Sexual Decision Making
According to the Sexuality Information and Education Council of the United States (SIECUS), a sexually healthy teen will show or have the following qualities within their relationships with themselves, parents and family members, peers and intimate partners.
Relationship with Self
- Appreciates their own body:
- understands changes that happen during puberty, and views them as normal
- practices health-promoting behaviors, such as abstinence from alcohol and other drugs and getting regular check-ups
- Takes responsibility for their own behaviours:
- identifies own values and acts on those values
- understands the consequences of their actions
- understands that media messages can create unrealistic expectations related to sexuality and intimate relationships
- is able to tell the difference between personal desires from that of their peer group
- understands how alcohol and drugs can affect making decisions
- Knows about sexual health issues:
- understands the consequences of sexual behaviors
- makes decisions about masturbation that fits with personal values
- makes decisions about sexual behaviors with a partner that fits with personal values
- understands their own gender identity and sexual orientation
- understands the effect of gender role stereotypes and makes choices about the best roles for themselves
- understands peer and cultural pressure to become sexually involved
- accepts people with different values and experiences
Relationships with Parents and Family Members
- Communicates effectively with family members about issues, including sexuality:
- has a good balance between family roles and responsibilities and their growing need for independence
- is able to negotiate with family on boundaries and tries to understand parents point of view
- respects rights of others and treats adults with respect
- understands and asks for information about parents’ and family’s values and thinks about them when developing their own values
- asks parents and other trusted adults questions about sexual health issues and accepts their guidance
Relationships with Peers
- Interacts with all people (including those with different sexual orientation and gender identity different from their own) in proper and respectful ways:
- communicates well with friends
- shows empathy in relationships
- recognizes and stays away from relationships that may not be healthy for themselves or others
- understands what sexual harassment behaviour is and rejects it
- respects others’ right to privacy and doesn’t share personal information that others have shared with them
- Acts on one’s own values and beliefs when they aren’t the same as their peers:
- understands pressures to be popular and accepted and makes decisions based on their own values
Relationships with Intimate Partners
- Shows love and intimacy in a way that’s appropriate for their age:
- believes that everyone has equal rights and responsibilities for love and sexual relationships
- can say ‘no’ and accepts when a partner says ‘no’
- tries to understand (empathize) how a partner feels
- Has the skills to decide how ready they are for mature sexual relationships:
- talks with a partner about sexual behaviors before they happen
- is able to communicate and negotiate sexual behaviors
- if they choose to have sex, protects self and partner from unplanned pregnancy and sexually transmitted infections (STIs) by using birth control, condoms, and other safer sex practices
Safer Sex Practices
Talk to your teen about sexual decision-making and the emotional maturity they and their partner need if planning to be sexually active.
Ask your teen:
- Do they feel pressured to have sex? Where’s the pressure is coming from?
- Why do they want to have sex? Why does their partner want to have sex?
- Do they feel comfortable talking to their partner about STIs, birth control and/or condoms?
- If birth control fails, how will they and their partner handle a pregnancy?
Any type of sexual contact or activity involves some risk. These risks could be physical, social or emotional. Practicing safer sex can reduce the chance of getting an STI or pregnancy. Talking to your teen about safer sex practices will help them make healthy decisions so they don’t take part in any sexual activity that may put them at risk. Abstinence—no sexual contact at all, including intercourse or oral sex—is the only 100% way to prevent an STI or pregnancy.
To make sexual activity as safe as possible, make sure your teen knows to plan ahead by:
- making sure that they talk about and understand each other’s limits around their sexual activity
- getting and giving consent for every sexual activity
- using condoms and dental dams
- using a condom to prevent STIs and as a backup form of birth control
- getting tested and treated for STIs and HIV
- talking to their partner about their past sexual relationships and their history of STI testing and treatment
- reducing the chance of getting an STI by limiting sexual partners
- understanding how drugs and alcohol make a person less inhibited, which makes them less likely to make good decisions. People who have sex while using alcohol or drugs are less likely to use condoms.
Teens with same sex partners may not have to worry about preventing pregnancies, but everyone needs to consider STI protection, for every activity.
It’s important that your child has the information they need to know at the right stage of their development. Things your child needs to know about birth control:
- using more than 1 birth control method (dual protection)—such as the birth control pill and condoms — protects best against pregnancy and STIs
- there are many choices for birth control, including abstinence. They’ll need to choose what’s best for them
- some birth control methods are harder to use or take more getting used to (e.g., diaphragm, sponge)
- birth control has to be used properly and every time they have sexual intercourse to prevent pregnancy and STIs
- they can talk to a doctor or go to a sexual and reproductive health clinic
Types of Birth Control
There are many types of birth control. Some will be more suited to your teen and their life than others. Understanding what each type is and how they work will help you when talking to your teen, and help them make their own decision about what will work best for them.
Abstinence means different things to different people. It may mean making the choice not to have any sexual contact including:
- self-touch (masturbation)
- direct touching of your partner’s genitals
- vaginal sex (penis to vagina)
- anal sex (penis to anus)
- oral sex (mouth to penis or mouth to vagina)
For some people, abstinence may include certain types of sexual contact. Abstinence prevents pregnancy and the spread of sexually transmitted infections (STIs) and HIV. If a person chooses not to partake in any of the sexual activity listed above, it means they’re protected from STIs, pregnancy and HIV and don’t need to use birth control. To learn more, see Abstinence.
A condom is a thin covering that fits over a hard (erect) penis. It decreases the risk of pregnancy by stopping sperm from getting to and entering the egg. It also decreases the risk of STIs and HIV by stopping semen, vaginal fluid or blood from passing between partners. Use a condom to prevent STIs and as a back-up form of birth control. Most condoms are latex, but there are non-latex ones. All condoms sold in Canada must meet government standards. To learn more about condoms and how to use them properly, see Condoms.
A vaginal condom is a soft, plastic (non-latex) sleeve with 2 flexible rings, one on each end. The closed inner ring goes inside the vagina to cover the opening of the uterus. The outer ring stays outside the vagina to cover the genitals. It decreases the risk of pregnancy by stopping the sperm from getting to or entering the egg. It reduces the risk of STIs by stopping semen, vaginal fluid or blood from passing between sexual partners. To learn more, see Condom-Vaginal.
Intrauterine device (IUD)
An intrauterine device (IUD) is a small, soft, T-shaped device with a nylon string attached to it. A health care provider has to put it in.
There are 2 types of IUDs (copper and hormonal). Hormonal IUDs are also called intrauterine systems (IUS). They work in different ways. Depending on the type of IUD, it can help prevent pregnancy for 3 to 10 years. New research suggests that long-acting methods of birth control, such as IUDs, work the best to prevent pregnancy over time. To learn more, see Intrauterine Contraceptives.
Birth Control Pill (‘The Pill’)
The pill is taken every day to prevent pregnancy. It contains hormones (estrogen and progestin) that are like the hormones females produce. They stop the ovaries from releasing an egg. To learn more, see Birth Control Pill.
Birth Control Patch (‘The Patch’)
The birth control patch is a thin, light brown patch that you wear on your skin. It has to be changed once a week. The sticky part contains hormones (estrogen and progestin) that are like the hormones females produce. These hormones are absorbed through the skin. They stop the ovaries from releasing an egg. To learn more, see Birth Control Patch.
Vaginal Contraceptive Ring (NuvaRing®)
The vaginal contraceptive ring is a soft, 5.5 cm , clear, plastic (non-latex) ring that a female puts in their vagina once a month. It contains hormones (estrogen and progestin) that are like the hormones females produce. They stop the ovaries from releasing an egg. To learn more, see Vaginal Contraceptive Ring.
Hormonal Birth Control – Extended and Continuous Use
Extended use is when a female takes a birth control product for 2 or more cycles without stopping, then take a planned, hormone-free break. During this break, their period will come. Females who use this method will have fewer periods. To learn more, talk to a health care provider.
Continuous use is when a female takes a birth control product without stopping (no planned hormone-free breaks). This means they won’t have periods. Talk to your health care provider to learn more.
You can also go to Hormonal Birth Control.
Progestin-Only Pill (POP)
Progestin-Only Pill (POP), also called the mini-pill, is a pill a female takes every day to prevent pregnancy. POP contains 1 hormone (progestin). It doesn’t contain estrogen. POP comes as a 28-day pack (there are hormones in all 28 pills). There are no hormone-free pills. POP prevents pregnancy by:
- decreasing the cervical mucous and making it thicker
- making the lining of the uterus thin
- slowing the egg as it moves through the fallopian tube
- sometimes stopping an egg from being released
To learn more, see Progestin-Only Pill.
Birth Control Injection (Depo-Provera® or ‘the Shot’)
The shot contains a hormone (progestin) like the hormone females produce. It doesn’t contain estrogen. The hormone stops your body from releasing an egg, makes the lining of the uterus thin and makes cervical mucous thick. You need a prescription for the injection. It’s given every 10-12 weeks. To learn more, see Birth Control Injection.
Vaginal spermicides are put in the vagina before sex to help prevent pregnancy. They contain (nonoxynol-9 (N-9)) that kills sperm. When sperm comes into contact with a spermicide, the sperm dies and a female can’t become pregnant. Spermicides come as film, foam, gel, cream or suppositories. Some types of spermicides can be hard to find in Canada. To learn more about spermicides and how to use them, see Vaginal Spermicides.
A diaphragm is disc-shaped, made of latex or silicone, and has a flexible rim. It’s inserted into the vagina before sex. It covers the cervix and stops sperm from entering the uterus. A diaphragm must be used with a special type of gel that kills sperm (spermicidal gel). There are no Health Canada approved spermicidal gels containing nonoxynol-9 available in Canada. People who use a diaphragm should use an acid buffering gel (e.g. Contragel®, Caya Gel®) which forms a barrier in front of the cervix, lowers pH of vaginal fluid which slows down sperm. To learn more, see Diaphragm.
The sponge is a one-size, disposable piece of polyurethane foam that’s put in the vagina to cover the opening to the uterus (cervix). The sponge is filled with nonoxynol-9, which is a chemical that kills sperm (spermicide). It helps prevent pregnancy by killing sperm and preventing sperm from entering the uterus. To learn more, see The Sponge.
Fertility Awareness-Based (FAB) Methods
Fertility Awareness-Based (FAB) methods is sometimes called natural family planning, It identifies the days of the month when the egg’s ready to be fertilized and becoming pregnant is most likely (fertile time). This can be used to:
- prevent pregnancy—don’t have vaginal intercourse or use another method of birth control during a woman’s fertile time
- become pregnant—have vaginal intercourse during a woman’s fertile time
To learn more, see FAB Methods.
Lactation Amenorrhea Method (LAM) (used after the birth of a baby)
Lactation Amenorrhea Method (LAM) is a way for breastfeeding to temporarily help prevent pregnancy. It must be used correctly to work. Lactation means your body is making breastmilk and amenorrhea means you aren’t having a monthly period. Breastfeeding hormones may stop your body from releasing eggs. You can’t get pregnant if you don’t release an egg.
LAM only works if your:
- baby is under 6 months old and
- baby is fully breastfed (baby gets no other liquid or food, not even water) or nearly-fully breastfed (baby gets vitamins, water, or other fluids or nutrients once in a while and they do not disrupt the frequency of feedings) and
- period has not returned. This means you have not had vaginal bleeding for 2 or more days in a row (not counting bleeding during the first 2 months after giving birth).
LAM does not work if you don’t have all 3 things above. Talk to your health care provider to see if this method is right for you. To learn more go to Lactation Amenorrhea Method.
A tubal ligation is a permanent method of birth control. Surgery is done to close the fallopian tubes (the tubes that the egg travels through). This stops the egg and sperm from meeting. If the sperm can’t reach and enter the egg, you can’t become pregnant. To learn more, see Tubal Ligation.
A vasectomy is a permanent form of birth control. The tubes (vas deferens) that carry the sperm from the testicles into the semen are cut and sealed. This means there’s no sperm in the semen, so no sperm to reach and enter the egg. To learn more, see Vasectomy.
Withdrawal (Pulling Out)
Withdrawal is used during vaginal intercourse to reduce the risk of pregnancy. Withdrawal is when the penis is pulled out of the vagina before ejaculation. Ejaculation shouldn’t happen near the partner’s vagina. If semen is near the opening of the vagina, sperm can reach and enter the egg. To learn more, see Withdrawal.
Emergency Contraception (EC)
A female can use emergency contraception (EC) if they aren’t sure if they’re protected from pregnancy (e.g., condom breaks, forgot birth control), or if they had unprotected sex. EC doesn’t protect against STIs and HIV. It works best if used right away, but can be used up to 5 days (120 hours) after unprotected sex. The 2 methods of EC are emergency contraception pills (ECPs) and the copper intrauterine device (IUD).
The 2 types of ECP’s are levonorgesterol ECP (e.g., Plan B®, NorLevo®, Next Choice®, Option 2®) or ulipristal acetate ECP (e.g., Ella®). You need a prescription for the ulipristal acetate and also for the copper intrauterine device (IUD). A health care provider has to put the IUD in. To learn more, see Emergency Contraception.
Sexually Transmitted Infections (STI)
An STI is an infection that’s passed on by sexual contact. STI has replaced the term STD (sexually transmitted disease). In medical science, infection is the term used to indicate a bacteria, virus, parasite or other microbe that has entered the body and begun to multiply. The term disease indicates that signs and symptoms of illness are present. There are many people with STIs who have no symptoms, therefore STI is a more accurate term.
The rates of STIs in Alberta are still going up. The rates of both Chlamydia and gonorrhea are highest in 15–24 year olds.
Here’s what your child needs to know about STIs:
- STIs are infections that are passed on by sexual contact. This includes vaginal, anal or oral sex or intimate skin-to-skin contact without penetration.
- any type of sexual contact or activity involves some risk
- although most STIs can be cured, some can’t, such as HIV, genital herpes and HPV
- STIs affect both men and women
- abstinence—no sexual contact, including intercourse or oral sex—is the only 100% way to prevent an infection
- practicing safer sex lowers the risk of an STI
- using a condom every time they have sex will protect them from STIs
- getting tested is an important way to protect their health and their partner’s health
- STIs can make it harder for people to become pregnant when the times comes that they want to be pregnant
- a pregnant woman can spread the infection to her baby before or during delivery
- it’s both their right and their responsibility to protect themselves
There are many types of STIs—some you or your child may not have even heard about. Below is information on the different types of STIs, how they’re passed between people, and how they’re treated (if they can be treated).
Chlamydia is caused by bacteria. While most people don’t have symptoms, it can cause symptoms such as pain when a person urinates (pees), pain during sex or anal discharge. Chlamydia is treated with antibiotics. To learn more, see Chlamydia.
Genital herpes is caused by the herpes simplex virus (HSV). It may cause blisters in the genitals, rectum or mouth. Because it’s caused by a virus, genital herpes can’t be cured. There is medicine that can help control it so that the outbreaks aren’t as serious or as often. To learn more, see Herpes.
Genital Warts or Genital Human Papillomavirus (HPV)
Genital warts are caused by the human papillomavirus (HPV). It causes skin growths on or around the genitals or anus. The symptoms can vary greatly. Some people have only a few warts or other people have many warts. The warts may also continue to grow and spread or go away on their own. They often come back after treatment. HPV can be prevented by getting immunized. To learn more, see HPV.
Gonorrhea is caused by bacteria. While most people don’t have symptoms, it can cause discharge from the penis, vagina or anus, or cause pain during sex or in the lower abdomen. Gonorrhea can also infect the throat, anus, pelvic organs and eyes. If not treated, gonorrhea can lead to pelvic inflammatory disease, testicle infections and infertility. Gonorrhea is treated with antibiotics. To learn more, see Gonorrhea.
Hepatitis B is a virus that causes liver infection. The virus can be passed on through sexual contact, sharing needles or contact with blood. Some people with hepatitis B have no symptoms, while others may be very tired, have a mild fever or muscle aches. While most people recover, some develop chronic infections. It can lead to serious liver disease, liver cancer and death. Hepatitis B can be prevented by getting immunized. To learn more, see Hepatitis B.
Syphilis is caused by a bacteria. Not everyone will have symptoms. If they do, the average time between infection and symptoms is 21 days. Early symptoms may include painless sores in the genitals, mouth and rectum, or a painless rash on the palms of the hands, soles of the feet or the whole body. If not treated early, it can lead to serious health problems like blindness, or problems with the nervous system or the heart. Syphilis is treated with antibiotics. To learn more, see Syphilis.
Trichomoniasis (also called ‘trich’) is caused by a parasite. Not everyone has symptoms. The symptoms can include pain when urinating (peeing), discharge from the penis or vagina, itching in the penis or vagina and pain during sex. Trichomoniasis is treated with antibiotics. To learn more, see Trichomoniasis.
HIV is caused by a virus. HIV can be passed on through sexual contact, sharing needles or contact with body fluids. HIV attacks the immune system (the body’s defense system against illness and infection). Without a strong immune system, the body can’t fight infection or disease. If it’s not treated, someone with HIV can develop AIDS. While there’s no cure, treatments can help people live long and healthy lives.
To learn more, see HIV.
HIV Pre-Exposure Prophylaxis (PrEP) is a drug that helps prevent HIV in people who have high ongoing risk of getting the virus. It is a pill taken once a day. It’s available to Albertans at high risk of getting HIV, at no cost. The medication is prescribed by health professionals who have knowledge in HIV prevention.
For more information on HIV PrEP as well as sexual and reproductive services and resources throughout Alberta, visit www.ahs.ca/srh