12 questions and answers about sexual and reproductive health and rights
Preparing for a lifelong journey 1 Preparing for a lifelong journeyWe all go through massive changes at every stage of our development as human beings. As we move from one stage of our life to the next, our bodies, feelings, likes and dislikes change as we develop the attitudes and values that will guide our choices, relationships and behaviours. Our attitudes and values continue to change as we face challenges and opportunities in our life, such as migration, education, and our relationships with others. Adolescence is a time in our lives when very particular changes take place. This is when we move from childhood to adulthood. As this happens, it is very important to be aware of and to take care of our sexual and reproductive health, because the decisions we make during this period will affect our health and well-being for the rest of our life. This brochure was developed to respond to common questions that adolescents on the move might have about sexual and reproductive health and rights and will help us all to: get informed about important issues related to our sexual and reproductive health reflect on issues that any of us might encounter throughout our life act by taking important steps that will help us preserve and improve our sexual and reproductive health. It will help us on our lifelong journey to know and understand ourselves, other people and society. 2 KNOW AND UNDERSTAND YOURSELF By knowing our body, our own values, and our wishes, we can set our personal boundaries as well as recognize and respect the boundaries of others. A sexual boundary is how far we are willing to go sexually or physically and these boundaries differ from one person to another. Understanding our own boundaries and those of our partner(s) is particularly important for a sexual experience where everyone feels safe and taken care of. 1. Am I ready? Stay informed There are many things to know when it comes to sex and sexuality. They include knowing our own body, thinking about our sexual orientation, figuring out if we are ready emotionally and physically, learning how to protect ourselves from sexually transmitted infections, being informed about contraceptives, understanding what consent is and what our rights and responsibilities are toward the person(s) we want to have sex with. We should make our own decisions about our sexual behaviours: these decisions should come from within ourselves. We may need more time than someone else to decide what we want, when, with whom and if we really want to make it happen at all. Our choices and the choices made by other people about their sexual life should be respected and not judged. For example, when it comes to having sex (or not) we choose the right circumstances, such as a comfortable and safe place, the right person and the right time.1 3 Reflect As we travel on our lifelong journey, it is important to be aware that we have rights and responsibilities. If we share the journey with someone, it is helpful to know where, when and how far we want to go. We need to ask ourselves: Am I emotionally and physically ready for this? Do I really know enough about myself and my partner? Do I know enough and have the right information about sex? Even if it can seem uncomfortable, we can also consider talking with our parents, guardians or other adults we trust about sex and sexuality, as they can give advice and support. Act Accurate information is the key to making informed choices. So, we always need to look for trustworthy information when learning about sex. For example, we need to be careful when we navigate the internet, or talk to other people, as they offer a wide range of information. We need to make sure that we find the information that is right for us! This brochure has some ideas about where to look. Sometimes, visiting a doctor or another health specialist might be necessary to give us accurate information before we can make a decision. If you want to learn more about many sexual and reproductive health topics, you can find useful information on this reliable source: In Arabic, English, French and 10 other languages:2 https://www.zanzu.de/en/ In Italian, visit the institutional website: https://www.salute.gov.it/portale/fertility/homeFertility.jsp https://www.zanzu.de/en/ https://www.salute.gov.it/portale/fertility/homeFertility.jsp 2. How does my body change throughout life? Stay informed Sexual development3 is a lifelong process for everyone, as our bodies change constantly. Our body goes through lots of changes that happen slowly over time. We might have some signs of puberty at an early age, while other changes show up years later. Those changes can also be particularly challenging for some of us. We can get pimples, mostly on our faces but on our bodies too. The hair we have on our arms and legs may get thicker and darker; and were likely to grow hair in new places: young men and women grow hair in their armpits and pubic area, while young men also grow hair on their face and chest. Stretch marks are common too, as a sign of our adult body taking shape. Physical changes, from body odours to growth spurts are just part of our puberty story. For boys, the penis and testicles get bigger; for girls, breasts develop and get bigger and their bodies may become more curvy. These visible changes are often our first sign of what is happening because we can see them, such as the changes to our external genitals during puberty. However, there are also invisible changes, with puberty also changing our internal reproductive organs. And these changes are responsible for: ovulation in females, which is the part of the menstrual cycle when an egg is released from the ovary. When the egg is released, it may or may not be fertilized by sperm. If fertilized, the egg may travel to the uterus and embed itself there to develop into a pregnancy. 4 Female genital mutilation5 As well as the visible and invisible changes that take place during puberty, this is also a time when the sexual life of girls and young women, in particular, comes under intense scrutiny. In some communities around the world, this scrutiny can lead to harmful traditional practices, such as female genital mutilation (FGM). FGM refers to all procedures that involve the partial or total removal of the external female genitalia or other injuries to the female genital organs for non-medical reasons. These reasons are linked, primarily, to the perceived need to control female sexuality. It is a deeply entrenched social and cultural norm in many places. It is estimated that around 200 million girls and women alive today have undergone some form of FGM. The practice can cause short- and long-term health complications, including chronic pain, infections, increased risk of HIV transmission, anxiety and depression, birth complications, infertility and, in the worst cases, death. It is internationally recognized as an extreme violation of the rights of women and girls and is forbidden by law in Europe. 5 spermatogenesis in males (making millions of sperm all the time) and the production of semen, which can lead to pregnancy if it comes into contact with and fertilizes an egg. Hormones are responsible for many biological processes in puberty in males and females and play a key role in the regulation of reproductive organs and sexual functions. Hormones trigger spermarche, when the sperm in boys testicles is first produced; and menarche, when a girl has her first period (usually between the ages of 9 and 15 - it varies from one individual to another).4 Reflect For most of us, many new things happen once puberty starts. Our bodies are unique, so puberty is different for each one of us as we all go through puberty at our own pace. No matter how we are feeling about all these changes to our bodies, we should remember that puberty is a normal part of growing up. Its really useful to understand what is happening in our body when these changes affect us for the first time so that we can feel confident that these are just a normal part of our lives. As our bodies change, so do our desires and emotions and that is part of the process, too. We may have all kinds of new feelings, like crushes and being sexually turned on. Some of us might worry about the size and shape of our breasts, penis, vulva, testicles, nipples, lips and so on. This is often because of the so-called ideal bodies shown in movies, on TV and in social media. 6 FGM can improve fertility. False. There is no evidence that FGM improves fertility. In fact, the complications caused by FGM can have a negative impact on fertility. Men support FGM. False. In most countries where data exist, most boys and men think FGM should end. If FGM is performed by a health-care professional, there is no risk of harm. False. FGM is a harmful practice and may lead to physical, mental and sexual health complications regardless of who performs it. Only girls who undergo FGM can enter womanhood and be considered respectable. False. Cultural norms are changing and there is growing acceptance of other rites of passage into womanhood that do not involve FGM. FGM does not harm relationships. False. Many women who have experienced FGM report adverse effects on sexual relations, which can have a negative impact on their relationship. FGM is a religious obligation. False. FGM is not supported in any major religious texts and many religious leaders believe that this tradition should end. Myths and facts about female genital mutilation (FGM)6 But knowing what to expect can make puberty seem less weird or stressful. And talking to our parents or other adults we trust also helps. After all, theyve gone through puberty too! We need to remember that each of us is unique just as we are. We should not be influenced by external models and instead discover and appreciate what we have and how we feel. Act If you want to learn more about our body, you can find useful information on this reliable source: In Arabic, English, French and 10 other languages:7 https://www.zanzu.de/en/body/ In Italian, the website of the Ministry of Health: https://www.salute.gov.it/portale/fertility/dettaglioContenutiFertility.jsp?lin gua=italiano&id=4551&area=fertilita&menu=fisiologia 7 https://www.zanzu.de/en/body/ https://www.salute.gov.it/portale/fertility/dettaglioContenutiFertility.jsp?lingua=italiano&id=4551&area=fertilita&menu=fisiologia https://www.salute.gov.it/portale/fertility/dettaglioContenutiFertility.jsp?lingua=italiano&id=4551&area=fertilita&menu=fisiologia 8 3. What is menstruation and what does it entail? Menstruation is normal and happens to girls and women of reproductive age around the world. It is a natural process that is responsible for monthly bleeding for women and girls as well as transgender or non-binary individuals who menstruate, with blood and tissue from the uterus coming out of the vagina. It is important to understand the menstrual cycle so we learn how to manage it every month. And it can tell us a lot about the functioning of our body. The average menstrual cycle is 28 days, but it can range from 21 to 35 days. For younger people who have just started menstruating, the cycle can be very irregular at first. However, it is important to see a doctor if irregular cycles continue. Most girls get their first period when theyre around 12. But getting it any time between age 10 and 15 is OK. There isnt one right age for a girl to get her period. This natural process tells us a lot about our health, and is the most common way for someone to know whether they are pregnant or not: the monthly bleeding usually stops when a pregnancy starts. However, it is important to know that bleeding does not guarantee that someone is not pregnant, as bleeding can sometimes happen during pregnancies. If there is any doubt, discuss it with a medical professional and/or get a pregnancy test. 9 Menstrual cycle8 Oestrogen Womb lining breaks down, causing your period. Oestrogen rises. Uterus lining begins to build up. Womb lining continues to thicken. If egg remains unfertilized, womb contracts in readiness to shed the built-up layer. Oestrogen peaks.Ovulation occurs. Uterus lining Menstruating can be uncomfortable for some people, and not for others. lt is common to have cramps in the abdomen, feel bloated and have pain in the thighs and back. Some people also have headaches, constipation, nausea or dizziness. Others may feel tense, angry or emotional before and during their period. lt is also normal to have less energy, tender breasts and acne. But there are some girls and women who dont have any of these symptoms at all. That is normal as well. Myths and facts about menstruation9 Women cannot have sex during menstruation. False. There is no reason why a woman should avoid sex during her period. This is her choice. Menstruating women and girls cannot bath or take a shower. False. There is no reason to avoid contact with water during your period - in fact, hygiene is very important at this time. If a woman has sex during menstruation, she cant get pregnant. False. The chances of getting pregnant during menstruation are low. However, it is still possible to get pregnant if you have sex without contraception, given that every womans ovulation cycle is different. Menstruation is dirty or dangerous. False. Menstrual blood is composed of regular blood and tissue, with no special or dangerous properties; so mensturating people do not need to be isolated or stigmatized. If a menstruating woman or girl touches the food or enters the kitchen, this will cause the food to go bad. False. There is no scientific proof at all that menstruation causes food to go bad. A woman/girl that has not had vaginal sex cannot use a tampon. False. Because of its small size, the use of a tampon does not pose any risk to women/girls who have not had vaginal sex. Girls can have a normal daily life while they are menstruating. To manage menstruation safely, hygienically and without shame we need to understand how to handle it. If we are in pain, this can be eased in many cases by applying gentle heat to the abdomen using, for example, a warm towel or taking a warm bath. If necessary, we can talk to a doctor about how to manage the pain and find the best solution for us. 10 Some people find that exercise helps to relieve cramps and makes them feel better in general. We can take part in any physical activity that we want to do. We should take good care of our personal hygiene: washing our genitals external folds every day with clean water. After washing, we should dry ourselves properly using a clean towel or dry cloth. When we are menstruating, whatever we use cloth, disposable or washable pad, period panties, menstrual cup, or tampon we should make sure we change it every six to eight hours. Using it for longer can cause infections. We should also remember to wash our hands before and after changing the pad or cloth and dispose of the material hygienically.10 Reflect Ask yourself: Do I have the information about how the menstrual cycle works? Do I know which products I can use while menstruating? Do I have all necessary information to manage my menstruations in a healthy and safe way? Enjoying good reproductive health is also about being connected to our body and knowing how it works. Disposable or washable pad Period panties Menstrual cup Cloth Tampon MENSTRUAL PRODUCTS 11 12 Act We can start tracking our menstrual period using a normal calendar or by using a free app on our smartphone. It can also be useful to understand how we feel during the different phases of the menstrual cycle. We should get informed on which menstrual hygiene materials are the most suitable for us among the many different options available, such as reusable menstrual pads; disposable menstrual pads; period panties; menstrual cups; and tampons.Remember that if you experience pain or need more information, you can contact the services included under Question 6 (important things to know about sex). There are many free apps that we can use to track the menstrual period. Here is one we recommend that also provides an overview of different products to help us manage menstruation. It is always important to do our own research and find the one that works best for us, making sure to read their privacy terms and conditions. In English, Chinese, French, Italian, Spanish, Turkish and many other languages: https://flo.health In addition, if you want to learn more about menstruation, you can find useful information on these reliable sources: In Arabic, English, French, and 10 other languages: https://www.zanzu.de/en/body/womans-body/menstrual-period/ In English: https://www.youtube.com/watch?app=desktop&v=ayzN5f3qN8g In Italian, the website of the Ministry of Health: http://www.salute.gov.it/portale/fertility/dettaglioContenutiFertility.jsp?ling ua=italiano&id=4553&area=fertilita&menu=fisiologia; https://flo.health/ https://www.zanzu.de/en/body/womans-body/menstrual-period/ https://www.youtube.com/watch?app=desktop&v=ayzN5f3qN8g https://www.salute.gov.it/portale/fertility/dettaglioContenutiFertility.jsp?ling%20ua=italiano&id=4553&area=fertilita&menu=fisiologia; https://www.salute.gov.it/portale/fertility/dettaglioContenutiFertility.jsp?ling%20ua=italiano&id=4553&area=fertilita&menu=fisiologia; 13 4. Am I normal? Stay informed We are all different and unique and it is difficult to say whether normal really exists. We might think that normal means being all the same. However, there might be different kinds of normal and theres really no such thing as a normal looking body or normal feelings. An exciting part of our journey is understanding and embracing such diversity, and learning to value the needs and opinions of other people, regardless of their appearance, country of origin, gender identity, sexual orientation, age and so on. As adolescents, we care very deeply about our friendships and relationships but, at the same time, we get worried about being judged for our appearance or behaviour. For example, social media and the need to gather likes can have a strong impact on us. When we feel concerned, we should remember that each and every one of us has unique strengths and talents, as well as a unique body. In particular, we all have our own beliefs and expectations about sex and sexuality, often influenced by wider attitudes, beliefs and behaviours that are common in our society, culture and family. But sometimes those topics are not discussed openly, and it can be difficult to find answers to our questions and reassurance for our doubts.11 14 Masturbation: is it normal?12 We might feel worried the first time we feel sexual desire, and this is definitely a common feeling! We may feel the urge to masturbate.Masturbation is when we have sexual pleasure (alone or with others) by stimulating sensitive parts of our genitals, often to the point of orgasm the peak of sexual arousal. Masturbating gives us the chance to learn more about our own body, our attractions, and what we like and dont like. Masturbation will not harm us, physically or mentally. Of course, its best to do it in private, somewhere we feel safe and comfortable and we dont invade someone elses privacy. At the same time, not everyone enjoys masturbation, and there is no reason to masturbate if you dont want to. That is perfectly normal too! Myths about masturbation13 False. There is absolutely no connection between masturbation and vision (or hearing). Masturbating can cause blindness. Masturbating can cause infertility. False. Masturbation does not lead to infertility in women and men. Masturbation can make it impossible to have an erection.False. There is no relationship between masturbation and erectile dysfunction (when you cant get or maintain an erection). Women and girls dont masturbate.False. Its common for people of any gender to do it, even if they dont talk about it! Masturbation can give you hairy palms. False. There are no hair follicles in the palm of your hand, and, therefore, no hair! 15 Reflect When our first sexual desires begin, we may ask ourselves questions about our sexual orientation and gender identity, such as am I attracted more to men, to women, to both or none? Sometimes we might ask questions about our gender identity, such as do I identify as being a male or female or something else? We may have other questions and doubts about our feelings on sex and sexuality. Sometimes we might wonder whether what we feel is right or normal. What matters is that we recognize and appreciate our own unique characteristics, regardless of what other people expect of us or what they may think. Certainly, this is not always easy to do, but it is so important to learn how to love and respect ourselves for who we really are! Act We can share our feelings and doubts with trusted adults and friends and do not hesitate to search for information! For more information on masturbation, for example, take a look at these reliable sources: In Arabic, English, French and 10 other languages: https://www.zanzu.de/en/sexuality/sex/masturbation/ In Italian, you can look at this section of the ISS website: https://www.issalute.it/index.php/falsi-miti-e-bufale/sessualita/la- masturbazione-fa-diventare-ciechi?highlight=WyJtYXN0dXJiYXppb25lIl0= https://www.zanzu.de/en/sexuality/sex/masturbation/ https://www.issalute.it/index.php/falsi-miti-e-bufale/sessualita/la-masturbazione-fa-diventare-ciechi?highlight=WyJtYXN0dXJiYXppb25lIl0= https://www.issalute.it/index.php/falsi-miti-e-bufale/sessualita/la-masturbazione-fa-diventare-ciechi?highlight=WyJtYXN0dXJiYXppb25lIl0= 16 KNOW AND UNDERSTAND OTHERS A positive and respectful approach to sex and relationships is a good first step to sexual health and to sex that is safe and pleasurable, without any violence or discrimination. Good sexual health means respecting and protecting our own sexual rights and the rights of our partner(s). 5. Why do relationships matter? Stay informed There are many types of relationships and also a lot of different ways to love someone. Here are some examples. Some of us try to build one special relationship with another person. These romantic relationships are an important part of life and can make us fulfilled and happy, but they can also be difficult and we often have to work hard to make them successful. Some people would rather not have a long-term relationship at all, and/or dont want to get married. Some people may want to be in a relationship or get married but are not allowed to do so, because of national, social or religious laws or norms. This can be a problem for people who want to be with someone of the same sex or someone from a different religion or ethnic group. 17 Some people worry about finding a partner and about if and when they should start dating, or if they are even allowed to date someone who has not been chosen for them by their families. Whatever the circumstances, there are some basic ground rules for a successful relationship. People in a good relationship make each other feel safe, happy, cared for and secure. They are happy to be intimate with each other and enjoy sex if and when they decide. In a good relationship, the partners respect each other, their bodies, their choices. That is why it is so important to be attentive, and show respect for the feelings, beliefs, wants and needs of our partner(s). This helps us to build a strong foundation that recognizes and celebrates their unique value. The concept of consent is also a key part of healthy relationships: an agreement to take part in a sexual activity. Before being sexual with someone, you need to know if they want to be sexual with you too. Also do not assume that because they have engaged in sexual activitiy in the past, they have already consented. Without consent, sexual activity is always sexual violence, no matter if the two people are a couple, married or in another kind of relationship: no one should ever feel under pressure to have sex.14 18 SEXUAL VIOLENCE Sexual violence refers to any act of violence that involves sexual contact without consent and that will cause harm to the person experiencing it. Sometimes the persons experiencing the harm may not realize they are experiencing it. Consent is when we agree and accept to take part in sexual activity and it must be freely given, reversible, informed, enthusiastic and specific (consent is as easy as FRIES).15 It is important to give consent freely (without pressure or coercion by anybody) and in an informed way, which means that the person should be old enough to understand and have all the necessary information about what sex is. A person may feel that they must say yes when someone demands sex because they feel threatened, fear for their safety, or because they need to sell sex just to survive. This is why consent is so important, and we must remember that saying yes does not always mean consent! Sexual violence can happen to anyone, but some groups of people are more likely than others to experience sexual violence, such as girls and women. The only person to blame for acts of violence is the perpetrator the person who commits the violent act. It is never the fault of the person who is violated, no matter where it happened, when it happened, where they were, how they were behaving or how they were dressed. It has an impact on people in different ways, and it might have all kinds of long-lasting consequences both physical and emotional. With the right support and care, it is possible to recover from violence. There are doctors, nurses, psychologists, social workers, and law enforcement officers who can help. They will listen and offer support, and they must respect your privacy in line with their legal obligations. Reflect Everyone is different and not everyone wants exactly the same kind of relationship. It is up to each of us to define the relationships that interest us, and that we are willing to build, when and with whom. And this may change over time. 19 Safety first! If you are in danger, call the emergency services 112 and go somewhere safe. Tell someone you trust, such as a parent, a guardian or a teacher. If you are under 18 (or if you want to report an emergency involving a child), call 114: it is free and operates 24/7. You can get confidential support from the Violence and Stalking National helpline by calling 1522 or downloading the 1522 app. The service is free of charge and is available 24/7 in Arabic, English, French, Italian and Spanish. You can find more information about sexual violence and other forms of violence here: 12 questions and answers about gender-based violence, in Albanian, Arabic, Bengali, English, French, and Italian: https://onthemove.ureport.in/reports/ 12 questions and answers about sexual violence, in Arabic, English, French and Italian: https://www.unicef.org/eca/reports/supporting-male-refugees-and- migrants-who-survive-or-are-risk-sexual-violence https://onthemove.ureport.in/reports/ https://www.unicef.org/eca/reports/supporting-male-refugees-and-migrants-who-survive-or-are-risk-sexual-violence https://www.unicef.org/eca/reports/supporting-male-refugees-and-migrants-who-survive-or-are-risk-sexual-violence 20 A healthy sexual act is one that is entirely free of coercion, assault, rape, discrimination, violence and pain. All of us should be aware of our individual right to stop a sexual act at any time. Sex is not compulsory: there are healthy relationships that involve sexual abstinence, where the people involved do not have sex. It is a good idea to think of the relationships that really matter to us. Looking at the information we have already talked about, what type of relationships are they? What makes them healthy or unhealthy? Act Try these activities from the following reliable sources: In English, a self-reflection activity on healthy relationships: https://www.york.ca/wps/wcm/connect/yorkpublic/463ac6dd-1d95-4d93- 9732-918375219ac0/SH+DVD+Student+Resource.pdf?MOD=AJPERES In Arabic, English, French and 10 other languages: https://www.zanzu.de/en/relationships-and-feelings/relationships/ In English to understand more about consent watch this UNFPA video: https://youtu.be/LrUhUGTF1iU Consent is more than saying Yes, in Italian: https://www.unicef.it/media/amore-e-consenso-san-valentino-piu-che- dire-si/ Consent is more than saying Yes, in English and French: https://onthemove.ureport.in/stories/# https://www.york.ca/wps/wcm/connect/yorkpublic/463ac6dd-1d95-4d93-9732-918375219ac0/SH+DVD+Student+Resource.pdf?MOD=AJPERES https://www.york.ca/wps/wcm/connect/yorkpublic/463ac6dd-1d95-4d93-9732-918375219ac0/SH+DVD+Student+Resource.pdf?MOD=AJPERES https://www.zanzu.de/en/relationships-and-feelings/relationships/ https://www.youtube.com/watch?v=LrUhUGTF1iU https://www.unicef.it/media/amore-e-consenso-san-valentino-piu-che-dire-si/ https://www.unicef.it/media/amore-e-consenso-san-valentino-piu-che-dire-si/ https://onthemove.ureport.in/stories/# 21 6. What are some important things to know about sex? Stay informed Sexual identity begins to emerge before puberty, but puberty brings with it a greater interest in sex and a greater range of sexual exploration. Sex is a common and healthy activity among humans, both for pleasure and reproduction. Having sex means different things for different people, and there are different types of sex. It is important to know that having sex and sexual contact has some physical and emotional consequences that we need to acknowledge and recognize. Pregnancy is one possible consequence of having sex. Pregnancies can be wanted, unwanted, or unplanned. The best way to lower the risks of pregnancies that are unwanted or unplanned is to protect ourselves. There are many forms of contraception that can be used for protection. You can consult a doctor to get advice. There are other risks related to sex we need to know about. Sexual violence and sexual exploitation, for example, are forms of violence that involve sex and can happen in-person and online. Many bacteria, viruses and parasites can be passed on through vaginal, anal and oral sex and these can cause illnesses that are called Sexually 22 Transmitted Infections (STIs). Common symptoms of STIs include vaginal discharge, urethral discharge or burning or abdominal pain. But someone can have an STI without having any obvious signs. Many STIs can also be transmitted from a mother to her child during pregnancy and childbirth. STIs acquisition is also associated with substance use together with other sexual risk behaviors including inconsistent condom use. Several STIs have severe health consequences if untreated; so, it is important to always test ourselves and be responsible when having sex. Early detection helps to minimize the health risks and prevents the spread of STIs to others.16 SOME COMMON SYMPTOMS OF SEXUALLY-TRANSMITTED INFECTIONS17 Unusualdischarge/bleeding Skin rash Burning or pain when urinating Bumps, soresor blisters Itching or rednessin genital areas Pain, such as lower abnominal pain Night sweats Unexplainedweight loss If you or your partner are experiencing any of these symptoms, you should take an STI test. 23 Genital warts Growths found on or around the genital and anal areas. Genital warts are caused by a virus called human papillomavirus (HPV). HPV (Human Papillomavirus) Genital Herpes Syphilis Chlamydia Gonorrhea HIV/AIDS A very common STI. HPV is usually harmless but it can sometimes cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils. A common STI that infects your mouth and/or genitals. Causes blistery sores. Theres no cure, but symptoms are treatable. Syphilis is a common bacterial infection. Its easily cured with medicine, but it can be dangerous if it is not treated. A very common STI caused by a bacterial infection. Doesnt always have symptoms, but easy to treat once its diagnosed. A common STI caused by a bacterial infection. Doesnt always have symptoms, but easy to treat once its diagnosed. HIV is an infection that breaks down your immune system and can lead to AIDS. Theres no cure, but treatment can help an infected person to stay healthy. The most common Sexually Transmitted Infections18 24 A focus on HIV19 Human immunodeficiency virus (HIV) is an infection that attacks and breaks down the bodys immune system. HIV destroys specific cells (called CD4 cells), weakening a persons immunity against infections and can lead to AIDS (Acquired Immunodeficiency Syndrome). AIDS is a medical condition in which the persons immune system is so compromised by HIV that other infections and diseases might occur with severe consequences to the individual. HIV is transmitted through unprotected sex, blood transfusion, the sharing of contaminated needles in health-care settings and drug injection and between mother and infant during pregnancy, childbirth and breastfeeding. Young people are particularly vulnerable to HIV (with 50 per cent of new infections occurring globally among young people aged 15 to 24). The symptoms of HIV vary, depending on the stage of infection. Effective treatment, if started promptly and taken regularly, ensures a quality and length of life for someone living with HIV that is similar to that for someone who is not infected. However, there is no cure for HIV. For these reasons, prevention is vital. For those who are sexually active, the best prevention is safe-sex behaviour. Safe sex includes using a condom; using it correctly and using one every time you have sex. This means learning how to use condoms and how to negotiate the use of condoms with your partner. Testing is also crucial if you think you might be infected and testing is provided in several hospitals and public and private clinics in Italy, together with confidential counselling. With proper care, people with HIV infection can live for many years, often without symptoms. It is also essential to know whether you are infected to avoid infecting others! 25 Reflect Ask yourself: do I have the information and the skills I need to protect myself and others? We can minimize the risk of HIV, STIs and unplanned pregnancies if we have the right information and we use contraceptive methods correctly.Enjoying sex and good reproductive health is not just about the physical side. Its also about the quality of our relationships, the respect we give and receive, and our emotional well-being. Act In Italy, you can call the toll-free number 800 861061 to ask about STIs, including HIV, and testing. You can call from Monday to Friday, between 1 pm and 6 pm. The service is free and totally confidential, and is available in Italian, English and French. You can also have regular medical check-ups in hospitals and other authorized clinics. Find the one nearest to you at this page: https://www. uniticontrolaids.it/aids-ist/test/dove.aspx. Medical personnel have been trained on these issues, and the entire consultation and testing process should always guarantee your privacy and confidentiality. You can also get more information on STIs by having a look at the following reliable resources: In Arabic, English, French and other 10 languages: https://www.zanzu.de/en/infections/sexually-transmitted-infections-stis/ and specifically on HIV and AIDS: https://www.zanzu.de/en/infections/hiv-and-aids/ https://www.zanzu.de/en/infections/sexually-transmitted-infections-stis/ https://www.zanzu.de/en/infections/hiv-and-aids/ 26 In Italian, the website of the Ministry of Health: http://www.salute.gov.it/portale/fertility/dettaglioContenutiFertility.jsp?ling ua=italiano&id=4557&area=fertilita&menu=malattie In English, the website of the Joint United Nations Programme on HIV/ AIDS (UNAIDS): www.unaids.org/en/frequently-asked-questions-about-hiv-and-aids In Italian, UNICEF website https://www.unicef.it/media/dieci-cose-da-sapere-su-hiv-e-aids/ https://www.salute.gov.it/portale/fertility/dettaglioContenutiFertility.jsp?lingua=italiano&id=4557&area=fertilita&menu=malattie https://www.salute.gov.it/portale/fertility/dettaglioContenutiFertility.jsp?lingua=italiano&id=4557&area=fertilita&menu=malattie https://www.unaids.org/en/frequently-asked-questions-about-hiv-and-aids https://www.unicef.it/media/dieci-cose-da-sapere-su-hiv-e-aids/ 27 7. How should I protect myself and others when having sex? Contraception methods20 Made from soft, thin synthetic latex or polyurethane. They are worn inside the vagina before sex to create a physical barrier. Internal condoms External condoms Combined contraceptive patch Vaginal ring Contraceptive diaphragm Oral contraceptive or the pill Implants Intrauterine device (IUD) Emergency contraception Made from very thin latex (rubber), polyisoprene or polyurethane. They are worn on the penis before sex to create a physical barrier. A small sticky patch that releases hormones into the body through the skin. A small soft, plastic ring that is placed inside the vagina and releases hormones. Can prevent pregnancy after unprotected sex or if the contraception used has failed. There are two types of this contraception: the morning after pill and the intrauterine device. A small T-shaped plastic and copper device thats put into the womb (uterus) by a doctor or nurse. A small flexible plastic rod thats placed under the skin in the upper arm by a doctor or nurse. It releases hormones and lasts for 3 years. A pill that releases hormones into the body. The pill needs to be taken every day and at the same time. A circular dome made of thin, soft silicone thats inserted into the vagina before sex. 28 Stay informed Remember those risks linked to unsafe sex? Contraception can help to minimize them. Some methods can protect us from HIV, STIs and unwanted pregnancies, such as internal and external condoms. Others, such as the pill, the vaginal ring, the patch or other hormone-based contraceptives, prevent pregnancies but do not protect us against contracting an infection. To reduce the risk of HIV, STIs or unplanned pregnancy we should use a condom every time we have sex with anyone else, from start to finish. We should not let anyone put pressure on us to have sex without a condom.Condoms come in many sizes, they are usually made of latex, but if you are allergic to latex, you can use a condom made from polyurethane. Condoms are effective when stored adequately (heat can damage them) and correctly used. Carefully open and remove condom from wrapper. Step 1 How to wear a condom21 Step 2 Step 3 Step 4 Step 5 Step 6 Pinch air out of the tip of the condom. Place condom on the head of the erect, hard penis. If uncircumsized, pull back the foreskin first. Carefully remove the condom and throw it in the trash. After sex but before pulling out, hold the condom at the base. Then pull out, while holding the condom in place. Unroll condom all the way down the penis. 29 For oral sex, direct contact between your mouth and the genitals or anus should be avoided. We should protect our mouth by having our partner use a condom or a latex sheet as a barrier between the mouth and the penis, vagina or anus. Be aware that drinking alcohol or using drugs makes us less aware of what is happening, affects our ability to fully consent to sex, increases the chance that we will forget to take precautions, and makes us more likely to take risks, such as unprotected sex.22 Reflect Sex education and information help us feel safer when having sex. The same goes for access to good quality health services and psychosocial support. We all have a responsibility to find out about the risks and use our knowledge to keep ourselves, and our sexual partner(s), as safe as possible. Yes, there are risks of STIs and unplanned pregnancies, but they can be managed. Feeling safe before, during and after having sex is very important, both emotionally and physically. Having sex is a much healthier and happier thing to do when everyone involved feels safe and their boundaries are respected. We should always ask ourselves: Do I know enough about preventing pregnancy and HIV/ STIs? Is my sexual behaviour risky? What should I do to make sure I am safer? Act Some types of contraception (such as condoms) can be bought at the supermarket, pharmacy or from vending machines. It is important to always check the date and not to use out-of-date or incorrect condoms or lubricant, to avoid a split in the condom. External condoms have different lengths, so we should know the right size and/or ask a health specialist or pharmacist for advice.For other types of contraception (such as the pill or the vaginal ring) we need to consult a doctor. To be prepared, get more information about contraception from the following reliable sources: In Arabic, English, French, and 10 other languages: https://www.zanzu.de/en/family-planning-and-pregnancy/contraception/ In Italian, the website of the Ministry of Health: http://www.salute.gov.it/portale/donna/dettaglioContenutiDonna.jsp?lingu a=italiano&id=4475&area=Salute+donna&menu=societa 30 https://www.zanzu.de/en/family-planning-and-pregnancy/contraception/ https://www.salute.gov.it/portale/donna/dettaglioContenutiDonna.jsp?lingua=italiano&id=4475&area=Salute+donna&menu=societa https://www.salute.gov.it/portale/donna/dettaglioContenutiDonna.jsp?lingua=italiano&id=4475&area=Salute+donna&menu=societa 31 KNOW AND UNDERSTAND SOCIETY We see people from all over the world in person and online of all shapes, sizes, ages, genders, personalities, shades of skin and shades of opinion.For a young person on the move who is now living in a new country, it can be difficult to get used to so many different kinds of people and their different views. We may feel that we are not understood, or that we are being judged. But remember, they are also trying to understand us! 8. The big question: why does sex exist? Stay informed Sex has many purposes and plays a key role in our human societies. It brings people together, creates intimacy, and can form families. It provides physical pleasure, stress relief and intimate connections for individual people. It is also how our species reproduces. Knowing how human bodies work, how babies are made or understanding pleasure are the first steps to answering the big why question. But there is so much more to find out! People from different cultures and many religions through the ages have seen sex as something so special that it is sacred, and perhaps even a divine gift: a way to show love to each other but also to create life. Sexual behaviours and sexuality might also vary from culture to culture and these differences may create confusion and frustration.23 32 Reflect If we hold strong beliefs, we may want to be sure that our sexual thoughts, desires and behaviour are in line with our religion, faith, culture, philosophy or role models. However, this can be sometimes difficult for people who have feelings and thoughts that do not align with the community and society they came from or are moving in to. Whatever we decide, we need to be kind to ourselves. If we feel that we cannot live up to our ideals or those of other people, we should not punish ourselves for that. It is better to talk to a trusted friend or adult, perhaps someone like a teacher, a nurse, a physician or a psychologist, or an independent professional or spiritual counsellor. We can ask ourselves: How do my religious views influence my sexual behaviour and what do they teach me about my sexual orientation? How does the culture of the country I come from and the country I live in now influence my sexuality and the way I express it? Act This reliable website can help us answer the big why question, but in the end, the decision is ours! In Arabic, English, French and 10 other languages: https://www.zanzu.de/en/sexuality/ https://www.zanzu.de/en/sexuality/ 33 9. If sex is a universal thing, does everyone experience sexuality the same way? Stay informed Human sexuality is much more than sex: it is also about gender identities and roles, sexual orientation, eroticism, pleasure and intimacy and it has strong links to reproduction. There are many ways people experience and identify their sexuality. Lets look at some important concepts to better understand it. Gender refers to the roles, behaviours, activities, characteristics and opportunities that any society considers appropriate for girls and boys, women and men. Sexual orientation is an enduring pattern of romantic or sexual attraction (or a combination of these) to people of the opposite sex or gender, the same sex or gender, or to both sexes or more than one gender. Gender identity is our personal sense of our own gender. Gender identity can be linked to our assigned sex at birth or can differ from it. Some terms can be new or confusing for some of us, so it is important to include some key definitions for building a common understanding and embracing diversity. Remember those concepts (and our understanding of them) are in constant evolution and so is our language. Heterosexual refers to people who are attracted to people of the opposite sex or gender. 34 Cisgender describes someone who feels that they are the same gender (or sex) as the physical body they were born with. We also hear the acronym LGBTI, the letters stand for: Lesbian (a person who identifies themselves as a woman, who experiences sexual, romantic, or emotional attraction to other women) Gay (a person who identifies themselves as a man, who experiences sexual, romantic, or emotional attraction to other men) Bisexual (someone who experiences sexual, romantic or emotional attraction to people of all genders) Transgender (people whose gender is not the same as the sex assigned at birth). Transgender may also add any of the other letters when describing themselves, because sexual orientation is not the same as sexual identity Intersex (people born with any of several variations in sex characteristics, including chromosomes, gonads, sex hormones or genitals that do not fit with the typical definitions for male or female bodies). More generally, LGBTI is an umbrella term used in this brochure to refer to people of diverse sexual orientation, gender identity, gender expression and sex characteristics. However, it is important to remember that the list above does not cover everybody, and there are many terms used to refer to people who do not conform to conventional or traditional notions of male and female gender roles, such as LGBTI+, LGBTQ and LGBTQAI.24 Reflect As individuals, we are all different but all equal, and part of a human community that is so diverse. Life would be very dull if we were all the same! Sexuality is influenced by the world around us, including biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors. 35 Sexuality is also about our own identity, the way we experience and pursue (or do not) sexual and romantic attraction, relationships and behaviours. So, we may ask ourselves: How would I describe myself? What are my sexual and romantic experiences, if any, so far? Do I have any preferences when it comes to finding a partner? Answering these questions may help us get to know ourselves, our feelings and interests, better. However, every human being is such a rich and unpredictable combination of emotions, attitudes and thoughts, as well as external and inner features; and that the way we behave during a sexual or romantic relationship at one moment in time does not necessarily define who we are forever. Act More information is available from the following reliable sources: In Arabic, English, French and 10 other languages: https://www.zanzu.de/en/relationships-and-feelings/men-and-women/ In Italian, visit this institutional website: https://www.infotrans.it/ which includes a glossary on the key terms. https://www.zanzu.de/en/relationships-and-feelings/men-and-women/
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