Adolescence, Abstinence, Sex, and Protection

Your pediatrician may have cared for you since you were a small child. As you continue to grow and change, you will have new health needs. Even though you are becoming an adult, your pediatrician can still help you stay healthy.

When you are 11 or 12 years old, most pediatricians will speak with you and your parent or guardian at your checkup and suggest that you spend some time alone with him or her during future health care visits. What you talk about during these visits will remain confidential. This way you will begin to learn how to take care of your own health.

Growing up is often confusing. Your body is changing and you may feel differently than you did a few years ago. The changes you feel now may leave you wondering what's happening to your mind and body. You may have questions about these changes and how you should take care of yourself.

Your pediatrician can answer questions about the following:

• eating right
• your height and weight
• exercise and sports
• acne
• dating
• body changes
• school performance
• alcohol and other drugs
• other concerns you may have

Why Do Teens Need A Pediatrician?

Some teenagers only visit their pediatrician when they are sick or hurt, but staying healthy means more than just seeing a doctor when something is wrong. As you become an adult, you need to take charge of your own health. This means preventing problems before they start. A first step might be to see your pediatrician once a year, just to make sure everything is OK and any problems are prevented from becoming serious.

You should also see your pediatrician when you are sick or concerned about what is happening to your body. Most likely, your concerns are normal. Growing up may also trigger changes in how you think and feel. You may feel sad, angry, or nervous at times. You should feel free to talk to your pediatrician about these things. After all, these emotions are a part of being healthy too.

A Word About... Privacy

Talking about personal things with your family and friends can sometimes be difficult. When you feel uncomfortable talking about certain things with your parents, you can always ask your pediatrician. Getting answers about how your body works, how you can take care of yourself, how to handle your emotions, and how to stay healthy, will help you make the right decisions about your health.

Your pediatrician will respect you as a patient. Because the pediatrician is your doctor, he or she will keep your discussions private whenever possible. However, your parents are obviously very concerned about your health and well-being, and your pediatrician will want to keep them informed of extreme situations; for example, if your life, or someone else's, is in danger. In most cases though, the information you share with your pediatrician will stay between you and your pediatrician.

What Health Services Do Pediatricians Offer?

The following is a partial list of different things that you can talk about with your pediatrician:

Sports or School Physicals- Many schools ask students to get a physical before joining a team sport. It's important for you to talk about your health with your pediatrician before you participate in any sport. Your pediatrician can help you avoid injuries and stay healthy and fit.

Treatment of Illnesses or Injuries - It is important for you to tell your pediatrician about any illnesses or injuries you have. Let your pediatrician know about pain you have or changes in the way you feel, even if you think they aren't serious. This is the only way your pediatrician can help you stay healthy.

Growth and Development - Your body is probably changing fast and you might want to talk to your pediatrician about what to expect as you grow.

For example, you may be wondering about the following:

• Will you be as tall as your parents?
• Is your sexual development normal?
• Will your acne clear up?
• Will your body fill out more?
• Should you be worried about your weight?

Personal and/or Family Problems - Sometimes you might have a hard time dealing with problems with friends or family. Feeling like your parents don't understand you, losing a best friend, getting teased at school, pressure from friends - all these things can get the best of you once in a while. If you don't know where to turn, remember that your pediatrician is there to help.

School Problems - As a student, you may worry sometimes about your grades and your future. No matter what you try, it may be hard to keep up with school, a job, sports, or other activities. Maybe you find it difficult to get along with others at school or to concentrate on your studies. Your pediatrician may be able to help you through this busy time of your life.

Alcohol and Drug Use - You may be tempted to take risks as you make new friends. You may also get a lot of pressure from your friends. Remember, what's right for them might not always be right for you. Becoming an adult means more than just physical growth. It also means determining what is right for you. This is especially important since many people you know may be using cigarettes, alcohol, or other drugs. Instead of going along with the crowd, you need to decide what is the best choice for you. Your pediatrician can explain how smoking, drinking, or taking other drugs can affect you.

Sexual Relationships - During visits with your pediatrician, you'll have a chance to ask questions about dating, sexual activity, and infections. Your pediatrician also can talk to you confidentially about postponing sex and how to protect yourself against sexually transmitted diseases (STDs) and pregnancy. It's important to make smart choices about sex now. The wrong choice could affect the rest of your life.

Conflicts with Parents - At times, It might be hard to get along with your family and this could lead to problems at home. Maybe it seems like no one understands you or respects your ideas. You're not alone. If you have a problem that your parents may not under­stand, talk with your pediatrician. Sometimes an outside person can give a better view of these difficult situations.

Referrals to Other Doctors for Special Health Needs - You may have a medical problem that will require you to see another doctor or specialist. In that case, your pediatrician can refer you to another doctor who can take care of your needs. A referral may involve an ophthalmologist (eye doctor) for vision, a psychologist or psychiatrist for stress or depression, or other doctors that handle specific medical needs. Even though you may need to see a specialist for a special problem, you should continue to see your pediatrician for regular checkups or illnesses. After all, he or she is still your doctor and will want to keep up with your general needs.

Educational Brochures, Magazines, or Videos on Health Topics - In addition to talking about your health with your pediatrician, you also may be able to learn more about how to take better care of yourself by reading brochures or by watching videos. The American Academy of Pediatrics offers free material covering health topics that might interest you, such as acne, sports and fitness, sexuality, substance abuse, eating disorders, and more. Ask your pediatrician for more information.

What You Can Do To Stay Healthy

Use the following list to take care of yourself and stay healthy

• Eat right and get plenty of sleep
• Know how to handle minor injuries, such as cuts and bruises, as well as minor illnesses like colds.
• Know how to seek medical attention for problems such as vomiting, headache, high fever, earache, sore throat, diarrhea, or abdominal pain.
• Take care of your mental health and ask for help if you have sleep problems, sadness, family stress, school problems, problems with alcohol or other drugs, or trouble relating to friends, family, or teachers.
• Avoid alcohol, cigarettes, smokeless tobacco (chew), and other drugs.
• Delay having sexual relations or use protection if you choose to have sex.
• Exercise regularly, with help from an adult who knows what is right for your body.
• Always wear your seat belt when you are in a car or truck.
• As you become an adult, you'll face many challenges. With help from your pediatrician, you'll learn how to make the right decisions that will help you grow up healthy.

Deciding To Wait Before Having Sex

Becoming a teen is exciting. Because you're becoming an adult, you will experience new physical changes. It's a time when you will try new things and make new friends. You also may think more about dating.

Dating can lead to sharing private thoughts, becoming very good friends, or just having fun with your new friend. Becoming close with someone may be confusing, and it could feel awkward at first. Don't worry, just be you.

As you get to know each other better, you may think about being more than just friends. You may get the urge to kiss and touch someone you're dating. But what happens if your date wants to have sex? Would you understand your feelings? How would you react?

Pressure To Have Sex

You hear about sex in songs, on television and in the movies. Some of your friends may talk about it, too. They may even tell you sex is fun or that "everyone is doing it."

No matter what you've heard, not everyone your age has had sexual intercourse. In fact, most young people your age choose not to have sexual intercourse.

Teenagers you know may talk a lot about having sex. There are several reasons for this. These young people may be curious about sex or may just want attention. Talking about sex also may mean that your friends feel lonely or that they simply want someone to care.

New Feelings

During a date, you may find that you become physically attracted to a person. These new feelings may excite and confuse you. It's normal.

If you decide to kiss and hug your partner, he or she may ask you to have sex. At that moment, you may be tempted to give in to your feelings right away. But before you make a quick decision, stop and ask yourself the following questions:

If somebody you're dating wants to have sex, it doesn't mean you have to want it, too. Before you act on your feelings, remember that you can be sexual with someone without actually having sexual intercourse.

Waiting to have sexual intercourse is one of the most important decisions you will ever make. Why not take your time and think it through?

What Does It Mean To Be Sexual?

When you are sexual, it can mean:

• Making up romantic and sexy stories
• Touching yourself in places that feel good
• Getting the urge to kiss and touch someone you like

Sexual intercourse is very different than these things. When you choose to have intercourse with someone, you are making a choice that could affect the rest of your life. Your decision to have intercourse with your partner could lead to a pregnancy. Having intercourse also can lead to a sexually transmitted disease (STD), such as AIDS.

Know What The Risks Are

Did you know that having intercourse increases your risk of catching many diseases? Would your family and friends understand if you caught a sexually transmitted disease or if you became a parent? Would the person you're having intercourse with help you raise a child? Are you willing to get married at your age? If marriage isn't for you, could you raise a child on your own?

These are just a few of the questions you should ask yourself before you have sexual intercourse. Whether you have intercourse is up to you. But before you make a decision, make sure you know all the facts.

The medical and physical reasons why you should not have sexual intercourse at a young age are:

• Having an unwanted pregnancy
• Getting sexually transmitted diseases (STDs) like gonorrhea, syphilis, chlamydia, herpes or genital warts

Catching the HIV virus that causes AIDS

There also are emotional risks to having sexual intercourse, such as:

• Regretting it when you are older and after you've met someone you truly love
• Being hurt by a relationship that is based only on sexFeeling guilty and scared
• Getting a bad name or reputation
• Some of your friends may decide that they want to have intercourse. That's their business. But don't let them force you into a decision. You know what's best for you.

What Are Your Limits?

Once you start dating, it's important to know what you want from a relationship.

• Think about what you want from a relationship before you make a split-second decision during a date.
• Talk to your parents or your date about your feelings and limits before you get too serious
• Know your limits, and never let someone else talk you into doing something you don't want to do.

Some boys think that girls should set the limits. Girls also may think that boys will know when to stop. A boy or a girl may try to pressure their date to have intercourse. You both need to understand that forcing someone to have intercourse is not right. If your partner really cares, he or she will respect your feelings and your choice not to have intercourse.

Stick By Your Decision

Saying NO isn't always easy. But it's better to say NO than to be pressured into doing something you will regret later. Sometimes it's twice as hard to say STOP to someone you care about, because you don't want to hurt your date's feelings. But if neither one of you stops, you both may regret what can happen next.

You can say NO without hurting your date's feelings. For example, you might say:

• I like you a lot, but I'm just not ready to have sex.
• You're really fun to be with, and I wouldn't want to ruin our relationship with sex.
• You're a great person, but sex isn't how I prove I like someone.
• I would like to wait until I'm married before I have sex.

If you choose to wait to have intercourse, try to avoid situations where you'll be forced into a decision. Try not to spend all of your time with someone you are dating, and avoid being alone with your date too often. It's also not a good idea for you and your friend to "make out together" if you don't really want intercourse. Be fair to your partner; don't be a "tease." It could give your date the wrong idea.

Acquaintance (date) rape is a serious problem for children and teens. This means a person threatens to hurt (assault) you if you don't have intercourse with them. No matter who threatens you, make sure you tell your parents, your pediatrician, or your teachers if you think you've been assaulted or put in danger.

Using alcohol or drugs also can cause problems during a date. Both of these affect your judgment, which may make it hard to stick to your decision not to have intercourse.

Don't pay attention to the sexual bragging and the dares of your friends or classmates. Decide for yourself. Being liked by your friends may seem more important than what you know is right. You may be tempted to keep up with the crowd, but usually these stories are just made up.

If you're having a hard time with your decision, talk to your parents, clergy or your pediatrician.

Abstinence: Young People Can Wait

Not having sex (abstinence) is the only sure way to prevent pregnancy and STDs.

People who wait until marriage to have sexual intercourse usually find out that it is:

• Less risky to health
• Easier to act responsibly and take precautions to avoid infections and pregnancy
• More special
• More satisfying
• More accepted by others

Be patient. At some point, you will be ready for sexual intercourse. Move at your own pace, not someone else's. Talk with your parents about their values. Your pediatrician can explain how intercourse affects your body, and why you should wait until you are older. To avoid the risks - and to make intercourse really special in the future - why not just wait for now?

Remember to ask your pediatrician if you have any questions about growing up. Your doctor is there to help. If you feel uncomfortable about discussing certain private things with your parents, you can always trust your pediatrician to help. Don't be afraid to ask.

The Correct Use Of Condoms

Remember, abstinence is the only real way to avoid pregnancy and getting sexually transmitted diseases (AIDS, syphilis, gonorrhea, chlamydia and genital HPV infection). Sexually transmitted diseases (STDs) and unplanned pregnancies are at all-time highs for people your age.

As a teen, you are faced with many challenges and decisions that will affect the rest of your life. Deciding when to begin having sex is one of the most important decisions you will ever make. It is perfectly normal not to have sex until marriage.

However, if you do decide to have sex, correct use of latex condoms will help you protect yourself and your partner against these risks.

Why Use Condoms?

A condom acts like a barrier or wall to keep semen, fluid from the vagina, and blood from passing from one person to the other during sex. These fluids can carry germs. If no condom is used, the germs can pass from the infected person to the uninfected person. Use of a condom also prevents unwanted pregnancies by keeping sperm out of the vagina.

Other good reasons to use condoms:

• They are cheap.
• They are easy to get (you don't need a prescription to buy them).
• They rarely have side effects.
• They are easy to use.

Some people have excuses for not using condoms, such as they are not comfortable, they lessen their enjoyment of sex, or they are unnatural. However, using a condom can make sex more enjoyable because both partners are more relaxed and secure. Besides, the risks involved with not using condoms make any excuses seem pretty weak.

How To Buy Condoms

When buying condoms, be sure the ones you choose:

• are latex - some condoms are made of natural membranes (lambskin) and not latex. Only latex condoms have been proved to work against STDs because they prevent the passage of harmful germs.
• have a reservoir (nipple) at the tip to catch semen.
• are lubricated with nonoxynol-9, which is a spermicide (chemical) that has been proven to give additional protection against STDs, including the AIDS virus.

Condoms come in different colors, textures, and sometimes sizes. A good-quality condom is the most important feature for safer sex.

Other points to keep in mind when buying condoms:

• Be sure to check the expiration date on the package. Do not buy or use them if they have expired.
• Condoms should be stored in a cool, dry place. You can carry a condom with you at all times, but do not store them where they will get hot (like in the glove box of a car). Heat can damage the condom. Also, carrying them in a purse or wallet is okay as long as it is not for long periods of time - this shortens their life.

Try not to feel embarrassed about buying condoms. By using condoms, you are proving that you are being responsible and there is nothing embarrassing about that.

How To Put Condoms On

Condoms are easy to use. However, they only work if they are used correctly. Follow these easy steps to make sure you are using them the right way:

1. Carefully remove the condom from the package.
2. Put the condom on the end of the penis when the penis is erect ("hard").
3. Hold the condom by the tip and carefully roll the condom all the way to the base of the penis.
4. Leave extra space (1/4 to ½ inch) at tip of the condom to catch the semen.

If you do not have much experience with condoms, you should practice putting a condom on and taking it off by yourself, before you use it for sex with another person.

Be sure to put the condom on when an erection first occurs. Do not wait until you are ready to have sex - it may be too late. Drops of semen may leak from the uncovered penis. These small drops are enough to pass STDs to the other person or to cause a woman to get pregnant.

For added protection against STDs and pregnancy, use a spermicidal foam, cream, or jelly along withthe condom. Make sure the spermicide you use contains nonoxynol-9.

Before unrolling the condom, place a small amount of the spermicidal foam, cream, or jelly inside its tip.

After unrolling the condom over the erect penis, place some more of the foam, cream, or jelly on the outside of the condom. Females can also use the spermicide inside the vagina for extra protection in case the condom breaks. Follow the directions on the spermicide package.

How To Take Condoms Off

Withdraw the penis from the vagina right after ejaculation, while it is still erect or "hard." Hold on to the condom at the rim while the penis is withdrawn. Be careful as you slide it off the penis. Do not tug to pull condom off - it may tear. Throw away used condoms immediately. Never use a condom more than once. Be sure to keep used condoms away from your partner's genitals and other areas of the body as well. This will prevent semen from getting on hands or other body parts. If this happens, wash any areas of the body that have been touched by the semen.

Always insist that a condom be used every time you have sex. It is the only way to be sure that you are protected from infection. You should say NO to sex if you don't have a condom or if your partner refuses to use one.

Special Points To Remember

• Whenever possible, buy lubricated condoms.
• If you buy condoms that are not lubricated, you also may need a lubricant to help prevent the condom from breaking. Lubricants may also prevent irritation, which could increase the chances of infection. Use only water-based lubricants (like KY jelly). Do not use oil-based lubricants such as petroleum jelly (like vaseline), hand or body lotions, or vegetable oil with latex condoms, since they can damage the condom.
• Other forms of birth control like the pill, diaphragm, or IUD do not prevent the spread of STDs - only condoms do. If another form of birth control is being used, a latex condom must also be used to make sure both partners are protected from STDs.

If you have had sex and you did not use a latex condom, you could have an infection and not know it. Some STDs take several months to show symptoms and some have no symptoms. See your pediatrician if you or your partner have any of the following:

• discharge from the vagina, penis, or rectum
• pain or burning during urination or sex - pain in the abdomen, testes, buttocks, and legs
• blisters, open sores, warts, rash, or swelling in the genital area or mouth - flu-like symptoms, including fever, headache, aching muscles, or swollen glands
• miss a period and think you might be pregnant

Not having sex is the safest. Condoms do not make sex 100% safe, but if used properly, they will reduce the risk of STDs, including AIDS. Know the facts so that you can protect yourself and others from getting infected. However, if you are having sex, be sure to always use a latex condom. It is the best way for you and your partner to stay healthy.

For more information about condoms and how to prevent STDs and pregnancy, talk with your pediatrician.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.