Sex Education and Wellness

Infection with gonorrhea and chlamydia causes two of the most common sexually transmitted diseases (STDs). Syphilis, another STD, occurs less often, but can be serious if it is not treated. STDs can be passed by vaginal, anal or oral sex.

Gonorrhea and Chlamydia 

Both gonorrhea and chlamydia can occur in the mouth, the genitals and the rectum. The infections also can appear in the eyes of a newborn.

Symptoms

Gonorrhea and chlamydia often have no symptoms. When symptoms do occur, they may show up two days to three weeks after infection.

Diagnosis

To find out if you have gonorrhea or chlamydia, your doctor may take a sample from your throat, cervix, urethra or another area where there may be an infection.

Treatment

Gonorrhea and chlamydia can be treated at the same time with antibiotics. It is important to take all of your medicine. Your partner also must be treated.

Health Risks

Both gonorrhea and chlamydia can cause severe problems:

Pelvic inflammatory disease (PID) is an infection of the uterus, fallopian tubes, and other parts within the pelvis. PID may lead to infertility.

Ectopic pregnancy can result from the scarring of the fallopian tubes caused by PID.

Syphilis 

Syphilis occurs in stages. If not treated, syphilis may affect your heart, blood vessels and nervous system.

Symptoms

Syphilis first appears as a painless sore called a chancre. It lasts 10 days to six weeks after contact with the disease.

If not treated, the next stage begins one week to three months later when a rash may appear.

The rash goes away in a few weeks or months, but that does not mean the disease is gone. It is still in your body. This is called the latent period.

How Syphilis Is Spread

Syphilis is spread by contact with a chancre. It also can be spread by touching the rash, warts or infected blood during the second stage of infection.

Diagnosis

In the early stages, your doctor can examine discharge from open sores to see if you have syphilis. A blood test also may be done.

Treatment

Syphilis is treated with antibiotics. If it is caught and treated early, long-term problems can be prevented.

Problems During Pregnancy If you are pregnant when you have gonorrhea, chlamydia or syphilis, problems may occur for both you and your baby. The infection can be passed from mother to baby.

Prevention Even if you already have had gonorrhea, chlamydia or syphilis, there are things you can do to keep from getting them again. These safeguards also help protect against other STDs:

Limit your sexual partners.

Know your partner.

Use a condom.

Avoid contact with any sores on the genitals.

Finally… If you think you may be at risk for gonorrhea, chlamydia or syphilis, get tested. These diseases will do the least harm if they are caught early.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © July 2000 The American College of Obstetricians and Gynecologistsrvical dysplasia describes the presence of abnormal, precancerous cells on the surface of the cervix or its canal. Doctors recognize two types of dysplasia: low-grade squamous intraepithelial lesions (LGSIL) and high-grade squamous intraepithelial lesions (HGSIL). The abnormal cells present in LGSIL usually return to normal on their own within 18 to 24 months, but the HGSIL cells, if not treated, can progress to cancer of the cervix. To detect these changes early, it is essential to have regular Pap smears.

Cervical dysplasia can occur at any age after puberty but is most common between the ages of 25 and 35. The condition has been linked to exposure to specific strains of the human papillomavirus (HPV), which causes genital warts. The risk of cervical dysplasia is increased in women who have multiple sex partners, who had unprotected sex at a young age (under 18) or with partners who have had multiple partners, or who have a history of sexually transmitted diseases or who smoke cigarettes.

Symptoms and Diagnosis 

Cervical dysplasia often produces no symptoms, but some women have bleeding or spotting after intercourse. Abnormal cells in the cervix are usually found on a routine Pap smear. To confirm the diagnosis after an abnormal Pap smear, a doctor will perform a colposcopy, an examination of the cervix using an instrument with a lighted magnifying lens. Doctors often take a sample of tissue for analysis under a microscope (biopsy) during a colposcopy to determine if dysplasia is present and, if so, to evaluate it and classify it as LGSIL or HGSIL. Some doctors also take a swab of cells from the cervix to determine if HPV is present and, if so, if it is one of the strains of the virus that are strongly linked to cervical cancer.

Treatment

LGSIL (mild) dysplasia often returns to normal on its own and usually can be managed with frequent follow-up care, including Pap smears every four to six months. More severe dysplasia (HGSIL), which is more likely to develop into cervical cancer, is usually treated surgically. The procedure doctors use most often to treat dysplasia is called by two names — LEEP (loop electrosurgical excision procedure) or LLETZ (large-loop excision of the transformation zone). Both names refer to the removal of the outer layer of cervical cells, which are at highest risk of becoming cancerous. The removed tissue is sent to a laboratory for examination to make sure that all the abnormal cells were removed. Your doctor will advise you not to have intercourse or use tampons for four weeks after the procedure. The doctor will recommend a Pap smear every four months for the first year after the procedure, which has a 95 percent success rate in removing abnormal tissue.

If the area of abnormal tissue extends up into the cervical canal, a procedure called a cone biopsy (in which the doctor removes a cone-shaped piece of tissue) may be required. The tissue is sent to a laboratory to look for cancer cells. This procedure is usually performed in an operating room using a local anesthetic during an outpatient visit. Afterward, you may need to rest for a day or so. In very rare cases, a cone biopsy can increase the risk of premature delivery in a future pregnancy so, if you have had a cone biopsy and become pregnant, tell your doctor that you have had the procedure.

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Excerpted from: Family Medical Guide, Fourth Edition, American Medical Association, 2004.

If you would like information about purchasing Family Medical Guide, click here.

Related Articles

Human Papillomaviruses and Cancer: Questions and Answers

JAMA Patient Page: Papillomavirus:

The Pap Test

Cervical Cancer

Loop Electrosurgical Excision Procedure

© Copyright 2004 American Medical Association All rights reserved.

Infection with the human papillomavirus (HPV) is very common in both women and men. More than 100 types of this virus have been identified. Some types of this virus are spread from person to person through sexual contact.

What Is HPV? 

Human papillomavirus is a very common infection that can be passed from person to person. Some types of HPV are spread through sexual contact. Studies suggest that at least 3 out of every 4 people will get an HPV infection during their lifetime.

More than 30 types of HPV can infect the genital areas of a woman or a man. Like many sexually transmitted diseases (STDs), there often are no signs of genital HPV. However, a few types of HPV cause warts. Warts that grow in the genital area are called condyloma acuminata.

HPV and Cancer Risk 

Some types of HPV are linked to cancer in both women and men.

Cervical cancer develops over a long period of time. HPV causes cells on or around the cervix to become abnormal. Most of the time, however, abnormal cells go away without treatment. A Pap test, sometimes called cervical cytology screening, is the best way to detect cell changes that may be an early sign of precancer of the cervix.

Diagnosis 

Routine Pap tests help diagnose an HPV infection. If a Pap test shows certain abnormal cells, your doctor may suggest an HPV test.

An HPV test checks for the types of HPV that may lead to cancer. For both a Pap test and an HPV test, a swab is used to collect a sample of cells. These cells then are sent to a lab to be checked more closely.

Routine HPV testing is not recommended in women younger than 30 years of age because HPV is very common in this age group and cervical cancer is rare.

Prevention 

Currently, there is no cure for HPV, although a vaccine has been developed. You can decrease your risk of infection by avoiding contact with the virus. To lower the chance of infection:

Limit your number of sexual partners.

Use condoms to reduce your risk of infection when you have vaginal, anal or oral sex.

Condoms cannot fully protect you against HPV infection.

Finally … Some types of HPV infection spread from person to person through sexual contact. To lower your risk of infection, limit your number of sexual partners and use condoms.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © November 2003 The American College of Obstetricians and Gynecologists

Making the decision whether to have sex can be tough. You should make up your own mind when the time is right for you. If you are not ready for sex, say so. But if you think you are ready to have sex, or if you already have had sex, you should take steps to avoid pregnancy and sexually transmitted diseases (STDs). Thousands of teenagers become pregnant each year because they do not use birth control or they do not use it correctly.

Teens and Birth Control 

There are many reasons teens may not use birth control. They may:

Think they will not get pregnant

Be afraid to go to a doctor or clinic to ask for birth control

Not know how to get birth control or think they cannot afford it

Worry about their parents finding out

Be afraid of what their partner thinks about birth control

Have sex that was not planned

Sex and Reproduction 

To understand how birth control works, you should know what happens during reproduction. A woman has two ovaries, one on each side of the uterus. Each month, one of the ovaries releases an egg into a fallopian tube. This is called ovulation. It usually occurs about 12-14 days before the start of the menstrual period.

During sexual intercourse (sex), the man’s penis goes into the woman’s vagina. This can lead to ejaculation. When a man ejaculates (“comes”), his penis releases semen, which contains millions of sperm. If this happens during sex, the semen spurts into the vagina. Sperm in the semen can swim up to the fallopian tubes and uterus. If a sperm meets an egg in the fallopian tube, fertilization — joining of an egg and sperm — can occur. When this happens, the woman can become pregnant, even if it is her first time.

What Type? 

When choosing a type of birth control, you should know your options. Most teens use hormonal methods, like the pill, or barrier methods, like condoms. You may choose a type of birth control based on many factors, including:

How easy it is for you to use

How easy it is for you to get

Protection against STDs

Your medical history

How well it prevents pregnancy

Hormonal Methods

Some types of birth control are hormonal. Hormones are substances made by the body to control various organs. Hormonal methods of birth control keep a woman’s body from releasing eggs. If your body does not release an egg, you cannot get pregnant.

Oral contraceptives, often referred to as the “pill,” are the most popular hormonal method. You have to take a pill at the same time every day.

What Does Not Work

Douching

Plastic wrap instead of a condom

Urinating right after sex

Having sex for the first time

Having sex in a special position

Withdrawing (“pulling out”) before ejaculation

The patch is a small (1.75 square inches) adhesive patch that is worn on the skin to prevent pregnancy. It is a weekly method of birth control. You wear a patch for a week at a time for a total of 3 weeks in a row.

The ring is a flexible plastic ring that is placed in the upper vagina. It is worn for 21 days and then removed for 7 days.

Barrier Methods

Another kind of birth control you can choose is barrier methods. They keep sperm from reaching the eggs.

The male condom (“rubber”) is the most popular barrier method (see box). It covers the penis so that after a man ejaculates, the sperm stays inside the condom. Condoms made of latex are the best protection from STDs.

The female condom is a thin plastic pouch that lines the vagina. It also is easy to buy in drugstores.

Spermicides are chemicals that are put into the vagina to kill sperm. They work best when used with a condom. Spermicides:

Come as foam, gel, cream, tablets, and film

Must be put in the vagina just before you have sex (10-30 minutes before for tablets and film)

Can be bought in drugstores

The diaphragm is a round rubber dome that fits inside the vagina and covers the cervix. It always is used with a spermicide. A diaphragm:

Must be prescribed and fitted to your body

The following two methods of birth control, the cervical cap and the Lea’s shield, also are available. They usually are not prescribed for teens. The cervical cap is a small thin rubber or plastic dome shaped like a thimble. It fits tightly over the cervix and stays in place by suction

The Lea’s shield is a dome-shaped silicone device with a loop for removal. It fits inside the vagina and covers the cervix. It is used with a spermicide.

Intrauterine Device

The intrauterine device (IUD) is a small, T-shaped, plastic device that is inserted and left inside the uterus. Two types are available in the United States: the hormonal and the copper. The hormonal IUD must be replaced every five years. The copper IUD can remain in your body for as long as 10 years.

Birth Control in an Emergency 

If you have sex without using any birth control, if the birth control method did not work (for instance, the condom broke during sex), or if sex was forced, you can use emergency contraception to prevent pregnancy. This only is used in an emergency — not for your regular birth control.

The most common method for teens is one in which special birth control pills that contain higher doses of hormones than regular birth control pills are used. You may have heard this called the “morning-after pill” even though it can be taken later than the morning after.

If you need emergency contraception, call your doctor’s office or go to a family planning clinic or hospital emergency room.

Your Parents and Your Privacy 

In most states, minors (people younger than age 18 years) have the right to make choices about birth control without their parents’ consent. Ask your doctor or nurse if the visit will be kept private. You may not want your parents to find out that you need birth control, but it is a good idea to discuss birth control with your parents.

Another Thing: 

STDs Sexually transmitted diseases are diseases that are spread by sexual contact — having oral, anal or vaginal sex with someone who has one. You should know how to avoid getting STDs. Some STDs can make you unable to have a baby later on. Some are painful, and one, human immunodeficiency virus (HIV), can even kill you. HIV causes acquired immunodeficiency syndrome (AIDS). Examples of other STDs are chlamydia, gonorrhea and herpes.

Talk to Your Partner Before you have sex, talk to your partner about using condoms. Do not be shy — be direct. Be honest about your feelings and needs.

Finally… As a teenager, you face many decisions. To be sure you make the one that is right for you, talk to someone you trust, such as your parents, your doctor or your school counselor. If you decide to have sex, use birth control and protect yourself against pregnancy and STDs.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © July 2005 The American College of Obstetricians and Gynecologist

Being pregnant means big changes for any woman.

Pregnancy and childbirth change your life. If you are pregnant and plan to have the baby, you must now care for and think for two people — you and your baby.

Feelings You may be happy that you are pregnant. You may be scared that you are pregnant. You may find it hard to believe or feel you are too young. You may feel like your life is out of control. You may need help with money or housing. Try talking to someone you trust and who can help you.

Choices 

You have choices. You may decide to end the pregnancy (abortion) or have the baby. If you decide to end the pregnancy, the earlier you do so the better.

You can obtain counseling about pregnancy options from your doctor or agencies such as Planned Parenthood.

If you decide to have the baby, you also have choices about what to do after the baby is born. You can keep the baby. You can place the baby for adoption. Talk with your family, doctor, a social worker, or a member of the clergy about your choices.

The final decision about pregnancy is yours.

Being a Mother 

Having a baby means you have to get used to a new way of life. Your baby will need your care for much of the day and night.

Caring for the Baby 

Caring for a baby can enrich your life. It also is a lot of work and responsibility.

Costs of Raising a Baby 

You should plan for the costs of raising a baby. You and your baby will need a place to live and money for food and clothing. You also may have other needs, such as a car seat, a stroller, or child care.

Prenatal Care 

Prenatal care is the health care you receive before your baby is born. It includes medical care and counseling. The earlier you get prenatal care, the better your chances are for a healthy pregnancy, birth, and baby.

Visits With Your Doctor 

At your first prenatal visit, your doctor or nurse will ask you many questions.

You will have a complete physical exam, which may include a pelvic exam.

Your doctor will set up a prenatal care plan for you. As your pregnancy goes on, you will visit your doctor more often.

Childbirth Classes 

As part of your prenatal care, it’s a good idea to take childbirth classes. Most areas offer classes led by trained staff.

Changes You May Need to Make 

There may be some changes in your lifestyle you need to make now. You should eat healthy foods and avoid things that could cause harm to your baby, such as alcohol, tobacco, marijuana and other drugs.

Eating Well

Eating the right food can increase the chance you and your baby will be healthy.

Because pregnancy requires extra nutrients, your doctor may prescribe a prenatal vitamin for you.

Make sure you are getting enough (at least 0.4 mg) of folic acid each day. If taken in the first three months of pregnancy, folic acid helps prevent certain birth defects of the spine and skull (neural tube defects).

Alcohol, Tobacco, Marijuana and Other Drugs

Alcohol, tobacco, marijuana and other drugs can harm your baby. If you use any of these substances, now is a good time to quit.

Risks of Problems 

Pregnant teens are more at risk for certain health problems, such as high blood pressure or anemia (low iron in the blood). They also are more likely to go into labor too early.

Planning for Your Future 

You can help make the future bright for you and your baby. Arrange to see your doctor four to six weeks after the baby is born to make sure you are healthy and to talk about your future health needs, including birth control.

The Postpartum Visit 

Soon after your baby is born, you will need to visit your doctor for a postpartum visit. This is an important visit.

Birth Control 

Not having sex — abstinence — is a sure way to avoid becoming pregnant again or getting an STD. If you choose to have sex, wait until your doctor tells you it is safe.

School 

Planning for your future also involves finishing school. Finishing your education will help you get a better job, earn more money, and have a better life with your baby.

Finally … Being prepared for your baby and planning for your future will help you make a big difference in your life and in your baby’s life.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright June 2001The American College of Obstetricians and Gynecologists

The teen years are exciting. They also can be confusing.

Your body is changing. You’re dealing with new feelings. Now is the time for you to look at how you feel about yourself, other people, problems, life and love. You’re also starting to notice your own sexual feelings.

Your Sexuality 

Part of your sexuality is what sex you are — male or female. It’s also the way you look, feel and act.

Physical Changes 

Sometime between the ages of 9 and 16, your body starts to change. This time of change is called puberty. Puberty is the time when your body develops so you can reproduce.

Girls’ bodies change a lot during puberty:

Their breasts grow.

Their hips may get bigger.

They may gain weight.

They grow hair under the arms and around the genitals.

Boys’ bodies also change a lot during puberty. These changes usually start around ages 12 to 14:

Their penis and testes get bigger.

The hair on their bodies grows thicker.

They start to grow hair on their faces, under arms, and around the genitals.

Their voices get deeper.

The testes start to make sperm.

Emotional Changes 

During your teen years, the hormones that cause the sex organs to grow and function also cause strong sexual feelings.

Sex and Reproduction 

During sexual intercourse, the erect penis goes into the vagina and moves in and out. This moving in and out of the penis can lead to orgasm.

When a boy has an orgasm he ejaculates semen. If the couple isn’t using any birth control, the girl can become pregnant.

The only way not to get pregnant is to not have sex. If you do have sex, use birth control every time.

Making a Decision 

Ask yourself what your feelings are about sex. Are you really ready for sex? If you are dating, do you know how the other person feels about sex? Make up your own mind about when is the right time to have sex.

If you are not ready for sex, say so, and stick to your decision. It’s okay to say “no.”

If someone tries to pressure you into having sex, it’s important to learn how to say no.

Relationships 

Real friendship (not just popularity) is very important to teens. Being accepted is a large part of friendship.

Homosexuality 

Many teenagers go through a stage where they wonder, “Am I gay?” Many boys and girls are attracted to members of their own sex during puberty.

If you think you may be gay and feel confused or unhappy, talk to someone you can trust. A school counselor, an older friend or relative, or someone at church may help you sort out your feelings.

Finally … Being a teenager can be both exciting and confusing. You face many decisions. To be sure you make the right ones, talk with someone you trust. Being well informed can help you make good choices as you deal with your new?found sexuality.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright September 1996 The American College of Obstetricians and Gynecologists

Puberty is the time in a girl’s life when her body changes from that of a young girl to that of a woman. It is also the time when a girl becomes physically able to have babies. Although there is no “right” time for puberty to begin, it generally starts earlier for a girl than it does for a boy – usually between 9 and 13 years of age. This is why many girls are taller and may act more mature than boys for a few years until the boys catch up.

How will my body change?

Following are some of the changes your body will go through during puberty:

Breasts:

In most girls, puberty starts with breast growth. When your breasts start to develop, you may notice small, tender lumps under one or both nipples that will get bigger over the next few years. When breasts first begin to develop, it is not unusual for one breast to be larger than the other. However, as they develop, they will most likely even out before they reach their final size and shape.

As your breasts develop, you may need a bra. Some girls feel that wearing a bra for the first time is exciting – it is the first step toward becoming a woman! However, some girls feel embarrassed, especially if they are among the first of their friends to need a bra. If the people around you make a bigger deal of your first bra than you would like, try to remember that they do not mean to embarrass you, they are just proud of how much you have grown.

Hair:

Soft hair will start to grow in the pubic area (the area between your legs). This hair will eventually become thick and very curly. You may also notice hair under your arms and on your legs. Many women shave this hair. There is no medical reason to shave, it is simply a personal choice. If you decide to shave, be sure to use a lot of soap and water and a clean razor made for women. It is a good idea to use your own personal razor or electric shaver and not to share one with your family or friends.

Body shape:

Hips get wider and your waist will get smaller. Your body will also begin to build up fat in the stomach, buttocks, and legs. This is normal and gives your body the curvier shape of a woman.

Body size:

Arms, legs, hands, and feet may grow faster than the rest of your body. Until the rest of your body catches up, you may feel a little clumsier than usual.

Skin:

Skin may get more oily and you may notice you sweat more. This is because your glands are growing too. It is important to wash every day to keep your skin clean and to use a deodorant or antiperspirant to keep odor and wetness under control. Despite your best efforts to keep your face clean, you still may get pimples. This is called acne and is normal during this time when your hormone levels are high. Almost all teenagers get acne at one time or another. Whether your case is mild or severe, there are things you can do to keep it under control. For more information on controlling acne, talk to your pediatrician.

Menstruation:

Your menstrual cycle, or “period,” begins. Most girls get their periods between 9 and 16 years of age.

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Copyright 2000 American Academy of Pediatrics