LESSON 7: Recognizing the Risks. My Future - My Choice A sexual health curriculum for teens

LESSON 7: Recognizing the Risks My Future - My Choice A sexual health curriculum for teens

BEFORE YOU GO INTO THE CLASSROOM MATERIAL LIST Three traffic light signs, different colors Risk cards Condom instruction cards Tape *Pieces of paper for question box *Homework SPECIAL INSTRUCTIONS There is an alternate protection activity at the end of the lesson on page 40. Additional information for instructor use only is on pages 31 39 at the end of this lesson. * Copies for each student LESSON 7: RECOGNIZING THE RISKS 7A

LESSON 7: RECOGNIZING THE RISKS OBJECTIVES By the end of the lesson, students will be able to: Recognize the consequences of becoming sexually active at their age Understand that postponing sexual involvement is the safest, most effective method of protection from STDs/STIs and pregnancy Identify possible consequences of sexual involvement, including what it means to be responsible for the results of one s decisions ACTIVITIES Risk assessment Condom instruction cards OREGON HEALTH STANDARDS ADDRESSED Concepts Interpersonal communication 7B LESSON 7: RECOGNIZING THE RISKS

CONSEQUENCES If time permits, address some prepared responses from the question box. If additional time is necessary, continue at the end of class. Redistribute pieces of paper for questions during this lesson. Today we ll discuss how to recognize the consequences of becoming sexually involved. We ll talk about what it means to be sexually active and how some negative consequences may include sexually transmitted diseases and infections (STDs/STIs). We ll discuss what causes them, how they are spread and ways to prevent them. We will also talk about the risk of pregnancy. What are some things that could happen if you decide to become sexually active? If someone did make the choice to be sexually active, what are some ways that person could reduce the risk of pregnancy or a sexually transmitted disease or infection? Write the heading Reducing risks on the board. Take answers and write on board under heading. Answers should include abstinence, condoms, birth control, monogamy, etc. LESSON 7: RECOGNIZING THE RISKS 17

STD/STI FACTS Here are a few facts about sexually transmitted diseases and infections I want to share with you: 10,000 teens are infected by sexually transmitted diseases and infections each day in the United States. That is one teen every eight seconds.* Correct and consistent condom use every time can reduce the risk of getting an STD/STI such as HIV or an unintended pregnancy. Abstinence is the only 100 percent effective way to avoid getting an STD/STI or an unintended pregnancy. There are several different types of STDs/STIs. Some are curable with treatment. Some have treatments to reduce symptoms but cannot be cured. No one is immune to STDs/STIs. Even when symptoms go away the infection may still be there. * Source: the Center for Disease Control and Prevention 18 LESSON 7: RECOGNIZING THE RISKS

STD/STI 1. What are some STDs/STIs that you have heard of? 2. How does a person know if they have an STD/STI? 3. What s the only way a person can know for sure if they have an STD/STI? 4. What could happen if someone didn t get tested and treated for an STD/STI? If someone is or has been sexually active, that person needs to be tested for STDs/STIs. Here s a little more information about some common sexually transmitted diseases and infections: Chlamydia is the most commonly reported bacterial STD/STI. Many times there are no symptoms. Gonorrhea is also a bacterial STD/STI that can cause painful urination or penile/ vaginal discharge but often has no symptoms. HPV or the human papillomavirus is an example of a viral STD/STI and can be passed through skin-to-skin contact. It can cause genital warts but often it has no symptoms. It can also cause cervical, penile and anal cancer. There is a vaccine available to prevent this STD/STI. Herpes is also a viral STD/STI. Most forms of herpes have no or minimal symptoms. Other side effects include recurring painful blisters or sores. There is currently no cure for herpes. Many of you have heard of HIV or the human immunodeficiency virus that can lead to AIDS. There is currently no cure for HIV and it can lead to death. If a person chooses to be sexually involved whether it is oral, anal or vaginal intercourse or genital to genital contact without penetration, it is important to use a latex condom or dental dam correctly and consistently every time to reduce the risk of getting an STD/STI. STD/STIs can affect people of any age, gender, or sexual orientation. No one is immune. Remember, the only way to guarantee that you will not have any of these consequences during your teen years is to postpone sexual involvement. Additional information on STDs/STIs on 34 37. LESSON 7: RECOGNIZING THE RISKS 19

TYPES OF PROTECTION Be sure you have the appropriate referral information if students have additional questions regarding resources in your area. There are many different types of protection that can help reduce the risks if a person decides to become sexually active. Some protection prevents pregnancies by blocking the sperm from reaching the egg. These are called barrier methods. Some barrier methods, such as condoms and dental dams, can protect against most STDs/STIs by stopping the transmission of body fluids. Most barrier methods do not require a prescription from a doctor and condoms can usually be easily accessed. Where are some places that you know of in the community where people can access condoms or dental dams? Some protection methods prevent pregnancy by changing hormone (chemical) levels so that the person does not get pregnant. It is important to remember that these forms of birth control do not protect against STDs/STIs. Also, these methods do require a prescription from a doctor. Be prepared to address comments or questions such as, I heard that condoms can break or can have holes in them that an STI can get through. See STDs/STIs and Condom Fact Sheet (pages 31 33). Information on dental dams is found on page 39. Additional information on STDs/STIs is on pages 34 36, and additional information on contraceptives is on page 38 39. 20 LESSON 7: RECOGNIZING THE RISKS

RISK ASSESSMENT ACTIVITY We can protect ourselves by not becoming involved in risky activities. Unfortunately, some people do not know the levels of risk for certain sexual behaviors. Keep in mind that people do not need to engage in risky behaviors to show affection. For this activity, hang red, yellow and green risk signs on the wall. Students should be in groups. Shuffle the risk behavior cards and distribute two or three cards to each group. Tell the students that sex means oral, anal or vaginal intercourse. Be sure to define the levels of risk. High risk/red light behaviors are unsafe. This includes the transmission of blood, semen, vaginal secretions and other body fluids and can transmit STDs/STIs or cause a pregnancy. Low-medium risk/yellow light behaviors are those activities that might create some danger of STDs/STIs or pregnancy. No risk/green light behaviors are those that involve no exchange of body fluids and pose no risk. In this activity, each group will receive some cards. Decide in your group what the level of risk is for each card. We will then discuss it as a group to see if we agree or disagree. Once we have decided on the level of risk for that activity or behavior, select someone from your group to hang the card under the appropriate category. LESSON 7: RECOGNIZING THE RISKS 21

RISK ASSESSMENT ACTIVITY Have each group read each of their risk behavior cards and report what level of risk they believe they are. Discuss as a class using the answer key on page 23 and decide under which risk level it should be placed. Clarify any misconceptions. NOTE: Risk behavior cards can be placed between categories because high, low-to-medium risk and no risk represent a continuum and some behaviors do not fall completely within any one category. Once all cards have been placed under a risk sign, debrief as a large group using the following questions and the answer key provided on page 23. 1. What types of activities are around the red light? 2. What could happen if someone engages in a red light activity? 3. How might that outcome affect someone s goals for his or her future? 4. What types of activities are around the green light? 5. Can you think of other activities that would fall into this category? 6. How do these activities support the goals and plans someone may have in life? 22 LESSON 7: RECOGNIZING THE RISKS

RISK ASSESSMENT ACTIVITY ANSWER KEY Discuss each answer with the group. The risk cards can be placed at any of the levels depending on the students reasoning. Refer to the following answer key for activity guidance. Abstinence green light Anal sex red light if unprotected; yellow light if a condom is used correctly and consistently each time Doing drugs or drinking alcohol red light Doing your homework green light Dry kissing green light Finishing your education green light Giving a friend a hug green light Giving or receiving a shoulder or back massage green light Going on a date to the movies or a dance green light Having sex with a person who has sex with multiple partners red light if unprotected; yellow light if using a condom correctly and consistently Having sex with multiple partners without a condom red light Having sex with multiple partners and using a condom yellow light if using a condom correctly and consistently each time Having sex with only one person (being monogamous) red light if unprotected. Yellow light if using a condom correctly and consistently each time. Having sex with someone who injects drugs red light Holding hands green light Learning about the risks of sexual activity green light Learning to play an instrument green light Masturbation green light Oral sex red light if unprotected; yellow light if a condom is used correctly and consistently each time Playing sports green light Sharing a soda on a date green light Thinking about how you feel and planning for the future green light Vaginal sex red light if unprotected; yellow light if a condom is used correctly and consistently each time Wet/tongue/making out yellow light LESSON 7: RECOGNIZING THE RISKS 23

ACTIVITY SUMMARY As you can see from this activity, there are plenty of behaviors that are no risk, or green light. The most effective way to protect yourself from pregnancy and disease or infection is to postpone sexual involvement until you are prepared for the responsibilities and consequences that may accompany this decision. If or when a person chooses to be sexually active, it is important to use protection correctly 100 percent of the time. 24 LESSON 7: RECOGNIZING THE RISKS

WHY USE PROTECTION For this activity, be prepared to take answers and write them on the board for the following discussion. Write the heading Why Teens Use a Condom on the board. Share the norm behavior with students refer to Oregon Healthy Teens survey data on how many sexually active eighth graders use a condom 100 percent of the time. To access the most current data, go to: http://public. health.oregon.gov/birthdeathcertificates/surveys/oregonhealthyteens/ Pages/index.aspx Can anyone tell me why they think teens would use condoms? Write answers on the board. Answers should include: Prevent STDs/STIs; Prevent pregnancy; Keep you safer. Then write this heading on the board: Why Teens don t use condoms Why do you think teens might not use a condom? Write the answers on the board. The list should include: Embarrassed to buy them; Don t know where to get them; Partner doesn t want to use them; Parent may find out; Doesn t feel natural. What would you say to friends who decide not to use protection because of one of the reasons on the list? Are any of the reasons on the list more difficult than dealing with an unintended pregnancy or sexually transmitted disease or infection? LESSON 7: RECOGNIZING THE RISKS 25

ACTIVITY SUMMARY Be sure to have local resource information available on how students can access their local resources; e.g., school-based health center, school nurse, local health department or clinic. As you can see, most (if not all) of you agreed that dealing with an STD/STI or an unintended pregnancy as a teen would be more difficult than dealing with anything on the second list. It s important to communicate with your partner about why you should use a barrier method if you decide to have sex. Being uncomfortable discussing protection with a partner probably means you are not ready to have sex. Remember that using a barrier protection method correctly and consistently can reduce a person s chances of pregnancy and STDs/STIs such as HIV. However, the only sure way to prevent pregnancy and STDs/STIs is to not be sexually involved. 26 LESSON 7: RECOGNIZING THE RISKS

HOW TO USE A CONDOM One of the most commonly used barrier methods is a condom. Condoms can help reduce the risk of pregnancy and STDs/STIs when used correctly and consistently during sexual intercourse. Most often, when a condom fails it is because it was not used correctly. Let s identify the steps in using a condom correctly. For this activity divide students into even groups. Distribute a set of condom instruction cards for each group. (Make sure to shuffle the cards.) Tell students you will give each group three minutes to put the cards in the correct order. These cards represent the steps to using a condom correctly. As groups finish, have them re-check their work to make sure the steps are in the appropriate order. Verbally walk through the correct order with the entire class. Award a prize to the group with the closest order (optional). *An alternate activity is included at the end of this lesson on page 40. LESSON 7: RECOGNIZING THE RISKS 27

DEBRIEF What steps surprised you or your team? What questions does your team have regarding these steps? Knowing how to correctly and consistently use a condom every time a person chooses to become sexually involved reduces the risk for contracting an STD/STI or unplanned pregnancy. Keep in mind, a person who is sexually active should get tested by a doctor regularly. This is important information to know so you can make healthy choices and reduce the risk for STDs/STIs and pregnancy. Next week we will review and practice refusal skills and the importance of effective communication. I have a worksheet for you to take home and discuss with a parent or guardian the information we learned today. Pass out homework handout. Pass around the question box. Remember, all students should put a piece of paper in the question box regardless of whether they wrote anything on it. 28 LESSON 7: RECOGNIZING THE RISKS

LESSON 7: RECOGNIZING THE RISKS Dear parent/guardian, As part of the My Future-My Choice program please work with your student to complete the following worksheet assignment. This week we talked about some of the consequences of sexual involvement including the transmission of sexually transmitted diseases and infections (STDs/STIs) and unplanned pregnancy. We also looked at how to reduce these risks through postponing sexual involvement and other methods of protection. Please take some time this week to answer the following questions and go over the answers together. 1. Please mark each statement true (T) or false (F). (See answers in the box below after completion.) a. A person would know if they have an STD/STI because they will have symptoms. b. The longer a person postpones sexual involvement, the less likely they are to get an STD/STI or have/cause an unplanned pregnancy. c. There are multiple ways to protect yourself against STDs/STIs and pregnancy. d. All STDs/STIs have a cure. e. Some STDs/STIs are spread through skin to skin contact. f. Chlamydia and Human Papillomavirus (HPV) are not common STDs/STIs. 2. Make a list of five healthy and enjoyable activities you could do in a relationship that does not involve sexual contact: ANSWERS a. False (the most common symptom of an STD/STI is no symptom). b. True. c. True (using condoms and getting tested for STDs/STIs help keep people safe, but abstinence is the only 100% effective method of protection). d. False. e. True (Human Papilloma Virus (HPV), Herpes and Syphilis are all spread when infected skin comes in contact with someone else s skin). f. False (chlamydia is the most common bacterial STI in the United States, and Human Papilloma Virus (HPV) is the most common STD/STI overall in the United States). LESSON 7: RECOGNIZING THE RISKS 29

STDs/STIs AND PROTECTION FACT SHEET (for instructor reference only) What do I need to know about STDs/STIs and condoms? The most effective ways to avoid transmission of sexually transmitted diseases or infections are to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected. However, for people whose sexual behaviors place them at risk for STDs/STIs, correct and consistent use of condoms or dental dams can reduce the risk of STD/STI transmission. While condoms cannot provide absolute protection against STDs/STIs, mostly due to human error, they are the best line of defense for people whose sexual behaviors place them at risk. The U.S. Centers for Disease Control and Prevention (CDC) states, Latex condoms, when used consistently and correctly, are highly effective in preventing transmission of HIV, the virus that causes AIDS. In addition, correct and consistent use of latex condoms can reduce the risk of other sexually transmitted diseases (STDs), including discharge and genital ulcer diseases. While the effect of condoms in preventing human papillomavirus (HPV) infection is unknown, condom use has been associated with a lower rate of cervical cancer, and HPV-associated disease. What are condoms? Condoms are a barrier method of contraception that can prevent pregnancy by keeping semen out of the vagina. Latex condoms also help prevent STDs/STIs that are spread by semen, blood or vaginal secretions, or by contact with infected sores in the genital area. Most condoms go over the penis and are sometimes called male or exterior condoms. A type of condom designed to fit into the vagina is called the female or interior condom. Both male and female condoms can also be used to protect the anus. What are condoms made of? Latex is the most common material used to make condoms today. Viruses such as HIV cannot get through it. However, some people are allergic to latex. Condoms made of polyurethane are a good substitute for persons with latex allergies. CONTINUED ON NEXT PAGE LESSON 7: RECOGNIZING THE RISKS 31

STDs/STIs AND PROTECTION FACT SHEET (for instructor reference only) continued How are condoms used? Condoms are most effective when used correctly and consistently. The following are some tips for using condoms: Store condoms away from too much heat, cold or friction. Do not keep them in a wallet or a car glove compartment. Check the expiration date. Don t use outdated condoms. Don t open a condom package with your teeth. Be careful that your fingernails or jewelry don t tear the condom. Body jewelry in or around the penis or vagina might also tear a condom. Use a new condom every time you have sex, or when the penis moved from the anus to the vagina. Only use one condom at a time. Do not use a male condom and a female condom at the same time either. Check the condom during sex, especially if it feels strange, to make sure it is still in place and unbroken. Use water-based lubricants rather than oil-based lubricants. The oils in Crisco, butter, baby oil, Vaseline or cold cream will make latex fall apart. Condoms and dental dams can be used for oral sex to protect against STDs/STIs. Myths about condoms There continues to be misinformation and misunderstanding about condom effectiveness. The Centers for Disease Control and Prevention (CDC) provides the following information to address some common myths about condoms. This information is based on findings from recent epidemiologic, laboratory and clinical studies. Myth #1: Condoms don t work. The fact is that latex condoms are highly effective, but only when they are used properly. Research indicates that only 30 to 60 percent of men who claim to use condoms for contraception actually use them for every act of intercourse. Further, even people who use condoms every time may not use them correctly. Incorrect use contributes to the possibility that the condom could leak from the base or break. 32 LESSON 7: RECOGNIZING THE RISKS

STDs/STIs AND PROTECTION FACT SHEET (for instructor reference only) continued Myth #2: HIV can pass through condoms. A commonly held misperception is that latex condoms contain holes that allow passage of HIV. Although this may be true for natural membrane condoms (such as lamb skin condoms), laboratory studies show that intact latex condoms, when used correctly, provide a continuous barrier to disease, including HIV, as well as sperm. Myth #3: Condoms frequently break. Condoms are classified as medical devices and are regulated by the FDA. Every latex condom manufactured in the United States is tested for defects before it is packaged. During the manufacturing process, condoms are double-dipped in latex and undergo stringent quality control procedures. Several studies clearly show that condom breakage rates in this country are less than 2 percent. Most of the breakage is due to incorrect usage rather than poor condom quality. Using oil-based lubricants can weaken latex, causing the condom to break. In addition, condoms can be weakened by exposure to heat or sunlight or by age, or they can be torn by teeth or fingernails. LESSON 7: RECOGNIZING THE RISKS 33

ADDITIONAL INFORMATION ON STDs & STIs (for instructor reference only) CHLAMYDIA Chlamydia is a common sexually transmitted disease/infection caused by chlamydia trachomatis, a bacterium, that can damage a woman s reproductive organs. Because symptoms of chlamydia are mild or absent, serious complications that cause irreversible damage, including infertility, can occur silently before a woman ever recognizes a problem. Chlamydia can be transmitted during vaginal, anal or oral sex. Chlamydia can also be passed from an infected mother to her newborn during vaginal childbirth. Chlamydia is the most frequently reported bacterial sexually transmitted infection in the United States. Under-reporting is substantial because most people with chlamydia are not aware of their infections and do not seek testing. An estimated three million Americans are infected with chlamydia each year. GONORRHEA Gonorrhea is a common sexually transmitted disease/inflection caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in mucous membranes of the body. Gonorrhea bacteria can grow in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacteria can also grow in the mouth, throat and anus. Gonorrhea is spread through sexual contact (vaginal, oral or anal). This includes penis-to-vagina, penis-to-mouth, penis-to-anus, mouth-to-vagina and mouth-toanus contact. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to child during birth. Gonorrhea infection can spread to other unlikely parts of the body. For example, a person can get an eye infection after touching infected genitals and then the eyes. Individuals who have had gonorrhea and received treatment may get infected again if they have sexual contact with persons infected with gonorrhea. 34 LESSON 7: RECOGNIZING THE RISKS

ADDITIONAL INFORMATION ON STDs & STIs (for instructor reference only) continued HEPATITIS B Hepatitis B (HBV) is a serious viral infection of the liver. HBV can cause chronic infection, cirrhosis (scarring) of the liver, liver cancer, liver failure and death. It is estimated that 4,000 to 5,000 people die each year in the United States due to the complications of cirrhosis and liver cancer as a result of HBV. HERPES Genital herpes is caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first episode. Although the infection can stay in the body indefinitely, the number of outbreaks tends to go down over a period of years. HPV Genital HPV infection is a common sexually transmitted disease/infection that is caused by human papillomavirus (HPV). Human papillomavirus, or HPV, is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these are sexually transmitted, and they can infect the genital area, such as the skin of the penis, vulva, labia or anus, or the tissues covering the vagina and cervix. Some of these viruses are considered high-risk types and may cause abnormal pap smears and cancer of the cervix, anus and penis. Others are low-risk, and they may cause mild Pap smear abnormalities and genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area, and sometimes form a cauliflowerlike shape. An HPV vaccine to be used before first sexual contact is now available for young people. This vaccine is called Gardasil. The Center for Disease Control and Prevention (CDC) recommends this vaccine for males and females age 11 12; the CDC says Gardasil is most effective before becoming sexually active. However, Gardasil can be administered to young women and young men between the ages of 9 and 26 and can prevent four LESSON 7: RECOGNIZING THE RISKS 35 CONTINUED ON NEXT PAGE

ADDITIONAL INFORMATION ON STDs & STIs (for instructor reference only) continued strains of HPV (two strains that cause 90 percent of genital warts, and two that cause 75 percent of cervical cancer cases).this vaccine is given in three doses over a six-month time span. People interested in getting vaccinated for these strains of HPV should talk to their parent/guardian and their health care provider to find out more information about Gardasil. They can also go to their local health department to find out more information about Gardasil. Source: www.gardasil.com www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html SYPHILIS Syphilis is a complex sexually transmitted disease/infection caused by the bacterium Treponema pallidum. It has often been called the great imitator because so many of the signs and symptoms are indistinguishable from those of other diseases. Syphilis is passed from person to person through direct contact with syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing or eating utensils. BACTERIAL VAGINOSIS Bacterial vaginosis (BV) is the most common vaginal infection in women of childbearing age. The cause of BV is not fully understood. BV is associated with an imbalance in the bacteria that are normally found in a woman s vagina. The vagina normally contains mostly good bacteria, and fewer harmful bacteria. BV develops when there is a change in the environment of the vagina that causes an increase in harmful bacteria. Source: http://www.oregon.gov/dhs/ph/std/facts.shtml 36 LESSON 7: RECOGNIZING THE RISKS

ADDITIONAL INFORMATION ON STDs & STIs METHODS (for instructor reference only) STI vs. STD. What is the difference? STD stands for a sexually transmitted disease, and STI stands for a sexually transmitted infection. Often the terms STD and STI are used interchangeably, but there is a slight difference. From a medical standpoint the term disease is defined as an infection that causes symptoms. Because many STDs may not have symptoms, it is technically more accurate to call these infections (STI). This may be a good reminder that a person should make sure to get tested for STDs even when symptoms are not present. Source: http://plannedparenthood.tumblr.com/post/33600737905/std-vs-sti LESSON 7: RECOGNIZING THE RISKS 37

ADDITIONAL INFORMATION ON BARRIER METHODS (for instructor reference only) Male condom Worn on the penis, a male condom keeps sperm from getting into a partner s body. Latex condoms, the most common type, help prevent pregnancy and STDs/STIs as do the newer synthetic condoms. Natural or lambskin condoms also help prevent pregnancy, but may not provide protection against STDs/STIs, including HIV. Male condoms are 85 98 percent effective at preventing pregnancy. Condoms can only be used once, and are most effective when used consistently and correctly. You can buy condoms, KY jelly, or water-based lubricants at a drug store or health department. Do not use oil-based lubricants such as massage oils, baby oil, lotions or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break. Female condom Worn in the body, the female condom helps keep sperm from getting into the body. It is packaged with a lubricant and is available at drug stores or health departments. It can be inserted up to eight hours before sexual intercourse. Female condoms are 79 95 percent effective at preventing pregnancy when used consistently and correctly, and may also help prevent STDs/STIs. Diaphragm or cervical cap Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup. Before sexual intercourse, you insert them with spermicide to block or kill sperm. The diaphragm is 84 94 percent effective at preventing pregnancy. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes. Spermicides These products work by killing sperm and come in several forms foam, gel, cream, film, suppository or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm or cervical cap to increase effectiveness. Spermicides alone are about 71 82 percent effective at preventing pregnancy. They do not prevent STDs/STIs. Source: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm 38 LESSON 7: RECOGNIZING THE RISKS

ADDITIONAL INFORMATION ON BARRIER METHODS (for instructor reference only) Dental dams Dental dams are square and are made of latex or silicone. This barrier method is used during oral-vaginal or oral-anal sex to prevent the transmission of STDs/STIs. It is held over the vulva or anus during oral sex to minimize direct contact and exchange of bodily fluids. Dental dams are a newer device and are not available everywhere. However, they can be found at a local health department or a family planning clinic. Source: www.brown.edu/student_services/health_services/health_education/ sexual_health/safer_sex_and_contraceptives/dental_dams.php LESSON 7: RECOGNIZING THE RISKS 39

ALTERNATE PROTECTION ACTIVITY TEACHER SCRIPT: One of the most commonly used barrier methods is the condom. Condoms can help reduce the risk of pregnancy and STDs/STIs when used correctly and consistently. When appropriate: Display condom. Condoms are something people may use when they have sex to reduce the risk of pregnancy or STDs/STIs. If you find any used condoms, leave them alone and do not touch them at all. If there s an adult around, tell them about it. Do not ever handle them. Let an adult throw them away. Brainstorming activity: (If school district policy allows, teacher can show an example of each kind of birth control/disease prevention method.) What is the only 100 percent safest way to avoid an unintended pregnancy or an STD/STI? (Students would respond abstinence. ) Write on top of poster paper in large letters Abstinence. Correct, for school-aged youth, abstinence is the safest choice. However, if people do choose to have sex, there are other ways that can reduce you or your partner s risk from unintended pregnancies and STDs/STIs. What are those other ways? 40 LESSON 7: ALTERNATE PROTECTION ACTIVITY

ALTERNATE PROTECTION ACTIVITY continued Write below abstinence Students responses. Examples: birth control pills, diaphragms, Depo-Provera, condoms, withdrawal Are any of these methods 100 percent safe? (Postponing sexual involvement is the only 100 percent safest method.) Correct, but some of them can be very effective if used correctly and consistently every time. Do any of these methods protect you and your partner from both unintended pregnancy and STDs/STIs? (Abstinence and condoms can prevent both STDs/STIs and pregnancy. Birth control such as the pill specifically prevents unplanned pregnancy, but not STDs/STIs.) What does that tell us? (open student conversation) ACTIVITY SUMMARY: We have talked about how complicated making the decision to have sex can be, even for adults. We have discussed what you should do if you find a used condom. We have also talked about different kinds of birth control and disease prevention methods; Remember: many STDs/STIs do not have signs or symptoms. So, with all this knowledge, why do you think postponing sexual involvement is the safest choice for sixth (seventh) graders? LESSON 7: ALTERNATE PROTECTION ACTIVITY 41