A proper comprehensive sexual education

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  • Sexual intercourse: often considered penetration of a vagina by a penis in heterosexual relationships. Sex is more broadly defined by a variety of activities including anal, oral and other types of foreplay.
  • Genetic sex: assignment at birth based on genetic characteristics of male (XY), female (XX) or intersex (see below)
  • Gender: a social construct typically pertaining to masculinity (men) and femininity (women). Gender is a spectrum and its presentation may or may not relate to one’s assigned sex. For example, men can present as feminine and women can present as masculine or anywhere in between.
    • Non-binary: people who do not identify as a single gender. They may identify as both or neither. This may affect the pronouns they prefer used when referring to them such as he, she, or they. If you don’t know how to refer to them, ask!
  • Sexual orientation: a pattern of romantic or sexual attraction to persons of the opposite, same or both sexes.
    • Kinsey scale: a scale used to describe a person’s sexual orientation based on the principal that sexuality is a spectrum.
    • Heterosexual: sexual attraction and activities between people of the opposite sex
    • Homosexual: sexual attraction and activities between people of the same sex
  • LGBTQAI
    • Lesbian: a homosexual woman
    • Gay: a homosexual man
    • Bisexual: a person who is attracted to people of both sexes
    • Transgender: a person who does not identify as the gender they were assigned at birth. They could be intersex. It is important to use the proper pronouns the person identifies as when referring to them. If you don’t know, ask!
      • Cisgender (cis): people who identify with the gender they were assigned at birth
    • Queer: an umbrella term used for homosexual people or non-cis people
    • Asexual: people who are not attracted to either sexes or not interested in sexual activities.
    • Intersex: people with sexual characteristics or chromosomes (ex. XXY or XYY) that do not fit the typical definitions of sex and gender. It is estimated that 1-2% of people are intersex.
  • Affirmative consent: a voluntary verbal agreement by partners to participate in sexual activities. This should be obtained before engaging in sex and can be revoked by anyone at any time. Consent should be enthusiastic and not coerced. The legal definition of consent varies from state to state.
    • Consent is not…
      • permanent for an individual. Just because you have had sex with someone before does not mean they will always consent to sex with you. 
      • agreement to all activities. Consent to one type of sex (ex. vaginal) does not mean consent is granted to other types of sex (ex. anal).
    • Who can consent?
      • People under the influence of substances like alcohol or drugs that can impair judgement can prevent someone from legally consenting to sex.
      • People with mental or developmental disorders may not be able to legally consent to sex.
      • People under certain ages (16-18 in the US) cannot consent to sex at any time legally. Varying “close in age exemptions" or age differentials exists to decriminalize consensual sex between two individuals where one or both are underage. These all vary from state to state.
  • Preventative measures
    • Male condoms (condom): a plastic/rubber barrier that goes over the penis or a sex toy during sexual activity to prevent the spread of STD/STIs and prevent pregnancy. 
    • Female condoms: an internal pouch that's inserted in the vagina or anus before sex for birth control and protection against STIs/STDs. 
    • Dental dams: a thin, flexible piece of latex that protects against direct mouth-to-genital/anus contact during oral sex that can spread STD/STIs.
    • Risk of sexual behaviors: having many sexual partners, having sex with a partner who has had many sexual partners, people who don’t get tested frequently, partners who do not use physical barriers of protection and partners who use injection drugs are all at a higher risk for STDs/STIs. People who receive unprotected sex, especially anal, are at a higher risk.
  • STDs (sexually transmitted diseases) and STIs (sexually transmitted infections).
    • Bacterial vaginosis (BV): a bacterial overgrowth in the vagina. In some cases, there are no symptoms in other cases, there may be abnormal vaginal discharge, itching, or odor. Testing is done during a pelvic exam by a doctor. Treatment can include a prescription antibiotic cream or medication. 
    • Chancroid: a bacterial infection that causes open sores on or around the genitals. It can be treated by antibiotics (oral or intramuscular injection) but large abscesses may need to be drained by a doctor. Uncommon in the US. 
    • Chlamydia: a bacterial infection that may not cause symptoms but can include genital pain and discharge from the vagina or penis. Common in the US. Testing is done via a pelvic exam or urinalysis. Antibiotic therapy is used for the affected patient and sexual partners. 
    • Crabs (scabies, pubic lice): tiny insects found in your genital area feeding on blood causing itching. They can get into eyelashes and eyebrows as well as pubic hair. Usually diagnosed by visual inspection. They can be killed with parasitic OTC or prescription creams and shampoos or a prescription oral medication.
    • Genital herpes (HSV): Herpes Simplex Virus which can cause both oral (HSV-1), anal and/or genital warts (HSV-2). These are painful blisters on the skin. They are common and very contagious. The diagnosis is confirmed by a swab or blood test. There is no cure but there are anti-viral treatments to prevent or shorten outbreaks and reduce transmission potential. 
    • Gonorrhea (the clap): a bacterial infection of the genitals, anus and/or throat. If left untreated, it may cause infertility. Symptoms include painful urination and abnormal discharge from the penis or vagina. This infection can present asymptomatically. Men may experience testicular pain and women may experience pain in the lower belly. It is tested for by urinalysis or swabs. It can be treated with antibiotics. 
    • Hepatitis A and B (HAV, HBV): Hepatitis A is very contagious liver virus. It causes fatigue, nausea, abdominal pain, loss of appetite, and a low-grade fever. It usually clears up in weeks to months. Hepatitis B virus is a serious liver infection. Symptoms can include yellowing of the eyes, abdominal pain, and dark urine. In chronic cases, liver failure, cancer, or permanent scarring can occur. It can be confirmed by a blood test. Chronic cases need anti-viral medication and possibly a liver transplant. It is incurable but preventable by HBV vaccine.
    • HIV/AIDS: Human Immunodeficiency Virus attacks the body’s immune system. If HIV is not treated, it can lead to Acquired Immunodeficiency Syndrome. There is no cure but with proper medical care, HIV can be controlled so patients can lead a long life and have a low risk of transmission. It may present as flu-like symptoms early on but often is asymptomatic until it progresses to the more serious AIDS so testing is key. HIV is diagnosed by a blood test however it can take up to 6 months after exposure for a positive test to show. PrEP or Pre-Exposure Prophylaxis is an oral anti-viral medication that can be used daily to lower your chances of getting HIV. 
    • HPV: Human Papilloma Virus is the most common sexually transmitted infection. There are many different types and usually HPV goes away on its own and does not cause any health problems. Some types can cause genital warts and cervical cancers but there is a vaccine to prevent these more dangerous strains for women AND men. HPV is usually detected by an abnormal pap test. Abnormal cell changes caused by HPV in the cervix can be removed or killed by freezing, cutting, lasers or electrosurgical techniques. 
    • PID: Pelvic Inflammatory Disease is a bacterial infection of a woman's reproductive organs. It is a complication of some STDs/STIs. It can lead to pelvic pain, fever and vaginal discharge. Long-term infections can lead to infertility. It can be diagnosed by a combination of a pelvic exam, blood and urine tests. It is treatable by antibiotics. 
    • Syphilis: a bacterial infection that starts as a painless sore and then a rash. Early syphilis can be cured, sometimes with a single shot of penicillin. Later stage symptoms include fatigue, swollen lymph nodes, sore throat, and/or wright loss. Without treatment, syphilis can severely damage your heart, brain or other organs and can be life-threatening. It is diagnosed by a blood test.
    • Trichomoniasis (trich):  a protozoan parasite called Trichomonas vaginalise that causes a foul-smelling vaginal discharge, genital itching, and painful urination in women. It is usually asymptomatic in men. Complications include a risk of premature delivery for pregnant women. It can be diagnosed by looking at vaginal fluid under a microscope. Treatment involves both partners taking one large dose of an oral antibiotic.
    • UTIs: a bacterial infection in any part of the urinary system. Urinary tract infections are more common in women. They usually occur in the bladder or urethra, but more serious infections involve the kidneys. A bladder infection may cause pelvic pain, increased urge to urinate, pain with urination, and blood in the urine. A kidney infection may cause back pain, nausea, vomiting, and fever. It can be diagnosed by urinalysis. Common treatment is with antibiotics. Risk is increased with sexual activity especially cross contamination of anal and vaginal sex. UTIs require immediate treatment by a doctor for full resolution. Peeing immediately after sex, breathable cotton underware, changing out of wet or sweaty clothing promptly, and staying well hydrated can reduce the risk of UTIs.
    • Yeast infections (candidiasis): are caused by the fungus candida which trigger inflammation, intense itchiness, and a thick, white discharge from the vagina. They are diagnosed by a pelvic exam often using a microscope. A single dose of an oral anti-fungal drug or application of an OTC anti-fungal cream cures mild infections. Suppositories (a pill with a drug inserted into the vagina that dissolves to deliver a drug) can also be used. Risk of yeast infections increase around frequent sexual activity, douching, scented bath products, flavored lubricants, oral sex and food play. Yeast infections are very common.  
  • Sexual Injuries:
    • Penis fracture: occurs when an erect penis is bent causing a tear in the membrane. This will cause pain, swelling and bruising. Surgery is often needed to correct the issue.
    • Vaginal or anal tearing: These surface cuts in sensitive skin often occur when a person engages in intercourse but isn't lubricated enough. Vaginal cuts generally heal quickly while anal tears may take longer. Proper lubrication, foreplay and relaxation help. Tears make it more likely to contract an STI/STD.
  • Pregnancy: when a sperm meets and egg it creates a zygote, a fertilized egg. Once a zygote implants into a uterus properly after about two weeks, it becomes a viable embryo. The embryo grows and is termed a fetus 8 weeks post conception. A typical healthy pregnancy lasts 39 weeks. Babies currently have a >90% survival rate being born after 27 weeks.  
    • Birth control and contraceptives: any method used to prevent pregnancy. Hormonal birth control requires a prescription. It can also be used to help irregular periods, polycystic ovarian syndrome (PCOS), endometriosis, acne, menstrual cramps, and low estrogen conditions.
    • The pill: an oral hormonal contraceptive that women take every day to prevent ovulation or release of an egg from the ovary. Cervical mucus is also thickened by these hormones which further decreases the chance of a sperm from reaching an egg and fertilizing it. It also thins the lining of the uterus known as the endometrium so a zygote cannot implant to create a viable pregnancy. Typical combination pills contain the hormones estrogen and progestin. One downside is forgetting to take a pill, not taking the pill at the same time every day or vomiting up a pill can increase your risk of pregnancy.
    • The patch: a thin, water proof piece of plastic that looks like a square bandage placed on a woman’s skin. It works like the pill, but you only need to change your patch once a week. This leads to higher levels of estrogen than some other methods. It may not be as effective for heavier women.
    • The implant: a very small rod inserted under the skin of a woman's upper arm to provide hormonal birth control. It's invisible and prevents pregnancy for up to 4 years. Insertion and removal are small surgical procedures. Lighter periods may result or periods stopping all together. This only contains progestin.
    • The shot: an injection of the hormone progestin that provides birth control for 3 months. It can be administered at home or by a healthcare professional usually in the upper arm or butt. 
    • The ring: a small, flexible piece of plastic that's inserted into the vagina to provide birth control. It works like the pill, but only needs to be inserted once a month. It may dislodge during vigorous sex or if improperly inserted.
    • IUD (intrauterine device): a T-shaped piece of plastic inserted into the uterus by a doctor. It provides long term hormonal contraception for 3-5 years. They can be easily removed when desired. Lighter periods may result or periods can stop all together. These contain lower levels of hormones than other methods due to its direct placement. Contains only progestin.
      • ParaGard: Copper based non-hormonal IUD can last up to 10 years. Copper produces an inflammatory reaction that creates a harmful environment for sperm preventing the fertilization of an egg. Instead of lighter periods, ParaGurad often results in heavier periods or longer periods with increased cramping.
    • Diaphragms: a dome-shaped, silicone cup that's inserted in the vagina hours before sex to prevent pregnancy. It needs to be used with spermicide to block sperm from reaching eggs.
    • Spermicides: a chemical that kills sperm. It's found in creams, lubricants, films, foams, gels, and suppositories often available at drugstores. It is used in combination with other methods of contraception.
    • Plan B or the morning after pill: A hormonal drug taken after birth control fails or after unprotected sex, that acts primarily by stopping the release of an egg from the ovary. If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the uterus. It cannot terminate a viable embryo or pregnancy. It does not require a prescription. The sooner it is taken after sex, the more effective it is but it can work for up to 72 hours after sex.
    • Sterilization: a medical method of birth control that intentionally leaves a person unable to reproduce. Sterilization methods include both surgical and non-surgical options.
      • Tubal ligation “tubes tied”: a surgical procedure in which the fallopian tubes are permanently blocked or removed preventing the release of an egg. 
      • Vasectomy: a surgical procedure where the tubes that transport sperm before ejaculation are cut or blocked to prevent sperm from entering into the urethra. Vasectomy’s can be reversed but the longer they are in place, the less likely it can be effectively reversed.
      • Hysterectomy: the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes, and other surrounding structures. Usually performed by a gynecologist for heavy periods, pelvic pain, endometriosis, unsuccessfully treated PID, adenomyosis, fibroids or prolapse of the uterus after birth.
  • Abortion: ending of a pregnancy by removal of an embryo or fetus. When done properly it is one of the safest medical procedures. Spontaneous abortion is also known as a miscarriage. You are 14x more likely to die from pregnancy or childbirth than a professional abortion in the US. 
    • Restrictions that vary by state: the age of a patient allowed to seek an abortion without parental consent, “mandatory” waiting periods, and how far along you are in the pregnancy. Waiting periods and psychological counseling are not medically necessary to receive an abortion but some states have created laws to hinder people seeking abortions. Ultrasounds or heartbeat detection are also not necessary in early term abortions but some states require them. Many states have made abortions after 20 weeks illegal, not based on an increased risk of the procedure.
    • Where to go: you can go to your OBGYN but you will often be referred to an outpatient clinic or Planned Parenthood. Crisis pregnancy centers (CPCs) masquerade as clinics but are not certified medical centers and do not perform abortions, they try to dissuade people from getting one. Be sure to do proper research on where to go.
    • Medical abortion: <12 weeks along you can get a medication or pill abortion that you can perform at home. This combination therapy is safe and effective. This often costs between $300-$800 but varies depending on state, clinic and your insurance provider.
    • Surgical abortion: is a procedure performed by a medical professional to end pregnancies and aid in partial/active miscarriages or unviable pregnancies. The cost similarly varies from $400-$1,000.
      • Vacuum aspiration or suction abortion: performed until 14-16 weeks along using a vacuum source to remove uterine contents through the cervix. Does not require dilation of the uterus.
      • D&C: dilation and curettage refer to the procedure of dilation of the cervix and surgical removal of part of the lining of the uterus and contents by scraping and scooping. 
      • D&E: dilatation and evacuation also use vacuum to assist in abortions after the first trimester. This may require an ultrasound. It is the most common type of surgical abortion.

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