The information in this publication is provided for reference only. All information contained in this publication is believed to be correct and complete.
TREATMENT OPTIONS FOR ATRIAL FIBRILLATION A number of treatments are available for Atrial Fibrillation. A patient’s treatment choices depend on …
The information contained in this document is intended for healthcare professionals only.
The information in this publication is provided for reference only. All information contained in ... FT-IR spectra after a Nicolet 4700 or a Nicolet 6700 spectrometer is ... or read “Installing OMNIC or EZ OMNIC” in the document titled OMNIC Spectros
Cervical smears and pregnancy. Who is this information for? ... you have had treatment in the past for an abnormal smear, and are pregnant or are considering
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An Information & Activity Booklet Grades K-8 1997-1998 ... star’s spin), these neutron stars are called pulsars. The core of a massive star that has 8 or
This Technical Information Booklet on International Rules for Corrugated Board and Cases is a useful compendium of International Rules.
In this booklet we have attempted to list all the various activities and events students were involved in last year. It shows all their various successes.
The information in this booklet is for dissemination and may not be used for commercial purposes. It can be used for anyone with due acknowledgement to TARSHI.
First Printed in: 1999 Reprinted in 2000, 2001, 2002, 2003, 2004 This Reprint: 2005
Designed by: Shefali Mahadik Roy Illustratins: Ravi Paul Abraham
We are grateful to The Ford Foundation for their support.
WHY TALK ABOUT SEXUALITY ?
Sexuality is a basic part of everyone's life. It is an intimate, personal and very important issue. But unfortunately, people don't talk about or even acknowledge it. This is the time in your life when you have many questions and hardly any straight answers. What is happening to my body? What is this sex stuff really all about? What is the right time to start? And what is safer sex that everyone talks about? Am I attractive? How will I know whether or not my relationship is good for me? Am I normal?
These are some of the questions that many young people have asked us. At TARSHI, we run a telephone helpline on reproductive and sexual health issues. People from all walks of life call in. Since 1996, over 20% of the 55,000+ calls have been from young people between the ages of 10 and 21 years. They have a lot of questions, doubts, misconceptions and interesting viewpoints but not many sources of accurate information about sexuality. We feel it is important that you have information that will help you be a happier, healthier, and more in-charge-of-your-life sort of person. Because questions and information needs vary with age, we have prepared two sets of booklets, in Hindi and in English. ‘The Red Book’ is for 10 to 14 year olds, and ‘The Blue Book’ is for
those who are older. This is a rough dividing line. Feel free to use whichever booklet that suits your needs. In this booklet you will find information about different aspects of sexuality and relationships. This book has been written keeping you in mind, - what you might want to know and what you might already know but be confused about. You can also check if what you know is accurate!
You have a right to a life of dignity, to liberty, and to health. This is true for all people of all ages. When it comes to sexuality, this means that you have the right to: z
Accurate information about sexuality
Express or not express your sexuality, safely
Make decisions about sexuality in your own life
Not be forced in any way into being physical or sexual
Say 'No' to an unwanted touch of any kind
BODY PARTS WHAT THEY ARE, WHAT THEY DO.... You may be tall, fat, thin, gay, dark, short, sporty, fair, bi, hetero, studious, lesbian, or have special needs because of a physical or mental disability..... your sexuality is not restricted to your body or certain body parts alone. However, because sexuality is also expressed through your body it is important to know how it functions.
You learn about your body from an early age but that knowledge is limited. No one tells you as much about your sexual organs as they do about your nose, eyes or stomach, for example. Knowing the right names of sexual organs is the first step to understanding more about how they function.
The outer layer of skin covering the penis is the foreskin. In an erect penis, this skin moves back so that the tip of the penis or the glans is exposed. The foreskin is attached at the underside of the glans and should not be pulled
back with force. People of some communities remove the foreskin during childhood - this is called circumcision. This is a matter of preference and custom. In a circumcised
penis, the glans is fully exposed all the time.The penis is usually slightly curved towards the tip. Also, the penis is not absolutely straight. It is slanted towards the left or right. Penile size cannot be increased by exercise, massage, or medicine. Penile size is not important for sexual satisfaction - it is technique that matters. To maintain good genital hygiene z
Wash genitals daily with water. No soap, antiseptic, deodorants etc. required.
Dirt might accumulate as a sticky substance, called smegma, under the foreskin. Gently move your foreskin back and wash the tip of the penis. It will be easier to do this when you do not have an erection.
While washing after defecating (shitting), wash in a motion away from the penis, i.e. front to back, to avoid any infection.
Change underwear regularly (at least once a day) and avoid synthetic undies.
Wash undies carefully to make sure that you wash off all the detergent. Dry them in the sun. Sunlight is an excellent disinfectant.
Avoid waxing or using razors, bleach, hair removers, or other chemicals near the penis or testes because the skin here is very sensitive. If at all you need to, you can carefully trim the pubic hair with a pair of clean scissors.
When a man becomes sexually excited his penis becomes hard and 'stands up'. This is known as an erection or a 'hard-on' and occurs because of increased blood flow to the penis. Erections sometimes occur spontaneously, without any sexual stimulus. Many men have morning erections and also erections during sleep. This is perfectly natural and normal. It does not mean they are 'over-sexed'. Male Genitals
Below the penis are two testicles which may not be of equal size. This is where the sperm
is produced. Semen or 'cum' is the whitish
Pubic bone Erect penis
sticky substance that comes out of the penis. It is formed in the body continuously
and contains sperm along with other sub-
stances. A few drops of clear, sticky fluid are
secreted from the tip of the penis soon after
it becomes erect.This is the 'pre-cum' or the pre-ejaculatory fluid. Pre-cum also contains some amount of sperm (actually, thousands of sperm) so it can also cause pregnancy.
Testis Cowper’s gland Anus
The quality and quantity of semen varies from person to person, and for the same person, from time to time. Semen is not made up of blood as many people believe. Sometimes semen comes out of the body at night, during sleep. This is called Nocturnal Emission, Night Fall or Wet Dreams. Nocturnal Emission is not necessarily accompanied by sexual feelings or sexual dreams. These start happening around puberty and some boys get quite embarrassed or frightened by this. Nocturnal Emission is a normal occurrence and do not lead to any weakness or loss of semen, because semen is produced continuously. Semen cannot be stored in the body at the rate at which it is produced. While urinating, you might find that a few drops of a whitish fluid come out just before the urine does. Both the semen and the urine come out from the same tube and opening and so if semen is present in the tube, it naturally comes out before the urine does. Very tight underwear and jeans may damage sperm production as the temperature in the testes increases due to tight clothing.
WOMEN BREASTS Women's chests are different from men's. This is because women have breasts that are made up primarily
of fatty tissue. This fatty tissue contains a milk duct system which is activated when a child is born. Breasts
may be round, conical, upright, sagging, soft or firm depending on age and fitness. The tips of breasts are called 'nipples'. They are dark in colour and highly sensitive to touch and temperature. The darker area around the nipples is called 'areola'. Sometimes when
the nipples are touched or stimulated, they become hard and seem to stand out. This is called nipple erection. This happens to both men and women.
ABOUT BRAS AND OTHER THINGS....... A brassiere or bra is meant to support your breasts. You may feel more comfortable wearing a bra especially if you go jogging or are the sporty type.The right bra for you is one that supports your breasts like a second skin without constricting your movements or breathing. Wear a bra that is neither too tight nor too loose and preferably a cotton one. Take off your bra at night to allow for proper blood circulation and so that you can breathe and sleep comfortably.
The right fit Place the measuring tape around your rib cage just below your breasts. To this measurement add 5 inches. If the result is an odd number, add one inch to it. For example, if the rib cage measurement is 26 inches, then 26+5=31". Because this is an odd number, you add one inch: 31+1=32". This is your bra size (Measurement 1). Next, place the measuring tape around your rib cage, at the fullest part of your breasts. This is Measurement 2. To get your cup size, you have to minus Measurement 1 from Measurement 2. A difference of 1" is cup size A, a difference of 2" is cup size B and a difference of 3" is cup size C. If Measurement 2 is 34", your cup size is B (34 - 32 =2). To avoid all the hassle of measurements, just try on different sizes and see what fits you best!
Do you know that....? z
Breast size cannot be increased except by surgical means.
Breasts are not equal in size. There is usually a slight difference in size between both the breasts.
The shape and size of the breasts change with age.
The size of your breasts has no bearing on your interest in sex or your ability to receive or give sexual pleasure.
Breasts are sensitive and respond well to gentle stimulation. Rough handling and squeezing may lead to severe pain.
Unusual discharge from, or lumps in the breasts need medical attention.
GENITALS The outer lips, inner lips, clitoris and vagina may differ in size, shape and colour from woman to woman. All these structures are part of what is called the vulva. The clitoris is a tiny (about the size of a small pea) structure, above the urinary opening, hidden within the folds of the inner lips where they join. It is extremely sensitive to touch and when stimulated gently becomes firmer and slightly bigger (something like a nipple erection). Clitoral Hood
The vaginal passage is elastic and muscular.
It stretches during delivery to allow the
Outer lips Urinary opening
baby to come out. The vagina is bathed by
secretions produced by the body to keep it
clean and healthy (also see page 19). It is normal for these parts of the body to exude
Anus Inner lips
a distinctive smell. When a woman is aroused, the amount of vaginal lubrication increases and she feels wet. The hymen is a delicate tissue in the vaginal passage. It has openings that let the menstrual blood pass through it. Sometimes when the body is jolted like when you run or jump, this tissue may break. A few girls are born without a hymen.
To maintain good genital hygiene z
Wash genitals daily with water. No soap, antiseptic, vaginal deodorants, etc. required.
While washing after defecating (shitting), wash in a motion away from the vagina, i.e. front to back to avoid any infection.
Change underwear regularly (at least once a day) and avoid synthetic undies.
Wash undies carefully to make sure that you wash off all the detergent. Dry them in the sun. Sunlight is an excellent disinfectant.
Do not insert any unclean, sharp edged objects into the vagina.
Avoid waxing or using razors, bleach, hair removers, or other chemicals near or in the vulva because the skin here is very sensitive. If at all you need to, you can carefully trim the pubic hair with a clean pair of scissors.
THE MENSTRUAL CYCLE Menstruation, menses, or periods is a part of the female reproductive cycle. You may have heard that a woman is ill or is dirty because she is having her periods. This is not true. In fact, it is a sign that her body is functioning
healthily and well. Some girls and women may have pain and cramps during periods but it is not the same as being ill.
Egg waiting for the sperm
Uterus Egg released Vagina Ovary
Inner lining of uterus
Blood & lining of uterus being shed
How menstruation occurs In most women, an ovary (see page19, Making Babies section) releases one egg or ovum every menstrual cycle (the time between two consecutive periods). Also, during every cycle the womb (uterus) prepares itself to receive a fertilised egg by thickening the lining of its walls. If fertilisation has taken place (sperm meets ovum), then the thickened lining is required to nurture the growing baby. If it has not happened, then there is no further need of the lining. So, the body sheds off the lining which comes out through the vagina as bits of lining, blood, clots and mucous. This usually takes about 2-8 days. Menstruation is regulated by the hormonal system, which in turn may affect energy levels and moods. That is why sometimes before and during periods, some women may experience mood changes, pain and tiredness.
What to use during periods The menstrual blood that flows out totals up to only a couple of tablespoons. However, because it flows out of the body it needs to be absorbed by something
for reasons of hygiene and convenience. Most women use either pads or tampons to absorb the blood.
Sanitary napkin, towel or pad Pads may be made of different materials. The ones that are available in the market are in the form of a thickish cotton pad encased in a synthetic material. They may be beltless, in which case you have to take off the adhesive strip and stick the pad on to your panties. They may also come with a thin belt, in which case the ends of the napkin are kept in place by the belt. Sanitary napkins come in a range of prices. If ready-made napkins do not suit your budget or are causing allergy, you can make them at home. All you need is cloth, gauze and/or cotton.
Tampon Tampons are cylindrical and absorbent and are meant to be inserted into the vaginal passage to absorb the menstrual blood. They are quite convenient and easy to wear if you know how to insert them. All you need to do is place the tip of your finger in the depression at the bottom end of the tampon (where the string is attached). A squatting position makes insertion easier. Put the tampon at the entrance of your vagina and gently but firmly slide it in till the
Wash your hands. Remove the cellophane wrapper. Pull the string to flare the base of the tampon. This will make an indentation.
Place the fore finger in the indentation and hold tightly along with the thumb.
Take a position that is comfortable (e.g. sitting with knees apart, squatting or standing with one foot on the edge of the toilet seat) relax and continue to insert until your finger has passed the vaginal muscle. Pull the string to remove.
base of the tampon is about an inch inside the opening of your vagina. If you do not insert it this far, the tampon will not 'sit' properly and may cause you discomfort while walking. Tampons cannot get lost in the body.
Menstrual Hygiene z
Always use a clean sanitary towel or tampon to absorb the blood.
Sanitary towels/ tampons need to be changed frequently (at least every four to six hours) in order to prevent bad odour, or infections.
If you are using a cloth which is to be reused, it should be washed thoroughly and disinfected by drying in the sun.
Maintain good genital hygiene during your periods. There is no reason why you should not bathe, wash your hair, etc.
Period Pain Sometimes some of you may feel pain or heaviness in the breasts, lower abdomen, lower back and/or thighs before or during your periods. It might help to use a hot water bag on the abdomen and/or gently massage the lower abdomen to ease the blood flow. Gentle exercise like walking and continuing with daily activities is helpful in preventing muscles from becoming constricted and cramped. In case of extreme pain, excessive flow of blood or irregular dates (cycles), consult a gynaecologist in order to avoid complications.
Do you know that.....? z
Menstruation usually begins in women between the ages of 9-16 years and stops around 45-55 years.
Menstrual cycles usually fall within a range of 21-35 days, the average being 28 days long. Sometimes a woman's cycle may
become irregular as her periods may be delayed or occur earlier than expected because of illness, mental tension etc. z
Irregularities in the menstrual cycle are quite common amongst young girls who have just begun to menstruate.
A missed period is usually one of the first signs of pregnancy in sexually active women.
Due to regular loss of blood, women need to supplement their diets in order to protect themselves from the harmful effects of nutritional deficiencies.
If you want to engage in penetrative sex during your periods, always use a condom to avoid infection as well as pregnancy. There is no single day when the chance of pregnancy is 0%.
Sometimes, either due to sports, functions, or trips, some women try to delay or hasten their periods through self-medication. Such steps should be avoided as they may harm the body and its natural rhythms. If you need to take any medicine to delay or hasten periods, consult a gynaecologist.
OH! WHAT A FEELING! Being sexual with someone is a matter of proceeding in degrees, of doing what you are comfortable with, checking whether you are enjoying it or not, whether it fits in with what you value and care about, and whether you are mature, capable and willing to deal with what might possibly happen afterwards.
Why you need to know this: z
so you have the information and skills to be in control of what you do sexually
to take charge of your life
to stick to what is important to you
to not give in to pressure or emotional blackmail to have sex if and when you are not feeling ready for it
Having sex is often taken to mean having intercourse or 'going all the way' or doing 'everything'. It does not have to mean that at all. Sex is not one activity- it is a combination of many things. And sex is not just a physical activity though it may be expressed in a physical manner. Sex involves feelings, thoughts, beliefs and values. People who have special needs because of a physical or mental disability also have sexual feelings. They may have some difficulty in expressing their sexuality in certain ways but that does not make their sexual feelings less valid or important. The sexual feelings and expression of people who are not heterosexual (see page 16) are also as valid as those of everyone else. Some of the sexual activities that people engage in:
hold hands fantasise gaze at someone they love kiss or smooch intercourse dance together masturbate talk massage each other......... Sometimes people imagine doing things. It's a bit like day-dreaming. Day-dreams or imaginings are called fantasies. People fantasise about many things - food, holidays, clothes, money, and also sex. Fantasies are a way of mentally exploring and playing with various options and scenarios. It is normal and natural to
fantasise. But it is wrong to convert fantasies into actions which may cause emotional and/or physical harm to another person.
For a sexual relationship to be an enriching and enjoyable experience, you must z
Respect and treat each other as equals and be honest with each other. Be in a consenting relationship i.e. not do anything sexual that makes you or your partner uncomfortable.
Use safe and effective ways to protect yourselves from physical and emotional harm, unwanted pregnancy and sexually transmitted infections.
Sexual activities may be performed alone or with other people. When people perform sexual activities on themselves, it is called masturbation. Masturbation involves people sexually stimulating themselves by touching, rubbing or fondling parts of their own bodies, especially their genitals, for sexual gratification. Both men and women masturbate. It is harmless as long as it does not interfere with other activities of daily life. Sometimes people masturbate with objects. Precautions to be remembered: use clean hands/ objects, keep your nails short, do not do anything that hurts or injures you. When people use the word 'intercourse' they are usually talking about vaginal intercourse. Vaginal intercourse means that a man's penis goes inside a woman's vagina (what, in slang, is called 'fucking', 'getting laid'). There are other kinds of intercourse also. Anal intercourse refers to the sexual act of putting the penis into someone's anus. Oral sex is any sexual act in which the mouth and/ or tongue is used on the penis or the vagina or any other body parts. Many people grow up thinking that vaginal intercourse is the only "right" way of having sex and that it is the only way to have an orgasm, but actually there are many ways of
expressing one's self sexually. The height or peak of sexual pleasure is called orgasm. Both men and women have orgasms. An orgasm is a feeling of great pleasure that has some physical manifestations. In a man, an orgasm is accompanied by ejaculation. Women do not ejaculate like men but they also have orgasms. Orgasms are sometimes mild and sometimes explosive. Sexuality cannot be 'increased' or 'decreased'. Sometimes people experience sexual problems that could have a physical or psychological cause. So-called 'sex-power' clinics, tablets, sprays, and lotions are of no real help. If you have a problem, the most sensible thing to do is to see a qualified professional (doctor or counsellor).
Any risks involved in sexual activity??? What people do depends on what gives them pleasure. There are no 'right' or 'wrong' ways of having sex. However some sexual acts are more risky than others- it could be the risk of injury or pain, of unwanted pregnancy, or of infections and diseases like STDs or HIV/AIDS. For example, any form of unprotected (without using a condom) sex carries a risk of HIV transmission. You owe it to yourself to learn about ways of reducing these risks (see page 23) so that you enjoy your sexuality in a healthy and safe manner. There are some ‘non-physical’ risks also. Sometimes when you say ‘no’, it is interpreted as ‘yes’ or if you agree to one sexual activity, it is taken for granted that you will agree to all activities. Often people hear what they want to hear and interpret things as they want them to be. Such situations may arise while on a date, while living together, in a marriage or in any other sexual relationship. Therefore it is important that you communicate clearly and honestly about how far you want to go and when you want to stop. If your partner does not respect your feelings and boundaries, you need to examine the relationship.
How well is your relationship going? Does your partnerz
make decisions for you all the
treat you like an object?
expect you to conform to
control what you wear and do?
tell you who not to talk to or meet?
make you feel inferior?
threaten to or get violent with you?
make you think you are stupid or
emotionally blackmail you with sulks
ask you for explanations but not offer any?
If any or a combination of these things is happening fairly regularly, you need to sort out your relationship fast. The longer it goes on, the worse it gets.
HOMO, HETERO, BI? What do these mean? You may have heard of the terms heterosexual, homosexual, or bisexual. A heterosexual is a person attracted to people of the opposite sex. A homosexual
Can you make out who is homosexual, bisexual or heterosexual? Of course, you can’t...
is a person attracted to people of the same sex (women attracted to other women are lesbians and men attracted to other men are gays). A bisexual is someone attracted to people of both sexes.
Can gays and lesbians be cured? Since lesbian, gay and bisexual people are not ill or abnormal, they don't need to be "cured". These are not abnormalities or perversions; they are orientations or preferences, just like being left-handed or right-handed. All people, whether they are hetero, homo or bi, have a right to live with dignity and in accordance with their preferences. Attempts to 'treat' them may succeed in temporarily changing sexual behavior but also can lead to emotional and other problems.
What causes homosexuality? That question is as difficult to answer as 'what causes heterosexuality?' No one knows for sure. Some foolishly suggest that maybe a person turned lesbian because she had a bad experience with a man, or a man became gay because a woman mistreated him. If this were truly the case, then there would be many more lesbian and gay people, wouldn't there?
Why do some homosexuals feel they have to announce their orientation to the world? Society encourages and conditions most people to be heterosexual. People who are different from the norm are often discriminated against. This discrimination may be blatant or subtle. Common ways of discriminating against people include: making fun of them, thinking of them in stereotypical ways (for example, all gay men are effeminate), isolating them, and not seeing them as full human beings. Many people say they don't have a problem with homosexuality as long as it is not flaunted. By this they mean that homosexual people should not talk about their partners or show any signs of sexual expression and so if some gays or lesbians do not hide their orientation, they are thought to be flaunting their sexuality. When
heterosexual people do the same thing (talk about their relationships or publicly demonstrate affection) it is not considered flaunting. Because of these discriminatory reactions many lesbian, gay and bisexual people actually have to hide their sexuality.
So, what are they like? Lesbian, gay and bisexual people do not fit the stereotypes that people have of them. They cannot be identified on the basis of mannerisms or physical characteristics. People who are lesbian, gay or bisexual come in as many different shapes, colours and sizes as do people who are heterosexual. Lesbian, gay and bisexual people are different from one another just like heterosexual people are different from one another.They have different personalities, likes, dislikes, strengths and weaknesses, like everyone else.
How do I know if I'm Gay or Bisexual? Usually it is in the teenage years that people begin discovering and becoming conscious about their sexuality. This is also the time of crushes and infatuations and of being confused about one's sexuality. Someone who is heterosexual may have very intense feelings for, and be strongly attracted to someone of their own sex, and someone who is homosexual may feel this way for someone of the opposite sex. That's fine. These things happen. Isolated experiences do not determine your sexuality or change it. Also, one may have been heterosexual for a large part of their lives before becoming gay (or the other way round!). This is also possible and may be very difficult for some or extremely liberating for some others. If you are confused about your sexuality, or know someone who is, it helps to talk and find out more. Ignoring something or suppressing it will not make it go away.
Do homosexuals feel that they belong to the opposite sex really? Most lesbian, gay and bisexual people are comfortable with their own biological sex; they don't wish to belong to the opposite sex and are not transgender (unhappy with and feeling trapped in one's biological sex, wanting to change it).
Gay men are effeminate.
Bisexuals are just plain confused.
Gay men are promiscuous.
Lesbians are over-sexed.
Women become lesbian because they can't find a man.
Homosexuality is a disease.
Lesbians are hairy and muscular.
Homosexuals are mentally ill.
Homosexual people are creative.
Marriage cures homosexuality.
You can tell if someone is lesbian or gay just by looking at them.
Bisexuals want the best of both worlds.
Lesbians and gays can convert you to homosexuality if you are not careful.
MAKING BABIES All it takes for a baby to be made or conception to occur is for a single sperm to meet the ovum. A man's semen contains millions of sperms. The life-span of a sperm is 72 hours. When a man Sperm
ejaculates in or near the vagina, his semen goes into the vagina. The sperms in the semen travel up the vaginal passage to enter the uterus or 'womb' and from here they move to the fallopian
sperm meets the ovum (ovaries release
Ovulation Uterus Implantation
tubes. It is in the fallopian tubes that the one ovum every month) to form a
fertilised egg.The egg after fertilisation moves into the uterus where it implants itself into the uterine lining which the body prepares afresh every month (see page 9). The egg grows in the uterus for 9 months after which it emerges into the world as a new-born baby. Pregnancy begins at conception and lasts until delivery. The most common sign of pregnancy is a missed period. Pregnancy can happen any time the sperms enter the vulva or inside the vagina. Remember that the pre-ejaculate (pre-cum) also has sperms. Ejaculation near the vagina can also lead to pregnancy. The only way to check if you are pregnant is to do a pregnancy test (at home with a home pregnancy kit available at the chemist or in a lab). Pregnancy is usually a very special period in a couple’s life. The first few months of pregnancy may be difficult, with some women experiencing morning sickness, tiredness, emotional states.
If pregnant, you need to z
Stages of pregnancy
Eat a balanced diet and not smoke or drink alcohol if you can help it.
Avoid self-medication. Always consult a doctor.
Report bleeding or spotting to your gynaecologist.
Go for regular gynaecological check-ups.
At 3 months
At 6 months
At 9 months
Take your immunisation shots.
Do not have intercourse if it is painful or uncomfortable.
A sexually active couple can use various methods to prevent conception if they do not want a child. These methods are called contraceptives meaning 'against conception'. Using contraceptives that are safe and reliable are a sign of responsibility and concern for oneself and one's partner. A mix of methods (eg. Condom + Pessary) is more reliable than using one method alone. Some methods are given below.
Contraceptives for men Condoms : A condom is a thin latex sheath to be worn on the penis to prevent the semen and pre-ejaculate from coming in touch with the partner's body. Condoms are to be worn every time a man has sex and as soon as he has an erection. Condoms cannot be reused. Condoms prevent pregnancy and infections like HIV and STDs. Scientists are trying to develop male contraceptives in the form of vaccines and implants that are long-lasting.
How to wear a condom
When the penis is hard, squeeze the air out of the tip of the condom and place it on the head of the penis
Hold the tip of the condom and gently unroll it completely
Let go of the tip when unrolled
After sex carefully withdraw. Hold the condom at the base while pulling out to prevent it from slipping off. Knot and dispose in a dustbin 4
Contraceptives for women Pills: Oral contraceptive pills are to be taken regularly even if a woman is not having sex everyday. These pills are available in the market but should be taken only after consulting a gynaecologist because they may not suit some women. Pills are very reliable.
Oral contraceptive pills
Pessaries: Pessaries are tablets that are inserted into the vaginal opening 10-15 minutes before intercourse. They absorb moisture and begin to gently foam. The foam produced contains a chemical that destroys the sperm. The chemical effect lasts only for about half an hour. IUCDs: These are Intra Uterine Contraceptive Devices (for example Copper T). They are placed in the uterus by a qualified doctor and can last for 3,5,7 or 10 years. Other contraceptives not easily available in India, are caps, diaphragms, female condoms and implants. Injectable contraceptives are available. Before adopting any contraceptive it is advisable to consult a qualified doctor, since contraceptives are known to have side
Copper T in the uterine cavity
effects in some people. Sometimes, despite taking precautions, a woman may find herself pregnant without being equipped or prepared for it. In such a situation she has to decide whether to continue the pregnancy or terminate it. This may be a difficult and painful decision to take. If she decides to terminate the pregnancy, she can have an abortion or a Medical Termination of Pregnancy (MTP). MTP is legal in India upto 12 weeks (upto 20 weeks in exceptional cases) and should only be performed by a qualified doctor. If it is done in the first three months the risk involved is relatively low. The risk increases considerably if done in the 4th or 5th month. It can even be life-threatening.
DANGEROUS STUFF Infections can occur because of certain habits, lack of hygiene, certain medication, and sex with an infected person. Infections can affect the genitals and other parts of the body. They may be transmitted through the genitals or other organs through sexual acts. Some infections that affect the genitals may have nothing to do with sex; they also happen to people who are not sexually active. However, these infections may have symptoms that are similar to those caused by Sexually Transmitted Infections (STIs). The older term for these infections was STDs meaning Sexually Transmitted Diseases. The most common signs and symptoms of infections are: Burning sensation while urinating (different from the slight burning if you do not drink enough water); itching, redness or rash in the genital area or mouth if you practise oral sex; sores on the genitals; unusual discharge from the genitals; foul smell from the genitals. STIs are usually spread from one person to another through sexual activity. Some STIs have signs and symptoms that can warn you but some have no external signs. Some of them are easily curable if caught at the early stage but some can cause complications later and some can be fatal. HIV infection is the most dangerous of these as it can be life-threatening. HIV stands for Human Immunodeficiency Virus. It can lead to AIDS which is the incurable Acquired Immune Deficiency Syndrome. This means that the body’s immunity gets weakened and can no longer fight infections. The person who
developes AIDS gets ill with different infections and may finally die because the body cannot properly recover from the infections. HIV is present in the body fluids of an infected person; blood and the sexual body fluids - semen and vaginal secretions - have the highest concentration of the virus. Certain "safer sex" activities lower the risk of exchanging infected blood or sexual body fluids - the most likely to spread HIV. Here is how people become infected with HIV: by blood transfusion and sharing equipment that allows the transfer of HIV infected blood (injection needles etc.); by engaging in unprotected sex - oral, anal or vaginal; children who are born to an HIV-positive woman may also be infected with HIV. There are no external signs that indicate whether a person is infected with HIV or not. The only way of detecting HIV infection is through some special blood tests. Before taking the test one needs to go in for what is called pre-test counselling that provides information about HIV, the test, the results and their implications. After the test comes post-test counselling that prepares the person to deal with the test results, negative or positive. A negative result means that the person is not infected. To remain uninfected, people need to take some basic precautions. To stay HIV-uninfected: z
Use only blood screened for HIV
Use disposable needles and syringes
If sexually active, use safer sex techniques (see page 27)
HIV is not transmitted by hugging, kissing, touching, sharing clothes, food, toilets, work spaces, mosquito bites, etc. Anyone can become infected depending on what they do, not who they are. Discriminating against someone on the basis of their HIV status is wrong. People who are HIV positive
(infected) need to take good care of themselves in terms of diet, medication, rest and stress control. Emotional and social support are crucial.
FOUL PLAY ! There are many ways of relating to someone sexually. Some things feel good whereas some others don't. For example, some touches might make you feel good while others make you feel dirty, horrible disgusted, angry or upset. It is for each person to decide what feels good and what does not. Sexual harassment can take many forms : visual, verbal, physical, psychological. Some examples are: unwanted touching, patting, brushing against, leering; unwanted exposure to someone's genitals; unwanted sexual jokes, comments, stories, posters; physical assault; demands for sexual favours under pressure which may be stated or implied (withholding marks, recommendation letters, etc.) Sexual abuse is considered to include any exploitative sexual activity, whether or not it includes physical contact, between you and another person who by virtue of his or her power over you - due to age, strength, position or relationship - uses you to meet his or her sexual and emotional needs. In very simple terms this refers to any sexual activity that you do not want. Some people think that unwanted sexual activity is abuse only when there is physical violence. This is not true. Threats, blackmail, and the possibility of violence are as frightening as actual physical violence. Just because someone may not have reacted the way one imagines they should have, it does not mean that "they wanted to be raped" or they they were "not really abused". No matter
what a person does (before, during and after), if that person does not want sex, it is abuse and not that person's fault. Anyone can be vulnerable to sexual abuse. Both girls as well as boys are at risk. Sexual abuse takes many forms and does not necessarily involve direct physical contact. A sexual act with forced intercourse is called rape. Another term that you might have come across is 'sexual harassment'. This is any unwanted attention/ action of a sexual nature as mentioned earlier. When someone is sexually abused by a relative it is incestuous abuse. Studies have shown that most sexual abuse is committed by someone known to the person who was abused, eg. a friend, relative, neighbour etc. No one 'asks for it'. The fake logic of sexual abuse being motivated by provocative clothing or behaviour is often used by abusers to wash their hands off what they have done. The person who has been abused is not at fault. Abuse involves a serious betrayal of trust and may affect a person's self-esteem and mental and physical health. Unfortunately, sexual abuse is quite common and many people have experienced it in some form or the other. If it has happened to you, remember that it is not your fault; it is the abuser who did wrong, not you; it does not have to scar you for life; seek help if you are overwhelmed by negative feelings. If you are currently in a situation that you feel might be abusive, speak to someone you trust, try getting out of the situation if you can, try not to be alone with the abuser, and seek help from the resources listed in this booklet. Someone who has been abused needs your support and reassurance, and respect for their wishes and privacy. If you know someone who is an abuser, do not protect them - they are a danger to other people.
PLAYING IT SMART This is the time of your life when you are naturally curious, want to know more, want to experiment with and experience different things and also feel overwhelmed by the number of 'dos and don'ts' that bombard you. Whether or not you are sexually active, you must know how to be mentally and physically healthy and safe. Safety implies reducing risks. In sexual activity there can be the risk of certain negative things happening if precautions are not taken before-hand. These include unwanted pregnancy, HIV infection, and sexually transmitted infections (STIs, or what are commonly known as STDs, but not the telephone type!). You know that you need to use safe and effective contraceptives (see page 21-22) to avoid unwanted pregnancy. There are no external signs of HIV infection and the early stages of some other infections. And there is no way of knowing for sure that someone is infection free. In fact they themselves may not know that they have an infection. Therefore you need to protect yourself. The only way to be totally safe is to not have sex at all (something that abstinence only programmes highlight), which after a point may be quite unrealistic for most people. There are ways of playing it "safer" to protect yourself. You must decide what risks you will and will not take. Delaying sexual activity till you are sure about what you want to do and are able to deal with the consequences (emotional, social and physical) is one of the ways of protecting yourself. If you want to be, or are sexually active, it is smart to know the relative risks involved in different kinds of sexual activities and practice those that are low risk.
Here are some common sexual activities grouped according to relative risk No risk: Masturbation and mutual masturbation (if no broken skin), touching, hugging, body massage, body rubbing, kissing, deep kissing (if no blood exchanged). Low risk: Oral sex on a man with a condom (worn as soon as penis becomes erect), oral sex on a woman with a barrier (a square piece of a cut open unused condom or the thin clingy plastic film used to wrap sandwiches in about a 5 inch square, placed on the vulva). Getting vaginal secretions, menstrual flow, urine, or semen on unbroken skin away from the vulva is OK. Some risk: Deep kissing (blood exchanged, like if you have bleeding gums or sores in your mouth), oral sex if done without a barrier, vaginal intercourse with a condom, anal intercourse with a condom (more risky than vaginal intercourse with a condom). Try not to get semen, vaginal secretions or blood into the mouth or on broken skin. Intercourse with a condom is not 100% safe because condoms do sometimes break or slip off. High risk: Vaginal intercourse without a condom, anal intercourse without a condom (much more risky than unprotected vaginal intercourse). The other thing to remember is that the more people you have sex with, the higher are the chances of your being exposed to risks. Monogamous (both of you have sex only with each other) relationships are safer. Safety also means safety of the emotional sort. If you are not in control of the situation you may find yourself being pressurised to do things you may not be ready for. Being smart about sex means being in control of what you do. Things like
drugs and alcohol are known to induce a loss of control. Also, there are certain feelings that encourage people to do risky things. Some of these feelings are : insecurity, shame, low self-esteem, fear of rejection, embarrassment and the need to be accepted and loved. If you find youself ‘giving in' because of these feelings and doing things you would rather not do, you need to take a good hard look at yourself and your relationship (see 14-16). Great sex like good relationships, is based on equality, communication and safety. Using protection is not selfish. It is smart and shows that you care for yourself and for your partner. If you are sexually active, remember: nonpenetrative sex is pleasurable and safe; always have protected sex (use condoms - see page 21 for how to use one); stay in control.
SURVIVING THE TEEN YEARS The teenage years are full of excitement, confusion, curiosity, discovery, frustration, dreams, disappointment, ideals, and growth. There is so much happening, so much to do, and so many mixed messages. On the one hand you are expected to "behave like an adult", and on the other, told that you are "too young to do this". There is so much to deal with - studies, a career, friends, relationships, movies, parties, temptations..... Do I want to marry? What sort of job should I go in for? Am I gay/ lesbian/ bisexual/ transgender? Am I an OK person? All this may become more difficult to handle if your needs are different because of a disability.
Your values and beliefs are challenged; you experiment with being different - sort of trying out a “personality” that suits you; discover what you like and what you don't; and take risks that earlier you could not. Some risks pay off - like discovering an aptitude while just checking out or fixing something (repairing the TV, cooking a meal). Some others don't. Trying out new behaviours like smoking or drinking (alcohol) may seem great fun or adult-like at first, but may later turn into a habit that controls you rather than the other way round. Friends may be a great support. They could also be the people who pressurise you to do things that are not good for you. Parents and teachers may have a lot of expectations that can feel restricting. When they begin comparing you with others (someone's son, someone else's daughter, the list never ends....!) it gets downright frustrating. At these times, they can seem such a pain. How does one deal with all of this to emerge as a relatively sane and healthy person? Growing up is not confined to passing an exam or getting a job or buying a house or a car. It has to do with decisions in all areas of your life, including your sexuality. Growing up is about developing the ability to use judgement, being your own person, responding appropriately to situations and learning from mistakes.
NOTE TO OLDER PEOPLE You may be a parent or teacher or an older well-wisher wondering how to talk to a young person about sexuality. What do I say? How much do I tell? How do I say it? What if this encourages experimentation? Will all this information cause harm instead of protecting young people? Talking sensibly and matter-offactly about these issues has never caused harm. In fact studies have shown that when young people have information about sexuality, they are more likely to make responsible decisions (including delaying sexual activity) and engage in healthier behaviours (WHO 1996). Whether you talk to them or not, young people in any case are exposed to all sorts of information (the media, friends, their own experiences). More than 20% of those who call the TARSHI helpline are between the ages of 10 and 21. They are from all walks of life - most of them go to school, some to work, some have had sex, some have not, some of them are scared about sex, some are scared about HIV, and some have had abortions. These young people have many misconceptions and questions about sexuality issues. The information they have is inaccurate and fragmented. Accurate information is essential not only to promote a healthy sexuality but also to prevent negative things like sexual abuse and infections from occuring. Sexuality is a part of everyone's life. Decisions about sexuality are based on not just information alone. It is in the home, at school and with one's friends that people develop their value systems and learn how to deal with their feelings.
If for some reason you find yourself unable to talk about these issues with young people, you could do some other things: get them some books to read, put them in touch with someone who they can talk to, and educate yourself so perhaps in time you can discuss things with them. Above all, encourage young people to ask questions and express their opinions. Talking is one of the ways of imparting 'sexuality education'. Young people's ideas about sexuality are influenced by not only what is said but also by what is not said, how things are said, and by unspoken attitudes that are expressed with or without awareness. Frank discussion and openness about sexuality conveys some very strong messages: z that
young people can be responsible
you are concerned about their well-being
you trust them
they can come to you without waiting for a
situation to develop into a crisis
SERVICES YOU CAN ACCESS
1. AAG, New Delhi For HIV/AIDS and De-addiction counseling Phone: 011-26187953, 26187954 2. Child Line, New Delhi For people under 19 years Phone: 011-24324503 3. Madhyam, New Delhi Legal Services for women in distress Phone: 011-24324503 4. Pratidhi, New Delhi For legal issues related to sexual abuse Phone: 011-22527259, 22058718 5. Sanjivini, New Delhi Counselling on emotional problems Phone: 011-26864488, 24311918 6. Sangini, New Delhi Counselling for women attracted to women Phone: 011-55676450 7. Sumaitri, New Delhi For those depressed, in distress or suicidal Phone: 011-2710763 8. TARSHI, New Delhi For sexuality issues Phone: 011-24372229
TAR S H I Talking About Reproductive and Sexual Health Issues believes that all people have the right to sexual well being and to a self-affirming and enjoyable sexuality.
TARSHI works towards expanding sexual and reproductive choices in people’s lives in an effort to enable them to enjoy lives of dgnity, freedom from fear, infection and, reproductive and sexual health problems.
Helpline: 011-24372229 Visit us at: www.tarshi.net
TARSHI is registered under the Societies Registration Act XXXI of 1860