The Book for Girls and their Boyfriends

A GUIDE

TO SAFE

SEX

VIOLETA BABIĆ

R O F K O O B E TH

S L R I G

S D N IE R F Y O B IR E H AND T

ном.

A GUIDE

TO SAFE

SEX

VIOLETA BABIĆ

THE BOOK FOR

GIRLS AND THEIR BOYFRIENDS

WHY

READ THIS IN ORDER TO HAVE SEX, BOTH YOU AND ND YOUR BOYFRIEND NEED TO BE MATURE E ENOUGH, NOT ONLY PHYSICALLY BUT ALSO MENTALLY AND EMOTIONALLY here is much talk about sex and it is no longer a taboo. Maybe you too, prompted by all the talk, will want to have sex with a young man you like, because you want to be like your girlfriends who already experienced it, or just out of curiosity, or maybe to stop your boyfriend from leaving you because you are not ready to sleep with him...

None of these are good reasons to start one’s sex life. In order to have sex, both you and your boyfriend need to be mature enough, not only physically but also mentally and emotionally.

T

And above all – it is important that you want it too!

At the beginning of the XX century girls had their first period only after the age of 16. Nowadays this boundary has shifted. Girls develop breasts earlier than before and they get their first period earlier than expected. At the beginning of the XXI century girls achieve their physical maturity at an earlier age, and even 12-year old girls appear older and can bear children!

Scientific studies in our country and the world indicate that men and women enter into sexual relations progressively earlier. Newspaper articles, magazines columns and online news are warning us that young people today usually have their first sexual experience between the age of 14 and 17, some even earlier, and that by the age of 19 they have had between five and twenty partners.

Furthermore, studies indicate that young people are ill-informed about sexual health care and protection, and that only rarely do they worry about possible teenage pregnancy, sexually transmitted diseases or the critical need for protection.

It is surprising to learn that many young people are unfamiliar with contraception, and while some might be aware or have some knowledge of methods of contraception, they are not sure which method would best suit them, how to use it and where to find it. It is astonishing to realize that many teens

4

have never heard of sexually transmitted diseases, and that girls visit gynecologists only when they realize: Oh my God, maybe I’m pregnant?! Small wonder then that teenage pregnancy is not a rare phenomenon in our country.

Pregnancy is a matter of making an informed choice. It is something a person wants. Every responsible girl should chose to have children instead of becoming pregnant by accident.

It is therefore vital that both boys and girls, once they have decided to enter into sexual relations as early as in their teens, should inform themselves on everything one must know about safe sex.

5

CONTRACEPTION IS A BIRTH CONTROL METHOD, I.E. A METHOD OF PREVENTING UNWANTED PREGNANCY.

CONTRACEP The need for sex is a normal thing.

Sex is an intimate act between two people who like each other or who are in love with each other. The only way to fully enjoy it is to have safe sex, and sex is only safe when you and your boyfriend use protection.

Constant worrying and fear of pregnancy can make intercourse less pleasurable than it should be.

Contraception is a birth control method, i.e. a method of preventing unwanted pregnancy. If this is so why not then always use contraceptives?

6

PTION When your boyfriend and you have a talk about contraception, on, choosing the best method for you two, you need to remember that berr th tha at protection against sexually transmitted diseases is as criticall as preventing pregnancy.

If you already decided to have sex with someone you do not know so well, and if you are unsure if your partner has a sexual infection (and how can you ever be certain at the very beginning!?), then maybe the two of you should go and take a test for sexually transmitted diseases together. And until you do, make sure to use the condom.

7

CONTRACEPTIVES FOR YOUNG PEOPLE ABSTINENCE

T

here is no such thing as a 100% sure method of preventing the unwanted pregnancy - except for sexual abstinence, i.e. not having sex. Some people view abstinence as refraining from vaginal intercourse, and believe that engaging in other forms of intimacy (touching, caressing, cuddling, mutual masturbation) is safe; however, each sexual contact leading to sperm being ejaculated in the vicinity of vagina can be considered risky. You and your boyfriend should keep in mind that any sperm ejected near the vagina can quickly reach your uterus.

WHERE CAN I FIND ALL THE INFORMATION?

8

Many health centers in our country have Youth Information Centers where young people can get information about contraception, problems involved in teenage pregnancy and consequences of abortion. For further information, go to ‌ (address, phone)

CONDOM

C

ondom (rubber) is a contraceptive used by men.

Condom is a cover made of thin rubber or, lately, of latex and polyurethane (which is thinner and stronger), and put on the penis by the man prior the intercourse. Condom separates the penis from the vagina and the cervix, and after ejaculation, sperm remains in the container on the top of the condom and cannot reach the female egg. Remember – only condoms provide protection against sexually transmitted diseases.

Once there was a time when condoms were purchased secretly but those times are long gone. Now they can be found near the cash register in every grocery store, in perfumery, at the newsstands and in pharmacies. They come in various colors and sizes, dry, lubricated, even aromatic.

9

HOW TO USE A CONDOM

C

ondom is placed on top of an erect penis and unfolded downwards, with the scroll facing outwards. It is best to first squeeze the air out of a small extension on the top of the condom as it should receive the sperm later. If a condom is incorrectly put, it should be discarded because it is likely that the sperm had already come in contact with it. Putting a condom requires practice (you might not succeed on the first try) but skill is also required to take it off. You must take good care not to leak semen since that could annul all your previous efforts.

ADVANTAGES

10

They are cheap, simple to use, and being the best tried and tested method of protection against unwanted p r e g n a n c y, s e x u a l l y transmitted diseases and the HIV virus causing AIDS, they present an excellent contraceptive for sexually active teenage girls.

HOW AND WHEN TO TAKE OFF THE CONDOM

T

he young man should take the condom off before the penis goes limp, and he should do this by holding the condom at the base of the penis as he pulls it out of you, to avoid the sperm leaking out or the condom remaining inside you. Next, he should carefully pull the condom off, tie it up, and toss it in the garbage instead of flushing it down the toilet - this can not only cause plumbing difficulties but condoms are not environmentally friendly they should not end up in the sewage but on the waste dump.

DISADVANTAGES Condoms should be used during every intercourse, meaning that you should always have one on you. Some couples find that irritating but you and your boyfriend need to be sensible and make the wrong decision not to use it just this one time.

The one time could lead to just the thing both of you wish to avoid.

Condoms may break or slip off during the intercourse. The

one to blame most often is the person misusing it. Luckily, they most often break before the intercourse itself. This is why it is very important to use only quality condoms.

There are also those complaining that their pleasure is not complete when they use condoms. Modern condoms provide maximum sensitivity which renders this kind of complaints irrelevant.

One thing you should know: the worst thing is not to use it all. If you wish to remain protected you must always use it!

11

A WARNING FOR BOTH OF YOU In order to avoid being without a condom because ‘he forgot to bring one’: • Both of you should buy condoms • Always check the expiry date • Never buy unknown brands of condoms • Keep the condoms away from the heat • Never carry a condom in the pocket for longer than a day • Never use the same condom twice

I heard that some condoms are scented and th at some are even manufacture d in different tastes. I would like to know why.

Some condoms ha ve a taste or are scented in order to make the sex more interesting an d pleasurable.

Only, they can also trigger an allergic reaction fo r some people!

12

WHAT IS THE BEST PLACE TO BUY CONDOMS? s are The best place to buy condom . ets ark erm sup and s pharmacie ed ibit exh are y the ere This is wh t for sale and stored in the bes e riat rop app at and conditions case temperature (which is not the s). and sst new the with

What to do if a condom breaks or slips off during the intercourse?

If that happens, the boy must quickly take his penis out and put a new condom. If the girl still suspects that some semen has leaked out of condom, she must consult the gynecologist right away or take the morning-after pill. It would not hurt if during the intercourse the young man occasionally checked if the condom is still in place and if it is intact.

CAN A CONDOM BREAK?

I feel bad because my bo yfriend thinks that I don’t trust him because I keep mentioning cond How do I convince him th oms. at we should start using it?

Using a condom is not a matter of trust. Don’t let anyone con vince you that asking to use a con dom means that you don’t trust a pe rson. Many people may have a sexua lly transmitted infection and yet be unaw are of it. Also many a men have thoug ht that they would be able to control themselves once they reach the clim ax, and have failed to do so. Your boyfr iend can tell you that he loves you, tha t you know each other and that the refore you do not need condoms. You need to tell him that this is precisely wh y he must help you protect yourselves.

And never feel guilty for choosing to be safe!

Of course it can, but it is not like it is an everyday event, especially if you and your boyfriend make sure to buy quality condoms, are careful about where you keep them, always check the expiry date and use them responsibly.

A condom can be ripped accidentally on a ring or a nail. Latex made condoms loose strength when combined with an oil based lubricant, which is why you need to avoid body milk, oil baths and hand creams. Condoms should also be kept away from the heat because it impairs their elasticity, causes breakage, so they no longer provide good protection. Tried and tested brands of condoms are definitely more reliable than cheaper or unknown brands, which is why it may be best to buy the best brands. They could cost a bit more, but better spend a bit more now than have problems later on, isn’t it?

Why do adults keep reminding us to be carefu l abou we do at the pa t what rties?

Parties, celebr ations and birt hday bashes are plac es where peop le go wild, situations where you do th ings that you usually don’t, where m usic is loud, people sm oke and drink al cohol…

If you too have had some alco hol in such a place, or if you notice th at your boyfriend is drunk, it mig ht be better if you ju st went home.

13

THE PILL

I

t’s been 50 years now since the birth control pill was invented! In the meantime it was constantly improved and adapted, and today it represents the most reliable and safest contraceptive method.

Provided that the girl strictly abides by the rules – taking the pill orally every day at the same time – the birth control pill is a very effective method of preventing pregnancy.

The pill contains hormones and prevents pregnancy by inhibiting ovulation and causing thickening of the mucus in your cervix, thereby hindering the access of sperm.

Hormonal dose in the modern pill is much lower than in the past, meaning that the advanced pills of the XXI century have few side effects.

There are two types of pills that very young girls can take: those that contain estrogen and progestin, and those containing only progestin (also known as the mini pill).

14

HOW TO TAKE THE PILL The pill must be taken orally for 21 days starting with the first day of your period, every day and at the same time, for example in the morning, for the hormones to have the best effect. The 21day are followed by seven pill-free days to produce a period-like bleeding. During this period a non-hormone pill is usually taken in order to maintain the habit of taking the pill. The effectiveness of the pill depends on the strict following of the proscribed rules, so if you wish to avoid getting pregnant you need to make sure to always take the pill at the same time.

You may want to link it to some other daily thing, such as the morning tooth brushing, to avoid missing it.

AND WHAT IF I FORGET TO TAKE THE PILL? just take If you forget to take the pill ut it, it as soon as you remember abo in at and then take the next one aga days of your usual time. After seven e again. correct taking you will be saf , again If you skip more than one pill ber take it as soon as you remem at in aga one t nex the about it, and , ime ant me the In e. tim your usual during make sure to use the condom if after ed pris sur be ’t Don intercourse. udges of skipping the pill you find sm even get blood on your underwear, or a period.

CAN EVERY GIRL TAKE THE BIRTH CONTROL PILLS? No. Make sure to mention to your gynecologist all the illnesses you have had. There is also a possibility that you might not be able to go on the pill if you are significantly overweight, if you suffer from migraine or if you are taking antibiotics or medication for epilepsy, since these can interfere with the effect of the pill.

15

REMEMBER The pill is prescribed by the doctor! The birth control pill that your best friend takes might not be appropriate for you as well! So, first you need to visit a gynecologist. Next, with your prescription, you need to go to a pharmacy and buy the prescribed pills.

Also, you need to see a doctor if you notice your vision blurring, if you start having very strong headaches or feel dizzy, or if your legs hurt or become swollen. If any of this happens you need to stop taking your pill.

Never forget that the pill does not provide protection against sexually transmitted diseases. Maybe it would be better if you use condom?

ADVANTAGES Efficiently prevents pregnancy.

Periods become short and painless, regular and predictable, with less blood flow.

Iron deficiency anemia is reduced, along with the risks of uterus and breast cancer; ovary cists and ectopic pregnancy are also rarer.

Acne disappears and skin becomes nicer.

Premenstrual syndrome and ovulation aches are also reduced.

Sex becomes more spontaneous since there is no more fear of pregnancy.

16

DISADVANTAGES There may be headaches, mood swings, passing nausea, unexpected menstrual bleeding, your breasts may become bigger and sensitive to touch. On top of that, you may become disinterested in sex!

Young girls can also take the birth control pill.

TRUE

FALSE

You can start using this already contraceptive very early on, cycle. l rua after your second menst ary por tem Not only do the con the to p sto a birth control pills put o als y the unplanned pregnancies, ar gul irre h help very young girls wit In s. iod per or extremely painful ibed as such cases they are prescr medication.

I heard that the gi rls who used to take pi lls cannot get pregna nt afterwards.

TRUE

FALSE

Not true!

As soon as you stop taking the pill you can get pr egnant again.

17

GLOSSARY Abortion is a deliberate, legal procedure to terminate pregnancy between weeks six and ten.

Vaginal tablets or suppositories are used to treat yeast infections and other difficulties.

Obstetrics is a branch of gynecology dealing with the care of women during pregnancy.

Vulva is the external part of female genitalia.

Amenorrhea is temporary or permanent absence of menstruation.

Anal contact is contact of the male sexual organ with the partner’s anus.

Antibiogram is the result of laboratory testing for sensitivity of certain bacteria to different antibiotics.

Antibiotic is a substance that kills microorganisms or inhibits their growth.

Vagina is the internal female reproductive organ, an elastic fibromuscular tube covered with mucous membrane. Menstrual blood and cervical secretion flow through it.

Vagina is the organ used for sexual intercourse and it also provides a part of the birth channel.

Neck of the uterus (cervix) is where vagina joins the uterus (womb).

Cervical firm walls expend only during childbirth.

Dysmenorrhea is painful menstruation.

Dysplasia is an irregularity in the structure of cells and tissues.

Ejaculation is the ejecting of seminal fluid and male seed from the male sexual organ.

An erection is the erecting, stiffening of the penis.

Ovaries are paired reproductive organs producing and storing eggs (ovum), and releasing one during the ovulation. They also excrete female sexual hormones, estrogen and progesterone.

19

Fallopian tubes are tube-like organs linking uterus and ovaries. On one end, they are linked to uterus, and on the other they join the ovaries, in the crinum-like shape. When the ovaries release an egg during ovulation, it enters the fallopian tube and travels to the uterus. It is in one of the tubes that the fertilization takes place.

Clitoris is the grain-like tissue located above the opening of vagina.

During sexual excitement it swells with blood and plays an important part in orgasm.

Colposcope is a type of microscope used to examine female external genitalia, vaginal and cervical walls. It consists of a system of magnifying lenses and strong light, facilitating medical examination.

Colposcopy allows early detection of cervical cancer.

Uterus (womb) is a pear-shaped internal muscular organ. It is in the uterus that the fetus gestates from conception to birth. Uterus stretches and expands to a great degree during pregnancy. Later it contracts back to its original size (7.5 cm).

Menarche is the first menstruation.

20

Menstruation (period) is the monthly flow of blood from the uterus of sexually mature women and girls. If the egg (ovum) is not fertilized during ovulation, the thickened mucous membranes of the uterus, which had been prepared to accept the fertilized egg, is no longer needed; it sheds off the walls of uterus and is discharged from the body, along with the unfertilized egg, through the cervix and vagina.

Microbiologist is a scientist studying microbes, the smallest living creatures (bacteria, fungi, molds).

Microbe is a microscopic organism, a microbe, an infectious germ.

Ovulation is the discharging of a mature ovum (female gamete, egg) from the ovary into the fallopian tube. It usually occurs between days 9 and 16 since the first day of menstruation, and generally takes place on day 14 for the girls with the 28-day cycle. This is the fertile phase. During this period a girl could get pregnant if she had sexual intercourse with a boy.

Oncology is the field of medicine concerned with the study and treatment of tumors.

Oral contact is the contact between the mouth and the partner’s sexual organ.

Orgasm is a pleasant feeling that a boy or a man experiences when ejecting semen. Girls and women experience it during masturbation or sexual intercourse, but sometimes they may not have it.

Penis is the male sexual organ.

Petting includes mutual touching, caressing, cuddling and kissing between partners, without sexual intercourse.

Miscarriage is a spontaneous end of pregnancy, within the first 20 weeks. This is when for some reason, the woman’s body rejects the fetus, which is why it is also called spontaneous abortion.

Nocturnal emission or a wet dream is ejaculation of semen during sleep due to sexual arousal.

Promiscuity is frequent change of sexual partners.

Puberty is a time of sexual maturation, transition from childhood to adulthood.

Reproductive organs are sex organs.

Secretion is discharge, a substance secreted by a gland.

Seminal fluid is composed of secretions of various glands and of the sperm. These secretions set the seed (spermatozoa, sperm cells) in motion and provide the necessary nutrients needed for the passage of semen through the male and female sex organs. Semen is ejected through the urethra and the tip of the penis. Urine and semen are never discharged at the same time.

The speculum is a special medical "spoon" which is inserted in the vagina for the examination of the vagina and cervix.

Sperm is the fluid discharged by ejaculation and containing mature, motile sperm cells.

Spermatozoa are male sex cells, male gamete, ready for fertilization of female ova during ovulation. They can live up to several days, and each ejaculation releases hundreds of millions of these cells.

Only one is needed for fertilization.

Sterility is infertility.

21

Classification of viruses is clustering of viruses according to types, based on their distinctive characteristics.

The hymen is a thin membrane separating internal from the external female genitals. The hymen is a small round opening through which menstrual blood flows. The hymen is torn during the first sexual experience (usually leaving small smudges of blood).

Cervical means pertaining to the cervix.

Cervix is the neck of the uterus.

Cytology is the biological discipline which deals with the study of cells.

Cytological analysis determines whether a damage on a tissue is benign or malignant.

22

CONTENTS WHY READ THIS...........................................................................................................................2 CONTRACEPTION ........................................................................................................................6 CONTRACEPTIVES FOR YOUNG PEOPLE ...................................................................................8 Abstinence ............................................................................................................................................8 Condom....................................................................................................................................................9 How to use a condom .............................................................................................................10 How and when to take off the condom..................................................................11 The Pill .................................................................................................................................................. 14 OTHER CONTRACEPTIVES ............................................................................................................. 18 Vaginal ring ...................................................................................................................................... 18 Morning-after pill ....................................................................................................................... 18 Foams, creams, films and gels ...................................................................................... 19 Spiral ......................................................................................................................................................20 Calendar-based method or fertility awareness ............................................... 22 Monitoring density of cervical mucus ....................................................................23 Measuring basal body temperature ..........................................................................24 Recognizing ovulation pain ...............................................................................................24 Maybe Baby.......................................................................................................................................24 ABORTION IS NOT A CONTRACETPTIVE ......................................................28 HOW TO IDENTIFY PREGNANCY................................................................................................ 30 TO HAVE THE BABY... OR MAYBE NOT ... ................................................................................34 VISITING GYNECOLOGIST ...............................................................................................36 VISITING GYNECOLOGIST IS A MUST… ...................................................................................38 WHAT TO EXPECT FROM GYNECOLOGICAL EXAM?.........................................................39 Inspection ...........................................................................................................................................39 Manual examination .................................................................................................................39 Smear test ....................................................................................................................................... 40 Colposcopy........................................................................................................................................ 40

Cytological examination ....................................................................................................... 41 Pelvic ultrasound .......................................................................................................................... 41 GYNECOLOGICAL INFECTIONS .....................................................................................................42 Cervical cancer ..............................................................................................................................42 Precancerous changes ............................................................................................................42 Vaginal discharge........................................................................................................................44 Vaginal smear test.....................................................................................................................45 SEXUALLY TRANSMITTED DISEASES.................................................................46 VENEREAL DISEASES .........................................................................................................................52 Pubic lice .............................................................................................................................................52 Mycoplasma......................................................................................................................................52 Ureaplasma .......................................................................................................................................53 Trichomoniasis...............................................................................................................................53 Candidiasis (thrush)...................................................................................................................54 Gonorrhea (the clap)................................................................................................................55 Chlamydia ...........................................................................................................................................56 Genital warts (or venereal warts) ...............................................................................56 Genital herpes ................................................................................................................................ 57 Hepatitis B .........................................................................................................................................58 Syphilis ..................................................................................................................................................59 HIV, human immunodeficiency virus, HIV (AIDS) ........................................ 60 GLOSSARY .........................................................................................................................................63

THE BOOK FOR GIRLS AND THEIR BOYS / A Guide to Safe Sex

By Violeta Babic • Illustrator Kuma • Reviewer Dr. Dijana Plut, Institute of Psychology, School of Philosophy, University of Belgrade • Expert editor - Aleksandra Mladenovic-Mihajlovic, Head of Gynecology and Obstetrics Hospital, Clinical Center Zemun, Belgrade • Editor Anđelka Ruzić • Graphic design Dusan Pavlic • Proofreader • Ivana Ignjatovic • Consultants Dunja Begović (20), Bojana Savović (30), Aleksandar Stanić (64) • Prepress Tatjana Valjarevic • Published by Kreativni centar, Gradištanska 8, Belgrade • tel.: 011 / 38 20 464; 38 20 483; 24 40 659 • www.kreativnicentar.rs • e-mail: info@kreativnicentar.rs • For the Publisher Ljiljana Marinković • Printed by Publikum • Circulation 3,000 • ISBN 978-86-7781-878-4