Guide for Teens & Families

Why is sexuality so important?

All of us are sexual. Our sexuality includes

• our body and how our body works
• our biological sex
• our gender — our biological, social, and legal status as girls and boys, women and men
• our gender identity — our feelings about our gender
• our sexual orientation — straight, gay, or bisexual
• our values about life, love, and the people in our lives

And sexuality influences how we feel about all of these things and how we experience the world.

When we think of sexuality, we might just think about our bodies. We might just think about our sex organs. But our sexuality has as much to do with how we think and feel as it does with how we behave. Sexuality is a basic part of our physical, mental, emotional, and spiritual lives.

Our sexuality should be enjoyed and celebrated. It is not something to be ashamed of or embarrassed about. Healthy sexuality allows us to be open, flexible, creative, safe, and responsible as we explore our sexual thoughts, feelings, and desires. It lets us recognize that sex can be fun and can also fulfill many emotional needs. Sex also has risks.

Having a healthy attitude about sexuality means knowing our values, beliefs, attitudes, limits, and boundaries, and respecting that knowledge by being responsible. It allows us to feel attractive, regardless of our age, gender, sexual orientation, race, religion, height, weight, or physical or mental ability. It lets us be ourselves.

Knowing as much as possible about our sexual selves, in terms of our beliefs, values, and physical needs will help us create responsible, healthy, and satisfying sexual lives.

Our Sexual Bodies

Girls and boys have different sex organs.
Only girls and women have vulvas. Only boys and men have penises. Vulvas and penises are located in the front of the body between the legs.

The Vulva

A girl's sex organs look like this:

The lips, urethra, clitoris, and opening to the vagina are all part of the vulva. The lips of the vulva are also called labia. The drawing of the vulva shows where these parts are. Sometimes, girls use mirrors to see the parts of their vulvas. The outer lips and inner lips are two folds of fleshy tissue on the outermost parts of the vulva.

The outer lips are closer to the legs. Pubic hair grows there on most adolescents and adult women. The inner lips protect the inner vulva. They do not have pubic hair.

The opening of the vagina is in the middle of the vulva. It is a passageway to a woman's reproductive organs. Above it, the opening of the urethra provides a passageway for urine to flow from the bladder to the outside of the body. It is not easy to see.

Only the tip of the clitoris is visible at the top of the vulva in the soft folds where the lips meet. The rest of the clitoris reaches inside the body.

A boy's sex organs look like this:

The Penis

The penis is easier to see than the vulva. Two testicles that look like balls hang beneath it in a sac called the scrotum. A foreskin covers the glans at the tip of the penis unless it was removed in an operation called circumcision. Circumcision is usually done for cultural reasons. In most cases, it has no health benefits.

We touch our sex organs for pleasure from the time we are babies.
Most adults, children, and infants enjoy touching their sex organs and other parts of their bodies. The clitoris is designed to give women and girls pleasure when touched. The penis gives men and boys pleasure when touched.

Touching our sex organs for pleasure — masturbation — is a normal, healthy part of life. Masturbation and other kinds of sex play can lead to orgasm — an intense feeling of pleasure that happens when the tension that builds up during sex play is suddenly released.

Puberty happens to everybody.
But it doesn't happen to everybody at the same time. Generally, girls start puberty earlier than boys. The bodies of some girls begin changing at age eight. Others don't start changing until they are 14. Boys' bodies start changing from age 10 to 12. Most often these changes are complete before a person is 20.

Some of the changes are the same for girls and boys. We get taller. We begin to grow hair under our arms and around our vulvas or penises. We sweat more, too, mostly under the arms. That's when a lot of people start washing more often and start using deodorants. Also, our voices deepen. This usually happens more suddenly in boys than in girls.

Many of us get pimples during puberty — on the face, back, chest, or buttocks. We get them as our skin starts growing thicker and the glands under it start making more oil. Our pores become clogged and infected. That's another good reason to wash and shampoo often.

Hormones make our bodies grow up.
Our bodies make chemicals called hormones that guide our growth into women and men — estrogen and progesterone in girls and testosterone in boys. Often we grow so fast that we feel clumsy. We even may have uncomfortable growing pains, usually in our arms and legs.

Estrogen causes lots of the changes. Girls' breasts begin to get fuller. Often one breast grows faster than the other. Their hips get rounder. Their waists get narrower. Their vulvas and clitorises grow slightly, too.

Girls may have a white, sticky discharge from their vaginas called leukorrhea. They shouldn't worry about it unless the vulva becomes itchy or irritated. If it does, a girl should visit her doctor or health care provider.

Boys' testicles get bigger and hang lower. Usually one hangs lower than the other. Their penises grow larger and get hard more often — and unexpectedly. Boys gradually start growing beards after their voices change. Sometimes boys' breasts become tender and somewhat enlarged, too. This is called gynecomastia. It usually lasts only a year or two, and then the size of the breasts returns to normal.

We inherit our size, eye color, and skin color from our parents. We also inherit large breasts or small breasts, thin legs or thick legs, big penises or small penises, and thick beards or thin beards. Most of the time we inherit average breasts, legs, penises, or beards. But we are all very different, no matter what — and that's normal.

Clitorises, lips, penises, and breasts vary in shape and size.

The appearance of the outer folds of the labia — the outer lips — varies in size, shape, and color from woman to woman. The color of the inner lips is also different for every woman. In some women, the lips are smooth — in others, they are wrinkled.

The clitoris may be smaller than a pea or bigger than a fingertip. It reaches inside the body up to five inches.

Soft adult penises are usually between 3 1/4 and 4 1/4 inches long. Some may be shorter, longer, thinner, or thicker. Five to seven inches is the average length of a hard penis.

Women's breasts are different in shape and size. The nipples may be flat or raised. They, and the area around them — the aureole — differ in color from woman to woman. A woman's breasts can give her sexual pleasure when touched. Small or large, her breasts can also produce milk after she has a baby.

Some people prefer big penises or big breasts. However, being attractive depends more on personality — how we think of ourselves, present ourselves, take care of ourselves, and respect ourselves and other people.

During puberty, things happen inside the body, too.

Most girls start having periods. Most boys start having wet dreams. And girls and boys begin having a lot more thoughts and feelings about sex.

Important changes are happening inside the body. The reproductive system is maturing. Boys begin producing sperm — the male reproductive cells. Girls' ovaries begin to ripen eggs — the female reproductive cells.

Pregnancy can happen if only one sperm joins with an egg. The sperm can reach the egg if a boy or man puts his penis in or near the vagina. Often our reproductive systems grow up faster than we do. That's why girls can get pregnant and boys can cause pregnancy before they finish growing up.

As Boys Become Men

Boys and men have erections.
Boys and men become sexually excited by sexual thoughts, wet dreams, or sex play with themselves or another person. Their penises fill with blood and get hard and erect. Boys and young men get erections for no reason at all. "Spontaneous erections" can be very embarrassing.

A sticky liquid spurts out of erect penises if men get very excited. This is called ejaculation or "coming." The liquid is semen or "cum," not urine. Ejaculation and urination cannot happen at the same time.

Semen contains sperm and is also called "ejaculate." Boys and men may have orgasms without ejaculation. They may ejaculate without orgasm. A hard penis becomes soft again after orgasm. And it will become soft again even without orgasm or ejaculation.

Sperm are made in the testes. There are millions in every drop of healthy semen. They move from the testicles to the seminal vesicles through tubes called the vas deferentia. In the seminal vesicle, they mix with other fluids to form semen. Usually, a teaspoonful to a tablespoonful of semen is released at a time.

The time when sperm is first produced is called spermarche (sper — MAR — key). Men's bodies make sperm all their lives. New sperm develop every minute. Sperm are absorbed by the body if they are not ejaculated.

A Man's Reproductive System

Wet dreams often come as a surprise.
Most boys and men have wet dreams. This happens if they get erections and ejaculate during their sexual dreams. These dreams leave them wet or sticky around their bellies and penises. Some boys wake up thinking that they've "wet the bed." Some boys never have wet dreams. Dreams or no dreams — both are normal.

As Girls Become Women

Girls and women have orgasms during sexual dreams and sex play.
Women and girls become sexually excited by sexual thoughts and dreams or sex play with themselves or another person. Their vaginas become wet, their clitorises become erect, and if they become very sexually excited, they may have orgasms or a series of orgasms. In some women, a clear fluid spurts out of the urethra during sexual excitement or orgasm. This is also called ejaculation.

The vagina connects the sex organs of the vulva to the other reproductive organs inside the body.
The soft folds of the walls of the vagina adjust to the size of the penis during vaginal intercourse and stretch during childbirth. Girls and women also have two ovaries, a cervix, a uterus, and two fallopian tubes.

A Women's Internal Sex and Reproductive Organs

Each ovary holds hundreds of thousands of pinpoint-sized eggs. Girls are born with all the eggs they will ever have. One ovary releases a mature egg about once a month. This is called ovulation. Before ovulation, the uterus builds up a spongy, soft lining. It is made of tissue and blood. This lining is like a nest for the egg if pregnancy happens.

After ovulation, the egg moves through a fallopian tube toward the uterus. Most of the time, the egg breaks apart before it gets there. Then the tissue and blood aren't needed. They flow out of the uterus, through the cervix and vagina out of the body. This is called menstrual flow or a "period." Different women have different amounts of flow during their periods. Usually, there are only four to six tablespoonfuls of blood in the whole flow. This is a small amount. The rest is bits of the unused lining and other fluids. By the time your period ends, the flow will have amounted to between half a cup and a full cup of liquid.

But the egg doesn't always break apart. If the egg meets a sperm in the fallopian tube, they can join together. The joining of the egg and sperm is called fertilization. Pregnancy begins if a fertilized egg attaches itself to the lining of the uterus. The lining stays in place until the pregnancy ends. That's why pregnant women do not have periods.

The first time menstruation happens is called menarche (meh-NAR-key). Some families celebrate menarche as the time when a girl becomes a woman. Other families are more private about it. But whether or not menarche is celebrated, it is an exciting and important moment in a girl's life. It is also normal for girls to feel nervous or scared when they start getting their periods.

The time from the first day of one period to the first day of the next is called a menstrual cycle.
On average, menstrual cycles begin between the ages of 12 and 13. They end when women are between 45 and 55 years old.

Periods last about five days. It may be seven to 21 days from the beginning of a woman's period to ovulation. Then there are usually about 14 days from ovulation to the beginning of the next period.

During puberty, it's not unusual for three, four, five, or six months to go by between periods. Eventually, they happen every four or five weeks. Sometimes there is a spotting of blood between periods. Some women know when they are going to have their periods by the way their bodies feel. Others don't. Some women keep a record of their periods on a calendar to become more familiar with their cycle.

Some girls and women may have physical or emotional discomfort up to two weeks before menstruating. This is called premenstrual syndrome (PMS). Usually mild, PMS happens in fewer than half of all women.

Women use sanitary pads, tampons, or menstrual cups to absorb menstrual flow.

Every package has instructions. Sanitary pads, tampons, and menstrual cups come in different sizes and varieties. Some are for lighter flows. Some are for heavier flows.

Pads stay in place by sticking inside the underwear. Tampons and cups fit inside the vagina. The walls of the vagina hold them in place. Each tampon has a string that hangs out of the vagina. The tampon is removed easily by pulling the string slowly. Some cups have a "stem" that can be pulled for removal. Other cups are removed by hooking a finger around the rim. Some cups are emptied, washed, and used again. Other cups are disposable. Pads, tampons, or cups and regular bathing are all a girl or woman needs to stay clean during her period. Douches, vaginal deodorants, and perfumed pads and tampons are unnecessary and may irritate the vulva and vagina.

Some girls wonder if using tampons or cups will stretch the hymen and make them lose their virginity.
The hymen is a thin skin that stretches across the opening of the vagina. There is usually an opening in it to let menstrual flow out of the body.

The hymen is very important to some people. They believe that a girl without a hymen is no longer a "virgin" — that a boy has put his penis in her vagina. Girls are born with various sized openings and shapes of the hymen. Some girls are born with very little hymenal tissue. They may seem to have no hymen at all. Others stretch theirs open during certain kinds of exercise like bicycling or horseback riding. Using tampons doesn't usually stretch the hymen open all the way.Cups may be more difficult to use if a woman has a lot of hymenal tissue.

Girls and women who use tampons change them every three or four hours, or more often if bleeding is heavy.
Too many bacteria can develop if a tampon is left in place too long. This can cause a rare illness called "toxic shock syndrome" (TSS). Although very rare, TSS is very serious. If you vomit and develop a high fever, diarrhea, muscle aches, sore throat, dizziness, faintness, or weakness, and a sunburn-type rash while using a tampon, take it out and see your clinician — fast. You can reduce your risk by using a pad or cup or less absorbent tampon while sleeping.

Usually, women and girls do not have serious problems with their periods.
Some feel depressed, tired, or moody. Some have cramps or nausea on the first day or two of their periods. Exercise and a healthy diet may reduce cramps. Putting a hot-water bottle or heating pad on the abdomen can help, too.

Usually cramps aren't severe enough to prevent normal activities. If they are, a girl should talk with her parent, the school nurse, a teacher, or a clinician. There are very good medicines that lessen the pain of menstrual cramps.

	All three of these young women will be 13 in three months — their bodies are developing at different rates.
	All three of these young men will be 13 in three months — their bodies are developing at different rates.

How Pregnancy Happens

Some kinds of sex play can cause pregnancy.
Sex play with another person can be very pleasant. Some kinds of sex play are kissing, hugging, body rubbing, touching, and sexual intercourse.

Putting the penis inside another person's body is called sexual intercourse. It is called vaginal intercourse if the penis goes into the vagina. It is called anal intercourse if the penis goes into the anus. Touching the penis, vulva, or anus with the mouth is called oral intercourse or oral sex. Oral sex, kissing, touching, stroking, and massaging that may lead to orgasm without intercourse is called outercourse.

Vaginal intercourse or touching the vulva with semen can cause pregnancy. During sexual excitement, the penis leaks seminal fluid. This is called pre-ejaculate or "pre-cum." It may have sperm in it from a previous ejaculation. Millions of sperm spurt out during ejaculation. Pregnancy can happen if any sperm land on the vulva or inside the vagina.

It doesn't matter if a woman has an orgasm, or if she is standing, sitting, or lying down. It doesn't matter if the penis is withdrawn before ejaculation, or even if it's the first time.

How sperm get from the vagina to the egg.
Sperm travel up the moist vagina, through the uterus, and into the fallopian tubes. If an egg is in one of the tubes, a sperm can join it. Only one sperm fertilizes an egg. The egg and sperm form a single cell that divides into more cells. The growing collection of cells is called a pre-embryo.

The pre-embryo attaches to the lining of the uterus.
This is called implantation — the beginning of pregnancy. It happens about six days after fertilization. The pre-embryo becomes an embryo about eight days after implantation. Six weeks later, the embryo develops into a fetus.

The fetus becomes a baby at birth.
A fetus doesn't breathe or eat inside a woman's uterus. The fetus gets nourishment and oxygen from the woman through the umbilical cord that connects to her. As the fetus grows, the woman's uterus stretches. After about nine months, the muscles of the uterus begin to push the fetus through the vagina. This is called labor. Once it takes its first breath, the fetus is called a baby. The clinician cuts the umbilical cord right after birth. The belly button (navel) is where the umbilical cord was attached to us.

Labor may last only a few hours or a day or more. It is hard work and hurts. Special classes in childbirth can help make it easier for the woman. Almost always, she has the help of a doctor, a specially trained nurse, or midwife. Sometimes the delivery has to be performed surgically through the uterus. This operation is called a cesarean section or "C-section."

Not all fertilized eggs become babies.
Fewer than half of all fertilized eggs become babies. Some do not attach to the uterus and leave the body in menstrual flow. Some implant, but their development ends in fewer than 20 weeks. These embryos and fetuses leave the body through the vagina. This is called miscarriage or spontaneous abortion. Sometimes women decide to end their pregnancies through a procedure called induced abortion. Sometimes a fetus dies after 20 weeks, sometimes just before or during birth. This is called a stillbirth.

Legal, induced abortion is a safe, common, and simple procedure, especially in the first three months of pregnancy. In the first 63 days, abortion can be provided with vacuum suction or with medication. Later in pregnancy, abortion is more complicated, but is still quite safe.

There are at least seven days a month when women can become pregnant from vaginal intercourse.
Sperm live from three to six days in the fallopian tubes. So vaginal intercourse can cause pregnancy up to six days before ovulation.

The egg lives a day after ovulation. So women are able to get pregnant up to a day, and perhaps even longer, during and after ovulation.

In total, a woman may become pregnant during a minimum of seven days of her cycle. The most likely time is during the six days before ovulation.

A woman's menstrual cycles may vary from month to month, so it may be hard for her to know when intercourse can cause pregnancy.

How women can tell if they're pregnant.
Usually the first sign of pregnancy is a missed period. Other signs are vomiting, having sore and swollen breasts, feeling tired and sleepy all the time, and having to urinate more often than usual.

A woman can buy a pregnancy test at a drug store or supermarket. If it says she is pregnant, she should go to a doctor, a Planned Parenthood^® health center, or another family planning clinic to be sure. Missed periods may be due to illness, travel, or worry. But the most common reason for missing a period is pregnancy.

Expressing Ourselves Sexually

Sperm determines the sex of a baby.
Our biological sex is determined when the egg is fertilized. Most often, men ejaculate two types of sperm. One produces a girl, and the other produces a boy. Our biological, social, and legal status as women and men is called gender. Gender identity is the way each of us feels about our gender and about what other people expect of us because of our genders. People whose gender identity conflicts with their sexual anatomy are called transgender.

Intersex people may be considered sexually ambiguous in different ways:

• They may have sex organs that appear to be somewhat female or male or both. They cannot, however, have complete female genitals and complete male genitals.
• They may have a large clitoris — more than two-fifths of an inch.
• They may have a small penis — less than an inch.

About one in 2,000 people is born with an intersex condition in the U.S. each year. Sometimes a female or male gender is assigned through surgery. Up to five infant gender-assignment surgeries occur every day in the U.S. Some people believe surgery should be postponed until intersex people are old enough to decide for themselves whether they would like their genitals to be operated on. Most people agree that babies with intersex conditions should be assigned a gender at birth. Some people believe that assigning a gender means performing surgery on their genitals, while others believe that a baby can be assigned a gender without surgery.

Sexual orientation is different from gender and gender identity.
Whether people are gay, straight, or bisexual is usually established before puberty and before they begin having sex. Although sexual orientation may begin to develop before birth, it may seem to shift throughout life. It is not something that people can decide for themselves, or for others.

People who have sexual desire for the other gender are called heterosexual or straight. People who have sexual desire for their own gender are called homosexual or gay. Gay women are also called lesbians. People who have sexual desire for both genders are called bisexual. People who are unsure of their sexual orientation may be called "questioning." But sexual orientation is more complex and diverse than these simple labels. This kind of complexity and diversity is not limited to people. It occurs naturally throughout the animal kingdom.

It is normal for boys and girls to have sex play with friends of either gender. People may also have sexy dreams and feelings about either gender. This does not mean a person is gay or straight or bisexual.

Some people fear or hate others who are gay, lesbian, bisexual, or transgender.
This is called homophobia. When gay, lesbian, bisexual, and transgender people have these feelings about themselves, this is called internalized homophobia. Friends, family, and religious authorities often encourage negative feelings about sexual orientation and gender identity.

Some teenage boys worry about being gay. They might act very "macho" to prove they are straight. They might try to "be the boss" in romantic relationships. Some teenage girls can act very "girlish." They may think boys always should be in charge. Some people who act in these ways are uncomfortable about their sexual orientation or gender identity. They may try to hurt people who they think are gay, lesbian, bisexual, or transgender by calling them names or attacking them. This is called gay bashing.

Self-acceptance about sexual orientation and gender identity is very important. The process of accepting and being open about sexual orientation and gender identity for gay, lesbian, bisexual, and transgender people is called coming out.

The first step is coming out to ourselves. It may happen when we are teenagers, but it may not happen until we are older. The next step involves coming out to our friends and family. The whole process builds self-esteem, but can be very stressful. Coming out often helps us feel closer to people we love, even though it can be risky.

Love and sexual desire are not the same thing.
Love is a strong caring for someone else. It comes in many forms — love for close friends, for parents and children, for God, and for humankind.

Sexual desire is a strong physical excitement. It can be a fantasy we create, a crush, or just a flirtation. Sometimes we let ourselves have sex because of it. Sometimes we don't.

Love can exist without sexual desire, and vice versa. Many people are happiest when both love and sexual desire are shared between both partners. When it comes to love and sexual desire, it is normal for people to be different — in their feelings, needs, and behavior.

It is easy to confuse love with infatuation.
Sometimes we decide to have sex because we think we are in love, but it turns out to be just an infatuation — a sudden emotional and sexual attachment. Infatuation makes us want to have sex just to feel closer to our partners. Sometimes it leads to long-lasting love. Most of the time, it doesn't.

Healthy relationships are based on respect, trust, honesty, fairness, equality, responsibility, and good communication.

People in healthy relationships protect each other from unintended pregnancy and sexually transmitted infection. They don't use pressure, guilt, or force to have sex.

We may want stability in our relationships at an unstable time.
Our bodies and hormones rush through changes so fast that we can become confused. The surging hormones intensify our feelings — the highs and the lows. In the middle of so much confusion, we might think a romantic relationship will help us feel stable.
We want it to be the one thing that does not change in our lives. But that might not be a realistic expectation.

At this age, romantic relationships can begin and get serious very quickly. We think they will last forever. But they rarely do.
We need to learn how to end relationships. Breaking up with someone we care about can be hard — for both people. But it never has to be cruel.

Sometimes we have to break off the relationship.
When we do

• We are ready. We know for sure that the relationship must end — even if it hurts to break up.
• We tell our partners our feelings have changed. We don't ask someone else to do it for us.
• We are kind. We point out the problems with the relationship, not with our partners.
• We are considerate. We don't hurt our partners on purpose.

Sometimes someone breaks up with us.
When they do

• We may feel rejected, but we accept what we have learned.
• We may be angry or depressed, but we don't hurt ourselves or others.
• We understand that we will feel better in time.

Some people believe that sexual intercourse outside marriage is never OK — other people think it is always OK. Most people believe something in between. Deciding whether to have sexual intercourse is often difficult — no matter how old we are.

Sexual intercourse is just one way to "have sex" or express feelings for another person. It carries the highest risks of infection and pregnancy. We need to be aware of and think about these consequences when we make decisions about sex.

We all make decisions using the values we learn from our families as well as our own religious and moral beliefs. We need to make responsible choices and accept the consequences.

Protecting Ourselves Sexually

The surest way to avoid pregnancy is not to have vaginal intercourse.

Couples can also decide to reduce their sexual health risks through safer-sex practices. Safer sex is anything we do to lower our risk of sexually transmitted infection. The basic rule for safer sex is — keep each other's fluids out of our bodies.
Having any kind of sex with other people has certain physical and emotional risks. We all must learn how to protect ourselves from unintended pregnancy, sexually transmitted infection, and relationships that are not good for us.

The safest way to avoid pregnancy and infection is not to have any kind of sex play. This is called abstinence. Many people abstain until they are past their teens. Some until they are married. Some abstain their whole lives.

People who decide to have vaginal intercourse but don't want to cause pregnancy use birth control.
Vaginal intercourse without birth control, even once, even the first time, can cause pregnancy. Of every 100 women who don't use birth control for vaginal intercourse for a whole year, 85 will become pregnant.

Although many methods of birth control are nearly 100 percent effective, no method is perfect. But women and men who use birth control can worry less about unplanned pregnancy. They can be more confident about the plans they have for their lives. Sharing the responsibility to prevent pregnancy also develops trust between partners.

There are many kinds of birth control.
Most kinds are reversible. They allow women to get pregnant after couples stop using them. All reversible methods are available without a parent's permission.

Some kinds are permanent. "Sterilization," however, is not recommended for young people. It does not allow them to have children.

Birth control works by preventing ovulation or fertilization of the egg. Some kinds are available in drugstores without a prescription. Others must be prescribed or fitted by a doctor or clinician.

Most reversible birth control is designed for women to use. They may use different kinds at different times in their lives. To decide which kind to use, women consider how safe it is, how well it works, how easy it is to use, how affordable it will be, and whether or not it will protect against sexually transmitted infection.

Both partners can decide to limit their sexual contact.
Some couples decide not to have any sex play. This is called continuous abstinence. It is a good way to put off taking sexual health risks until we are mature enough to handle them.

Women who put off vaginal intercourse until their early 20s have other health advantages. They reduce their chances of becoming sterile or developing cervical cancer because they are less likely to get sexually transmitted infections than those who start younger. However, many people find it hard to abstain for long periods of time.

Some couples use periodic abstinence. They keep very careful records to try to tell when pregnancy could happen. They abstain from vaginal intercourse whenever they think there's a chance it could cause pregnancy.

Many couples have safer-sex play with outercourse. Finding other ways for sexual pleasure besides intercourse can help us learn how to give and receive pleasure. This is important because many teens get little satisfaction from sexual intercourse because their partners do not know how to give them pleasure. Outercourse also protects against most serious sexually transmitted infections. One drawback — it may lead to a couple's desire to take a risk and have unprotected intercourse.

Many people use withdrawal when no other method is available — the man pulls his penis out of the vagina before he "comes." But many men become so sexually excited that they don't withdraw in time. Also, they leak a few drops of fluid before they ejaculate. Even these few drops can cause pregnancy.

Caps, diaphragms, shields, IUDs (intrauterine devices), and hormonal pills, patches, rings, implants, and shots are reversible methods that require a prescription.

Diaphragms, caps, and shields are worn in the vagina for vaginal intercourse. IUDs are inserted into the uterus by a clinician and work continuously for years. Birth control pills contain hormones and are taken daily on a monthly schedule. Hormonal shots are injected every 12 weeks. Rings are inserted into the vagina for three weeks and taken out for the fourth week. Patches are applied to the skin of the buttocks, stomach, outer arm, or upper torso once a week for three weeks in a row out of four weeks. Implants are placed under the skin of the upper arm for up to three years.  Many teen women prefer shots because they are very private. However, there is debate about possible long-term health risks for teenagers because the shot is associated with temporary bone-thinning.

Many teen women prefer hormonal injections because they are very private. However, there is debate about possible long-term health risks for teenagers. Although it has not been proven, some scientists believe using hormonal injections for many years may decrease bone strength in some young women.

Like other medicines, prescription birth control may have side effects and health risks for some women. They can also have other health benefits besides preventing pregnancy.

Clinicians can help women decide what method might work best for them. Sexually active women should have a gynecological checkup, Pap test, and screening for sexually transmitted infections at least once a year. Clinicians may not test unless asked — so be sure to tell them that you want to be tested.

Condoms, female condoms, and contraceptive sponges, foams, creams, jellies, films, and suppositories are reversible methods that can be bought "over the counter," without a prescription. They are easy to use and rarely cause side effects when used as directed. Condoms are worn on the penis. The others are inserted into the vagina before vaginal intercourse.  Women who only have sex now and then may prefer over-the-counter methods to avoid the possible, ongoing side effects of prescription methods.

Sterilization is a permanent method usually chosen by older people who are very sure they will not want any children in the future. Sterilization is a simple operation that keeps egg and sperm from meeting. The operation for men is simpler than the one for women.

Emergency Contraception (EC)

• is designed to prevent pregnancy after unprotected vaginal intercourse
• is also called "post-coital" or "morning-after" contraception.
• is provided in two ways
  • emergency hormonal contraception pills
  • insertion of an IUD
• EC pills can reduce the risks of pregnancy up to 120 hours (five days) after unprotected intercourse. The sooner they're taken, the better.

At least one in four people who has sex with other people gets a sexually transmitted infection.
Sexually transmitted infections are "germs" that are passed from one person to another by vaginal, oral, or anal intercourse, or other intimate contact. The most serious are passed through sexual intercourse. Millions of teens are infected but have no symptoms and do not know it.

Many sexually transmitted infections cause serious diseases or damage a person's health permanently without showing any symptoms. People who aren't treated and cured may never be able to have children. Certain infections can be passed to the fetus during pregnancy and birth. Some can cause a lifetime of health problems or even death. The most serious is HIV (human immunodeficiency virus) — it has no cure. It causes AIDS — the most advanced stage of HIV disease. AIDS usually causes death.

Condoms protect against pregnancy and sexually transmitted infections.

Latex condoms and female condoms offer protection against most serious sexually transmitted infections, including HIV. All sexually active people who have sexual intercourse with more than one partner — or whose partners have sexual intercourse with more than one partner — should use condoms. People allergic to latex can use condoms made of polyurethane. No other methods of contraception reduce the risk of sexually transmitted infections.

Some barrier methods offer limited protection against some infections. The Pill, injections, implants, IUDs, withdrawal, periodic abstinence, and sterilization do not protect against any. If you need protection against infection, use condoms as well.

If you have a sex partner and one of you even thinks you are infected, don't put off doing something about it. Even if the symptoms are gone, you may still be infected. Stop all sexual activity and see your health care provider.

Common signs or symptoms of sexually transmitted infections are sores and blisters on or near the sex organs or mouth; unusual discharges from the penis or vagina; itches, rashes, and bumps on the sex organs and other parts of the body; and burning pain during urination. HIV can be in a person's body for 10 years or more before symptoms appear. During that time people with HIV can infect their partners — without knowing.

Don't let embarrassment become a health risk. Many people find sex and sexual health very difficult to talk about. Some even find it shameful because they think having an infection means they are not moral. But when shame gets in the way of common sense, it keeps people from taking good care of themselves and their partners.

All plants and animals that reproduce sexually can get sexually transmitted infections. Morality and shame have nothing to do with it. Keep yourself healthy by speaking frankly with a clinician about your sex life. Some of them won't ask — so take charge and speak up. Testing, examination, and treatment for sexually transmitted infections are confidential.

Some people hurt us by trying to force us to have sex with them.
This is sexual abuse. Most often sexual abusers are people we know. They may be our friends. They may even be in our own families.

Sexual abuse includes unwanted touching, fondling, watching, talking, and giving baths, douches, or enemas. And it includes people forcing us to look at their sex organs. It happens whenever our sexual privacy is not respected.

Forced sexual intercourse is called rape. If a spouse, friend, or date forces sexual intercourse, it is called acquaintance rape. If the abuser is a family member, it is called incest. Sexual abuse, rape, acquaintance rape, or any kind of intercourse between an adult and a minor, including incest, are serious crimes. The victims of these crimes are not responsible for what happened to them.

Sexually abused people can be helped by revealing the abuse to a trusted parent, friend, teacher, or advisor — even if they promised to keep it a secret. A parent, other relative, guidance counselor, clergy, clinician, teacher, or close friend may be able to help stop the abuse. Abused people need to find someone who will believe them, know how to help them, and keep them safe — even if they've been threatened not to tell.

Know the truth about sexuality, birth control, and pregnancy.
There are lots of crazy stories about sexuality, birth control, and pregnancy. The truth is:

• a woman can get pregnant even if
  
  • she is having vaginal bleeding
    
  • she doesn't have an orgasm
    
  • she doesn't have vaginal intercourse very often
    
  • she has vaginal intercourse standing up
    
  • she urinates right after having vaginal intercourse
    
  • she douches with Coke^® or Sprite^®, or anything else
    
  • the man pulls his penis out of her vagina before he "comes"
    
  • she jumps up and down after vaginal intercourse
    
  • she hasn't had her first period yet
    
  • she's under 12 years old
    
  • it's her first time
  
  
• Men do not have stronger sex drives than women.
  
• The size of a man's penis does not depend on how much sexual intercourse he has.
  
• A man's sex drive does not depend on the size of his penis.
  
• Masturbation does not make a person gay or straight.
  
• Masturbation will not make a person blind or crazy or cause hair to grow on the palms of the hands.
  
• Men aren't harmed if they don't ejaculate when sexually aroused.
  
• When a woman or a man says "no," believe it.
  
• Women with larger breasts do not have stronger sex drives.
  
• Plastic wrap wrapped around the penis is not an effective contraceptive.
  
• Nobody has a right to touch anyone who does not want to be touched.
  
• The pill does not prevent sexually transmitted infections.
  
• Having a sexually transmitted infection does not mean that someone is a "bad person."
  
• Oral sex can transmit certain sexually transmitted infections, such as gonorrhea, chlamydia, hepatitis, herpes, and syphilis.

Sometimes, it seems that having sexual intercourse is more important than anything else. It isn't.

Sometimes, it seems that having sexual intercourse will solve all our problems. It won't.

Sometimes, people have sexual intercourse before they're ready and when they don't really want to. It's not worth it.

Having sex before we are ready can interfere with our dreams and plans for the future.

When we plan ahead and wait until we're ready, sex can be exciting, satisfying, caring, and rewarding. If we know what we're doing, and if we stay in charge, we can have happier, healthier, and more successful lives.

Some Conversation Starters for You and Your Teen — Questions You Can Ask

How have you changed in the last two years? What do you like and what do you not like about the changes?

How do you think you'll be different in five more years? Do you think you'll like these changes?

This webpage describes some differences between boys and girls. Do they act or think differently from each other? How? Why?

At what age do you think a person is ready to have sex? How do you decide?

At what age do you think a person is ready to be a parent?

What do you think are the qualities that a parent should have?

Information about sex can be easy to get.
Besides your local public library, there are many other local and national organizations that provide information about sex and sexuality.

Many Planned Parenthood centers have Web sites and also offer printed information, group discussions about sexuality, and counseling on such topics as parent/child communication, birth control, sexually transmitted infections, pregnancy, and abortion. They can help children and parents who find it hard to talk about sex.

Your temple, church, or mosque also may offer a family life education program.