What is Sexual Health?
Sex and Relationships
Wrapping up the facts…
Tongue & Grove
What do you think affects safer sex?
Sexually Transmitted Infections
Visiting a Sexual Health Clinic
EMERGENCY: Had unsafe sex with a guy?
Rape and Sexual Assault
What Is Sexual Health?
Sexual health isn’t just about your vagina’s health; it also includes the person it’s attached to! Sexual health involves the way you think and more importantly your feelings and emotions about sex and relationships. It affects us all, whether we’re sexually active or not and can be about pleasure, excitement and love, not just the worries about things going wrong (like catching a Sexually Transmitted Infection – STI).
As teenagers, the whole idea of having sex can be new and exciting, but can also feel daunting, so this guide aims to discuss some of the issues you might be too embarrassed to talk about. If you are reading this guide, although you may not be sexually active it doesn’t matter, because it’s putting you in the know, which may come in handy one day.
Good sexual health is about being positive and respecting yourself and your partners, as well as making it safe and enjoyable. Sex should be fun, and no-one should put you under pressure to do it, whether it’s your girlfriend, best friend or some random girl off the internet! Everyone is equal and should be respected. It’s not just about popping down to your local Sexual Health Clinic; it’s about being educated and aware of your sexual health all round. Remember your sexual health makes up part of your overall health, which is why it is so important.
You should not have sex until you feel ready. For all girls, the legal age of consent is 16 years of age in England, Wales and Scotland (17 in Northern Ireland). However, all sexual health services are available to under 16s, and they will never tell anybody you’ve been, with a few rare exceptions (explained later).
Sex & Relationships
There are lots of different types of (sexual and non-sexual) relationships that girls can have: they can be long-term, short-term, long or short-distance, over the internet or in person! Any type is fine as long as you are happy and safe, and consent to everything. One thing a lot of young people tend to forget to do before having sex is talk about it – talk about it to someone who you really trust or someone you’re going to have sex with! If you’re too uncomfortable to talk about it, are you really ready to have sex?
Remember that if you don’t want to have sex you can always say no and at any point. It’s up to you what sexual activities you do and more importantly don’t do (and this includes oral and vaginal sex). You may like certain things being done to you which you may not like doing to someone else, and that’s fine as well.
Sex isn’t all about vaginas; sex can also be about being close; kissing, cuddling, snuggling and things like that! Remember you have a whole life ahead of you, so you don’t need to rush into anything thinking you have to do it all at once!
Try and avoid big age gaps – they can put you in a vulnerable position (why not talk about this with a youth worker or sexual health nurse?)
Vaginas are very clever but also complex parts of your bodies. The vagina is part of the female reproductive system, which is very different to the male. Firstly, all the reproductive system is inside the body, rather than dangling between your legs! Whatever you look like down there, all girls are different and that is perfectly normal, but if you’re worried you could always go to a Sexual Health Clinic (see below).
You may have heard of other girls or guys mention that vaginas can smell, or that vaginas can be referred to as being ‘fishy’. Even though we are brought up to always be clean and wash, this smell surprisingly comes from over washing. Your vagina is very clever as it has a self-cleaning mechanism within it. Most girls will get some kind of discharge from the vagina, which can change throughout the month, don’t worry, this is totally a normal. But if the discharge becomes abnormal, such as a change in colour, smell or just doesn’t look right, then it could be thrush, Bacterial Vaginosis (BV) or a STI (see below), as well as other causes. It’s always a good idea to use a soap which is pH balanced, like aqueous cream, to clean the outside of the vagina. Never clean inside the vagina as this could stop the vagina from being able to clean itself.
We all know about periods, although some may hear a doctor or nurse refer to your periods as menstruation or your menstrual cycle. A period will generally happen to every female once a month from puberty to menopause. There is no set time when you will start a period – don’t worry if you don’t start when your friends do, everyone is different and it is perfectly normal.
Every month, your body prepares itself to get pregnant, your womb lining becomes soft and thick and your ovaries release an egg but if this is not fertilised by a sperm from a guy then this lining and the unfertilised egg is shed with a small amount of blood, this comes out of the vagina – this is what a period is. A period can usually last between 3 and 7 days. During the time of your period it is common to experience tummy ache, bloating, emotional changes and skin changes.
Using tampons or sanitary towels? Because a period can be a bit messy, there are options to keep you clean and comfortable. Sanitary towels are absorbent pads that you stick on to your knickers and will need changing on a regular basis. Tampons are bullet shaped and made from cotton wool-like material, these are inserted into the vagina either with your finger or a cardboard applicator and have a string attached so you can remove it easily but it needs changing on a regular basis. Choosing either option is perfectly normal; choose which ever is comfortable for you.
Toxic Shock Syndrome (TSS) is a very rare but potentionally fatal condition caused by a bacteria that usually lives on your body but occasionally will release toxins that can make you very unwell. It has been associated with women that leave tampons in the vagina too long. Always read the information leaflet that comes with your tampons this will explain more about TSS.
If you do get a pregnancy result that wasn’t what you were expecting or want to know more about vaginal health, then you can always access support from your local Sexual Health Clinic, GP or youth project – all of which are confidential and trained to deal with these issues. If you would like more information on pregnancy, log on to: http://www.brook.org.uk/pregnancy
Wrapping the facts up…
Condoms aren’t just for penises; they also come in pretty handy when using sex toys. There are a huge variety of sex toys available for you from both the high street and the internet. If you do buy one from a reputable place, make sure the packaging is intact and is going to be comfortable for you. However, some girls are more creative than others and end up using anything they can get their hands on, but this is not advised. Just because you’re gay and you’ve got a vagina, doesn’t mean you have to use sex toys.
However, if you use your girlfriend’s or anyone else’s sex toy, a condom is a really useful way of making sure you don’t end up catching or sharing STIs. Check out the handy checklist (below) to find out the best way to look after your condoms, so that they can safely look after you.
Dams or dental dams are small square sheets of flavoured latex, which go between the vagina or bum hole and the mouth when giving or receiving oral sex. They help to reduce you and your partner from sharing STIs. If you haven’t got any dams, you could even use a piece of cling film (non-microwavable!). They should be used with lube. Whilst there are loads of reasons why you might not want to use dams, there is always one good reason why you should.
Store condoms in a dry place – not too hot or too cold!
The right size condom for what you want to use it for
If your hands are greasy (e.g. from eating greasy/oily foods!) then wash your hands, as grease/oil can cause condoms to split
BRITISH HEART MARK and CE MARK (one or both)
Make sure the date on the packet has not passed today’s date (the year comes before the month e.g. 2010/09)
Check the condom packet for any damage, like holes or tears, and if you find any don’t use it as the condom will be more likely to split
Open the packet carefully making sure you don’t tear the condom with fingernails or your teeth
Just because you’re a gay girl, doesn’t mean we shouldn’t talk about contraception. All these types of contraception are available to you from the NHS. Some will protect you from STIs and others will prevent pregnancies from occurring and others will do both.
- Condom $%
- Female Condom $%
- Not having sex $%
- Dam %
- Mini Pill (Progestogen only) $
- Combined Pill (Oestrogen and Progestogen) $
- Intrauterine Contraceptive Device (IUCD)/’The Coil’ $
- Diaphragm or cap with spermicide $
- Contraceptive Implant $
- Depo-Provera Injection $
- Contraceptive Patch $
- Emergency Contraception (see below) $
- Sterilisation $
- Contraceptive Vaginal Ring $
% = Prevents you from catching/sharing STIs
$ = Prevents you from getting pregnant
Tongue & Groove
It can be sometimes really difficult for a gay or bisexual girl to work out when it is that you’ve lost your virginity. When having sex with a guy, some straight girls think it is the first time you have sex. The joy with gay sex is, it is what you want it to be, don’t worry about what you do, as long as it’s safe and you both give your consent.
Just because there’s no penis, doesn’t mean to say there is no sex, in lesbian and bisexual relationships sex can be: mutual masturbation, oral sex, playing with sex toys or even just being intimate with each other. Oral sex between two girls is when one partner uses their mouth and tongue on your vulva, clitoris or vagina to pleasure you. Many women enjoy this but some won’t even consider doing or receiving it. It might be a good idea to ask what your partner wants or likes when it comes to sex. The important thing to remember is that not all gay girls limit themselves to oral sex or even do it at all.
During sex, girls can orgasm like just guys can. An orgasm is when your muscles tighten around your genitals causing a feeling of intense pleasure; this can last for a small period of time to perhaps minutes. You may have heard of a term used before called female ejaculation. This can happen when a women orgasms but it doesn’t happen to all women and don’t worry if you don’t – you can still have a pleasurable sex life! Female ejaculation is basically a fluid that comes from a gland and is usually clear and odourless but don’t worry, it’s not you losing control of your bladder and peeing! Women who ejaculate can produce anywhere from a teaspoon to many tablespoons of liquid!
What do you think affects having safer sex?
Before you get yourself in a situation where you’re likely to have sex, think about what could affect you having safer sex? Here are a few ideas young people have come up with. Why not pick one and talk about it with a sexual health nurse or youth worker?
- Low Self Esteem (e.g. Body Image)
- Destructive Behaviour (e.g. not caring about yourself or others)
- Mental Health
- Peer Pressure
- Partner Pressure
- Drugs (e.g. Poppers, Ecstasy or ‘E’, Cocaine)
- No Self Acceptance (e.g. not accepting you have feelings towards other girls)
- Lack of Resources and Education
- Not Having Time
The Human Papillomavirus (HPV) vaccine is an injection that is offered to all 12 to 13 year old girls (year eight) and protects you against two strains of the HPV virus that can increase the chances of you getting cervical cancer.
It is important to remember the vaccine does not protect you completely from cervical cancer and you will need to have cervical screening when you reach 25 years of age.
Remember the vaccine does not stop you from catching or sharing STIs.
Girls come in all shapes and sizes including their breasts! Everyone’s normal is individual to them; so don’t worry if you’re different from your best friend. Breasts can be different in shape and size, lumpy or smooth, small or large, dark or light in colour and some may have hair around the nipples. It is not uncommon for breasts to be uneven or different sizes when you are growing; by the time you’re fully developed they may look very similar but this is not always the case.
Sometimes during development, the nipples can invert (pointing inside rather than out) this is normal also but if an outward pointing nipple starts to become inverted its best you go and see your GP. In some cases, you can get stretch marks on your breasts which look like red wiggly lines – but don’t worry they will fade eventually within a year or 2! Your breasts start to develop when you start puberty and it can take up to 5 years for them to fully develop. It’s wise to become familiar with your breasts and knowing what they look and feel like, so you know what normal is for you.
It’s important you perform a breast self examination every now and then. To see instructions and pictures demonstrating this log on: http://www.cancerscreening.nhs.uk/breastscreen/breastawareness.html
Sexually Transmitted Infections (STIs)
Sexually Transmitted Infections (STIs) are infections that can be passed on when you’re having sex. Most STIs have no symptoms (asymptomatic), so you’re very unlikely to know you have one without being checked out at a Sexual Health Clinic (see below). However, some STIs you can see, like Genital Warts and Genital Herpes, and these will be evident on the skin around your vagina and bum.
Some STIs do have symptoms and if you get any of the following symptoms, you should definitely get it checked out: pain when you pee, lower tummy pain, bleeding after sex or between periods, deep pain when you have sex, unusual discharge from your vagina, a painful or painless sore around the genital area or something that just doesn’t feel right down there. The best way to protect yourself from most STIs is to use a condom or dam, as this acts as a barrier between you and your partner or toy.
Worried you might have caught an STI? The timescale between catching an STI and finding out whether you have one or not varies from STI to STI. However, in general, sexual health doctors and nurses recommend waiting until 2 weeks after you’ve had unsafe sex before having a sexual health screen and then returning in 3 months’ time to cover the HIV ‘window period’. Statistically, gay girls are the least at risk group of catching HIV.
The only way you will know if you have an STI is to get tested at a Sexual Health Clinic (for more information on visiting a Sexual Health Clinic, see below). There is loads of information out there on individual STIs, log on to: http://www.nhs.uk/Conditions/Sexually-transmitted-infections/Pages/Introduction.aspx
Visiting a Sexual Health Clinic
Sexual Health Clinics are places where you can go and get supported, tested and treated for STIs and HIV. Some clinics even offer contraception too! They can also offer counselling about pretty much anything to do with sex, as well as providing free condoms and lube! They are open to people of all ages and sexualities. It can be quite scary seeing other people there, but just remember that you’re there because you’re taking responsibility for managing your own health. Sexual Health Clinics are run by specially trained sexual health doctors and nurses. You may feel embarrassed at first and feel like the staff might judge you, but they won’t; they’re more interested in your health and well-being.
Sexual Health Clinics will never tell anybody you’ve been to see them and anything you tell them will be kept completely confidential, even if you are under 16. The only time they will tell someone else (like social services) is when either you or another person is in serious danger of being hurt and they will only do this after talking about it with you first.
Sexual Health Clinics have their own health record system, which the rest of the hospital and your GP cannot access. When you go to the clinic for the first time, you will have to register, where they will need to take some personal details down like your name, address, date of birth, etc. You could even make up your name (like Daffy Duck, but if you do make up your name, make sure you remember it!), the fact is, it doesn’t matter as long as you’re receiving the right healthcare!
Get tested – how?
The doctors and nurses understand that getting tested might seem a bit daunting especially if it is your first time – before any tests are done, you’ll start things by first having a chat with a health advisor or a nurse. Talking about your sexual life and history helps to identify your sexual health needs, and what tests are most appropriate for you.
There are lots of different ways to check you out for STIs this can involve taking a series of swabs from your vagina and cervix. An instrument called a speculum, maybe used to help the doctor or nurse examining you see up the vagina to the cervix to take a swab and make sure that everything is okay. The speculum is lubed up and inserted into the vagina, this doesn’t hurt, but may feel slightly uncomfortable, and it certainly won’t mean you’ve lost your virginity.
Any swabs taken will be used to help if identify any of the following STIs: Chlamydia, Gonorrhea, BV, thrush and Trichomoniasis. However, if the thought of someone else examining you is too off putting, then most clinics nowadays have the option of self taken swabs, which allows you to do the test yourself in the privacy of the toilet! In addition to having a swab taken, you may also be offered a blood test to check for viruses such as HIV and Syphilis.
Results – how do I get them?
Most clinics now give patients their results via text messages. However, you can opt to have these given to you over the phone or by letter. Your result will either come back as being negative or positive: a negative result means you are free of infection, and a positive result means you have something. You may be asked to call the clinic, this is not necessarily bad news.
To find your nearest Sexual Health Clinic log on to: http://www.tht.org.uk/howwecanhelpyou/clinicfinder.
“Sexual Health Clinics can sometimes be called GUM, GU Medicine or Genito-Urinary Medicine Clinics”
EMERGENCY: HAD UNSAFE SEX WITH A GUY?
If you have unsafe sex with a guy; you’re not sure whether you used condoms or not; or if there may be a small chance that some of his semen may have got into your vagina in one way or another – there is a risk you could get pregnant – you need to act quickly so that you don’t end up making the wrong decisions Remember, if you’ve had unsafe sex, there’s always a risk of sharing STIs too.
If you find yourself in this situation, you can take what is called the emergency contraception pill (ECP) which can prevent a pregnancy from occurring – this needs to be taken within the first 72 hours (3 days) of when you think you put yourself at risk of getting pregnant – the earlier the better! This is free from most NHS services such as sexual health clinics. Although available from most pharmacies, you may end up having to pay for it. Have a look on at the back of this guide for Local Services near you who will either be able to help you or know who can help you. Remember it can only be you who can obtain the ECP, not a friend or partner.
Whoever prescribes the ECP to you should also inform you about intrauterine devices (IUD). This is another method of emergency contraception which is also commonly called ‘the coil’ which is very effective. This can be used either 5 days after you’ve had unsafe sex or within 5 days from the suspected date of ovulation (if you have a regular menstrual cycle). You can go to any of the services mentioned above who will be able to help and advise on where this can be fitted.
If you suspect you are pregnant (even if it is a couple of months later), it’s really important you go to any of the services as mentioned above to get the right support you need on whatever decision you make on the pregnancy. The option of having an abortion is available to you up until the 24th week of pregnancy, although it is unusual to have an abortion this late, most are carried out under 12 weeks which is less risky. If you can, try and talk to a trusted family member or friend, as it can help having someone with you to support you.
Rape and Sexual Assault
If somebody touches you or does something to you sexually that makes you feel unhappy, it can be very confusing and make you feel distressed. Some people may not be sure as to what exactly happened to them and may feel unsure about what to do next. It is very important that you seek professional help and support if you feel that you may have been raped or sexually assaulted. If you are in immediate danger then always phone 999 for the police.
The police will always have someone for you to speak to about what happened which can be arranged by you calling or visiting your local police station. It is important to know that the police have a duty to investigate what has happened. This does not always lead to a prosecution or conviction but it may do so. There are also rape crisis and other appropriate agencies who can support you, which you can be referred onto either through yourself, the police or a sexual health clinic (as well as other young people services). There are many helplines who can confidentially help you talk through your options and make sense of how you may be feeling.
Have a look at these sites for help: http://www.thehavens.co.uk/
Bacterial Vaginosis – is a common cause of vaginal discharge which is not a STI. The discharge is not normally sore or itchy but can be cleared up with a course of antibiotics from your GP or local Sexual Health Clinic.
Casual sex – this is sex with a person who is not a girlfriend or a regular partner, e.g. a one-off.
Dam – also known as a dental dam, this is a small square of flavoured latex, which can be used for rimming.
Discharge – is a fluid (which is not urine, cum or precum) that comes out of a guy’s urethra (the penis hole!) it can be clear, coloured and possibly thick.
Femidoms – also known as a female condom, this can also be used safely for anal sex. You can insert this into the vagina or by putting it on the penis first. Instructions are normally on the outside packet.
Mutual Masturbation – is where 2 sexual partners engage in foreplay.
Non-sexual (relationships) – it’s totally up to you if you want to have sex when you’re in a relationship. Some guys prefer not to for lots of different reasons.
Ovulation – is when one or more eggs are released from one of your ovaries during menstruation.
Partners – someone you are having sexual relations with, whether it be regular or a one-off.
Safer sex – is when you take precautions when you have sex to reduce the chances of getting infections, e.g. using condoms, dams*, having a Hep B vaccine, etc.
Sex life and history – a ‘sexual history’ is where you will be asked personal questions, such as when you last had sex, who with, what type of sex, etc. This is so a doctor or nurse can assess your sexual health needs and provide appropriate care.
Sexually active – someone who has started engaging in sexual activities with another person.
Thrush – is a yeast infection which can develop in the vagina. It can cause itchiness and soreness, sometimes with a white discharge. The yeast already lives in your body but can sometimes grow out of control, it can affect some women more than it can others. It isn’t necessarily caught or passed on through sex.
Vaccination – an injection that could prevent a particular infection or disease, e.g. HPV.
© 2010 Michael Fanner (author)
All of the advice and information in this guide was written to the best of the author’s knowledge at the time of publication. This guide has been used by the Royal College of Nursing and University of Greenwich in their postgraduate and professional development courses and has been presented at the UK Department of Health’s HIV and AIDS Prevention Strategy Conference.