Advocates for Youth

Talking Points - discussing teenage pregnancy, rights of the child and other related concerns.

Discussing teenage pregnancy, rights of the child and other related concerns
Our country has recognized the RIGHTS OF THE CHILD as well as its citizens’ REPRODUCTIVE RIGHTS; these would be the best framework for advocating for health and services that are child- and youth-friendly.

The right to life and health of the child merits enough concern for the teenage parents as their child’s well-being will be determined by the health and well-being of the teenage mother. Also, the teenage mother has the right to bank on the government and the rest of society to provide her the support systems that will ensure her good health before, during and after pregnancy.

It is also important to emphasize the RIGHT TO THE BENEFITS OF SCIENTIFIC PROGRESS. This basically guarantees a person’s right to information on, and access to, new reproductive health technologies which are safe, effective and affordable. How should we address the needs of teenagers who are already
sexually active ? How can we help them make better choices?

The key is providing teenagers the necessary information about their rights as young citizens of this country as well as their responsibilities to, and the rights of, the unborn or newly born child. It is only through understanding all these rights and responsibilities as well as the consequences of their decisions that teenagers could make an informed choice.

Oral contraceptives (pills), injectables, IUD and condoms, among others, are examples of modern methods of contraception. These methods have been clinically proven effective. Permanent methods include tubal ligation (for women) and vasectomy (for men). It is always advisable to seek a medical expert’s opinion prior to using any of these methods.

Do women naturally experience pain the first time they have sexual contact?

If there is good lubrication and preparation for sexual intercourse, it should not be painful for a woman.

Can women get pregnant by ingesting semen?

No. Pregnancy occurs only if there is a union between the ovum and the spermatozoid.

Can women get pregnant in a swimming pool?

Sperm cannot live at outdoor temperatures. Further, they need to fertilize an ovum for pregnancy to occur.

Reproductive Health Services – Both for girls and boys, for pregnant and non-pregnant teens. Adolescent Reproductive Health Services include the checkup of teens for early detection of abnormalities and possible infections in their reproductive system. They may present conditions that lead to infertility or cancers, which can be prevented if detected early. As for pregnant teens, youth-friendly medical hospitals, clinics and services must be established that would help prevent further demoralization of teenagers who are in troubled and confused situations. Privacy and confidentiality must be guaranteed to them. Support services such as counseling and referral to other established youth-friendly institutions must be in place. The principle behind all of this is caring for our health-seeking and support-seeking teenagers. We would like to shy away from the old school of thought where one who experiences teenage pregnancy or other reproductive health-related issues will be condemned, maligned and left alone to grope in the dark.

Many religious extremists are quick to equate contraception (and family planning) with abortion. This is misleading. As pointed out earlier, contraception and abortion are distinct from each other and blurring the line between the two is a tactic employed by religious extremists to dissuade people from using contraception.
It is imperative to correct misleading information, untruths, misconceptions and myths about abortion. This would be an initial step towards dispelling the common perception among the general population that abortion is immoral and evil, that women who seek abortion services deserve to be judged harshly, and that abortion service providers are immoral and unethical. Such perception is fueled in large part by the scare tactics and moralistic teachings of religious extremists.
Following is a brief discussion which is hoped to help correct some of the myths and misconceptions about abortion as well as lessen the social stigma attached to abortion.

What are the types of abortion?

Spontaneous Abortion is defined as the loss of a pregnancy before fetal viability (22 weeks gestation). The stages of spontaneous abortion may include: threatened abortion (pregnancy may continue); and inevitable abortion (pregnancy will not continue and will proceed to incomplete abortion where the products of conception are partially expelled, or to complete abortion where the products of conception are completely expelled). (WHO, 2003)
In the Philippines, 27.3% of the respondents of the 1993 Safe Motherhood Survey (SMS) reported an early pregnancy loss (either spontaneous or induced abortion). Ninety-three percent of the early pregnancy losses were reported as spontaneous.
Induced Abortion is defined as a process by which pregnancy is terminated before fetal viability. (WHO, 2003)
Unsafe Abortion is defined as a procedure for terminating pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both. (WHO, 2003)
Safe Abortion is a procedure performed by trained health care providers with proper equipment, correct technique, and sanitary standards. (WHO, 2003) However, there is more to safe abortion that the safety of the procedure itself. Frances Kissling of the Catholics for a Free Choice says that abortion safety and legality cannot be separated, as safety also means not having to fear a police raid or imprisonment when seeking and providing abortion services, and transforming abortion from a guilty secret into a socially accepted procedure that is openly available from sympathetic and well-trained providers. (Kissling, 1993)
Septic Abortion is defined as abortion complicated by infection. Sepsis may result from infection if organisms rise from the lower genital tract following either spontaneous or unsafe abortion. Sepsis is more likely to occur if there are retained products of conception and evacuation has been delayed. Sepsis is a frequent complication of unsafe abortion involving instrumentation. (WHO, 2003)

Are all abortions unsafe? Can abortion be performed safely?

Not all abortions are unsafe. Abortion can be performed safely when done by health care providers with the proper equipment and correct technique under sanitary conditions. In fact, in countries where women have access to safe services, their likelihood of dying as a result of an abortion performed with modern methods is no more that 1 per 100,000 procedures. In developing countries where most unsafe abortions occur, the risk of death following unsafe abortion complications is several hundred times higher that that of abortions performed professionally under safe conditions.
It is basically the illegal nature of induced abortion in this country that makes abortion unsafe for women. In counties where abortion is legal, it is generally performed early in pregnancy by a skilled practitioner under safe conditions. Induced abortions under these circumstances are therefore safe procedures that pose even lesser risk than carrying full-term pregnancies (Table 1). In addition, the experience of some countries has shown that legalizing abortion helps reduce or eliminate women's deaths related to abortion. For instance, when Romania legalized abortion, its abortion-related mortality rate fell to one-third of its peak level. The death rates due to abortion decreased 85% five years after its legalization in the United States. Where access to legal abortion was liberalized such as a Barbados, Canada, Tunisia and Turkey, abortion rates did not increase. (Center for Reproductive Rights, 2000)

TABLE 1. Risk of Death Associated with Birth Control Methods, Pregnancy, and Abortion

	Chance of Death in a Year
Birth control pills (nonsmoker)	1 in 66,700
Birth control pills (heavy smoker, 25 or more cigarettes per day)	1 in 1,700
IUDs	1 in 10,000,000
Barrier methods	None
Natural methods	None
STERILIZATION :
Laparoscopic tubal ligation	1 in 38,500
Vasectomy	1 in 1,000,000
PREGNANCY:
Terminating pregnancy:
Illegal Abortion	1 in 3,000
Legal Abortion:
Before 9 weeks	1 in 100,100
Between 9 and 12 weeks	1 in 100,100
Between 13 and 15 weeks	1 in 34,400
After 15 weeks	1 in 10,200
Risk per pregnancy from continuing pregnancy	1 in 10,000 (underscoring ours)

Adapted from: R. Hatcher et.al., Contraceptive Technology, 17th rev.ed. (New York: Irvington
1998), Table 9-4, in Boston Women's Health Book Collective, Our Bodies, Our Selves for the New Century. 1998. New York: Simon and Schuster. Note: The table does not take into account other factors such as social class, race, nationality and pregnancy history.

Does abortion cause breast cancer?

Major medical and cancer organizations in the United States have issued statements disputing claims that abortion increases a woman's risk for cancer or that women who have abortions get a deadlier form of cancer. The National Cancer Institute, for one, concluded, "There is no direct evidence of a direct relationship between breast cancer and induced abortion."

Does abortion cause infertility?

There is no credible research evidence linking induced abortion with infertility. Abortions done under safe conditions by experienced providers are not likely to cause complications, like infections, which may cause infertility. Neither does this procedure make it more difficult to carry a future pregnancy to term. It is unsafe abortions that cause not only complications that may lead to infertility, but also the unnecessary deaths of women.

Is there such a thing as a post-abortion syndrome?

As defined by anti-choice groups, the so-called post abortion syndrome (PAS) is a "post traumatic stress disorder commonly experienced by women who have had one or more abortions." Its symptoms supposedly include "anxiety, suicidal impulses, regret/guilt, self-destructive behavior, sadness," and so on. However, the American Psychological Association (APA) concluded that legal abortion "does not create psychological hazards for most women undergoing the procedure" and that "data from [a] long-term study demonstrate that even highly religious women are not at significantly greater risk of psychological distress because they had an abortion." Serious emotional problems following abortion are uncommon. Research results show that most women report a sense of relief, although some may experience temporary depression. In fact, psychological disturbances after childbirth (post-partum depression) occur more frequently than after abortion. What needs to be looked into is the extend to which social biases against women and abortion contribute to the psychological disturbances women experience.

Will the availability of sex education or contraceptive information and services encourage teenagers to have sex, and maybe even bad to abortion in the event that pregnancy happens?

Teen sex happens because of complex societal causes, including peer pressure and perhaps sexually-oriented TV, movies and advertisements. The availability of contraceptive information and services do not give rise to teen sex. Reality dictates that these services in conjunction with non-judgmental sex education be made available to help teens make responsible decisions about their sexuality and prevent them from becoming parents at a time when they are not yet physically, emotionally and economically prepared.
We can no longer close our eyes to the fact that some teenagers do have a sex, get pregnant at a time when they are not yet ready, seek abortions, and sometimes even die due to maternal causes. These are the facts:
15% of young adult females and 31% of young adult males have engaged in "premarital sex" (YAFS3)
2% of births are to teenage women less than 18 years old (NDHS 1998)
20% of births to teenage women are unplanned (NDHS 1998)
8.5 % of women who undergo abortion are teenagers, 42% of whom had undergone abortion more than once (Raymundo and Cruz, 1999)
6.3% of women who died of maternal causes in 1998 are below 19 years old (VSR 1998)
These statistics point to the fact that teenagers have limited access to very essential reproductive health information and services. Turning a blind eye to these problems will not make these go away. The government's and society's continuing refusal or reluctance to confront the issue to teenage sexuality will mean that teenage women will continue to be exposed to the risks of early and unwanted pregnancies that pose a threat to their health and quality of life. Such a situation could lead them resort to unsafe abortions.

Status of laws on abortion
Different countries have different laws on abortion. There are some countries that severely restrict abortions while there are countries that permit abortions without restrictions as to reason. Table 2 shows that around 74 countries covering 26% of the world's population have adopted laws that restrict abortions while there are 121 countries covering 74% of the world's population which permit abortions on various grounds. Of these 121 countries, 54 (covering 40.5% of the world's population) allow abortions without restriction as to reason. Included in these countries are the United States of America, Canada, many European countries, Bahrain, South Africa, China and Italy (where the Vatican is located).

Most of the world's women do not control when, with whom and with what protection, if any, they have sexual relations.
This powerlessness is most acute in developing countries where HIV prevalence is highest (20-30% in women) and where the epidemic is escalating.
Women's most urgent need - and arguably the world's most urgent need in relation to HIV/AIDS - is for a prevention technology which women control themselves.
Now rather than later, lack of power and autonomy is the root cause of women's vulnerability. But empowerment will take generations!

Why must the technology be controlled by women?

We know from experience with contraceptives that when women control use and when they do not need to involve their partners, the method is used more effectively.
Condoms (male or female) offer protection but they are not used and women cannot control their use. Studies have shown very low use of male condoms even in favourable circumstances.

What is a microbicide?

A microbicide is any substance that can substantially reduce transmission of sexually transmitted infections (STIs) when applied either vaginally or rectally. While no effective microbicidal products are currently available, potential products could be in the form of:
Gels
Creams
Films
Sponge or vaginal ring
Suppositories
Contraceptive and non-contraceptive formulas
A cream, gel or suppository that can be discreetly inserted into the vagina before sex. Ideally it would kill or block not only HIV but also other sexually transmitted infections. For the many women, especially in developing countries, wanting to have children, we also need a microbicide which is not a spermicide.

Who needs microbicides?

15 million new STI cases are reported each year in the U.S., translating into 42,000 new infections each day. Roughly one half of individuals infected with STIs contract lifelong infections.
Two-thirds of new STI infections occur in people younger than 25 years of age. .Biologically, women are four times more vulnerable to HIV and are the fastest growing group with HIV/AIDS in the country. They accounted for 23% of new AIDS cases and 32% of new HIV cases in 2001.
African-American women and Latina women suffer disproportionately from HIV/AIDS: though only 23% of the female population in the US, they account for 76% of AIDS cases reported among women.

Why is there a need for methods of disease prevention that women initiate?

Many women lack the power within relationships to negotiate condom use and the social and economic resources to abandon partnerships that put them at risk. .Anatomical differences place women at a greater risk of contracting STIs than men.
Age-related changes in the cervix make risk of infection even higher for adolescent women.
Heterosexual sex, once the source of only a small fraction of HIV infections, now accounts for three out of four new infections in women.

Why are STIs a major health concern?

All STIs, both those that create visible, open sores and those that are invisible and asymptomatic, increase a woman's risk of contracting HIV. .Pelvic Inflammatory Disease (PID) is a common result of undetected or untreated STIs. As many as 100,000 U.S. women may become infertile and 45,000 may experience a dangerous ectopic pregnancy as a result of PID.
Researchers estimate that at least one in four Americans - and maybe as many as one in two - will contract an STI in their lifetime.
The total cost on the US economy of STIs, excluding HIV infection, was approximately $10 billion in 1999 alone. That number rises to $17 billion when the economic costs associated with HIV are included.
In parts of sub-Saharan Africa, as many as one in four people are infected with AIDS, 55% of them are women. Nearly 25% of 15- to 19-year-old girls are infected with HIV compared with 4% of their male peers.
More than 10 million children under the age of 15 have lost one or both parents to AIDS worldwide.

What options exist for detection, treatment and prevention of STIs?

Many women who contract STIs do not experience symptoms, making detection difficult. Screening of asymptomatic women is the only way to detect many infections. While cost-effective technologies for STI screening exist, routine screening is not common because of lack of awareness among healthcare providers and lack of resources for screening activities.
Bacterial STIs can often be treated and cured with antibiotics, especially if diagnosed early. We have no cure for viral STIs, but symptoms associated with the infection can be remedied. Treatments for HIV/AIDS, including antiretroviral drug therapies, are often successful in reducing the amount of the virus in the body. .Adequate and appropriate treatment for STIs, especially for HIV/AIDS, is often not available to the under- and uninsured. Those most affected by and infected with HIV/AIDS often lack access to treatment options.
Abstinence and consistent condom use are the only effective methods of STI prevention available. These are not feasible options for some women. .Aside from the female condom, no woman-initiated methods of STI prevention are currently available.

Why might women be more likely to protect themselves if microbicides were available?

Microbicides are less intrusive than condoms, could be applied in advance of intercourse, and could be used without the partner's knowledge.
Even if microbicides were theoretically less efficacious than condoms, they may be more effective in prevention of STIs due to greater consistency and prevalence of use. In other words, microbicides could have a greater protective effect in practice than condoms because they might be used more often and more consistently.

Do products which contain N-9 help prevent STIs?

Clinical trials have shown N-9, the active ingredient in most over-the-counter spermicides, has not been effective in preventing HIV transmission and is not recommended as a method of STI prevention.

Why so little research?

Sixty candidate microbicides are in the pipeline; but none will be available to the public very soon.

Research and Development is being done by small biotechnology companies, individual academic researchers, on shoestring budgets.

Development costs tens of millions of dollars which only the big pharmaceutical companies have.

Trials must meet high ethical standards, e.g. all women enrolled must use both condom and microbicide; huge numbers of participants required and will be very costly.

Microbicides are not seen as profitable; principle market being poor women. Advocates argue that the potential market is larger than this.

Some advocates say candidate microbicides should be distributed at low cost to women in need, before further testing. They are generally regarded as safe, we just don't know how well they work - 80% or 30% efficacy.

Sources:
1. Centers for Disease Control and Prevention. Tracking the Hidden Epidemics: Trends in STDs in the United States, 2000. Report prepared for the 2000 National STD Prevention Conference, Milwaukee, Wisconsin.

2.Emron. STD Update: Incidence Trends and New Screening Tests. The Contraception Report. 2000; 2(3); 4-10.

3.Heise, Lori. Topical Microbicides: New Hope for STI/HIV Prevention. CHANGE, 2000.

4.The Rockefeller Foundation Microbicide Initiative. Mobilization for Microbicides: The Decisive Decade. 2002

5. WHO Fact sheet 246 June 2000.

What is Emergency Contraception (EC)?

Emergency Contraception is a safe and effective birth control method that can prevent pregnancy after unprotected intercourse or contraceptive failure through the use of hormonal (pill) or non-hormonal (intrauterine device - IUD). The most common form of emergency contraception is emergency contraceptive pills (ECPs), which contain high dosages of the same hormones found in daily birth control pills - estrogen and progestin or levonogestrel.

Is EC the Same Thing as the "Morning-After Pill"?

Some people like to call it the "morning-after pill," although a woman can take her first dose of EC up to 72 hours (about 3 days) after unprotected intercourse or birth control failure (i.e., the condom broke, etc.) and the second dose 12 hours after the first one. The process of using the emergency contraceptive pill method involves taking two doses of pills, twelve hours apart. It is important that a woman takes the first EC pill as soon as possible and not later than 72 hours and should remember to take the second dose after 12 hours.

How do ECPs work (mechanism of action)?

Emergency contraceptive pills do not cause abortion. The World Health Organization (WHO) studies and other experts confirm that emergency contraceptive pills can not dislodge or interrupt pregnancy. ECPs take effect before pregnancy. ECPs inhibit or delay ovulation, have effect on the ovulation that interferes with the migration of spermatozoids from the uterine cervix to the tube, and prevents the implantation of a fertilized egg in the uterus. All the processes take place before pregnancy. Implantation of a fertilized egg (zygote) takes 5 to 7 days. ECPs are taken within 3 days from sexual intercourse. It should be noted that even without any intervention of ECPs, not all sexual intercourse results in fertilization of an egg. However, to ensure that pregnancy is prevented after unprotected sex and to allay one's anxiety over unwanted pregnancy, women should take the ECPs.

Can ECPs be considered abortive?

No, ECPs cannot interrupt or harm pregnancy. ECPs act in the same form as most modern contraceptives except for the fact that it s administered after and not before sexual intercourse. It should not be confused with Mifepristone (RU486), popularly known as the "French pill," that is capable of interrupting a pregnancy. ECPs (combined ethinyl estradiol and levonogestrel or progestin [levonogestrel] - only pills) prevent pregnancy while Mifepristone (RU486) can interrupt pregnancy. ECPs take effect before pregnancy, while Mifepristone take effect after pregnancy started. The World Health Organization tested levonogestrel in many countries and found out that the use of levonogestrel alone as an emergency contraceptive is more effective and much better tolerated by women.

When should ECPs be used?

To prevent pregnancy, ECPs should be taken within 72 hours after intercourse when:
No contraception is used.
A contraceptive method failed (i.e., condom breaks or slips).
Contraceptive pills are missed or incorrectly used.
Coercive sex or rape took place
Emergency contraceptive pills are more effective the sooner they are taken
After unprotected intercourse. It should be taken only in emergency situations such as stated above and should not be taken as a regular contraceptive because its effectivity is reduced with repeated or constant use.

Any woman of reproductive age who has had unprotected intercourse and who:
Does not want to become pregnant.
Does not have contraindications.
It is not recommended that women use ECPs as a regular contraceptive method because studies have shown that repeated and constant use of ECPs decrease its effectivity. ECPs should only be used in emergency situations. If a woman is sexually active and does not want to become pregnant, she should use the regular contraceptive pills and not the ECPs.

What are the advantages of ECPs?

It is safe, effective and easy to use.
It can be used any time during the menstrual cycle.
No office visit or physical exam is required.

What are the disadvantages of ECPs?

Are there any side effects associated with ECPs?

As with most medications and contraceptive pills, there are possible side effects, depending on each woman. The possible temporary side effects are:
Nausea Vomiting Headaches Dizziness Fatigue
Spotting or bleeding
Breast tenderness
These side effects are more common in combined pill regimens. Progestin or levonorgestrel-only pills have less side effects. The temporary side effects generally do not last more than 24 hours.

What kinds of emergency contraceptive pills are available?

In the United States, there are two "dedicated" emergency contraceptive pills currently approved by the Food and Drug Administration (FDA). One is Preven, a combination of estrogen and progestin, and the other one is Plan B, which contains Progestin (levonogestrel) only. In Asia, there are several brand names, such as Yu Ting and Hui Ting, Madonna, and Postinor. In Southeast Asia, ECPs are available in Burma, Malaysia, Singapore and Thailand. It is in the process of registration in Indonesia. In the Philippines, Postinor was registered in April 2000, but was subsequently delisted by the Bureau of Food and Drugs (BFAD) in December 2001 before women even knew of its existence. The delisting of Postinor (levonogestrel) in the Philippines is believed to have been instigated by religious groups who are against contraception and who are actively disseminating misinformation by falsely claiming ECPs to be an "abortifacient" in spite of the fact that the World Health Organization and experts have already endorsed it as a safe contraceptive and that it can not interrupt or harm pregnancy. Regular contraceptive pills can also act as emergency contraceptives if taken in higher doses, depending on the progestin content of the different pills. This requires a doctor's assistance to determine the correct dose.

How can women get ECPs?

In some countries where ECPs are available, a doctor's prescription is required. However, in some States in the United States such as in California and Washington, ECPs are available over the counter (without need of doctor's prescription).

What is the principle behind Natural family planning method?

The basic priniciple is to determine the fertile periods of a woman using the physiologic signs and symptoms.

What are the various types of NFP?

Basal Body Temperature (BBT)
Cervical Mucus Method / Billing's Ovulation Method
Sympto-Thermal Method
Lactational Amenorrhea Method (LAM)
Cycle Calculation Method / Calendar Method / Rhythm method

What is the overall Actual Failure rate of NFP?

What are the indications as to when we can provide NFP?

for women who do not wish to use other contraceptive methods because of health or religious or personal beliefs
for women who want to use a less effective method of family planning

What are the advantages of NFP?

Widely acceptable ; no known side effects
Used either to delay or to achieve pregnancy
Promotes self-awareness and knowledge of the human reproductive functions.
Promotes shared responsibility between couples

What are the disadvantages of NFP?

It requires commitment, cooperation, and open-communication between partners
Requires daily record of signs and symptoms of fertility
"Emotional stress" experienced by some couples due to the need to abstain from intercourse during certain days

What are the contraindications of NFP?

What are the pre requisites before giving NFP?

To get client history and physical examination is not strictly necessary.
Client education is very important; it requires intensive training of both partners

What is the principle behind BASAL BODY TEMPERATURE (BBT)?

during menses, a woman's BBT changes from a lower to a higher level
before ovulation (estrogen dependent), the temperature pattern is at a lower level
shortly before, during ovulation (progesterone dependent) the BBT rises
"THERMAL SHIFT"(TF)
0.4 - 1.0 deg Fahrenheit
0.05 - 0.2 deg Centigrade
Note :
ovulation occurs 1 to 2 days before the "thermal shift" or on the day of the thermal shift
ovulation can occur :
- 1 day after the "thermal shift"
- or rarely 3-6 days before the "thermal shift"

What are the important pointers to remember in BBT ?

BBT pattern changes from a lower to a higher level during menses.
by monitoring her BBT, one can determine her infertile phase.
safest way to avoid pregnancy is to avoid intercourse all throughout the cycle until after BBT rises and remains high for 3 days.
The following affects BBT monitoring :
sore throat
colds and flu
fever
toothache
vomiting
diarrhea
anxiety
sunburn
medications
travel
sleep disturbances
alcoholic beverages

Take temperature every morning upon waking up and before any activity.
If not possible, take the temperature about the same time everyday after at least three hours of undisturbed rest.
Take the temperature (under the tongue, in the vagina, or in the rectum). The temperature should be taken in the same manner/site throughout the cycle. Rectal and vaginal temperatures are usually higher than oral temperatures.
Leave the thermometer in place for five minutes.
Read and record the temperature immediately after taking it.
Record it on a chart by placing a dot in the center of the box that matches the temperature printed on the left side of the chart. Connect the dots marking the temperature on a daily basis so as to see the pattern.
Record any unusual event such as illness, worry or any changes in the lifestyles.

It is the point of reference to determine the thermal shift due to ovulation.
This is determined by the following:
identify the first 10 temperatures of the cycle
disregard the temperatures for D1 - D5
find the highest temperature from D6 - D10
draw a horizontal line on the highest temp from D6 - D10. This is the coverline.
ABSOLUTE INFERTILE PHASE DAYS :
- From the rise in the temperature due to ovulation, wait for 3 consecutive days above the coverline.
- Intercourse is allowed from the 4th day of the thermal shift until the end of the cycle. This is infertile phase of the cycle.

What is the principle behind the CERVICAL MUCUS METHOD?

- uses the changes in the cervical mucus consistency as to predict ovulation and to determine when it has occurred.
1) After menses ends
most women - no mucus
vagina feels dry
these are called dry days
2) After the dry days
mucus - sticky, pasty or crumbly
color - white or yellow
vagina - still dry, little sticky
these means that ovulation is coming, this is considered a fertile time
3) As ovulation gets nearer
mucus - welt, increases in amount
color - clearer
4) At the time of ovulation
mucus - very wet, stretchy and slippery (raw egg white)
vagina - feels very wet
this will last for several days
the last day of the wet and slippery mucus is called the peak day
5) After ovulation
mucus - very sticky, and pasty, decreases in amount

How do we use CERVICAL MUCUS METHOD?

- requires the woman to observe what she feels and sees at her vulva and record
1) Begin checking the mucus - WHEN ?
the menses ends or becomes lighter
there is no prior sexual intercourse, and
a woman is not sexually stimulated
2) Check the sensation of wetness and dryness while standing
3) Inspect underwear regularly for the presence of mucus
4) Wipe across the opening of the vagina with a piece of clean tissue paper, clean cloth or clean finger.
5) Using the middle/index finger and the thumb, test the consistency, the slipperiness, the stretchiness and the color of the mucus.

What is the principle behind SYMPTO-THERMAL METHOD (STM)?

it is a combination of Basal body temperature (BBT) and Cervical mucus method as well as other signs that help identify her fertile time.

What are the "OVULATORY SIGNS" ?

dull ache or sharp pain in the area of the ovary lasting from a few minutes to a day or two
fluid retention (swelling of the hands and feet)
increase or decrease in sexual desire
slight bleeding for one or two days may occur (noted during ovulation)
AFTER OVULATION (BEFORE MENSES)
oily skin and hair, pimples or increase in acne
uterine cramps
low back pains
craving for sweets and/or salty foods
breast tenderness
increase or decrease in sexual feelings

The acceptor of this method is required to observe her BBT, cervical mucus and other and to record them in a chart.

1) Intercourse can occur during the first 5 days of the menstrual cycle if the peak day and thermal shift rules were applied
2) Menstruation days are relatively
infertile days - average or long cycles
fertile days - short cycles
3) After menses, intercourse can occur on the evening of every other dry day during the infertile days before ovulation
4) The first day a woman observes any type of mucus or when she begins to feel wet sensation, it is the beginning of the fertile phase.
5) Couples abstain from intercourse until the peak day rule and thermal shift rules have been applied whichever comes later.

What is the principle behind the LACTATIONAL AMENORRHEA METHOD (LAM)?

it involves post-partum women
effectiveness of breastfeeding as a contraceptive is brought about by the increased sucking frequency
RETURN OF OVULATION :
- MOST WELL BREASTFEEDING WOMEN - 4-12 and even up to 24 months
- NON-BREASTFEEDING WOMEN - as early as 1-2 months after delivery

What are the forms of voluntary surgical forms of contraceptions (VSC)?

FEMALE SURGICAL CONTRACEPTION (TUBAL LIGATION)
MALE SURGICAL STERILIZATION (VASECTOMY)

ALMOST 100% EFFECTIVE
involves the cutting ligation and tying of the fallopian tubes
2 TYPES : 1) MINI-LAPARATOMY; 2) LAPAROSCOPY
OPERATIVE PROCEDURE : 10-20 MINUTES
ANESTHESIA USED : LOCAL
1) MINI-LAPAROTOMY
3 cm abdominal incision
above the symphysis pubis
2 types:
    a) interval minilaparotomy
    - 1st 7 days of menstrual cycle or anytime within the woman's cycle of pill intake or if she has an IUD
    - incision : above the symphysis pubis
    b) postpartum minilaparotomy
    - 1st 8 weeks after a normal delivery
    - incision : below the umbilicus/navel above the level of the fundus of the uterus
2) LAPAROSCOPY
a 1-5 cm abdominal incision below the umbilicus
a laparoscope is inserted
uses electrocautery or fallopian rings or clips

What is the principle behind female VSC?

What are the indications for TUBAL LIGATION?

couples who have enough number of children they desire
women who cannot practice any other family planning methods (religion, cultural, or personal beliefs)
women whose child-bearing is dangerous (high risk)

What are the advantages of TUBAL LIGATION?

inexpensive
can be done on an out-patient basis
easily performed
does not affect the female hormonal balance
does not lessen the couple's sexual desire and enjoyment
decreases the maternal and child mortality and morbidity risks when done before or during the woman's high-risk period

What are the disadvantages of TUBAL LIGATION?

it is a permanent procedure ; it is hard to reverse
needs a trained surgeon to do it
cannot be prescribe for those below 25 years or with less than 2 children
psychological and emotional preparations needed

What are the various components to consider in the provision of tubal ligation ?

SCREENING OF CLIENTS
- pelvic infection, which should first to be treated before VSC
- a systemic or localized infection
- medical problems (heart disease, diabetes, bleeding tendencies)
- obesity
- pregnancy
- previous surgery (adhesions)
COUNSELING
- procedure is permanent
- no effect on the sexual and other body functions
- possible risk of failure
COMPLETE PHYSICAL AND PELVIC EXAM
LABORATORY EXAMS
INFORMED CONSENT FORMS
- signed by the client
- witnessed by her husband

What are the various rumors/misconceptions on tubal ligation (TL)?

Tubal ligation results in the loss of sex drive.
Tubal ligation stops menstruation and leads to premature menopause.
Tubal ligation is not suited for women whose activities entail lifting of heavy objects or other strenuous activities.

What are the other information needed by patient on TL?

Surgery is done on the 1st half of the cycle when she had no sexual contact, or within the first 3 days of delivery.
After surgery,
    - 2 days rest is required
    - no sex or any hard work for 1 week
    - lower abdominal discomfort for a few days
    - wound care

What are the danger signs to watch out in TL?

When is check up conducted after TL?

1st - after 1 week
2nd - after 1 month
3rd - after 3 or 6 months subsequent yearly check-up-Pap smear

1 cm skin incision made in the scrotal sac
vas deferens is tied and cut
failure rate : 1:1000 cases due to :
    - unprotected coitus before reproductive tract
    - spontaneous recanalization
    - occlusion of the wrong structure
    - undiagnosed duplication of the vas deferens

What is the principle behind vasectomy?

What are the indications of vasectomy?

couples who have enough number of children they desire
men whose wives cannot practice any other FP methods whether permanent or temporary

What are the contraindications of vasectomy?

single, childless men
unhappily married men
men who are undecided as to whether they would still like more children

What are the advantages of VASECTOMY?

convenient
effective and reliable
safe, simple and easy to perform
does not affect male hormonal balance
does not lessen the couple's sexual drive it may even enhance it
inexpensive

What are the disadvantages of vasectomy?

being permanent, it is hard to reverse
it needs a trained doctor do it
cannot be prescribed to those below 25 years and with less than 2 children
emotional and psychological counseling required

What are the components in the provision of VASECTOMY ?

SCREENING OF CLIENTS
They should not have the following problems :
    - local skin infection or genital tract infection
    - hernias and other related pathology of the male genital tract
COUNSELING
permanent nature of the procedure
absence of effect on libido and other sexual failure
risk of failure
COMPLETE HISTORY/PHYSICAL EXAM
HISTORY WITH EMPHASIS ON THE FOLLOWING :
    - scrotal/inguinal operation
    - bleeding disorders
    - drug allergy
    - STDs
    - UTI
PHYSICAL EXAM FOCUSES ON :
    - thick scrotal skin
    - scrotal mass
    - hernia
    - elephantiasis
    - varicose
INFORMED CONSENT FORM

What are the rumors/ misconceptions about VASECTOMY?

Vasectomy is castration or "kapon"
Vasectomy results in the loss of male characteristics such as body hair, low pitch voice, sexual power, and ultimately, in impotence and homosexuality.

What are the other things that clients need to know about vasectomy?

Inform the client about the mechanism of action of the method as well as the technique of the operation
After surgery,
client should return at home to rest for 2 days
ice pack on the scrotum for at least 4 hours
client may resume sexual intercourse, but he must use barrier methods (condoms)
tubes will not clear of sperms until after 15-20 ejaculations
wound care, he should not bathe the area for at least 2 days

What are the danger signs after vasectomy?

When is check up after vasectomy done?

What are the essential points to consider in VSC?

IMPORTANCE OF COUNSELING :
considering the method is permanent
surgical procedure
NEUTRALITY IN COUNSELING
one should not persuade or influence people to choose one method over the other
one should assess clients' knowledge about the different FP methods
one should give information they lack, help them apply the facts about FP to their own circumstances so that they can make their own well-considered, free and informed decisions.

What are the special considerations for VSC counseling?

(PEOPLE WHO MAY LATER CHANGE THEIR MINDS)
young couples
couples with children
couples with unstable union
clients pressured by spouse to undergo VSC
a client who has made a hasty decisions
a client who has decided under stress (while under labor pains, immediately following delivery or abortion).
a client whose future goals are limited to home and family
a client with unrealistic expectations of VSC

What are the expectations about reversal ?

sterilization reversals is not available in most places
clients should be made to understand the chances of reversing the procedure is low
the reversal is costly and involves complications (ectopic pregnancy)
lengthy surgery

What are INTRA UTERINE DEVICEs (IUD)?

a small device introduced to the uterus to prevent pregnancy
two types :
    1) Lypes Loop
    - S-shaped with two strand tail
    - effectivity : 96-99%
    2) Copper T 380 A
    - T-shaped with a coil copper wrapped around its stem and arms
    - effectivity : 98-99%

What is the mechanism of action of IUD?

directly preventing fertilization through biochemical changes
interferes with the transport of sperm in the genital tract
decreases the number of viable sperm
speeds up the ovum transport through the fallopian tubes

What are the advantages of IUD use?

no systemic effect
easy to use
less instructions to remember
does not interfere with sexual intercourse
not messy
safely used during lactation
can be used without other people knowing
less expensive than pills

What are the disadvantages of IUD use?

danger of expulsion
must be inserted by a trained health worker
temporary side effects : mild abdominal pain

made of latex that fits over the erect penis
effectivity : 98% (consistent and correct use)

What is the mechanism of action of condoms?

What are the advantages in using condoms?

Encourages male participation in reproductive health.
relatively inexpensive
can be bought over the counter
easy to use and carry
used only when needed
protection against HIV/AIDS and STD
prevents cervical cancer
prevents messy post - coital discharge of semen

What are the disadvantages of using condoms?

loss of sexual arousal
reduced sensitivity of man's penis
allergic reactions
breakage of condom when not correctly used

What is a DIAPHRAGM?

small rubber cup that fits inside the vagina over the opening to the uterus
three types :
    1) Flat-spring rim
    2) Coil-spring rim
    3) Arching-spring rim
effectivity : as high as 98% as low as 80%

What is the mechanism of action of diaphragms?

a device that holds the spermicidal cream
barrier placed in the vagina covering the cervix

What are the advantages of diaphragm use?

very few side effects
used only when needed
can be placed 2 hours before intercourse
good for pregnant or breastfeeding women

What are the disadvantages of diaphragm use?

allergy to rubber or spermicides
foul-smelling vaginal discharge
pelvic discomfort or pressure on the rectum or bladder
vaginal ulceration

What are CERVICAL CAPS?

cup-shaped device that fits over the cervix and is held in place at least partially by suction
three types:
    1) Prentif cavity rim
    2) Dumas cup
    3) Vimule cap
effectivity : as high as 90% and as low as 70%

What is the mechanism of action of cervical caps?

prevents sperm from entering the uterus
device to hold spermicidal cream against the cervix

What are the advantages of cervical cap use?

can be left for more than 24 hours
can be inserted many hours or even a day or two before intercourse
needs only a small amount of spermicides

What are the disadvantage of cervical cap use?

What are ORAL CONTRACEPTIVES PILLS (OCP)?

composed of synthetic hormones which prevents pregnancy when taken regularly
three types:
    1) Combined Monophasic - contains synthetic estrogen progesterone in a fixed dosage, effectivity is 99.6%
    2) Combined Multiphasic - composed of progesterone and estrogen
    3) Progesterone - only pill, effectivity is 97%

What is the mechanism of action of OCPs?

Primary Action
suppressing the release of gonadotrophin releasing hormone (GnRH)
directly inhibiting release of follicle stimulating hormone (FSH) and lutenizing hormone (LH)
Secondary Action
thickening of the cervical mucus
inhibits follicle development in the ovary
inhibits sperm penetration into the ovum
inhibits ovum transport to the uterus

What are the advantages of OCP use?

reduces dysmenorrhea
regulates menstrual cycle
reduces menstrual blood flow (useful to anemic women)
decreases premenstrual syndrome
preserves reproductive ability
decreases risk of severe form of P.I.D.
decreases risk of ectopic pregnancy
decreases risk of ovarian & endometrial cancer
decreases rate of benign breast disease
decreases incidence of acne
does not interrupt sex
can be stopped anytime

What are the disadvantage of OCP use?

supply of pills
compliance
minor side effects: nausea, headache, and breakthrough bleeding

What are the DANGER SIGNS OF PILL INTAKE?

A - abdominal pains, gallbladder disease, blood clots, pancreatitis
C - chest pains, coughs, shortness of breath, blood clots in the lungs, heart attack
H - headaches, dizziness, weakness, numbness, stroke
E - eye problems, speech problems, stroke
S - severe leg pains, blood clots in legs
Other signs :
depression, jaundice, breast lump

What are INJECTIBLES?

are progestin-only, long acting contraceptives that provide protection from 2 to 3 months for each injection
effectivity : 99.6%
2 most commonly used:
1) DMPA or Depo-Provera
2) Net or Norigest or Noristerat

What is the mechanism of action of injectables?

inhibits ovulation
thickens the cervical mucus
less blood supply to the lining of the uterus

What are the advantages of injectable use?

highly effective, long-lasting, and safe
protection against endometrial and ovarian cancer
no serious complications associated with estrogen containing pills
does not interrupt sex
most confidential method
prolonged amenorrhea, beneficial to some women
does not affect breastfeeding

What are the disadvantages of injectable use?

breakthrough bleeding or spotting
frequent amenorrhea
delayed return of fertility (18 months)
weight gain
decrease libido, depression, headaches, dizziness, allergic reactions, heavy bleeding

What are INJECTABLE IMPLANT CONTRACEPTIVES?

are progestin-only contraceptives implanted beneath the skin for long term use, ranging from 6 months to 5 years
effectivity : 98.99%
3 types:
    1) Norplant - most widely used
    2) Biodegradable implants - Copronor
    3) Injectable microspher and micro-capsule

What are the advantages of implants?

long lasting and highly effective
continuous protection up to 5 years
reversible
contains no estrogen
no pelvic examination is needed

What are the disadvantages of implant use?

changes in menstrual pattern
headaches
weight gain
dizziness
severe lower abdominal pains
arm pains or bleeding on insertions site
heavy bleeding

What are VAGINAL RINGS?

a levonorgestrel-impregnated ring that a woman can place in her vagina
effectivity : 96.5%

What is the mechanism of action of vaginal rings?

What are the advantages of vaginal ring use?

minimal client - physician contact
can be self-administered
easily removed in case of pregnancy
fewer side effects than oral contraceptives
does not affect breastfeeding
decrease menstrual blood loss

What are the disadvantages of vaginal ring use?

What are VAGINAL SPERMICIDES?

made of an inert base and a spermicidal agent
effectivity : 95% when used consistently
four types:
    1)tablet
    2)foam
    3)jelly
    4)suppositories

What is the mechanism of action of spermicides?

What are the advantages of spermicides?

used only when needed
can be stopped anytime when pregnancy desired
no systemic effect
less to developed P.I.D.
protection against STD

What are the disadvantages of vaginal spermicides?

What is a VAGINAL SPONGE?

a sustained release system for the spermicide
effectivity : exceeds that of spermicides but lower than the use of diaphragm or condom

What is the mechanism of action of sponge?

What are the advantages of vaginal sponge use?

What are the disadvantages of vaginal sponge use?

allergy
vaginal dryness, soreness, itching
not good choice for women with anatomical change.

What is reproductive health care?

Reproductive Health Care is the constellation of methods, techniques, and services that contribute to reproductive health and well-being by PREVENTING and SOLVING reproductive health problems.

What are the ten elements of RH?

Family Planning
Maternal and Child Health and Nutrition
Prevention and Management of Abortion Complications
Prevention and Treatment of RTIs/ STIs/ HIV/AIDS
Education and Counseling on Sexuality and Sexual Health
Breast and Reproductive Tract Cancers and Other Gynecological Conditions
Men's Reproductive Health
Adolescent Reproductive Health
Violence Against Women

What are the similarities between Males and Females?

We often think of anatomy as a way of understanding the differences between males and females, yet both sexes are very similar physiologically before birth. The following male and female sex organs develop from the same tissue in the fetus during the first six weeks of fetal life:
The glans (head) of the penis in the male and the clitoris in the female.
The penis and the vagina.
The testicles and the ovaries.
The vas deferens and the fallopian tubes.
When we are born, we are equipped with sex organs that grow mature, as we grow older. It is not until adolescence that we begin to get signals that our sexual organs are maturing (i.e. a boy's ejaculation or a girl's first menstrual period).

What are the difference between male and female sex organ?

One difference between males and females is that in males the organ responsible for the male role in reproduction are the same organs that provide sexual pleasure, but in females there is one organ which seems to have no other function than to help a woman have sexual pleasure. This organ is the clitoris.

What is the clitoris ?

The clitoris is located in the soft folds of skin in front of a woman's vagina.
Because the clitoris comes from the same tissue that develops into the glans of the penis in the male, it has the same number of nerve endings as the glans; and because it is so much smaller, about the size of a pea, it is very sensitive.
Direct or indirect simulation of the clitoris is the main way a woman reaches climax or orgasm.

What is the urethra?

Below the clitoris is the urethra, which is the passageway for urine from the bladder to the outside of the woman's body.

Just below the urethral opening is the entrance to the vagina.
The vagina is the elastic muscular passage extending from the woman's outer sexual organs (the vulva) to the uterus.
The vagina is about 4 inches long and can receive a man's penis during sexual intercourse.
The vagina, also called the birth canal, is the passage through which the baby is born.
The vagina is not a hollow tube. The walls are collapsed when empty, but it can stretch to accommodate a penis or a full-term baby.
The vagina is designed to clean itself by periodically shedding mucus and dead cells.

Often, but not always, a small web of skin called the hymen partly covers the opening of the vagina.
For centuries, people mistakenly believed that if this web were torn or missing, a woman is not a virgin.
Actually, the hymen hardly exists in some women. In others, it is very easily stretched.
For some women in whom the hymen is still intact, first sexual intercourse may be uncomfortable.
The clitoris, urethra and the vagina are surrounded by the labia minora (inner lips) and the labia minora (outer lips). All of the woman's reproductive organs are located inside her body.

The neck of the uterus, which is called the cervix, protrudes down into the back of the vagina.
The cervix is the entrance to the uterus and contains mucus-producing glands.
The cervix feels like the end of a nose with a dimple in it.
If fertile mucus is present in the vagina during intercourse, sperm released by the male will travel through the cervical opening and into the uterus.

What is the uterus and its functions?

The uterus, also known as the womb, is a pear-shaped muscular organ in which the fertilized egg grows and develops into a fetus.
Normally, the uterus is about 3 inches long and 2 inches wide. During pregnancy, it stretches and grows with the fetus.
In pregnant women, the lining of the uterus, called the endometrium, nourishes the fetus.
In women who are not pregnant, the lining is shed about once a month if an egg is not fertilized. The shedding is called menstruation.

What is a period or menses?

A girl"s first period can come as quite a shock. It normally happens around 12 or 13 years, and it can come without any warning. One can be sitting in the movies, or at school, or one could wake up one morning and find some blood between their legs. Just like that. As you can imagine this could be frightening if one did not anticipate it and know what it was.The blood of course, comes from inside the uterus lining and out through the vagina. Usually at the time the period comes, one may have a stomach ache or one may feel nothing. Sometimes for months before the first period, girls have vague abdominal pains, or feel sleepy, or irritable. That usually clears up, as if by magic, after one had two or three normal periods.
It is a fact that periods are often irregular in time and duration for the first year they occur.It is best for girls to dismiss the warnings of their well meaning relatives about "the curse" and accept the discomforts of menses ( the period) as a small inconvenient fact of life.
Another fact of life is that periods are very necessary part of being a woman. To understand why, you need to know about the womb.

The womb is where a baby lives for the nine months it develops inside a female's body. Most of the time, obviously, one haven t got a baby inside. But the female body gets prepared just in case.
What are the ovaries and their functions?
Connected by ligaments to the uterus are two ovaries, one on each side of the uterus.
These are the organs that store the egg cells. They also produce some of the female sex hormones that regulate the menstrual cycle and are responsible for the development of female secondary sex characteristics.
At birth, a girl's ovaries contain all the eggs she'll ever have---about 400,000. However, she'll probably use only about 400 of the eggs in her lifetime.

What is an egg or ovary?

The eggs or ova (which are about the size of a dot made by a sharp pencil) are among the llargest cells in the human body.
When an egg is expelled from one of the ovaries, it travels to the uterus in one of the Fallopian tubes. This takes from 3-5 days.
If the egg is not fertilised, it will disintegrate and be absorbed into the body.

What male body parts comprises the male sex organ?

The testicles and the penis are the male external sex organs.
The penis is made up of spongy erectile tissue.
Most of the time it is soft and limp.
But when a man becomes sexually excited, his penis stiffens and grows larger in width and length.
An erect penis is about 5-7 inches long and an-inch-and-a-half in diameter, regardless of its size in a normal (flaccid) state.
The entire penis is highly sensitive, particularly the glans or head of the penis.
The testicles, which produce sperm and the male hormone called testosterone, are located in a wrinkled-looking pouch called the scrotum, which hangs behind the penis.
Adult men have two testicles about the size and shape of plums.
The testicles contain hundreds or thousands of chambers where sperm develop.

What is the scrotum?

The scrotum controls the temperature of the testicles. Scrotal temperature is about six degrees below body temperature. This is ideal for producing sperm.
In warm weather, the scrotum becomes somewhat larger and more limp to expose and cool a larger skin area.
In cold weather, the scrotum contracts to conserve heat.

What is the prostrate gland?

After passing through the seminal vesicles, the vas deferens also goes through the prostate gland, where additional fluid is added to nourish the sperm.

What is the vas deferens?

The vas deferens is a tubular structure that joins with the urethra, which becomes the sperm's passage through the penis to the outside of the body.

Sperm, which are the microscopic male reproductive cells, make up less than two percent of the total ejaculate.
They are much smaller than the egg.
Each has a head and tail, like a tadpole.
When ejaculated during sexual intercourse, they swim through the vagina, through the cervical opening into the uterus and on up into the Fallopian tubes.
Sperm can live for 6-8 hours in the vagina.
But once they get up into the uterus and tubes they can live for three to five days.
They usually reach the tubes within an hour to an hour-and-a-half after ejaculation.
On reaching the top of the uterus, half go into one Fallopian tube and half go into the other.
They swim against strong currents set up by the cilia in the Fallopian tubes, which act to draw the egg down toward the uterus.
Of several hundred million sperm ejaculated, only about 2000 reach the tubes.
Even though the egg must be totally surrounded by sperm in order to be fertilized, only one sperm is able to actually penetrate it. The rest are absorbed by the body.

What is circumcision?

CIRCUMCISION is the removal of the hood of the skin called the foreskin, which covers the end of the penis.
People have very strong feelings about this but either way, a man can make love, ejaculate sperm and make babies.
Among Jews, Muslims, and some African cultures, it is done to comply with religious laws and traditions.
In boys and men who are not circumcised, the foreskin can be pulled back to reveal the glans.
The glans and foreskin should be washed carefully because perspiration, urine and glandular secretions called smegma can become trapped underneath and possibly an infection.

What are wet dreams?

WET DREAMS, also known as seminal or nocturnal emissions in males, are erotic dreams that cause sexual excitement during sleep and lead to orgasm (climax). Because males ejaculate fluid during orgasm, such dreams have come to be known as "wet dreams."
Females also have erotic dreams that can lead to orgasm.
Wet or erotic dreams are common for both sexes at all ages and are a way in which sexual tension is relieved.
It is also common not to have wet or erotic dreams.

What is masturbation?

Usually by age 13 or so, the body is ready for mating. Physically, one can have children. Mentally and socially, one is not ready to have them yet. So nature has created her own solution. Its called masturbation. Men do it. Women do it. Even some animals do it. It's a way of getting sexual release without the full act of mating with a member of the opposite/same sex.
Mating at an early age is a mistake. One should first learn about the normal functions of ones body and information on family planning on how to use them. Also one has to know.
Masturbation is healthy and a normal function. It s sometimes called "playing with yourself". Girls use their fingers to caress and rub their vagina and clitoris. Boys do the same with their penis.
This usually happens when your imagination creates scenes that cause you to become sexually excited, sexual tensions builds up, and that is when the urge to touch and play with oneself begins.
If carressing and rubbing becomes long enough, orgasm follows.

This is a release of the sexual excitement that has built up inside you. And it is a great feeling. To repeat : masturbation is normal, healthy part of growing up. Don't worry nothing dreadful happens when one masturbates.

What is a penile erection?

ERECTION of the penis takes place when a man becomes sexually excited. His penis, which is usually soft and limp, swells and becomes larger and erect.
Erections are caused when veins in the penis fill with blood.
A climax will cause an erection to go down quickly but the erection will subside gradually by itself without orgasm.
Men generally have erections as a result of sexual stimulation. Erections also can be caused by tension in the pelvic muscles, irritation of the penis or a full bladder.
Sometimes, particularly during adolescence, erections seem to happen for no apparent reason. When a man has a climax during sexual activity, a wet dream, or masturbation, semen spurts out of the erect penis. This is called EJACULATION and is caused by muscles in the penis that contract and shoot out fluid containing sperm.
It is possible for a man to ejaculate fluid without having an orgasm. This doesn't happen often to most men and doesn't necessarily mean anything is wrong if it does.

What is premature ejaculation?

Premature ejaculation refers to a condition in which the penis is unable to sustain an erection and the man ejaculates very quickly.

What are sexual and reproductive health and rights?

What are sexual and reproductive health and rights?

The right to health, which embraces sexual and reproductive health, is recognized in various human rights documents and other consensus documents, such as in Article 12 of the International Covenant on Economic, Social and Cultural Rights where States Parties recognize "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health." Both the Universal Declaration of Human rights and the International Covenant on civil and Political Rights protect the right of life, which includes the right to health. The Beijing Platform for Action adopted by Governments during the Fourth World Conference on Women (1995) recognizes that women's right to the enjoyment of the highest attainable standard of physical and mental health is "vital to their life and well-being and their ability to participate in all areas of public and private life."
The World Health Organization (WHO) has defined health as "a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity." This definition is adopted in both the Cairo document and the Beijing Platform for Action ( 1995). The Beijing Platform of Action goes further to state that "women's health involves their emotional, social and physical well-being and is determined by the social, political and economic context of their lives, as well as by biology." It recognizes that " a major barrier for women to the achievement of the highest attainable standard of health is inequality, both between men and women and among women in different geographical regions, social classes and indigenous and ethnic groups."
This recognition is consistent with the mandate of the Convention on the elimination of all Forms of Discrimination Against Women (Women's Convention) that States Parties must take "appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on a basis of equality of men and women, access to health care services, including those related to family planning." The United Nation's Committee on the Elimination of Discrimination Against Women (CEDAW), the body that monitors compliance with the Women's Convention, declared under its General Recommendation on Women and Health, that States Parties should "ensure universal access for all women to al full range of high quality and affordable health care, including sexual and reproductive health services."
The Cairo document echoes the definition of health in its definition of reproductive health:
"Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. In line with the above definition of reproductive health, reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counseling and care related to reproduction and sexually transmitted diseases."
"Bering in mind the above definition, reproductive rights embrace certain human rights that are already recognized in national laws, international human rights documents and other consensus documents. These rights rest on the recognition of the basic right of all couples and the individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents."
Pursuant to the interdependence and indivisibility of human rights as recognized in the Cairo document, and the recognition that "reproductive rights embrace certain human rights that are already recognized in national laws, international human rights documents and other consensus documents," the Reproductive Rights Resource Group-Philippines (3RG-Phils.) advocates for the recognition, respect, protection and promotion of the following human rights as sexual and reproductive rights:
The right of life
Which includes the right not to have one's life put at risk by reason of pregnancy, gender, or the lack of access to sexual and reproductive health care information and services.
The right to liberty and security of person
Which includes the right to determine, control and enjoy one's sexual and reproductive life, and decide freely and responsibly on matters related to sexuality and reproduction free of discrimination, coercion and violence; the right to be free from coercion or violence in one's sexual life and in all sexual decisions, such as rape and other forms of sexual violence, female genital mutilation, and forced sterilization that infringe upon women's sexual and reproductive self-determination; the right to be free from any medical intervention except with full, free and informed consent; the right to be free from externally imposed fear, shame, guilt and beliefs based on myth and other psychological factors inhibiting a person's sexual response or impairing her sexual relationship; the right to be free from forced pregnancy, sterilization and abortion; the right to demand equality, full consent, mutual respect and shared responsibility in sexual relationships.
The right to equality and to be free from all forms of discrimination
Which includes the right to have control and make decisions over one's sexuality and fertility as an essential ingredient of equality of persons and equal participation in all spheres of life; the right not to be discriminated against by any legislation, regulation, program, cultural norm or practice in respect of sexual and reproductive health information and services because of gender, age, poverty, civil status, sexual orientation or practice, mental or physical ability, religion, ethnicity or other condition or status; the right to be free from sexual violence.
The right to privacy
Which includes the right to make autonomous decisions regarding one's sexual and reproductive life; and the right to privacy in the provision of sexual and reproductive health care services, such as to confidentiality of information given during the consultation and care.
The right to freedom to thought
Which includes the right to make decisions about sexual and reproductive health and rights; the right to seek, receive and impart information about sexual and reproductive health; and the right to be protected from restrictions to access to sexual and reproductive health education, information and services by reason of dominant religious beliefs in society.
The right to information and education
Which includes the right to complete, appropriate, correct, gender-sensitive information and education that can enable a person to make and give free and informed decisions and consent; and the right to information as to the relative benefits, risks and effectiveness of all methods of fertility regulation and prevention of unplanned pregnancies.
The right to choose whether or not to marry and to found and plan a family
Which includes the right to protection against any compulsion or requirement to marry without the person's free and full consent; and the right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children.
The right to decide whether and when to have children
Which includes the right to have the information, education and means to do so.
The right to health care and health protection
Which includes the right to the highest possible standard of sexual and reproductive health care that is accessible, comprehensive, appropriate, gender-sensitive, and the respectful of human rights; and the right to sexual and reproductive health care which includes (a) family planning information, counseling and services, (b) prenatal, postnatal and delivery care, (c) health care for infants, (d) prevention and treatment of sexually transmitted diseases (STDs) and reproductive tract infections (RTIs), (e) safe abortion services, where it is legal, and management of abortion-related complications, (f) prevention and treatment of infertility, (g) information, education and counseling on human sexuality, reproductive health and parenthood.
The right to benefits of scientific progress
Which includes the right to enjoy the benefit of and have access to reproductive health technology, including that related to infertility and contraception.
The right to freedom of assembly and political participation
Which includes the right to pursue and promote sexual and reproductive health and rights through political involvement and the formation of organizations; and the right to participate in the leadership, planning and decision-making, management, implementation, organization and evaluation of reproductive health care programs and services.
The right to be free from torture and inhuman and degrading or ill treatment
Which includes the right to be protected from all forms of exploitation, degrading treatment and abuse in relation to sexuality and reproduction, including involuntary motherhood or forced pregnancy, domestic servitude and violence.
The right to development
Which is a universal and inalienable right and an integral part of fundamental human rights.
It has been said that the advancement of sexual and reproductive rights requires abiding by three ethical principles that underpin women's sexual and reproductive health and rights: (1) the principle of bodily integrity and self-determination, not as individualistic concerns, but as "inseparable from women's full and equal participation in all aspects of human life;" (2) the principle of equality, including equal participation in all spheres of life, whose essential ingredient is women's ability to make decisions over their sexuality and fertility; and (3) the necessity of enabling conditions, which means assuring basic economic and social rights, such as adequate food, shelter, education, in livelihood, medical care and necessary social services, and security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond one's control, in order to create an environment that is essential for the genuine exercise of free choice.

The Philippine government's commitments to action
The Philippine Government has committed to respect, protect and promote sexual and reproductive health and rights, particularly of women. This commitment also has a constitutional basis, and thus, is given binding effect by the 1987 Philippine Constitution which has declared the State's commitment to a just and dynamic social order, social justice, human rights, gender equality, health, and an integrated and comprehensive approach to health development.
The specific constitutional policies related to sexual and reproduction health and rights are:
"The State shall promote a just and dynamic social order that will ensure the prosperity and independence of the nation and free the people from poverty through policies that provide adequate social services, promote full employment, a rising standard of living, and an improved quality of life for all." (Art. II, Sec. 9)
"The State shall promote social justice in all phases of national development." (Art. II, Sec. 10)
"The State values the dignity of every human person and guarantees full respect for human rights." (Art. II, Sec. 11)
"The State recognizes the vital role of the youth in nation-building and shall promote and protect their physical, moral, spiritual, intellectual, and social well-being." (Art. II, Sec. 13)
"The State recognizes the role of women in nation-building, and shall ensure the fundamental equality before the law of women and men." (Art. II, Sec. 14)
"The State shall protect and promote the right to health of the people and instill health consciousness among them." (Art. II, Sec. 15)
"The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. There shall be priority for the needs of the underprivileged sick, elderly disabled, women, and children. The State shall endeavor to provide free medical care to paupers." (Art. XIII, Sec. 11).
"The State shall defend:
The right of spouses to found a family in accordance with their religious convictions and the demands or responsible parenthood;
The right of children to assistance, including proper care and nutrition, and special protection from all forms of neglect, abuse, cruelty, exploitation, and other conditions prejudicial to their development;
The right of the family to a family living wage and income; and
The right of families or family associations to participate in the planning and implementation of policies and programs that affect them." (Art. XV, Sec. 3)
The promotion of health, including sexual and reproductive health, as a human right entails addressing the social, economic, political and cultural conditions of the country that undeniably impact on people's particularly women's health. When the Philippine Constitution mandates an "integrated and comprehensive approach to health development," it requires, among others, "better food and housing, better education, and increased purchasing power" of the people, in addition to "more access to health services, higher allocation of resources to health, more active people's participation in health efforts, a reorientation of the health development strategies and the political will to act on policies and plans."
Under Cairo and other human rights instruments and other consensus documents, and pursuant to the foregoing constitutional policies, the Philippine government is obliged to undertake positive steps in advance sexual and reproductive health and rights particularly in the following key areas:
(1) changing laws, policies, and attitudes that continue to inhibit the full exercise of reproductive and sexual rights, particularly of women; this will include what the Committee on the Elimination and Discrimination Against Women calls "barriers to women's access to appropriate health care," such as laws that restrict access to contraception, practices that require a spouse's consent for a woman to obtain contraception, discrimination in the delivery of sexual and reproductive health services, gender violence, and economic policies and programs that lead to poverty;
(2) enforcing gender-sensitive laws and policies, and raising awareness among boys and men of their responsibility for promoting equity and equality in relations with girls and women; this will include effective enforcement of laws against gender-based violence and those that promote women's empowerment in social, economic, cultural and political life, and education men and boys toward eliminating gender-based violence;
(3) strengthening health infrastructures to make comprehensive care more widely available, and putting priority on financing for sexual and reproductive health care, as well as spending funds more efficiently and effectively.
In working in these three areas, Government, decision-makers in health care, and health service providers must not forget the three ethical principles that underpin women's sexual and reproductive health and rights, and women's human right in general: bodily integrity and self-determination, equality, and necessity of enabling conditions that take into account women's specific needs and situations.
Author: Evalyn G. Ursua is a feminist lawyer who has been working on women's human rights for 11 years
Source : Rights Vol. 1 No. 1&2 Special Double Issue , July to December 2001 & January to June 2002
"Human Rights and Women's Sexual and Reproductive Health and Rights" pp 6-10

What are Sexually transmitted infections (STIs)?

These are infections obtained by having unprotected sexual intercourse with a partner who has the infection. Sexual exposure may either be oral, vaginal-penile intercourse, anal penile intercourse. There are other STI that can be obtained through other means such as blood transfusion or by mere body contacts or through "fomites". One has to know how to prevent getting these infections.

What are the types of STIs?

STIs are classified according to the following:
Discharge syndromes - those that produces discharge. Eg. Gonorrhea, non gonococcal urethritis, post gonoccocal urethritis, vaginitis, candidiasis, trichomoniasisUlcerative syndromes- those infections that produces papular or skin ulcer lesions eg.herpes simplex, syphillis and chancroidNon ulcerative syndromes - eg. Scabies, venereal warts, crab lice
Others - eg. Hepatitis B, Infections mononucleosis, and HIV/AIDS
The following table shows you the difference among the different STIs:
A. Discharge (Tulo)

Type	Incubation Period	Causative Agent	Signs and Symptoms
1. Gonorrhea	2-7 days	Neisseria gonorrhea	 vaginal & urethral discharge foul-smelling, yellow to yellow green, possibly pus-like, thick  areas affected : urethra, anus, throat, vagina, joints, eyes
2. Non-gonoccal urethritis (NGU), Post-gonoccal urethritis (PGU)	10-14 days	Chlamydia trachomatis	 itchiness, urethral discharge whitish, mucoid/less in quatity  areas affected : urethra, eyes, vagina, throat, anus
3. Vaginitis	3-7 days	Gardnella	 opaque-white discharge
4. Candidiasis/ Moniliasis	7-10 days	C Albicans yeast (fungus)	 itchiness, white-cheesy, curd-like vaginal discharge  sweet smelling
5. Trichomoniasis	7-14 days	protozoa	 greyish-greenish, frothy, fishy odor, copious discharges  strawberry cervix

Type	Incubation Period	Causative Agent	Signs and Symptoms
1. Syphilis	9-90 days	Treponema pallidum	 1st stage : chancre (firm, hard, painless ulcer, oval/round, well-delineated, usually solitary, heals in 2-6 weeks (with or without treatment) 2nd stage : rash on body (not itchy), areas affected: follicles, mucous areas; lymphadenopathy,"flu-like" can be latent for years  3rd stage: gumma, aneurysm, neurosyphilis (may cause stroke); may affect heart, brain (meningitis), bones; can be fatal
2. Herpes simplex	2-10 days	Herpes simplex virus 1 (HSV-1) oral-facial, Herpes simplex virus 2 (HSV-2) -genital	 multiple, painful shallow ulcers (cold sores)  affected areas: genitals, face, fingers, eyes, brain
3. Chancroid	3-10 days	Haemophilus ducreyi	 soft & tender ulcer painful, dirty-grey ulcers  painful & enlarged lymphnodes (buboes)

Type	Incubation Period	Causative Agent	Signs and Symptoms
1. Scabies	7-10 days	Sarcoptes scabiei	 "galis-aso"  itchiness at night
2. Venereal warts	7-10 days	Human papilloma virus (type 6&11)	 "kulugo"  warts in genitals
3. Crab lice	7-10 days	Phthiuris pubis	 itchiness nits ("jkuto sa buhok sa ari")  reddish brown pinpoint marks/bite marks

Type	Incubation Period	Causative Agent	Signs and Symptoms
1. Hepatitis B	6 weeks - 6 months	Hepatitis B virus	 jaundice, abdominal pains, chalk-colored stools  "flu-like"
2. Infectious mononucleosis	7-10 days	Epstein Barr virus	 kissing disease  flu-like symptoms
3. AIDS	3-12 years	HIV	 depending on opportunistic infections that set in

What are the general principles as with regards to STIs?

Co-infections are common
An individual may have more than one form of STI Investigate. No single STI can be regarded as an isolated problem.
An infected partner always exists!
The sexual history and the management of the sexual partners are of imminent importance.
Self-medication leads to resistance to antibiotics and complicates what would have been a simple treatment.

What is the relationship of STI with HIV/AIDS?

STIs and HIV
STIs give reference to sexual behavior. STIs serve as co-factors to HIV (genital ulcers, history of STD increase probability of acquiring HIV) STIs provide an environment that is favorable for HIV.
STIs complicate treatment plan of a PWA.
HIV and STIs
HIV makes a person more susceptible to STIs (or any diseases) secondary to immune deficiency.

What are the other classifications of STIs ?

A. STIs with genital discharge
Gonorrhea
NGU (Non-gonococcal urethritis)
- PGU (Post- gonoccal urethritis)
B. STIs with ulcers
Syphilis Chancroid Herpes simplex Lymphogranuloma venereum
Granuloma inguinale
C. STIs with no ulcer or discharge
Venereal warts Scabies Phthiuris pubis
Hepatitis B
D. Genital diseases almost exclusively found in women
Candidiasis/ Moniliasis
Trichomoniasis

What are the classifications of STI according to Modes of transmission?

A. Sexual transmissions
All STIs except Infectious mononucleosis, trichomoniasis, cadidiasis/moniliasis
B. Blood transfusion
Syphilis
Hepatitis B
C. Perinatal transmission (mother-child)
Syphilis Hepatitis B B Herpes simplex
Gonorrhea
D. Non-sexual contact
Syphilis - contact with abraded skin Herpes simplex- contact with abraded skin Venereal warts- contact with infectious lesions
Scabies -clothing or linen
E. Kissing
Infectious mononucleosis
Herpes simplex

STD stands for Sexually Transmitted Disease (SOMETIMES CALLED Sexually Transmitted Infection). It is caused by sexual contact- vaginal, oral or anal--with someone who is infected.

What causes STD infection?

STD infection is caused by sexual contact-vaginal, oral or anal-with someone who is infected. Other types of touching/kissing can also cause STD such as Herpes and HPV.
Aren't STDs only a problem for older people who sleep around?
No. In fact, some STDs like Chlamydia and Gonorrhea are actually more common among the teens than among older men and women. And you can get STD by a single sexual contact.

What are STD symptoms?

Most of the STD symptoms can be found either on the genitals or in and around the mouth, like sores or rash.

Who can I talk to about STD?

Talk to an adult-perhaps a parent, school nurse, teacher or family doctor--to get advice on where to have a test. It's best to talk than worry on your own.

How do I check if I have STD?

You will have to undergo a blood and urine test or a swab from the vagina or penis. Not all the tests need you to have physical examination, and you might not even have to undress.

What should I do if I have STD?

Get yourself treated by a doctor and don't have sexual contact with anyone until you have completed your treatment (antibiotics/medication) and are no longer infectious. It's important.

What if I have passed on STD to others?

It is important that you tell them so that they can have a test. If they have been infected, they should also be treated and refrain from sexual contact till the infection is cured.

STD can recur if you haven't followed the instructions or completed the course treatment. It is important that you complete your treatment.

How can I protect myself from STDs?

Use condoms during vaginal, oral and anal sex. A girl can use a female condom or a boy can use a male condom. Both male and female condoms shouldn't be used simultaneously.

Can you get STDs from kissing?

Some STDs (such as oral herpes) can be transmitted by touching or kissing. You shouldn't have sexual contact with anyone who has visible sores or genital rashes.

Does masturbation cause STD?

How can I tell if someone has an STD?

Some people with STDs may have visible symptoms, but many people don't. Also, you could have STD without visible symptoms but still be infectious.

Does sexual intercourse hurt?

If a woman is sexually excited and relaxed the vagina will probably be moist enough for a man's penis to go in without hurting. If it hurts, a water-based lubricant like KY Jelly can be used.

What is sexual intercourse?

What "counts" as losing virginity?

Different definitions exist, but most people agree that if you have had penetrative sex, then you've lost your virginity.

Can a girl become pregnant even without sexual intercourse?

Yes, if a man's penis goes near goes near a woman's vagina there may be some sperm in the fluid which comes out of the man's penis before he ejaculates. This can lead to pregnancy or STD.

Can a girl get pregnant having sex standing up or in a bath?

Yes. A girl can still become pregnant if she has sex standing up or in the bath. Sexual intercourse, in any position or environment, can lead to pregnancy.

What kind of emotions does one experience during sex?

Varied emotions can be experienced. In a trusting, loving relationship, sex can be a most intense and pleasurable physical and emotional experience a person can have.

When sexual excitement builds up and reaches a peak a person might experience an orgasm, also called a climax or coming. Sexual excitement might be experienced through masturbating, kissing, or sex with another person.

Some people moan or groan with pleasure or even cry out or speak to each other. There may also be some squelching and squishing noises that are perfectly normal, even if embarrassing and funny.

Oral sex is when one person licks or sucks another person's penis or vagina. When oral sex is done to a man it is called a blowjob and to a woman it is called licking out.

Can a girl get pregnant from oral sex?

No. A girl cannot get pregnant from giving or receiving oral sex. Not even if she swallows his sperm. But she can get STD and HIV.

You are ready for sex when you can take responsibility for its consequences and are in a relationship of mutual trust and commitment. TEENAGERS ARE NOT READY FOR SEX.

Having sex can lead to pregnancy, and/or HIV or STDs. There can also be emotional consequences to having sex. It can change relationships and cause hurt, anger and resentment.

Will I be glad when I'm older that I lost my virginity at a young age?

It is difficult to say. But, if you are a teenager, it would be better to wait till such a question won't actually bother you.

Can I talk to my partner about sex?

If you can't talk about sex to your partner, then you're not ready to have sex. Honesty and responsibility are both very necessary.

Is there a "safe time" to have sexual intercourse?

There is no safe time to have unprotected sex if you wish to avoid pregnancy and STDs. Even unprotected sex during a girl's period can result in pregnancy, and it also increases the risk of HIV transmission. If she has irregular periods, "safe" days can be particularly difficult to predict. This method also offers no protection from STDs such as HIV.

When does ovulation occur?

Ovulation approximately occurs in the middle of the cycle, i.e. duration of the cycle minus 14 days. But this also varies depending on the duration of the menstrual cycle.