Dr Lyn Wren Family Physician Shanghai United Family Hospital 26 th March 2014

1. Sexual Education: The Ongoing Conversation Dr Lyn WrenFamily PhysicianShanghai United Family Hospital26th March 2014 WAB Middle School Coffee Morning

3. Sexual Education A recent study has shown that about 50% of children are already sexually active by the time their parents talk to them about sexual health Less than 50% of 15-19 year olds stated their parents have never spoken to them about sexual health (YRBSS – US data)

5. Some Facts Youth Risk Surveillance Survey SOME STATISTICS (15-19 year olds) • 40% of sexually active high school students did NOT use a condom last time they had sex • Nearly 80% did NOT use birth control when they last had sex • 10% reported date violence • 50% of new sexually transmitted diseases every year, occur in the 15-24 year age group • In 2009, more than 8000 young people were diagnosed with HIV (in the US) • 12% of females had been forced to have SI against their will

6. What We Can Look At Today

7. 1. Maximize Your Influence As A ParentOur society is increasingly sexualized and there are many influences on our children. Our aim should be to influence them the most. • BUILD THE RELATIONSHIP: This is #1!! Studies show teens are more likely to listen to us if they feel loved (this is the power of relationship) • GET TO KNOW THEM: Look for every opportunity be spend time with them, connect with them, find out what makes them tick, find out their views and opinions • HAVE FAMILY ROUTINES: Build regular family time & routines into your week – family meals, weekend brunch, walks, movie & game nights, bedtime stories etc • BE INVOVLED: Be involved in their lives (attend sports games, school events etc…. Even if they don’t express a desire for you to)

8. 2. Pushing Our Own Comfort Level Boundaries • Become more relaxed and natural when talking about sexual issues. If you are not comfortable, then you can be honest about that but keep the dialogue going. • Watch the language that we use – avoid words that convey embarrassment, shame or guilt • Watch our ‘knee jerk reactions’ – don’t over-react. • Deal with questions as they arise. Never say ‘you are too young to talk about that’ or “go and talk to your dad/mum about that” – delaying or not answering the question communicates ‘don’t talk to mum and dad about sex related issues’ • Know your limitations – there may be a time to engage a health professional, community nurse, sexual health practitioner or counselor

9. 3. Instill A Moral Compass:This means giving reasons ‘why’ rather than just giving rules • Look to explain the reasons behind our logic, opinions or expectations, rather than just giving them rules to obey • Reasons WHY need to be accurate • Look for opportunities to get them involved in the process • This shows respect for their opinions/ideas • You will get to know what they are thinking • It shows a willingness to work together • It builds confidence & problem solving skills • Helps them mature and grows their independence to make good decisions when you are not around

10. Moral Compass Versus Rule-Obeyers Rule Obeyers • Obey when there ARE rules • Can ‘disobey’ when there is no one watching • Can ‘disobey’ when they think they can get away with it Motivated by an inbuilt ‘moral compass’ Can make decisions: • Independently of whether there are rules • When there is no-one watching or telling them what to do • To do the right thing even if there are no rewards or punishments

11. 4. Everyday Moments Are Key‘Sex education is not a single, tell-all discussion’ • Every day questions: can you catch sexually transmitted diseases from toilet seats; what is the HPV vaccine; “mum, why is my penis getting hard?”; • Every day comments: so and so ‘hooked’ up after the party the other day; so and so called someone else ‘gay’ • What’s in the news: Miley Cyrus’ latest sexualised video clip • What is on T.V: eg high profile rape case; movie with threesomes, same sex relationships etc • Every day activities or comments: eg children touching their private parts; finding a condom in your teens room; seeing your child looking at porn

12. 5. Give The Right Amount Of Information At The Right Time • If opportunities to talk about it are not happening – you can create the opportunities • Give age appropriate information • Don’t give more information than they are looking for • Use resources • Look at them together when your children are younger • With teens, they may prefer to look at the resources alone but you should have looked at them too and then raise the possibility of discussing

13. Some Tricky Questions • I think I might be gay • My boyfriend/girlfriend wants to have sex but I don’t feel ready – what should I do? • Is oral sex safe? • Does the pill make you fat? • Is masturbation bad for health? • Can you get pregnant from anal sex? • What’s the big deal about sexting?

14. The A-Z of Love & Sex Today we will look at just some of the areas that are essential for us to know & that may have changed since we were teens

15. ATTRACTION • Who are you attracted to? • Normal to have curiosity & feelings about both sexes • Normal to have confusing feelings • It takes a while to sort these out • Bisexual, MSM & WSW are more ‘normalized’ in our society but are still a minority & marginalized group in society Heterosexual Straight Homosexual Gay Men Who Have Sex With Men MSM Women Who Have Sex With Women WSW Lesbian Bisexual A

16. SEXUAL ATTRACTION • Around 4-6% of Americans identify themselves as gay, lesbian, bisexual or transgender • There are many factors that affect our sexual orientation eg genetics, family dynamics, environmental factors etc • 80% of LGBT students say they have been subject to verbal harassment at school • Many LGBT still feel ashamed about their sexuality • It is important to create a supportive environment in regards to people’s sexuality 4-6% of high school students are LGBT (US Figures) LGBT

17. c The CHOICE is Yours Am I Ready For Sex? • Be ready to say ‘NO’ and set boundaries that you are comfortable with • Abstinence is a good choice • Everyone has a right to their own thoughts and feelings about sex & relationships • Do what is right for YOU and not what others around you are doing • It is important never to pressure other people or make fun of them for their choices • More than 50% of high school students choose not to have sex yet

19. US FIGURES: Youth Risk Behaviours Surveillance System (15-19 yo, US CDC 2011)

20. D Dating & Relationships Dating is about relating – getting to know someone and feeling relaxed in their company It’s all about communication, honesty, mutual respect, trust & intimacy Asking someone out on a date is risky – you put yourself out there! But don’t worry if they say ‘No’ – that’s a normal part of the process! Take is slowly Listen to others and really ‘hear’ what they are saying

21. How NOT to dump your partner • Text message or message on Facebook or phone call • Not answering the phone and generally avoiding the person • Letting them see you ‘hook up’ with someone else • Getting a friend to do it • It is part of growing up and being responsible to talk it over quietly with the person • It might not be easy but it shows you are learning about healthy relationships Splitting Up After Dating FACE TO FACE

22. HOW CAN YOU GET PREGNANT? H • It is BOTH you & your partner’s responsibility but ultimately you have responsibility to protect your own body • Sexual intercourse • Withdrawal technique • Ejaculation on the outside, near the vagina area

23. i Infections Love is in the air, but that’s not the only thing you might catch……. Sexually Transmitted Infections (STIs) 50% of newly diagnosed STIs occur in the 15-24 year old age group

24. SAFESTSAFERNOT SAFE

25. MYTHS about Sexually Transmitted Infections (STIs) • Only people who “sleep around” get them. • You can avoid STI’s by having oral or anal sex • You can’t get an STI more than once • You CAN tell if someone has an STI • All STIs can be treated WRONG

26. Human Papilloma Virus Many times microscopic so they CAN’T be seen - this is how they are easily spread Can spread from vaginal, oral & anal sex Associated with cancer of the cervix in females HPV Vaccine gives partial protection from cancer

28. CHLAMYDIA: THE SILENT DISEASE VERY COMMON Can be transmitted by vaginal, oral & anal sex No symptoms in females in most cases Linked to Pelvic Inflammatory Disease and Infertility Get a Chlamydia check EVERY YEAR after you become sexually active (urine test)

29. HERPES VERY COMMON 1 out of 5 over the age of 14 have it The virus can be released from skin that does not appear to have a sore Can spread by vaginal, oral and anal sex No treatment to cure it

30. OTHER STDs GONORRHOEA SYPHILIS HEPATITIS B & C HIV PUBIC LICE OTHERS

32. M • Most sexual risk taking behaviour occurs when alcohol and other substances are involved • Unprotected sexual intercourse – STIs and pregnancy • Date violence & date rape • Unable to say “NO” or enforce “NO” • Participate in ‘sexual acts’ you would otherwise say ‘no’ to • Can’t remember afterwards • Multiple partners • Reputation affected • Photo/Videos taken SEXUAL RISK TAKING BEHAVIOUR22% reported using alcohol or drugs prior to their last sexual encounter – YRBSS High school students 2011 Minimize The Risks

33. Responsible Alcohol Consumption: • Don’t drink • Eat before you drink • Drink low alcohol drinks • Space your drinks out and alternate with non-alcoholic drinks • Count how many drinks you have had • ‘Say NO’ to other substances • Have a friend or group of friends who watch out for each other & intervene when they see you are ‘risky’ • Don’t leave the group or wander into isolated situations/places • Never leave your drink unattended (even with a friend) PARTY SAFE ONE RISKY ACTION CAN HAVE LIFE-LONG CONSEQUENCES

34. n • Don’t be afraid to say NO if you are not ready • If someone says ‘NO’ it is your responsibility to respect that ‘No means No’ Encourage each other in standing up for what they believe

35. US FIGURES: Youth Risk Behaviours Surveillance System (15-19 yo, US CDC) Mm

36. o ORAL SEX isNOT RISK FREE • Many infections can be transferred by oral sex & linked to oral cancer • SURVEY • Guys cited seeking pleasure as the main reason for oral sex • Girls cited “improving the relationship” or “gaining popularity” but they also cited often feeling used & that it damaged their relationships

37. p Planned Pregnancy

38. Option 1

39. But if they BOTH decide to have sex, they should think ahead…. • 82% of 15-19 year old high school students in the YRSS Survey in the US did NOT use birth control pills when they last had sex • 13% of 15-19 year old high school students used NO form of contraception when they last had sex

40. Common Birth Control Methods

42. Respect Yourself & Others • No means no! Do not pressure anyone into having sex. • Do not use lines or give into lines like ‘you would do it if you loved me’ • Do not take advantage of others when they are drunk or high • It is your responsibility never to harm others • Do not talk about people like they are “just a body” • Don’t talk about your sexual exploits • Don’t use derogatory terms eg slut, frigid R

43. S Sexualization of our Society

45. Our society is focusing on being sexy or sexually attractive It causes a person’s value to come from their sexual appeal or behaviour rather than other characteristics Teach them that their sexuality is just a part of who they are!

46. How you dress & act will affect how others view you and treat you • This includes sexting • What message are you sending out? • Once a message or photo is sent out, you lose control of it. Someone might forward it or use it to blackmail you • Even things like ‘snapchat’ have security weaknesses (hacking) Even though sexy TEXTING ( ‘sexting’) is in vogue….. Think before you sext! T

47. U USE CONDOMS 40% of sexually active high school students did NOT use a condom last time they had sex (YRSS findings) If you are having sexual contact, this is the only way to reduce the risk of sexually transmitted diseases!

48. Condoms USE CONDOMS Don’t rely on condoms for contraception – There can be a 10-15% failure rate Make sure you know how to use them properly

49. W WHAT ABOUT MASTURBATION? • Masturbation is touching of your body parts to bring about sexual pleasure and maybe orgasm✔ • Masturbation is bad for your health✗ • Masturbation will make my penis smaller✗ • Only guys masturbate✗ • Masturbation is a personal thing✔

50. Z Keep it ZIPPED • At your age it is normal to get sexual feelings & physical responses eg erections, pleasurable feelings • Learning to take control of your feelings is part of growing up • Take is slowly • Become more comfortable around girls/guys • You don’t have to be in a relationship too quickly