Healthy Relationships Workshop

1. Healthy Relationships Workshop Adopting a respectful approach to sexuality and sexual relationships

2. Workshop Goals • Promote healthy relationships and open, effective communication; • Increase self-awareness of the risk of contracting a sexually transmitted infection; • Encourage the adoption of attitudes and behaviors that promote sexual health; • Reinforce a sense of agency and self-efficacy regarding sexual interactions; and • Incorporate consent as the basis for every sexual encounter.

3. Group Guidelines • Confidentiality, Confidentiality, and Confidentiality • Non-heteronormative discussion • Be respectful of each other’s opinions • Do not talk over one another • Confidentiality, Confidentiality, and Confidentiality • Open and honest conversation • Do not record or report to others what any one person said in the Workshop • Cell phones must not be used during the Workshop • Confidentiality, Confidentiality, and Confidentiality

4. Whatchamacallit? Everyone has them, but what is it called?

5. Sensuality

6. Sensuality Defined • Touch – handle or feel gently usually with the intent to understand or appreciate • Sight – a thing regarded as worth seeing • Smell – to have a characteristic aura or atmosphere • Taste – to have perception, experience, or enjoyment • Sound – to suggest a particular feeling, state, or thing by the way something is said

8. Communication

9. Be Flexible Be Patient Be Timely Be Honest Be Intuitive Be Accepting 6 Rules for Open & Honest Communication with the Person You Love by Scott Stablie (2014)

10. Communication is • Listening – involves hearing and paying attention • Speaking – conveying a message(s) and the other person understands meaning and intent • Be assertive when communicating – speaking up for yourself, while respecting the right of others to do the same • Communicate about tough issues – not being afraid to verbally express differences of opinion and/or thought • Develop opportunities for face-to-face communication – identify the right time to talk (serious matters cannot be disgusted at a party or sporting event)

11. Five Circles of Sexuality

12. Intimacy/Relationships

13. Healthy Relationships Activity

14. Questions • Intimacy allows you to • Pose questions without being judged • Determine if you are both on the same page • Have more sex • Give and take in conversation (listen) • Intimacy, specifically refers to • Openness and trust between two people • Being close to another person • Sharing ideas • Taking time to know your partner

15. Five Circles of Sexuality

16. Sexual Identity

17. Genderbread Person

18. Sexual Identity Four elements: • Biological Sex – sex assigned at birth, and based on genitalia; • Gender Identity – how you view/define yourself regardless of biological sex; • Sexual orientation – the sex that you are attracted to physically and/or romantically. • Gender Roles – society’s expectations of you based on biological sex

19. Biological Sex: The Equipment Under the Hood • “On the left we have ‘female’ and on the right we have ‘male,’ the two biological sexes we all grew up knowing about. In the middle, we have a new term “intersex,” which describes someone whose sexual organs are not strictly male or female.”

20. Gender Identity: Who You Think You Are • “Gender identity is all about how you, in your head, think about yourself. It’s about how you internally interpret the chemistry that composes you (e.g., hormone levels).”

21. Gender Expression: How You Demonstrate Who You Are • “Gender expression is all about how you demonstrate your gender through the ways you act, dress, behave, and interact–whether that is intentional or unintended.”

22. Sexual Orientation: Who You Are Attracted To • “Sexual orientation is all about who you are physically, spiritually, and emotionally attracted to. If you are male and you’re attracted to females, you’re straight. If you’re a male who is attracted to males and females, you’re bisexual. And if you’re a male who is attracted to males, you’re gay. Maybe.”

23. Sexual Orientation: Dr. Kinsey’s 7-point scale • 0 – Exclusively Heterosexual • 1 – Predominantly heterosexual, incidentally homosexual • 2 – Predominantly heterosexual, but more than incidentally homosexual • 3 – Equally heterosexual and homosexual • 4 – Predominantly homosexual, but more than incidentally heterosexual • 5 – Predominantly homosexual, incidentally heterosexual • 6 – Exclusively Homosexual

24. “Coming Out” – of the closet Is the process by which someone. . . Accepts and identifies with their gender identity and/or sexual orientation Shares their identity willingly with others SometimesWe talk about coming out as if it were a one time thing. But for most folks coming out is a series of decisions – sometimes daily – that LGBTQ people navigate in every new setting they enter. People may be “out”[ in some spaces, and “in” ] others. ]/[ to Family ]/[ to Friends ]/[ to Classmates/Coworkers A decision to come out to a person or group is one of safety, comfort, trust, & readiness.

25. “Coming Out” – of the closet It’s dangerous, unhealthy, and unhelpful to force someone to come out, or to “out” someone else (i.e., disclosing someone’s gender identity or sexual orientation to others without the person’s consent), regardless of your intentions (sometimes people think they’re being helpful, or acting on the person’s behalf to conquer their fears), but. . . IF SOMEONE COMES OUT TO YOU. . . Say “I always knew”, or downplay the significance of their sharing with you. Go tell everyone, bragging about your “new trans friend”. Forget that they are still the person you knew, befriended or loved before. Ask probing questions or cross personal barriers you wouldn’t have crossed earlier. Assume you know why they came out to you. DON’T:

26. Gender Roles Who gets to decide?

27. What Are the Roles? Men Women

28. Five Circles of Sexuality

29. Sexual Health

31. Sexually Transmitted Infections

32. Chlamydia • Caused by a bacterium • Incubation period: 1 – 3 weeks • Most (men and women) are asymptomatic • Penile discharge in men may be runny or whitish • Abnormal vaginal discharge in women • Causes Mucopurulent Cervicitis (MPC) in women; and Nongonococcal urethritis (NGU) in men • Easily detected with urine testing and cured by antibiotics

33. Gonorrhea • Nicknames are clap, drip, dose, or strain • Caused by a bacterium • Incubation period: 1 – 30 days, average of 2 – 5 days • Discharge may be thick, milky white, yellowish or greenish • Burning sensation while urinating • Swollen and tender testicles in men • Most women are asymptomatic • Easily detected through urine testing and cured with antibiotics

34. Herpes • Two types (Type I and II) both caused by viruses • Type I is commonly called “cold sore” or “fever blister” • Type II is genital type that incubates 2 – 7 days • Type II symptoms: swollen lymph glands, muscle aches, headaches, fever and difficult urination • Symptoms can reoccur • Detection by culturing the lesion • Treat symptoms with medication, but no cure

35. Human Papilloma Virus (HPV) • Commonly referred to as genital warts that is caused by a virus • Long incubation: 3 weeks – 9 months • Associated with cervical cancer, as well as anal penile, vulvas and vaginal cancers • More than 99% of cervical cancers have HPV DNA detected within the tumor • HPV vaccine recommended for adult (male and female) ages 19 – 26 years • HPV vaccine recommended for adolescents (females 9 – 26); and boys (13 – 21 years) and if having sex with men up to age 26.

36. Syphilis • Nicknamed Bad Blood, pox, or zipper cut • Caused by a bacterium • Incubates 10 – 90 days, average of 21 days • Painless sore called a chancre, located at the site of exposure (e.g., genitals, lips, anus or other area of direct contact) • Skin rash, fever swollen lymph glands, hair loss and muscle aches in secondary stage • Skin rash on palms of hands, bottoms of feet or any other part of the body lasting 2 – 6 weeks

37. Syphilis Continued • Disease has three stages: primary, secondary, and early latent • Can be passed from mother to child (in utero) • Easily detected by blood test • Can be cured with antibiotics

38. HIV/AIDS • Can be infected with the virus and not know it • Must be tested to know that you are infected • HIV is spread through exchange of body fluids (e.g. semen, vaginal secretion, blood) • Mother that is pregnant (and infected with HIV) can transmit the virus to the unborn child • Being infected with STIs greatly increases your chances of being infected with HIV • Medications can keep person healthier, but there is no cure for HIV/AIDS

39. Post-Exposure Prophylaxis (PEP) Can I prevent HIV After I've Been Exposed? • Yes. Post-exposure prophylaxis (PEP) involves taking anti-HIV medications as soon as possible (within 3 days) after you may have been exposed to HIV • PEP is a month-long course of emergency medication • PEP must begin within 72 hours of exposure • PEP consists of 2-3 antiretroviral medications and must be taken for 28 days

40. Pre-Exposure Prophylaxis (PrEP) What is Pre-Exposure Prophylaxis (PrEP)? • PrEP is a way for people who don’t have HIV but who are at very high risk of getting it to prevent HIV infection by taking a pill every day. • PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection • PrEP be considered for people who are HIV-negative and at very high risk for HIV infection (e.g. gay or bisexual man engaged in anal sex w/o condoms, man who has sex with both men and women)

41. Who should get PrEP? HIV uninfected, plus: Any HIV+ partner(s) Condomless sex in past 6m Any STI in past 6m High number of sex partners In high-prevalence area or sexual network Commercial sex work Shared injection equipment Recent drug treatment & current relapse

42. What are the side effects of PrEP? • “Startup syndrome” • Flatulence (3-4%)* • Nausea (8-20%)* • Mild headache (6-22%)* • Symptoms resolve within first 30d, for most * post-marketing reported frequencies (Lexi-Comp) US Public Health Service. PrEP Guideline – 2014.

43. Key Points Daily dosing affords greatest protection Occasional missed dose probably OK (less OK for women…) Nonadherence creates opportunities for infection

44. Contraceptive Methods • Abstinence – denial and/or non-participation in any sexual intercourse (e.g. oral, vaginal) and is 100% effective in preventing pregnancy and sexually transmitted infection STIs. • Condom (female) – made of thin rubber, inserted into a woman's vagina before sexual intercourse. • Condom (male) – sheath (or covering) worn over the penis during intercourse • Depo Vera – is long-acting reversible hormonal contraceptive birth control drug that is injected every three months. • Diaphragm – a flexible cup made of silicone or latex, placed inside the vagina to block sperm from reaching an egg; 94% effective for pregnancy prevention. Not an effective barrier protection for STIs and HIV. • Intrauterine Device (IUD) – a small contraceptive device shaped like a "T" containing either copper or levonorgestrel (progestin hormone) and fits inside the uterus; 99% effective for pregnancy prevention.

45. Contraceptive Methods • NuvaRing – a small, bendable hormonal ring that is inserted into the vagina • Plan B (Morning After Pill) – emergency contraception is a backup plan that helps prevent pregnancy when taken within 72 hours (3 days) after unprotected sex. • Spermicide – contains chemicals that stop sperm from moving. • Tubal Ligation – surgical procedure for female sterilization that involves severing and tying the fallopian tubes (“having your tubes tied”). • Vasectomy - surgical procedure performed on males to surgically cut the tube carry sperm.

46. Condom Skills Game

47. Common Sexual Myths • “Orgasm is the only goal” • “All persons have multiple orgasms” • “Men think about sex every seven seconds” • “Every person orgasms” • "You can tell the size of a man's penis by his shoe size“ • "You can only orgasm through penetrative sex" • "He cums first“ • "Faking an orgasm is OK" Common myths about sex and sexual pleasure by Samantha Evans and Roisin O’Connor (2015)

48. Common Sexual Myths • "Sex is just like it is on TV“ • "Condoms ruin sex“ • "Sex needs to last hours“ • “Oral and anal sex aren’t really sex” • “You can’t get STIs through oral or anal sex” • “Pulling out prevents pregnancy” Common myths about sex and sexual pleasure by Samantha Evans and Roisin O’Connor (2015)

49. Five Circles of Sexuality

50. Consent Objectify, objectify, objectify: How do you know if someone wants to have sex with you?