My child is becoming an adult and sexuality is becoming more of an issue. What do I do?
The first step is to determine whether there's a problem or not, in this case related specifically to sexuality. After all, while sex is a small word, it is a huge topic. Sex can be a meaningful way to share love with another human being, and yet it is often the source of shame, pain, and even illness or death. It is the instinct that ensures the continuation of our species, but it is also the drive that can result in the most self-destructive consequences. Sexual feelings can be especially confusing to young people, but can also present problems for adults. The consequences for the choices we make in our sexual behaviors can have far-reaching effects. Some of the consequences are positive and some are negative, even potentially life-threatening. Planning a pregnancy with a partner to whom one is committed, and then conceiving a child, is usually a positive consequence. Conceiving a child as a result of having sex with someone who is not a lifetime partner is likely to have very negative consequences. The act itself may be the same, but the consequences will likely be very different.
So where do I start, as a parent?
We can think of sex as having two major components: the physical/mechanical aspects, and the social/cultural aspects. The physical/mechanical aspects of sex don't change much over time. They involve the drive associated with reproduction and the functioning of the physical "equipment" used in the act of sex. The sex drive is powerful, and appears to involve not only biological factors but also emotional and interpersonal factors. The social/cultural aspects of sex are more complicated. In our society, there are rules about sex that are not necessarily related to anything physical, but rather to one's beliefs about what is right/wrong or healthy/unhealthy. Problems with sexual functioning often arise when our biological drives and the cultural rules are in conflict. Some experts believe that the cultural rules influence and control our drives, while others believe that our biological drives tend to overpower the cultural rules. This is a complex argument which we won't be able to resolve in this report. However, it is important that you realize there are certain "rules" associated with sexual behavior and that these rules influence what you think of as right/wrong and healthy/unhealthy.
What are the "rules" about sex?
Sexuality and the rules associated with it vary from individual to individual, from culture to culture, and across time periods throughout history. An interesting recent development in American culture has been a move toward disapproval of male promiscuity. While once there existed a double standard about male and female sexual behavior, our culture has recently moved toward discouraging promiscuity by both genders. A saying such as "He's just sowing his wild oats" would be considered unacceptable today - even in Herkimer County - by many people because one would not make such a statement about a female. Another recent trend has been a move away from the sexual freedom associated with the late 1960s and early 1970s, and toward an emphasis on monogamy and celibacy, on delaying the time of first sexual intercourse, and on encouraging individuals and couples to practice not only safe sex but also self-control. To understand sex and sexuality a review of the basics of human sexual development through the life span are presented below. Information is also provided about sexually transmitted diseases (STDs) and various methods of contraception.
Infancy and Early Childhood Babies and very young children are not considered by our culture to be sexual beings. On the other hand, infants and children do engage in exploratory touching of their own genitalia in order to learn about their bodies. That's technically normal. At young ages, touching of others' bodies is also typically exploratory with no sexual overtones or intentions. Penile erections in male infants are usually a response to becoming chilled or a sign of a full bladder, not an indication of sexual excitement. Around the age of three, children begin noticing differences between the physical characteristics of males and females, and they may openly comment about their observations or ask frank questions. Adults sometimes misinterpret these comments and questions, thinking that they sound sexual in nature. Usually they are merely reflections of natural curiosity. Curious children may also engage in exploratory play to discover the differences and similarities between males and females, and typically such behavior should not be a cause for concern. In fact, this may be a good time developmentally for parents and other care givers to begin to teach children about what kinds of self-touch are acceptable and unacceptable in public and about the difference between "good touch" and "bad touch" by other people. When a child conducts him/herself in provocative ways that seem inconsistent with the norms of that age group, it can be a sign that the child has been exposed to sexual behavior that is inappropriate for their level of development. This is a good time to speak with a professional, if only to make sure there's nothing more serious going on. For example, a young child who masturbates frequently or until sore, or a child who sits on an adult's lap and attempts to fondle the adult, may have been sexually violated or abused. Also, children who grow up in what is referred to as a "sexually charged" home (that is, a home where adult sexual behaviors are performed in view of children) might also act sexually inappropriate, perceiving this behavior as a means of gaining attention or status in the family. Fortunately, very effective treatment is available in most communities for children who have been victims of incest or other sexually abusive behaviors. In Herkimer County, the Child Advocacy Center at (315) 866-0748 is a very good place to start.
- Adolescence and Puberty Puberty, usually occurs sometime between the ages of about 9 and 15 and is the stage of development where the body typically grows to sexual maturity. This is, perhaps, the most stressful of all the human developmental stages, even for the most well-adjusted or "normal" person. Multiple physical changes occur in both males and females during this time, with the most notable being the development of sexual genitalia. Both males and females experience growth spurts in height and weight, they begin to grow pubic hair, their voices take on a more adult-like tones, and they may develop facial acne. People often notice that adolescents tend to become more "moody" and emotionally sensitive during this stage of development. Social changes also begin to occur during this time, and these are often more stressful for the teenager and his/her parents than the physical/emotional changes taking place. Perhaps most importantly, the adolescent's peer group begins to occupy a central place in his/her life. This is often difficult for the family to accept, as it represents a move away from the closeness and dependence of childhood. The two genders also begin to treat each other differently during this time. Whereas boys and girls may previously have treated each other as fierce rivals, or perhaps as unworthy of being noticed, during adolescence they usually begin talking nicely to one another, "hanging out" together in small groups, and even engaging in flirtatious behavior.
Puberty typically begins earlier for girls than for boys, usually between the ages of 9 to 14. The first tell-tale signs include the development of breasts, a height/weight growth spurt, and the growth of underarm hair. Usually within a year of these changes, the first menstrual period begins. An adolescent girl may also begin to experience arousal in response to sexual situations, and most girls begin to masturbate for the purpose of achieving sexual release sometime during their adolescent years.
The beginning of menstruation can be a positive or a negative experience, depending upon the individual girl's level of preparedness for the event. If she has been adequately prepared by her parents for the onset of her first period, and is supported in viewing it as a positive "rite of passage" into adulthood, she may be capable of seeing it as a welcome and joyful development. On the other hand, it is not uncommon for girls to be completely unprepared for the event, and to feel disgusted or afraid of what is happening to them. Such girls are more likely to perceive their periods as presenting them with painful or uncomfortable symptoms, and are therefore more likely to see the onset of menstruation as a "curse" rather than a "blessing."
Another common feature of puberty for many adolescent girls is mood instability. They may seem more sensitive and emotional during this time, laughing out loud one minute and breaking into tears the next. Many also experience for the first time the irritability and crankiness that are often associated with the menstrual cycle. Such "moodiness" is actually a complex set of feelings and behaviors believed to be related to the fluctuating levels of sex hormones that are becoming active in the adolescent female body.
Boys usually start puberty a little later than girls, and the initial changes are not quite as obvious or visible. A subtle change in body structure may be noted by increasing height and weight, and increasing muscle tone or mass. A gradual deepening of the voice and the development of facial hair are some of the more obvious signs, and some boys also develop moderate-to-severe facial acne. The penis and testicles begin to grow to adult-like proportions, pubic hair begins to grow, and a boy may begin to masturbate for the purpose of achieving sexual release. Nighttime release of semen (sometimes known as "wet dreams") may occur. Mood instability does not seem as pronounced in boys as it is in girls, but this varies from individual to individual. In fact, some boys are just as bothered by hormonal changes as girls are, and can experience the emotional sensitivity, moodiness, and irritability that many girls experience.
What should a parent do during adolescence?
For those who love an adolescent, this can be a trying time. There are several things that you can do to be of help and support to a developing young man or woman.
First, be a good listener. Just the simple act of listening attentively can often be enough to calm someone down and provide reassurance. It is a very simple thing to do, and yet is often the most difficult thing to achieve -- especially if you become easily worried about what you hear or try to engage in problem-solving to quickly. Some of what you may hear will make little sense to you, but try to listen without passing judgment or offering unwanted advice. If you make an unsolicited judgment or question the adolescent's use of logic, you may discourage him/her from talking to you in the future.
Second, the beginning of adolescence is a great time to schedule a general medical exam and have a down-to-earth talk with a professional medical provider. A "clean bill" of health and reassurance that the changes taking place are natural and normal can provide great comfort and instill confidence for the future.
Third, provide your adolescent with frank and accurate information about sexuality, sexually transmitted diseases, contraception and intimate relationships. There is no evidence to support the often-heard claim that providing information encourages children to engage in sexual activity. In fact, there is good evidence that adolescents as a population in this country are now responding positively to public education campaigns encouraging abstinence and safe sexual practices; more and more teens are reporting their intentions to remain celibate, form monogamous relationships, and engage only in "safe sex" behaviors.
Lastly, accept that adolescence is a very difficult stage of development, and expect that going through it with your teenager will be challenging. Adolescents often experiment with new behaviors; as difficult as it is for loved ones to observe this process, doing so is a necessary task at this stage of development. Engaging in new behaviors helps teenagers develop courage, confidence in their decision-making abilities, and feelings of competency. However, most experimental behavior entails risk; therefore, the more information an adolescent has at his/her fingertips, the better chance s/he has of making an accurate risk-benefit determination. So, make yourself available to your adolescent to talk about concerns and questions they have regarding sex and sexuality. You will not have all the answers but your willingness to listen and provide support will sometimes be all that is needed.
What about homosexuality and bisexuality, especially if I'm not comfortable with these concepts?
It is quite common in the United States for the first experimental or exploratory sexual behaviors to be with a person of the same sex. Such exploratory behavior in and of itself is not considered "homosexual," and does not necessarily indicate that the individual is, or will become, a homosexual. It is not yet clear which particular factors determine absolutely the development of a person's sexual orientation. However, research suggests that homosexuality is influenced by multiple factors; these include biological and physiological reasons, family, and social factors. Social factors are the least powerful in influencing sexual orientation. Other research suggests that homosexuality is NOT caused simply by having been exposed to, or being influenced by, the homosexual behavior of other people.
Those who consider themselves homosexual or bisexual usually say that they first noticed their preference just before or during adolescence. Homosexuality is the orientation of approximately 4 to 10% of the population, and is far more common in males than females. Those who are homosexual typically report having had a very difficult time during adolescence. The use of illicit drugs and alcohol, suicidal thoughts and gestures, truancy, and psychological complications are more commonly reported for homosexuals than for heterosexuals in the same age groups. Research has shown that homosexuals suffer from more stress than heterosexuals, presumably due to the cultural prohibition against homosexual behavior. In fact, homosexuals are often the victims of ridicule and rejection, not only from their peers but also from their own family members. Homosexuals are also often the victims of hate crimes, and many are forced to live their lives in secrecy and shame in order to avoid being the target of public scorn.
How should I deal with teen pregnancy?
Teen pregnancy is a devastating experience for most teens and their parents. Research indicates that one out of four of all women will become pregnant before the age of twenty. There are several options for pregnant teenagers including keeping their child, adoption and abortion. Each of these should be - and usually is - carefully considered:
- Keeping the Child
Most teens who choose to keep their child continue living at home with their parents. This arrangement typically affects the entire family, as everybody becomes engaged in the care of the new baby. Most teenaged mothers are able to finish high school, but few go on to attend and graduate from college.
Less than 10% of teen mothers choose to give their child up for adoption. White, suburban teens with high educational goals are more likely to place their babies in adoptive homes. Most states allow minors to place their babies for adoption without parental consent or involvement.
Approximately 30-40% of teenage pregnancies end in abortion. The top three reasons that teenagers say they decide to abort are (1) concern about how a baby or pregnancy would change their lives, (2) believing that they are not mature enough to raise a child and, (3) the financial costs of raising a child. Most teens who have an abortion involve at least one parent in their decision. Currently, 29 states require parental consent for a minor to have an abortion.
In the first trimester, a surgical abortion can be done. An instrument the size of a pencil is placed inside the uterine cavity and creates suction to remove the fetus. This procedure requires local anesthesia, but does not require hospitalization. It is considered a safe procedure when done by a qualified medical professional. Side effects include cramping, pain and bleeding. For more information about side effects, risks, and advantages, talk to a health care professional, or contact Herkimer's Planned Parenthood chapter at (315) 866-3085..
Recently, the so-called "abortion pill" RU 486 has been approved for use in the United States. This is a medication combining two synthetic hormones that, when taken together during the first five to nine weeks of pregnancy, induce miscarriage. They do this by causing the uterine lining to disintegrate, thereby resulting in termination of the pregnancy. RU 486 can only be prescribed by a doctor.
What should I tell my children about sexually transmitted diseases, or STD's?
The best information for your child is good information - not what they hear from their peers or girlfriends and boyfriends. Here is most of what you'll need to provide:
Human Immunodeficiency Virus (HIV) is the virus that causes Acquired Immune Deficiency Syndrome (AIDS). HIV can be transmitted through blood, semen and vaginal fluids. HIV can also be found in minute quantities in saliva, tears and urine. The virus can be contracted whenever blood, semen or vaginal secretions from an infected person are allowed to invade another person's body by way of sexual activity, shared needles, or any activity wherein bodily fluids are shared. This includes oral sex when the person performing oral sex has a cut or sore in their mouth; even very small cuts that are not noticeable may introduce HIV to the blood stream. There currently is no cure for HIV/AIDS, but there are a number of medications that prolong life for an indefinite period of time.
Gonorrhea is a sexually transmitted disease that is caused by the bacteria gonococcus. It can infect the genitals, anus and throat (via oral sex). Symptoms appear between 2 days and 3 weeks after exposure. For many people, the symptoms are so mild that they go undetected. For others, the symptoms include painful urination (burning) and for females, pain in the lower abdominal area. Males may also have a thick milky penile discharge. If the infection is in the throat, the glands in that area may be swollen or sore. Gonorrhea is easily treated with an antibiotic, but if left untreated it can cause sterility.
Chlamydia is currently the most common bacterial STD in the United States. It may be transmitted through vaginal or anal sex, although it is rare. It may also be transmitted to a female's throat by if she performs oral sex on an infected male. Chlamydia usually develops seven to fourteen days after exposure and can produce noticeable symptoms or no symptoms at all. Symptoms for females generally consist of painful urination, lower abdominal pain or bleeding after sex. Men's symptoms include painful urination and a discharge from the penis. Chlamydia is treated with antibiotics. If left untreated, it can cause urethral infections, cervicitis, pelvic inflammatory disease (PID) or nongonococcal urethritis (NGU). It can also lead to complications during pregnancy.
Herpes is caused by the Herpes Simplex Virus (HSV), which is transmitted through the skin and mucous membranes of the genitals and mouth. There are two types of herpes: Type I and Type II. Type I is usually found in the mouth, while Type II is typically found in the genital area. Either form can be transmitted to the mouth or genitals by oral sex. Herpes can be transmitted at anytime, even when no sores are present or obviously visible. Symptoms usually occur two to twenty days after exposure, although many people don't experience symptoms until much later. The symptoms usually begin with a tingling sensation, burning or pain in the legs, genitals or buttocks, but such symptoms do not occur in all people. Following this stage, sores begin to develop. After a few days, the sores turn into watery blisters. Several days later, they rupture and become "weeping" and oozing. Then three to four days after this phase, they turn into scabs and begin to heal. There is no cure for herpes, although there are antiviral drugs that can help reduce the number of outbreaks. Researchers are currently working to develop a vaccine for herpes. In women, herpes increases the risk of miscarriage and premature delivery during pregnancy.
Syphilis is a bacterial infection spread through sexual or skin contact. It may be present in the mouth, genitals or anus. There are four stages in syphilis. In the "primary" stage there is a painless sore called a chancre. In the "secondary" stage which occurs one to six months after infection, flu-like symptoms are felt. In the "latent" stage there are no apparent symptoms. The latent stage may last ten to twenty years. In the final or "late" stage, the body's organs begin to fail; heart disease, blindness and severe mental problems are typical. Syphilis is easily treated with antibiotics. Without treatment, death is likely. Syphilis is uncommon in the United States, although medical researchers have recently reported that it appears to be on the increase.
" Genital Warts
Genital Warts are caused by the Human Papillomavirus (HPV) which is spread through sexual intercourse. Symptoms occur between 3 weeks to 8 months after initial exposure. The warts are initially hard, painless bumps in the genital area. Warmth and moisture encourage the growth of warts. Eventually the genital warts themselves develop a "cauliflower" appearance. There are several treatments for warts including having them burned off with acidic treatments, surgery, or laser treatments. It is impossible to cure HPV, and because of this the warts may reoccur. Untreated warts are especially dangerous in females because they can travel up into the body cavity and flourish. Early intervention and regular check ups can help to minimize the risk of serious consequences.
It is important for any person who is sexually active to have regular checkups with their doctor, whether an STD is suspected or not. Many STDs do not have noticeable symptoms, and regular exams will help to diagnose and treat any undetected STD. Most of these diseases can have catastrophic consequences if left untreated. Regular checkups also help minimize the spread of STDs across the population.
I'd rather talk to my adolescent about prevention and abstinence, or birth control. Where should I start?
Again, your teenager needs nonbiased neutral information about avoiding pregnancy, so here it is:
- Abstinence Abstinence is the best way to prevent STDs, and is an increasingly popular choice for protection from unwanted pregnancy. Many teens cite religion as their primary reason for abstinence, but concerns about their health and meeting goals they have set for their future are also compelling reasons why abstinence is gaining in popularity. Teens can often find valuable support by participating in church- or synagogue-related activities, where they are surrounded by peers who have made the same commitment to abstinence. Furthermore, some teen groups actually use written contracts as a way to promote abstinence until marriage Finally, there are purely personal reasons for abstinence. Some teens believe that abstinence is the best way to promote dignity and respect for themselves and others. Others simply feel that they are not emotionally ready to become sexually active. Additionally, many teens are beginning to consider it "cool" to be a virgin. For many, being a virgin or abstaining indicates strength and a commitment to oneself.
- Condoms are effective in preventing STDs and pregnancy, but they must be used correctly in order to be effective. It is currently estimated that condoms fail approximately 10 to 20% of the time due to incorrect use. With correct use, the failure rate goes down to about 2%. To be correctly used the condom should be rolled onto the erect penis with about half an inch of space remaining at the tip to catch the ejaculated semen. Never use Vaseline or any other type of oil on the condom; this could cause it to weaken and tear during intercourse. If a lubricant is needed, use one that is water-based. Always check the expiration date on the condom wrapper. Never keep condoms in a wallet; this can cause deterioration of the latex. And never keep condoms in the glove compartment; higher temperatures during the warmer months can cause the latex to deteriorate. Condoms are inexpensive and readily available. It is highly recommended that a condom be used every time one has sex -- not only as a form of birth control, but also for preventing the transmission of STDs. If a person has sex with someone whose sexual history is unknown or who has had multiple sex partners, a condom becomes a very important defense against disease.
- Withdrawal Method Many teens think that the withdrawal method is an effective form of birth control. In reality, just before ejaculation, thousands of healthy, potent sperm are released from the penis and serve as a lubricant. These sperm are more powerful than those in the seminal fluid, so withdrawal then becomes pointless and ineffective because it is already too late! Therefore, the withdrawal method is not considered an effective form of contraception, but rather a very effective method of conceiving a child. Further, this method provides no protection from STDs.
- Birth Control Pills Birth control pills are about 99.6 % effective when taken correctly and consistently. They are generally considered safe for most people and can only be obtained through a doctor's prescription. Some people experience side effects that include depression and moodiness, weight gain, acne and headaches; but the pill has also been credited with helping women avoid some diseases as well. Uncomfortable symptoms can be alleviated by changing the dosage of the pill or the type of pill used. Birth control pills can also be used to regulate the menstrual cycle, improve acne, and serve as a treatment for ovarian cysts. However, birth control pills do not protect against STDs.
- Norplant Norplant is a contraceptive device that is implanted into the arm of a woman. The implant contains a hormone known as progesterone that is slowly released into the bloodstream to prevent pregnancy. It is designed to last five years, and is 99.8% effective. It is highly effective and requires no daily routine; once medically inserted, no other intervention by the individual is necessary. However, it does not protect against STDs. Only a qualified health professional such as a doctor or nurse practitioner can implant Norplant, and the same type of professional may remove it at any time.
- Depo Provera Depo Provera is an injection that provides protection from pregnancy for three months, and is 99.7% effective. It causes the ovaries to stop releasing eggs. When eggs are not released, the lining of the uterus is disrupted and, as a result, most women stop menstruating while taking Depo Provera. It may take up to one year for fertility to return after ending the Depo Provera injections. Depo Provera does not protect against STDs