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Safer Sex – Talking about Birth Control and Sexually Transmitted Infections (STIs)

It can be hard for parents to accept that their son or daughter may be involved in a sexual relationship. If parents cannot acknowledge that their child is in a sexual relationship, they likely will not talk about sexuality with them.

 

Talking to youth about sexuality is important because it can increase their ability to make healthy decisions, including whether or not to have sex.

SARAH & JOSH’S STORY…

 

Sarah and Josh met two years ago volunteering at Stampede. What started as friends turned into a dating relationship that they both had fun with. Recently Sarah’s group home coordinator Vic had a call from Josh’s parents asking if he could talk to the couple about safer sex. Josh told his parents that he loves Sarah and is ready to take the relationship to the next level. His parents are really happy that he had shared this with them and although they are worried, they know that at age 23 Josh wants to make his own choices. Vic feels comfortable talking about the topic with the couple, but where can he get the most up to date information and advice about birth control and STIs?

When a relationship becomes serious, it is important that youth have the skills and knowledge needed to make healthy choices.

 

Youth need to know about:

 

  • The consequences of sexual activity including pregnancy and sexually transmitted infections (STIs).
  • How to give and get consent to take part in sexual activity.
  • How to talk about safer sex with a partner including negotiating use of condoms.
  • Where to go for information about birth control and STIs.

The goals of sexual health education, according to the Canadian Guidelines for Sexual Health Education are:

 

  • To help all Canadians obtain positive outcomes (e.g., rewarding relationships, self-esteem, informed reproductive choices, non-exploitive sexual relations); and
  • To help all Canadians avoid negative outcomes (e.g., unintended pregnancy, STIs, sexual coercion).

Abstaining from sexual activity is the only method that offers 100% protection from pregnancy and STIs.

 

This means not taking part in any sexual activity that involves exchanging body fluids, genital to genital contact, or skin to genital contact. If abstinence is not possible, then birth control and condoms should be used consistently and correctly.


 

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Research looking at sexual activity rates, birth control use and pregnancy rates found little difference between youth with physical disabilities and those without a disability (PHAC, 2013). Parents and providers can help youth build skills to make healthy choices about sex and provide information about how to get birth control and STI testing.

CONSENT FROM PARENTS AND GUARDIANS

Visiting a clinic or doctor’s office to talk about birth control and sexual health can be an uncomfortable experience. Youth may need support to connect with services that can help them. Health care professionals will assess whether or not the youth can understand the nature of their visit and make decisions about any drugs or treatment. Some youth with disabilities may need the consent of a parent or guardian to receive health care to help them with decision-making.


 

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Even if the youth you care for can consent for their own care, they may want your support. Ask them if they would like you to come to the clinic with them. They may want your support to get to the clinic or they may want you to sit in the waiting room while they see the health care professional alone.

PREVENTING PREGNANCY

Pregnancy is a significant risk of sexual activity and is a concern for many youth. An unintended pregnancy can have life changing consequences that can be considered even more challenging when a youth has a disability.

 

To learn more about pregnancy and pregnancy options, click here.

WHAT IS BIRTH CONTROL?

Birth control is also known as contraception and refers to methods used to prevent a pregnancy. Contraception works by either preventing the fertilization of egg by the sperm, or preventing the fertilized egg (embryo) from implanting in the uterus. No method of birth control is 100% effective and most do not give protection from STIs. There may be side-effects with some methods. The best birth control method is the one that will be used consistently and correctly.

Methods of birth control are sometimes divided into categories:

 

  • Natural family planning – includes abstinence, fertility awareness and withdrawal (“pulling out”). These methods require planning and are not considered very effective since many people have a hard time using these methods correctly.
  • Hormonal – includes the pill, patch, vaginal ring, “the shot” (Depo-Provera injections), and hormonal IUD. These methods are very effective, but a visit to a health care provider is needed. The emergency contraception pill is a hormonal method that can be purchased at many pharmacies without a prescription.
  • Barrier – includes diaphragms and male and female condoms. A prescription is needed for the diaphragm and it needs to be fitted by a healthcare provider. Male and female condoms can be purchased at pharmacies or supermarkets. Some youth clinics have them available for free. If used consistently and correctly, male and female condoms can be effective at preventing both pregnancy and STIs.
  • Spermicidal – includes foams, jellies, film and sponge. These methods are less effective and usually need to be used with another method of birth control.
  • Other – includes copper IUD and surgical methods (e.g., tubal ligation and vasectomy). Surgery is considered permanent and the IUD can be removed at any time. All are very effective but require a visit to a health care provider.

To learn more about methods of birth control, click here.

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If there has been unprotected sex or the birth control method fails (e.g. the condom breaks) in the last five days using emergency contraception (EC) can help prevent pregnancy. EC does not prevent against STI transmission. STI testing and treatment may still be needed after unprotected sex. 

 

The two forms of EC are the copper IUD and emergency contraception pills (ECP). ECPs works best if taken within first 24 hours after an unprotected sexual activity but can be used up to 5 days. Some ECPs can be purchased at a pharmacy without a prescription, while other ECPs do require prescription from a health care provider. The Copper IUD can be used as emergency contraception as well as a long term reversible birth control method. The copper IUD needs to be inserted into the uterus by a trained health care professional. Visiting a health care provider as soon as possible after unprotected sex can be helpful to assist in deciding which type of EC is the best considering the person and circumstances. A health care provider will also be able to assist in creating a more reliable birth control plan for next time and provide any STI testing and treatment. To find sexual health clinical services in Alberta visit: www.ahs.ca/srh 

HOW TO ACCESS BIRTH CONTROL

Some birth control methods can be purchased over-the-counter (e.g., male or female condoms, emergency contraception pill, spermicidal foam). Other methods require a prescription (e.g., birth control pill, patch, ring, IUD). Some methods require insertion or fitting by a healthcare provider (e.g., IUD and diaphragms). Access for youth to no-cost birth control and prescriptions can be found at Alberta Health Services Sexual and Reproductive Health Clinics.

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Not everyone can use all birth control methods due to their health condition or disability. For example:

  • Latex allergies and sensitivities are particularly common in people diagnosed with spina bifida. Even though condoms are commonly made from latex, there are non-latex condoms widely available and should be used if there is a latex allergy.
  • Using condoms can be difficult for anyone with reduced dexterity.
  • Hormonal methods, such as the pill (taken daily), may not be the best option for youth with learning disabilities who may have a hard time remembering to take it.
  • Seizure medication reduces the effectiveness of the birth control pill.

The good news is that there are lots of different methods to choose from and there is something that will work for everyone, no matter the disability.

PLANNING TO USE BIRTH CONTROL

Deciding to use birth control is the first step. If youth are sharing that they plan to have sex or have been sexually active already, they are ready to talk about protection.

Some questions to ask youth include:

 

  • Are you truly ready to be sexually active? Do you trust the other person? Do you both give each other consent to have sex? (for more decision making information click here)
  • Do you need a birth control method that gives protection from STIs? It is recommended that people use a condom (male or female) every time they have vaginal, anal and genital to genital contact in order to prevent STI transmission. Other birth control methods do not protect against STI transmission. Dual protection (e.g., using a hormonal contraception plus a condom) greatly lowers the risk of unintended pregnancy and STI.
  • Do we need to visit the doctor to talk about which method is best? What are the side effects? Where can we go to get birth control? This may take planning as some types of birth control will not work right away.
  • What will you do if you do not like the type of birth control you choose? If someone has unpleasant side-effects or does not like using the chosen method, it is important to talk with a health care provider. Quitting a method suddenly can lead to unintended pregnancy.

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Hormonal contraception can be used to control menstruation by stopping periods or making them lighter and shorter. This is very helpful for those who have hygiene issues and heavy bleeding (caused by the use of certain medications) or for someone who finds it hard to cope with periods because of a physical or intellectual disability.

WHAT ARE STIs AND BBPs (STBBIs)?

Sexually transmitted infections (STIs) and blood borne pathogens (BBPs) are also risks of sexual activity. STIs are types of infections that are spread through sexual contact. STIs are sometimes called sexually transmitted diseases or STDs. There are many types of STIs. Some are easily cured with prescribed medication; others have no cure (PHAC, 2015). BBPs are infections that are spread by the blood and other high risk body fluids such as semen, vaginal or rectal fluid.

There are many myths about STIs:

 

  • MYTH: Only people who have lots of different partners are at risk.
    FACT: Anyone who is sexually active can come into contact with STIs and it is possible to contract an STI during the first sexual experience. Do not assume that youth who are dating for the first time are not at risk.
  • MYTH: It is easy to tell if someone has an STI just by looking at them.
    FACT: Having an STI is not like having the chicken pox. Many people show no symptoms and if there are any, they may not be visible. Testing is the only way to know for sure if someone has an STI and partners can only really know if they ask each other. Anyone can get tested at a sexual and reproductive health clinic, STI clinic, or doctors’ office. Testing and treatment is free.
  • MYTH: STIs are only spread through sexual intercourse.
    FACT: STIs can be passed on through skin-to-skin contact, with no body fluids involved. Oral sex is a high risk activity for STIs along with vaginal and anal sex without protection.

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Sexual contact means any intimate skin to skin contact in the genital area. This includes touching, oral, vaginal or anal sexual activity with a partner of either sex. Youth may need information that both giving and receiving oral sex carries risk for STIs.

TYPES OF STIS AND BBPS (STBBIs)

Sexually transmitted infections are classified as:

 

  • Bacterial (e.g., chlamydia, gonorrhea, syphilis),
  • Viral (e.g., HPV, genital herpes), and
  • Parasite (e.g., public lice, scabies).

If detected early, bacterial and parasite STIs are generally easy to treat. Viral STIs can be treated, but are more difficult to cure. Some viral STIs are not curable at this time. Untreated STIs can lead to damage to the reproductive system, which may cause problems with fertility later in life.

 

Some types of BBPs are human immunodeficiency virus (HIV) and hepatitis B. HIV is a virus that attacks the immune system and makes it hard for the body to fight diseases and infection. There is no cure for HIV. However, with early diagnosis and treatment people can live long, healthy lives. HIV can lead to a condition called AIDS (PHAC, 2015). Hepatitis b is a liver infection caused by the hepatitis B virus and is more infectious than HIV.

 

For more information on STBBIs, click here.

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The most common symptom of STBBIs is having NO symptoms at all. If a person experiences any problems (e.g., unusual bleeding or discharge, pain, lumps, bumps, sores or rashes) they should see a healthcare provider ASAP.

PREVENTION

For those who choose not to abstain from sexual activity, condoms reduce the risk of STBBIs. It is recommended that people use a condom (male or female) every time they have vaginal, anal, and genital to genital contact. Condoms or dental dams should be used during oral sex.

Vaccination is another way to prevent STBBIs;

 

  • HPV Gardasil vaccinations are routinely given to grade 5 boys and girls in Alberta. Gardasil protects against four common strains of HPV.
  • Hepatitis B vaccinations are routinely given to grade 5 boys and girls in Alberta. The vaccine may be given during the first year of life, if parents were born in an endemic area or if they are carriers of the disease.

TALKING WITH YOUTH ABOUT CONDOMS

Safer sex means protection, from pregnancy and STIs. This includes using birth control, getting tested for STIs and using condoms. Talking about condoms and safer sex with youth can be difficult for parents and service providers, but when condoms are used correctly they are very effective.

 

Condoms can prevent pregnancy and STIs and the best time to talk about using them is before a youth starts to have sex. It is important to help them get familiar with what condoms look like and how to use them correctly but it is equally important to help them talk about and negotiate condom use with a partner.

Here are some tips for talking about condoms:

 

  • Choose a time without distractions and prepare for some embarrassment and maybe giggles.
  • Not everyone can use latex condoms dues to allergies. Latex free condoms are available along with female condoms that do not contain any latex.
  • Be sure to show condoms inside packages and talk about where condoms can be bought and also picked up for free (e.g., sexual health clinics).
  • Explain that condoms, like medicines, have an expiry date and that it is best not to use the condom if that date has passed.
  • People with hand mobility challenges may find it difficult to use condoms as they require some fine motor skills. A partner can be encouraged to help and this makes condom use something that couples can talk about together.
  • Discuss setting limits about sex and condoms – no condom means no sex! Talk about what might happen if a couple wants to have sex but they don’t have a condom. What if one person does not like using condoms? For more tips about talking to a partner about condoms see STI high risk portal.

For instructions on how to use condoms visit the male and female condom information sheets.

WHERE TO GET HELP

For birth control information, prescriptions and no-cost supplies;

Youth can go to an Alberta Health Services Sexual and Reproductive Health Clinic.

 

For STI testing, treatment, information and support in Calgary;

Youth can go to an Alberta Health Services Sexual and Reproductive Health Clinic or STI Clinic.

Youth can also get help at:

  • Walk-in clinics,
  • A family doctor, and
  • Urgent care facilities.

RESOURCES & REFERENCES

RESOURCES

 

For Sexual Health Services in Alberta, click here

 

For HPV vaccination information in Alberta, click here

 

Easy Reading Brochure: Sexual Health

 

REFERENCES

 

Public Health Agency of Canada (PHAC). (2013). Questions & Answers: Sexual health education for youth with physical disabilities. Retrieved from http://librarypdf.catie.ca/pdf/ATI-20000s/26289_B_ENG.pdf

 

Public Health Agency of Canada (PHAC). (2015). Canadian guidelines on sexually transmitted infections. Retrieved from http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/index-eng.php