as headache, leg swelling, changes in sexual desire and in vaginal lubrication, mood swings, vomits, skin disorders; bloating; weight changes, etc. These effects are often solved changing the type of pill. Therefore, you should go to the doctor. - They loose their birth control effectiveness if taken with other medicines, such as antibiotic, paracetamol, or if vomiting or having diahrrea. - Smoking is not recommended while taking the pill.

Page

30

Diversex Project

Vaginal Ring
The Vaginal Ring is a method that consists in inserting a flexible and almost transparent ring into the vagina, which contains hormones that prevent the ovulation from happening. These hormones are absorbed by the body through the vaginal walls. The vaginal ring must be started to use on the first day of the menstruation putting it inside the vagina, where it must stay for three weeks. After that time, the ring must be removed on the same day of the week it was introduced, and not put it on for a week, during which menstruation appears. At the end of this week, a new ring has to be introduced again to start the whole process. It can happen although seldom that the ring falls out the vagina. In that case there is no need to worry, it should only be washed with cold water and put it on again. In case it has remained out of the vagina for more than 3 hours, the best thing to do is put it on as soon as possible and use the condom or any other barrier method during the following 7 days, since the rings birth control effectiveness might have reduced. It should be stated that it is not very frequent that the man feels the ring during intercourse.
Protection against Sexually Transmitted Infections Protection Pregnancy Advantages No

99% effectiveness - Easy to use. - Possibility of having more predictable menstruations. - Possible reduction of the risk of gynaecological cancer. - Reduction of the symptoms of menstruation such as bloating, irritability and cramps. - Prevention of osteoporosis. - It requires medical prescription. - Risk of vaginal infections. - Possible unpleasant side effects: weight gain, breast tenderness, mood swings. - Increase of blood pressure, especially for smokers.

Disadvantages

Page

31

Diversex Project

Intra-muscular shots
There are two types: gestagen alone or combined (gestagen and estrogen). Combined shots are applied monthly (the time it takes for hormones to be absorbed through the muscle) and gestagen shots are every three months (the time it takes for the substance to be liberated from the muscle). They are considered highly effective and have a long birth control effect that can be stopped as soon as the treatment is stopped. As an inconvenient there is the possible consequence of irregularity or disappearance of menstruation, weight gain and, on occasion, nervous disorders such as anxiety. Hormonal shots can also be used in men, or the so-called antifertility vaccines that prevent the sperm cell from adhering to the base of the egg.

Protection against Sexually Transmitted Infections Protection Pregnancy Advantages

No

Disadvantages

99% effectiveness - Safe and very effective. - Reversible. - Easy to use (it is not necessary to acquire a daily habit). - Side effects (especially irregular menstrual bleeding or blood loss during the first three months), headaches, nausea, breast tenderness, weight gain, mood swings, acne, amenorrhea.

Page

32

Diversex Project

Patches

Skin patches are stickers full of hormones that prevent ovulation and are absorbed through the skin. Patches can be worn on the lower abdomen, buttocks, or upper body over clean and dry skin. Never should it be put on breasts. The first patch should be put on during the first day of menstruation, and changed on the same day each week for three weeks, putting it on in different places to avoid irritation. During the fourth week the treatment stops in order to have the menstrual period. In case of forgetting to put the patch again after the weeks rest, or changing it after a week, it should be put again as soon as possible, and use a condom or another additional barrier (birth control method) during the following 7 days, since there is risk of pregnancy.

Protection against Sexually Transmitted Infections Protection Pregnancy Advantages

No

99% effectiveness - Easy to use. - Once prescribed, medical supervision is not necessary. - Regularity of the cycle. - It requires medical prescription. - Possible skin rash. - Possible unpleasant side effects: weight changes, breast tenderness. - Patches might fall.

Disadvantages

Page

33

Diversex Project

Implants
They are like birth control pills that sit under your skin, generally in the arm area. They slowly leak out hormones over time, which stop ovulation with high effectiveness. There are several types: Norplant, which has 6 matchsticks with an effectiveness that lasts 5 years, and Jadelle with two 3-year flexible rods. Among its advantages there is a long birth control effectiveness, the recovery of fertility immediately after the implants are removed, and as a disadvantage there are irregularities in the menstrual cycle, weight gain and headache.

Protection against Sexually Transmitted Infections Protection Pregnancy Advantages Disadvantages

No

99% effectiveness - At least 5 year effectiveness duration. - Easily reversible. - Pre-menstrual symptoms may improve. - It requires initial medical intervention. - Initial high cost. - Possible unpleasant side effects: weight change, breast tenderness, nausea, acne. - Pre-menstrual symptoms may worsen.

Page

34

Diversex Project

5.3. Intra Uterine Method


IUD
It consists of a very flexible small plastic and metal device that is placed inside the uterus. It has several effects: As a reaction to the device more flow is segregated, which makes it difficult for the sperm cells to get in. It alters the movement of the Fallopian tubes interfering in the pass of the egg through the uterus. It prevents the implantation of the egg in case fertilisation has taken place. Putting it in the uterus is easy but it has to be done by a medical professional. Once placed, small strings have to come out so that you can check, after each menstruation, whether the device is still in place and hasnt been expelled. In the first three months of using it, it is normal that the menstruation is more abundant and unpleasant than ever and that there is some blood loss between menstruations. A disadvantage of the use of the IUD is the risk of getting an STI (Sexually Transmitted Infection). If that happened, viruses would take advantage of finding a foreign body to go up to the uterus swiftly and the infection would get worse. Thats why any small vaginal infection should be controlled more than ever. If you have a burning pain in the vagina or a smelly vaginal flow, you should go to the gynaecologist.
Protection against STI Protection Pregnancy Advantages Disadvantages

No 99% effectiveness - Considered to be the most effective reversible birth control method. - It is kept in place until a medical professional takes it out. - It requires medical intervention and periodical control. - If pregnancy occurs, it can be complicated. - Some users have experienced pain and bleeding. - If instructions are not followed and big size tampons are used, they can get tangled with IUD strings.

Page

35

Diversex Project

5.4. Surgical Methods


Vasectomy (male sterilisation)

It consists in a small surgical procedure in which the vas deferens is blocked so that the sperm cells are stopped from being expelled when ejaculating. At the end of the XX century, about 42 million men within reproductive age had chosen this sort of sterilisation. Currently, in several countries vasectomy without scalpel has been implanted, which is quicker and not so unpleasant. As advantages it is effective and permanent, but it is not recommended for very young men, and it is done as a minor operation. It is easier to carry out this sterilisation in men than its equivalent in women and it is feasible to check its results through a semen exam. It is not recommended temporarily as it can cause an infection in the area, and the doctor should consider the presence of other simultaneous infections.

Protection against STI Protection Pregnancy Advantages

Disadvantages

No 100% effectiveness - Permanent protection of unintended pregnancies. - No long-term side effects. - No influence in sexual pleasure. - Not easily reversible. - Possible surgical complications such as bleeding, infections, reaction to anaesthetic, swelling.

Page

36

Diversex Project

Tubal ligation (female sterilisation)


It consists in a surgical procedure in which the Fallopian tubes are tied and cut, so that the eggs and the sperm cells are stopped from going through, and therefore, pregnancy is prevented.

It is recommended for women who have completed the desired size of their family, and it is indicated for those who have a health problem and a risk in future pregnancies or who can use other contraceptive methods, but it is not advisable for very young women.

Protection against STI Protection Pregnancy Advantages

No 99,6% effectiveness - No side effects. - No interference in the sexual relationship. - Easy technique. - Very effective. - Reversibility is not guaranteed, so having the operation has to be a very firm decision. - It is not recommended for young women.

Disadvantages

Page

37

Diversex Project

5.5. Natural birth control methods

This type of contraception is based on the identification of the womens fertile days, in which they have to abstain from sexual intercourse. There are 3 natural methods: the so-called calendar, body temperature and cervical mucus. Failure rates are very high. They normally range from 20 to 30%. They shouldnt be used by women who have irregular cycles because the fertile days cant be predicted. The advantage is that they dont have the side effects that other methods with chemical substances or hormones have. The combination of the three methods can reduce risk of pregnancy, since pregnancy is more likely to happen using just one.

Page

38

Diversex Project

The calendar method


It consists in keeping, during at least 6 months, a register of the dates in which the menstruation starts, with the aim of knowing when the ovulation takes place. Since ovulation takes place between 12 and 15 days before menstruation, it is considered that the fertile days for those women with 28-day regular cycles, are those comprised between the ninth and the eighteenth day, counting from the day that menstruation started. In the case of those women whose cycle lasts between 25 and 35 days, the fertile days are between the seventh and the twenty-first day from the day menstruation started. Variations in weight, having given birth before or stress cause this method to fail. Its effectiveness is found to be under 60%. Example: The first day of menstruation is counted as day 1 and the day before the start of the following, as the last day of the cycle. With a shorter cycle, we subtract 18 from the amount of days of the cycle. The result is the first day with a highest risk of pregnancy. With a longer cycle, we subtract 11 from the amount of days of the cycle, which gives us the last day of high probability of pregnancy. The period comprised between these days is the one with a higher probability of pregnancy. So: Shorter cycle: 26 days. Longer cycle: 28 days. 26-18 = 8 28-11 = 17 th The first fertile day in this case would be 8 and the last fertile day 17th.
Protection against STI Protection Pregnancy Advantages

No 60-80% effectiveness - Very inexpensive. - No devices or medicines are required. - No side effects. - Women learn a lot about their own bodies. - Not very effective, especially when calculations are wrong. - Not recommended for young people.

Disadvantages

Page

39

Diversex Project

The temperature method


The basal body temperature is the lowest temperature that a person can reach at the moment of waking up. Ovulation happens the day of the month in which temperature is in its lowest point. The method consists in measuring and registering your temperature orally, vaginally or rectally in a chart during a period longer than six months to obtain certain reliability. The temperature increases from 0,2 to 0,5 centigrade degrees in the 24 hours after ovulation, due to the growth of the progestin levels produced at that moment. To prevent pregnancy it is necessary not to have intercourse during at least the 7 days before the day when the temperature is expected to rise and the 3 days after the day it rises. The effectiveness of this method is higher when there is no intercourse from the first day of the menstrual cycle until the 4 days after the temperature rises, which means having sex is limited to 10 or 11 days in each cycle. The greatest inconvenient of this method is that some women do not experience the pattern of temperature above mentioned. Additionally, body temperature can vary due to the flu, stress, etc.

Protection against STI Protection Pregnancy Advantages

No 85% effectiveness - Very inexpensive. - No devices or medicines are required. - No side effects. - Women learn a lot about their own bodies. - Not very effective, especially when calculations are wrong. - The greatest inconvenience is that some women might not experience standard patterns of temperature, and besides body temperature may suffer variations due to the flu, stress, etc. - Not recommended for young people.

Disadvantages

Page

40

Diversex Project

Billings or cervical mucus method


It consists in the daily observation of the vaginal secretions to detect their variations and predict ovulation. The rise of the levels of estrogens produced before ovulation causes the mucus to be more transparent, slippery and abundant. Sexual relationships have to be avoided from the moment when the mucus appears with the mentioned aspect, until it gains a thicker consistency and a yellowish colour. However, fluid consistency can also vary because of vaginal infections, use of some medicines or sexual excitement, and all these can lead to misinterpretation. Additionally, as it is a subjective appreciation, on occasion, sorting out the fertile days is difficult.

Protection against STI Protection Pregnancy Advantages

Disadvantages

No 81% effectiveness - The method doesnt have any physical side effects. - Users can be taught to use it by professionals and non professional volunteers without medical assistance. - Learning the method increases the perception and knowledge of reproductive functions and can help couples get pregnant. - Family planning responsibility is shared, which can contribute to a greater communication and cooperation. - Not very effective. - A long period of learning as well as periodical assessment is needed. - The method requires a daily control of body functions and, generally, a chart has to be made; this might be unpleasant and difficult for some women. - Sexual abstinence can cause difficulties in the couple and psychological tension. - Women with irregular menstrual cycles might have difficulties in applying the method properly.

Page

41

Diversex Project

Breast feeding method

Breast-feeding, apart from being good for the babys health, it has birth control effects and helps lengthening the period of time between pregnancies. Its effectiveness is greater during amenorrhea linked to breast-feeding, as a consequence of a series of physiological responses (caused by nipple stimulation) that interfere with the hormones necessary for ovulation. If a mother breast-feeds her baby exclusively, or almost exclusively, and remains in amenorrhea, protection against pregnancy is 98% effective for the first six months after birth.

Protection against STI Protection Pregnancy Advantages

Disadvantages

No 94-98% effectiveness - It can be used by all women who are breast-feeding. - It doesnt require any devices or supplies. - It offers immediate protection after birth. - There is a risk after more than half a year from birth, if menstruation re-appears or if breast-feeding is complemented with supplemental feeding.

Page

42

Diversex Project

5.6. Emergency birth control method


Emergency contraception pills or the morning after pill
What it is
It is a treatment to prevent pregnancy after having unprotected sex or sex during which birth control wasnt used or birth control methods failed. Also for cases of in which women were forced to have sex. It consists in taking two pills that contain a high dose of female hormones as soon as possible and before 72 hours (3 days) after having had unprotected sex. These hormones act on the endometrium (inner membrane in the uterus, which is developed in preparation for the implantation of a fertilized egg). It is very important that the endometrium is found in an optimal state for implantation. What the hormones do is to cause the endometrium to fail to be mature enough for the egg to be implanted.

Treatment
It is advisable to take two pills with some food. If you vomit within 3 hours after having taken the pills, the treatment should be repeated. In case of vomiting for a second time during the 3 following hours after having repeated the treatment, you should seek professional help.

Page

43

Diversex Project

Your period may come, at the latest, 3 weeks after treatment. If it does not, you should have a pregnancy test, since the morning after pill is not 100% effective. Your period can come sooner, later, heavier, lighter; any of these shouldnt be a reason to worry.

Where to find it
It is administered at no cost in Primary Care Centres and Emergency departments of Hospitals.

IMPORTANT!!!

Emergency birth control is an emergency method only, and should NEVER be used as a regular birth control method, since it can cause long-term health problems because of the high doses of hormones they contain.

Protection against STI Protection Pregnancy Advantages

No 94% effectiveness - It can be used after intercourse. - Possibility of carrying on with the pill regularly. - It doesnt affect fertility at long-term. - It must be used within 72 hours after intercourse. Its effectiveness decreases as time goes by. It has to be found relatively quickly. - It requires medical prescription. - Frequent side effects. In case a dose is vomited it is necessary to make sure to repeat it. - Medical professionals can refuse to prescribe it or administer it for ethical reasons.

Disadvantages

Page

44

Diversex Project

5.7. Not considered birth control methods


CAREFUL WITH SOME NOT RELIABLE AT ALL METHODS !

WITHDRAWAL (pulling out) or Coitus interruptus is not considered a birth control method, since it is not very effective. It is when the guy removes his penis from the other persons body before he ejaculates. You can be at risk getting pregnant due to the preejaculate fluid (the fluid on the tip of the penis that has sperm in it).

Protection against STI Protection Pregnancy Disadvantages

NO NO - It interrupts the sexual act. - It can cause a decrease of sexual pleasure due to fear of withdrawing at the appropriate time. - It can lead to a sexual malfunction such as early or delayed ejaculation.

VAGINAL RINSING. It is when women try to wash out the sperm in the vagina after ejaculation. It is not effective at all, since the sperm reaches the uterus in one or two minutes, and trying to wash it out not only cant it prevent this, but it can contribute that it happens.

Protection against STI Protection Pregnancy Disadvantages

NO NO - It is not a reliable method at all. It doesnt work. - Trying to rinse the vagina can cause vaginal infections due to the alteration in the vaginal mucus caused.

Page

45

Diversex Project

Birth control methods summary chart


BARRIER METHODS
Male Condom Protection

STI

Protection pregnancy

Advantages
Available without prescription. No important side effects. Easy to get. No medical control needed. Available without prescription. Its not necessary to wait until the penis is erect to put it on. Its not necessary to take it out after ejaculation, and its easy to use. It helps preventing certain infections. It can be put on before starting the sexual relationship. No side effects. No side effects. No need for further applications of spermicide although additional sexual acts occur. Available without medical prescription. Not known side effects.

Disadvantages
Allergy to latex, but easy to get polyurethane condoms. Might reduce spontaneity of sexual relationship. Might reduce sensation of penis into vagina. There always has to be one at hand. Its more expensive than the male condom. It is not very nice looking, since it is a bit bulky.

Yes

84-98%

Female condom

Yes

75-85%

Diaphragm

No

80-91%

Cervical Cap

No

75-91%

Spermicides (used alone)

No

50-80%

It requires learning to use it and medical revisions. Size might vary due to weigh changes, pregnancy, etc. It might move during intercourse. High reported failure rates. Not recommended for women with deformation of the cervix. Allergy to spermicide or rubber. It might be difficult to insert if properly. It can slip out of place during intercourse. Allergy or sensitivity. Not very effective as a birth control method when used alone. Because of their unpleasant taste, it might stop some couples from practising oral sex. Sometimes they can cause irritation in the genitals.

HORMONAL METHODS The pill

Protection

STI

Protection pregnancy

Advantages
Very effective method during the whole menstrual cycle, as long as it is used correctly. It reduces the unpleasant symptoms of menstruation, both cramps and flow. It is a reversible method: if a woman wants to get pregnant she only has to stop taking them and its effects will stop immediately. Easy to use. Possibility of having more predictable menstruations. Possible reduction of the risk of gynaecological cancer. Reduction of the symptoms of menstruation such as bloating, irritability and cramps. Prevention of osteoporosis. Safe and very effective. Reversible. Easy to use (not necessary to acquire a daily habit). Easy to use. Once prescribed, medical supervision is not necessary. Regularity of the cycle. At least 5 year effectiveness. Easily reversible. Pre-menstrual symptoms may improve.

Disadvantages
Possible side effects such as headaches, leg swelling, changes in sexual desire and in vaginal lubrication, mood swings, vomits, skin disorders; bloating; weight changes, etc. They loose their birth control affectivity if taken with other medicines, such as antibiotic, paracetamol, or if vomiting or having diarrhoea. Smoking is not recommended while taking the pill. It requires medical prescription. Risk of vaginal infections. Possible unpleasant side effects: weight gain, breast tenderness, mood swings. Increase of blood pressure, especially for smokers.

No

99%

Vaginal ring

No

99%

Intramuscular shots Patches

No

99%

No

99%

Implants

No

99%

Side effects (irregular menstrual bleeding or blood loss during the first three months), headaches, nausea, breast tenderness, weight gain, mood swings, acne, amenorrhea. It requires medical prescription. Possible skin rash. Possible unpleasant side effects: weight changes, breast tenderness. Patches might fall. It requires initial medical intervention. Initial high cost. Possible unpleasant side effects: weight change, breast tenderness, nausea, acne. Pre-menstrual symptoms may worsen.

Page

46

Diversex Project

INTRA-UTERINE METHODS IUD

Protection

STI

Protection pregnancy

Advantages
Considered to be the most effective reversible birth method control. It is kept in place until a medical professional takes it out.

Disadvantages
It requires medical intervention and periodical control. If pregnancy occurs, it can be complicated. Some users have experienced pain and bleeding. If instructions are not followed and bid size tampons are used, they can get tangled with IUD strings.

No

99%

SURGICAL METHODS Vasectomy (male sterilisation) Tubal ligation (female sterilisation)

Protection

STI

Protection pregnancy

Advantages
Permanent protection of unintended pregnancies. No long-term side effects. No influence in sexual pleasure. No side effects. No interference in the sexual relationship. Easy technique. Very effective.

Disadvantages
Not easily reversible. Possible surgical complications such as bleeding, infections, reaction to anaesthetic, swelling. Reversibility is not guaranteed, so having the operation has to be a very firm decision. It is not recommended for young women.

No

100%

No

99,6%

NATURAL METHODS
The calendar method The temperature method

Protection

STI

Protection pregnancy

Advantages
Very inexpensive. No devices or medicines are required. No side effects. Women learn a lot about their own bodies. Very inexpensive. No devices or medicines are required. No side effects. Women learn a lot about their own bodies. The method doesnt have any physical side effect. Users can be taught to use it by professionals and non professional volunteers without medical assistance. Learning this method increases the perception and knowledge of reproductive functions and can help couples get pregnant. Family planning responsibility is shared, which can contribute to a greater communication and cooperation. It can be used by all women who are breast-feeding. It doesnt require any devices or supplies. It offers immediate protection after birth.

Disadvantages
Not very effective, especially if calculations are wrong. Not recommended for young people. Not very effective, especially if calculations are wrong. The greatest inconvenience is that some women might not experience standard patterns of temperature, and besides body temperature may suffer variations due to the flu, stress, etc. Not recommended for young people. Not very effective. A long period of learning as well as periodical assessment is needed. The method requires a daily control of body functions, and generally, a chart has to be made; this might be unpleasant and difficult for some women. Sexual abstinence can cause difficulties in the couple and psychological tension. Women with irregular menstrual cycles might have difficulties in applying the method properly. There is a risk after more than half a year from birth, if menstruation reappears or if breastfeeding is complemented with supplemental feeding.

No

60%

No

85%

Billings or cervical mucus method

No

81%

Breast-feeding

No

94%

EMERGENCY BIRTH CON TROL

Protection

The morning after pill

STI

Protection pregnancy

Advantages
It can be used after intercourse. Possibility of carrying on with the pill regularly. It doesnt affect fertility at long-term.

Disadvantages
It must be used within 72 hours after intercourse. Its effectiveness decreases with time. It has to be found relatively quickly. It requires medical prescription. Frequent side effects. In case a dose is vomited it is necessary to make sure to repeat it. Medical professionals can refuse to prescribe it or administer it for ethical reasons.

No

75-89%

Page

47

Diversex Project

6. Abortion
The decision of having an abortion has to be felt as a personal experience. Family can be a good alternative to turn to. When someone decides to carry on with an abortion, it is important to contact the medical resources as soon as possible, so that it is safer for you. Before the 12th week, it can be done surgically using a local anaesthetic, but after that time, general anaesthetics or epidural must be used. Even before 8 weeks, RU-486 or the abortion pill can be taken. 24 hours after this pill has been taken the expulsion of the embryo and other ovular components takes place through the vagina. You must go to the medical centre again after 36-48 hours of the first intake, for the administration of a second pill and remain there for observation. After some 10-14 days a new visit has to be made to check that the expulsion has been complete. Before the intervention or taking the RU-486 an interview has to be held with a psychiatrist to dictate one of the statements by which law does not punish abortion (danger for the mothers life, reported rape, babys risk of emotional or physical damage). Most part of the interventions is made under the statement of danger for the babys mother, given that an unwanted pregnancy can be the cause of a lot of emotional disorders. Of course, nobody has an abortion just for the sake of it. The patient has to be informed about the medical, psychological and social consequences of either carrying a pregnancy to full term, or interrupting it. If interruption is chosen, the procedures can be:

Page

48

Diversex Project

Suction-Aspiration or vacuum abortion: performed vaginally, it consists in opening the cervix of the uterus and emptying it of ovular components. Risks during the procedure: tearing of the cervix and perforation of the uterus. Post-abortion complications: haemorrhage, infections. Labour Inducing abortion: for abortions later in pregnancy. It is more expensive and more traumatic, because it is similar to giving birth: the administration of drugs causes contractions of the uterus, which provokes the expulsion of the foetus. Risks of this procedure are: haemorrhage, tearing of the cervix or o damage to uterine lining. In the next step, the woman has to sign a document acknowledging and accepting the procedure, risks and follow-up treatment which she will undergo. When a woman is under age, an express consent by her legal tutor; mother, father or another adult is needed. Its not enough that an adult accompanies her through the process. After the abortion procedure, intercourse cant be practised during, at least, 15 days. It is normal to bleed as in menstruation and, in the days after the procedure, to have a slight fever.

Page

49

Diversex Project

7. Sexually Transmitted Infections


Is it ok if we do it without protection? If he has proposed me, Im sure that hes also proposed to other women. I prefer it / I only do it with condom, thank you.

7.1. How to detect an STI


Sexually Transmitted Infections are those passed through sexual contact, both by genital contact or by seminal/vaginal fluid exchange. YOU HAVE TO BE VERY CAREFUL DONT GIVE ANY SYMPTOM!
SINCE SOMETIMES THEY

In order to diagnose and treat the infection as soon as possible, it will be necessary to visit the doctor if you observe any of the following:

If you are a man:


-have the need to pee more often than normal and have a burning or a stinging feeling when peeing. -notice a yellowish or smelly discharge coming from your penis. -observe any kind of sore in the genital area, such as ulcers, warts, etc.

If you are a woman:


-feel pain in your pelvis during sexual intercourse. -have a burning or stinging feeling when peeing. -have a burning or stinging feeling in the vagina during sexual intercourse. -have more abundant flow than normal, yellowish in colour and/or smelly. - notice any kind of sore in the genital area, such as ulcers, warts, etc.

Page

50

Diversex Project

7.2. Main STI and their treatment


Name CHLAMYDIA Symptoms It is an infection caused by bacteria. Pain or burning during urination and irritation or swelling of the genital tissue, although these symptoms can go unnoticed at the beginning. It is an infection caused by bacteria. The period of incubation can be between 6 and 10 days. - Women can be carriers without symptoms. If there are, they can be: greenish or yellowish discharges, burning during urination... - Men can have yellowish discharges coming from their penis, burning when urinating. If left untreated, it can cause sterility. It is an infection caused by bacteria within 3 to 6 weeks of exposure. It develops in three stages: - First Stage: A painless red/brown sore (chancre) appears and goes away without treatment. - Second Stage: Rash on the skin and flu-like symptoms. - Third Stage: internal organs are affected. It can cause death. It is an infection caused by a virus passed through genital or oral-genital contact, since the virus can also invade the mouth. Symptoms last for approximately 20 days, and might consist in very painful bumps that subsequently become very painful open blisters. Sores may reappear, since the virus doesnt go away. HPV stands for human papillomavirus. It is passed through genital, anal-genital, oral-genital sexual contact. 3 or 8 weeks after the infection has been passed, warts appear in the genital area. It is important to control this infection, since in women it is related to cervical cancer. It is an infection caused by an excess of the fungus called candida albicans, found in most peoples bodies, which appears due to an unbalance in the vaginal flora. Symptoms are intense itching feeling, swelling and irritation of the vulva and whitish and creamy discharges. Caused by a parasite that affects mostly women. It can also be transmitted without sexual contact, such as by sharing underclothes, wet towels, etc. Itching and painful yellow-green vaginal discharge with strong odour. Men usually do not have any symptom but if they do it consists in the inflammation of the gland. Mite (tiny insect) transmitted by close personal contact (not necessarily sexual) between people. It causes a red rash and intense itching especially in the webbing between the fingers, the wrists, genitals and breasts. It is an infection caused by bacteria characterised by painful ulcers with strong odour in the genital area. They are parasites that attach to body areas where there is hair such as genitals or hair scalp. It causes an intense itching that does not disappear when scratching. HIV and AIDS attack the bodys immune system, making it difficult to fight off infections and diseases. This virus is transmitted through blood, semen, vaginal fluids and breast milk (for further information see next chapter).

Main STIs Treatment Antibiotic for those whove had the sexual contact, although there are no symptoms. Antibiotic.

GONORRHEA

SYPHILIS

Penicillin. If treated in early stages it can be easily cured.

GENITAL HERPES

Keeping a good hygiene of the areas affected and Aciclovir to improve the symptoms. Removing the warts by the specialist medical doctor.

HPV OR GENITAL WARTS

CANDIDIASIS (Thrush)

Vaginal suppositories o antifungal vaginal creams.

Oral or vaginal antibiotics.

TRICHOMONIASIS

SCABIES

Skin lotion for treatment of scabies.

CHANCROID

Antibiotics. Anti parasite cream over the whole body. There are retroviral treatments for AIDS, but none can make the virus disappear.

CRABS OR PUBIC LICE

HIV/AIDS

Page

51

Diversex Project

8. The AIDS virus


When the HIV or Human Immunodeficiency Virus enters the body, it attacks the immune system, and it eventually (it can take years) exposes the body to infections and other diseases. This group of diseases that appear because of the damaged immune system is called AIDS (Acquired immunodeficiency syndrome). When somebody has tested HIV positive we say he or she carries the virus of AIDS in their body and, although AIDS has not appeared and the person does not have any symptom, he/she can pass the virus on to other people if the appropriate measures are not taken.

How is HIV transmitted?


HIV is found massively in blood, semen, vaginal fluids and breast milk. People can catch it when a big enough amount of the virus from somebody who is infected enters the blood of another person through a wound, puncture, and injury or through vaginal or rectal fluids. Outside the blood the virus cant survive, it cant live outside the human body. In order to prevent HIV transmission, make use of the male and female condom from the first time you have intercourse (for further information about its use, see pages 21-24).

Page

52

Diversex Project

How is the virus detected?

There is no way of knowing whether someone is infected just by looking at them. Only the result of a specific blood test will tell whether someone has been infected. This blood test has to be taken 3 months after the last day a risky behaviour took place. This period of time is necessary so that the antibodies generated by our body can be detected. An early detection of the virus and its treatment can delay the development of the disease for many years and improve the quality of life for those who have developed the symptoms.

Where can you be HIV tested?

Being HIV tested is totally free of charge. It is done at Primary Health Care Centres (ask your family doctor or ask for the Sexual and Reproductive Health Care Programme); at some associations that work in AIDS prevention and treatment (see the guide of resources). For further information on the phone and confidential on any matter related to HIV/AIDS you can call the AIDS prevention and treatment programme run by the Catalan Government 900 21 22 22.

Page

53

Diversex Project

Risky behaviours

Not all sexual behaviours involve the same risk of infection Very high risk Possible risk
Oral-genital relationship (fellatio cunnilingus) Mutual masturbation

No risk

Anal intercourse

Vaginal intercourse

Caresses, intimate kisses, massages, etc.

<>

- Remember: whether someone has the HIV virus or not can only be known through a specific blood test. You cant say: "Ive known him/her for a long time", because you havent been there in his/her past sexual relationships as to know whether he or she used protection. - Any of us, no matter the age, job, aspect, etc. can get infected with HIV if the right measures are not taken to protect ourselves. The fact you are young doesnt mean you have less risk. The risk of getting infected only depends on the protection you take.

Page

54

Diversex Project

9. Sexual Rights
Sexual rights are fundamental and universal human rights. Sexuality is a part of who we are as human beings. Its full development depends on the accomplishment of basic human needs such as the desire of contact, intimacy, emotional expression, pleasure, tenderness and love. Sexualitys complete development is essential for individual, interpersonal and social wellbeing. Sexual rights are universal human rights based on freedom, dignity and equality. Since health is a fundamental right, sexual health must be a basic human right. 1. Right to sexual freedom: Sexual freedom involves any persons possibility of fully expressing their sexual potential. This excludes any form of sexual exploitation or abuse. 2. Right to sexual self-determination, integrity and safety: It includes the capacity of deciding about anyones own sexual, personal and social life within the limits of whats ethic. It includes the capacity of body control and enjoyment, free from torture, mutilation and violence of any kind. 3. Right to sexual privacy: It involves the right to make personal decisions and behave individually about ones own intimacy when other peoples sexual rights are not invaded. 4. Right to sexual equality: Opposition to all forms of discrimination, regardless of sex, gender, sexual orientation, age, race, social class, religion or physical or emotional limitation.
Page

55

Diversex Project

5. Right to sexual pleasure: Sexual pleasure including selferoticism is a source of physical, psychological, intellectual and spiritual wellbeing. 6. Right to sexual emotional expression: Every individual has the right to express his/her sexuality through communication, contact, emotional expression and love. 7. Right to sexual free association: It means the possibility of getting married, getting divorced and establishing other type of responsible sexual associations. 8. Right to make free and responsible decisions about reproduction: Right to decide having or not having children and right to have access to birth control methods. 9. Right to information based on scientific methods: Right to get sexual information through free and ethic scientific information and right to appropriate diffusion at all social levels. 10. Right to sexual education: This is a process that starts with birth and lasts the whole life. It should involve all social institutions. 11. Right to sexual health care: Sexual health care must be available for the prevention and treatment of every sexual problem, concern and disorder.

Page

56

Diversex Project

10. Useful resources


BARCELONA
Centre
Programa de atencin a la salud sexual y reproductiva. CAP de Abrera Programa de atencin a la salud sexual y reproductiva. Centro de atencin a la mujer Programa de atencin a la salud sexual y reproductiva. Centro de atencin a la mujer Programa de atencin a la salud sexual y reproductiva. Centro de atencin a la mujer Centro de Planificacin Familiar Town Abrera Alella Address Maresa, 15 Doctor Mas de Xaxars, 10 Joan Fuster i Ortells, 1 Av. Auterive, s/n Ntra. Sra. De Lourdes, 119125 Sant Pere, 81, 1r 3a Fluvi, 211 Pintor Goya, 29 Gomis, 38 Teodora Lamadrid, 47, local 1 Balmes, 52 Doctor Santpon, 60 65, baixos Junta de Comer, 23 25 Calabria, 79 Telephone 937 702 253 935 550 354

Web Site

Argentona

937 579 210

Arenys de Mar

937 958 044

Badalona

933 882 374

VIH-DA Asociacin Programa de atencin a la salud sexual y reproductiva. CAP Badia del Valls Centro de Interrupcin Voluntaria del Embarazo. Centro de Reproduccin Humana ACTUA (Vih - SIDA) Ambits Esport (Vih - SIDA)

Badalona Badia del Valls Barber del Valls Barcelona Barcelona

933 894 675 933 080 013 937 185 754

www.bcnet.upc.es/vih-da

934 185 000 934 178 500

www.interactua.net www.ambits-esport.com

Asociacin de asistencia de Mujeres Agredidas Sexualmente Asociacin CEPS. Asociacin para la prevencin y promocin de la Salud Asociacin ciudadana antisida de Catalunya Centro de interrupcin voluntaria de embarazo. Centro Casanovas de Ginecologa. Centro de interrupcin voluntaria de embarazo. Centre Mdic Les Corts, S.C.P Centro de interrupcin voluntaria de embarazo. GINEMEDEX, S.A. Centro de interrupcin voluntaria de embarazo. Instituto Ginetec, S.A. Centro de interrupcin voluntaria de embarazo. Tcnicas cientficas de Barcelona S.L. Centro de interrupcin voluntaria de embarazo. Clnica d'Ara-Agrupacin Tutor Mdica Centro de interrupcin voluntaria de embarazo. Centro Mdico Aragn Centro de Prevencin y Control de Infecciones de Transmisin Sexual. CAP Drassanes Coordinadora Gai - Lesbiana. Stop Sida Cruz Roja Catalunya

Barcelona Barcelona

934 875 760 933 456 048

www.violacion.org

Barcelona

933 170 505

www.lanzadera.com/acasc

Barcelona

934 269 734

Barcelona

Nicaragua, 128 Dalmases, 61 Espronceda, 345 Dalmases, 34

934 308 708

Barcelona Barcelona Barcelona

932 111 750 933 493 838 934 342 424

Barcelona

Bergued, 17

934 192 626

Barcelona Barcelona

Barcelona Barcelona

Federacin Catalana de ONG's SIDA Fundaci Salut i Comunitat Joves Positius. Hispanosida

Barcelona Barcelona Barcelona

Programa de atencin a la salud sexual y reproductiva. CAP Sant Mart

Barcelona

Viladomat, 158 Av. Drassanes, 19 - 21 Finlndia, 45 Joan d'Austria, 120124 Providncia, 42 Al Bei, 25 - 3 Escudellers Blancs, 1 bajos 1a Pl. de la infncia, s/n

934 511 509 934 414 612

900 601 601 902 222 293

www.cogailes.org www.creuroja.org/index.htm

932 850 873 932 440 570 933 182 056

www.gencat.es/entitats/ongsida.htm www.fsyc.org

933 070 766

Page

57

Diversex Project

Centre
Programa de atencin a la salud sexual y reproductiva. CAP Drassanes (Ciutat Vella) Programa de atencin a la salud sexual y reproductiva. CAP Rio de Janeiro (Nou Barris) Programa d'Atenci a la Salut Sexual i Reproductiva. CAP de l'Eixample Programa de atencin a la salud sexual y reproductiva. CAP de Numancia Programa de atencin a la salud sexual y reproductiva. CAP d' Horta Programa de atencin a la salud sexual y reproductiva. CAP de Sant Andreu SIDA - Estudi Centro Joven de Anticoncepcin y Sexualidad (CJAS) Red 2002 (Red Comunitaria sobre VIH/SIDA) Asesora de Salud de Begues Programa de atencin a la salud sexual y reproductiva. CAP del Bergued Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva. CAP de Castelldefels Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Centro de informacin y recursos para mujeres Centro de Planificacin Familiar. CAP Llus Millet d'Esplugues de Llobregat Programa de atencin a la salud sexual y reproductiva Planificacin Familiar. CAP Ramona Via Programa de atencin a la salud sexual y reproductiva Servicio de Informacin sobre Sexualidad y Anticoncepcin para Jvenes (SISA) Programa de atencin a la salud sexual y reproductiva Centro de Planificacin Familiar Programa de atencin a la salud sexual y reproductiva. CAP Gav Programa de atencin a la salud sexual y reproductiva. CAP Dr. Bartomeu Fabrs Angl. Programa de atencin a la salud sexual y reproductiva

Town Barcelona

Address Av. Drassanes, 17-21, 3r

Telephone 934 431 864

Web Site

Barcelona

Av. Ro de Janeiro, 83 91

932 769 910

Barcelona

C/ Manso, 19, 6

934 247 458

Barcelona

C/ Numancia, 23

934 393 421

Barcelona

C/ Lisboa, s/n

934 072 763

Barcelona

Av. Meridiana 428, 6

932 745 516

Barcelona Barcelona

Bisbe Laguarda, 4, local 4 C/de la Granja, 19-21 Bajos Sardenya, 259 3 - 4 Passeig de l'Esglsia, 1 Ctra. De Ribas, s/n

932 681 484 934 151 000

www.sidaestudi.org www.centrejove.org

Barcelona Begues Berga

637 811 796 936 390 166 938 243 400

www.red2002.org.es

Caldes de Montbui Calella Canet de Mar Castelldefels

Av. Fontcuberta, 128 Sant Jaume, 209 - 217 Via Canet un s/n Guillermo Marconi, s/n

938 654 455 937 665 950 937 942 961 936 640 554

Cervell Corbera de Llobregat Cornell de Llobregat Cornell de Llobregat El Masnou El Prat de Llobregat El Prat de Llobregat El Prat de Llobregat

Santa Anna, s/n Buenos Aires, 9 Verge de Montserrat, 1 Llus Mollet, 2 - 4

936 841 466 936 505 301 934 742 841 934 702 929

Sant Miquel, 126 Av. Verge de Montserrat, 24 Av. Verge de Montserrat, 24 2 Av. Pare Andreu de Palma, 5 - 7

935 550 291 934 792 933 934 792 933 934 785 082

Esparraguera Gav Gav

Av. Millenari, s/n Riera de les Parets, 7 Riera de Sant Lloren, s/n Riera de les Parets, s/n

937 772 427 936 383 340 936 383 400

Gav

936 383 200

Granollers

P. de l'Esglsia, 9, 4t l

938 792 424

Page

58

Diversex Project

Centre
Programa de atencin a la salud sexual y reproductiva Centro Municipal de Planificacin Familiar. Joves per a la Igualtat i Solidaritat (JIS) Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva ACTUA Valls (vih - SIDA) Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Punt Jove de Salut Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Centro de Planificacin Familiar. CAP Les Planes rea bsica de Salud Just Dona. Centro Cvico Salvador Espriu Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva

Town Igualada L'Hospitalet de Llobregat L'Hospitalet de Llobregat L'Hospitalet de Llobregat La Llagosta La Palma de Cervell Malgrat de Mar Manresa Martorell Matar Molins de Rei Mollet de Valls Montcada i Reixac Montmel Pallej Parets del Valls Pineda de Mar Premi de Mar Ripollet Rub Sabadell Sabadell Sant Andreu de Llavaneras Sant Andreu de la Barca Sant Boi de Llobregat Sant Boi de Llobregat Sant Cugat del Valls Sant Feliu de Llobregat Sant Joan Desp Sant Just Desvern Sant Just Desvern Sant Sadurn d'Anoia Sant Vicen dels Horts Sitges Terrassa Tordera Vallirana

Address Pg. Verdaguer, 170 Juan de Toledo, 22 Ronda de la Torrassa 105 3 Planta Pl. dels Ocellets, s/n Ctra. De Vic, 2 Pirineu, s/n Av. Costa Brava, s/n Soler i Marc, 6 Av. de les mancom. comarcals, 9 Rda. General Prim, 35, 1 Onze de Setembre, s/n Av. Rivoli, 7 Pg. Jaume I, s/n Pl. Ernest Lluch, 1 Pl. Mossn Cinto Verdaguer, s/n Av. Catalunya, 127, b Tarragona, 49 La Plaa, 91 - 93 Crta. N 150, c/Tarragona Nou, 28 Passeig Gaud, 31 Crta. De Barcelona, 473, 4 Jaume Brotau 2 Av. Constituci, s/n Joan Bardina, 29 Pl Montserrat Roig, 1 Mina, s/n Marquesa de Castellbell, 98 - 100 Av. Barcelona, 62, Bajos Av. Industria, s/n Tudona, s/n Gelida, s/n Crta. de Sant Boi, 108 Cam dels Capellans - Barrachina Uni, 36 Sant Ramon, 42 Joan Capri, 7

Telephone 938 031 504 932 600 034 934 219 310 933 329 273 935 749 810 936 720 805 937 619 500 938 748 416 937 751 965 937 579 210 936 802 876 935 798 381 935 754 094 935 444 440 936 630 457 935 730 744 937 671 505 937 547 710 935 942 199 935 887 373 937 271 900 937 123 603 937 952 427 936 530 049 936 351 214 936 529 843 935 891 122 936 662 290 934 775 152 934 733 375 934 738 996 938 183 929 936 566 700 938 942 754 937 885 065 937 650 384 936 832 919

Web Site

www.joves.org

Page

59

Diversex Project

Centre
Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Programa de atencin a la salud sexual y reproductiva Consulta Jove

Town Vic Viladecans I Viladecans II Vilafranca del Peneds Vilanova i la Geltr Vilassar de Dalt Vilassar de Mar

Address Pl. Divina Pastora, 6 Pg. Marina, 2 - 4 Mare de Du de Montserrat 124-126 Pl. Peneds, 1 Manel Marqus. s/n Plaa de la Vila, 8 Santa Maria, 59 - 79

Telephone 938 890 222 936 472 170 936 586 812 938 170 740 938 814 422 937 508 800 937 540 640

Web Site

Page

60