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Sex Doctor

2008-11-21T05:28:00.000-08:00

Homophobia, prejudice & attitudes to gay men and lesbians

2008-10-20T08:22:00.000-07:00

What is homophobia?

There is no single definition for the term ‘homophobia’, as it covers a wide range of different viewpoints and attitudes. Homophobia describes hostility or fear of gay people and homosexuality, but it is not limited to this specifically. For example someone might be called homophobic if they dislike gay people; or if someone is violent towards a gay person they could also be described as homophobic.

Attitudes to gay men and HIV

People can have a wide range of views about sexuality even if they have grown up exposed to the same ideas. While some people believe homosexuality is a valid lifestyle, others violently object. Some people believe that homosexuality is unnatural, others see it as a sin and have said that for gay men 'AIDS is a plague sent from God'.

At the beginning of the AIDS epidemic, gay men in many countries were frequently singled out for abuse as they were seen to be responsible for the spread of HIV. Sensational reporting in the press that became progressively anti-gay fuelled this theory. Some UK headlines read, “Alert over ‘gay plague’”,¹ and “‘Gay plague’ may lead to blood ban on homosexuals”.² One prominent gay activist was attacked outside a London subway by a gang of youths who suggested that he should be killed before he could spread this ‘gay plague’ to others. Groups in the USA monitoring homophobic violence reported an increase in incidents when public awareness about AIDS increased in the 1980s.³

Homophobia around the world

A 2007 report by UK gay rights organisation Stonewall found that gay people in the UK experience more extreme homophobia as young people than as adults. The research found that two thirds of young gay, lesbian and bisexual pupils had experienced direct bullying in Britain’s schools. 92% of young gay people had been subject to verbal abuse, and 41% has been physically assaulted.

A 2008 survey found that 66% of gay and lesbian people would expect to face barriers due to their sexuality if they wanted to run as an MP in the UK. One in five lesbian and gay people in the UK said they had experienced bullying in the workplace as a result of their sexual orientation.⁴

In 2005 a gay man was killed every two days in Latin America because of his sexuality. In Brazil, where the government launched a campaign against homophobia in 2004, 2,509 gay men were murdered between 1997 and 2007.⁵

A demonstration in Brussels, Belgium calling for laws against homosexuality to be repealed

In many African countries, such as Zimbabwe and Zambia, homophobia is legitimised by governments, and gay people face persecution and violence from police, employers, hospitals and community organisations. In South Africa, the law has been changed to improve rights for gay and lesbian people, however it remains to be seen whether social attitudes towards homosexuality have really improved in that country.⁶

In India, lesbians are stigmatised more severely than gay men, as there is huge social and family pressure for women to get married. India’s traditional family-oriented culture provides no space for open discussion of sexuality. Gay and lesbian people are subject to harassment and persecution from police and government agencies.⁷

In Iran in 2005, two men were executed for alleged homosexual activity.⁸ President Ahmadinejad demonstrated the Iranian government’s attitude towards homosexuality in a speech in the US in 2007, when he claimed that there were no homosexuals in Iran.⁹

What causes people to be prejudiced against gay and lesbian people?

There are many factors that can cause a person to be homophobic. Research has shown that prejudice against gay people and homosexuality can be influenced by the person:

Having strong religious beliefs that disapprove of sex and/or homosexuality
Having little/no social contact with lesbian and gay people
Reporting no homosexual experiences or feelings

'When you're scared, especially of something you actually know nothing about, hatred is a natural reaction.' - Robert, 25

Prejudice among young people

Young people who do not act in line with their gender stereotype may be subjected to severe homophobic bullying. Boys are stereotyped as sporty and strong decision-makers, and girls are expected to be emotional and expressive. As a result, boys who show their feelings or who are too intimate with other boys are often called 'girls', 'faggots' or 'poofs'. Girls who are considered to be too boyish or who hold feminist views run the risk of being called 'dykes' or 'lesbians'.

“There was not a word, not a mention about being gay.”

- Tim -

The boundaries for boys’ gender roles are much more rigid than they are for girls. As a result boys have a limited number of ways acceptable to their peer group to express their emotions. This often means that emotional expression between boys may be seen by their peers as homosexual interest. Between girls, in contrast, close friendships that involve embracing, touching and sharing thoughts and feelings are more legitimate and are less likely to be seen by their peers as an indication of homosexuality.

Young people often use words associated with homosexuality as standard insults. This is one way that young people learn it is highly undesirable to be gay. This can silence young people who are experiencing gay feelings and stop them from coming out, and even encourage young gay men to pretend to be heterosexual and join in homophobic taunts to protect themselves.

Many gay and lesbian adults say that they began to identify themselves as 'different' in their secondary school years. In this period, the absence of support, understanding or information was sometimes a source of distress in itself and often magnified their anxieties.

'I was waiting and expecting to hear something about homosexuality, safe sex and different things in sex education. Maybe some information that could help me. But I got nothing.' - Tim

'There was not a word, not a mention about being gay.' - Luke

Types of homophobia faced by gay and lesbian people

Homophobia comes in many forms: malicious gossip, name-calling, intimidating looks, internet bullying, vandalism and theft of property, discrimination at work, isolation and rejection, death threats or even sexual assault.

Gay Pride celebrations around New York City in 2007

Gay and lesbian people may be subject to varying levels of homophobia depending on where they live, as negative attitudes towards homosexuality can be common even in places where it is legal. For example, areas with a strong religious tradition, such as the Southern states of America, are much less tolerant of homosexuality than areas where there is a strong and established gay scene, for example San Francisco in California.

A homophobic climate forces gay and lesbian people to decide whether to declare their sexual orientation, and face the possible discrimination from their family and society, or conceal their sexuality, allowing others to presume their heterosexuality.¹⁰ Having a concealed identity can cause great anxiety for young gay and lesbian people, and the dilemma of whether to ‘come out’ can cause severe personal distress. Equally, for young people who have been brought up to believe that homosexuality is wrong, the realisation that they might be gay can cause them to feel immoral, and lead to feelings of low self-esteem.

Homophobia can cause extreme harm and disruption in the lives of young gay and lesbian people. In the USA many young gay, lesbian, bisexual and transgender people have become homeless as a result of being rejected by their families after revealing their sexual orientation. A 2006 study found that between 20 and 40 percent of young homeless people were gay, lesbian, bisexual or transgender.¹¹

What can be done to tackle homophobia?

Schools have an important part to play in challenging homophobic attitudes. Lesbian and gay pupils are more likely to feel positive about school if their school has explicitly stated that homophobic bullying is against the rules. In schools that have said homophobic bullying is wrong, young gay people are 60 percent more likely not to have been bullied.

Young people in Massachusetts perform a play about homophobia in high school

Studies have shown that personal attitudes become more tolerant towards gay people if individuals are exposed to an educational programme about homosexuality, such as lectures, courses and workshops.¹²

Also, when schools respond strongly to homophobic bullying, lesbian and gay young people are more likely to feel able to be themselves, more likely to feel part of the school community and more likely to be happy. Therefore it is important to report any incidents of homophobia so that more young people are encouraged to do the same. This also acts as a deterrent to those carrying out homophobic bullying.

Community based organisations have good scope to provide support to gay and lesbian people who might feel marginalised and isolated, especially in societies where homosexuality is banned. Such groups have influence on attitudes of the general public and can campaign for tolerance towards homosexuality.

Other bodies and agencies that could positively influence the way that gay, lesbian and bisexual people are treated are leaders of political parties, police forces, health services, broadcasters and employers.

Finally, many governments throughout the world uphold laws that ban homosexuality. Repealing these laws would reduce discrimination against gay and lesbian people, and would go some way to encouraging societies to embrace the diversity of different sexualities. Eradicating homophobia would not only enhance the human rights and quality of life for gay and lesbian people, it would also encourage gay men to be tested for HIV and other sexually transmitted infections. In the current climate in many places, gay men are too scared to come forward for medical services due to the negative way they expect to be treated.

Homosexual or Gay? Defining Homosexuality

2008-10-20T08:21:00.000-07:00

Why are people called homosexual or gay, and what does it mean?

The terms heterosexual and homosexual are rarely used in everyday speech. More often people use slang words or terms which are abusive. Throughout the last century the terms used to describe gay people and that gay people used to describe themselves, have changed. These changes are important in telling us a lot about how lesbian and gay people lived their lives and felt about themselves as well as social reactions to them. What about the terms, 'straight', 'gay' and 'lesbian' which are commonly used?

The term 'homosexual' is not nowadays sex specific. It was first used by Victorian scientists who regarded same-sex attraction and sexual behaviour as symptoms of mental disorders or moral deficiency. Homosexual men and women decided to use the term 'gay' in order to distance themselves from being labelled as somehow abnormal or ill. In fact, some people find the term 'homosexual' insulting and abusive and object to its use.

Gay male and lesbian female symbols

Generally, the terms 'gay' and 'lesbian' are seen as being less laden with negative implications than 'homosexual'. The term 'gay' is used to describe both homosexual men and lesbian women but has become particularly associated with homosexual men. Its derivation is unclear but may come from the nineteenth century French slang for a homosexual man 'gaie'. Throughout this century it has been used as a sort of code word between homosexual men.

However, in the late fifties and sixties it came into everyday use in association with the struggle for gay rights. In this context the word 'gay' came to represent, as it does now, a word with no negative connotations but associated with a positive and proud sense of identity. Nowadays, the term 'lesbian' is used in relation to homosexual women and is derived from Lesbos, the name of the Greek island on which the lesbian poet Sappho lived in antiquity. In the past homosexual women have been called 'Sapphist' (again after Sappho). 'Straight' is used to describe heterosexual people and is an equivalent term to 'gay'.

'I don't mind so much what people call me as what they mean by it. I have been called a dizzy queen by some friends, and that's all right. But, mostly with people who are seriously prejudiced it's about how they say it - they say 'gay' like it's a curse not something to be proud of.' - Mark, 19

Choosing which term to use and how to use it can be troubling. If a person is describing themselves they can be anxious about the reaction they might get. If a person is talking about someone else, or the issue in general, they can feel anxious about causing offence or saying the wrong thing.

'I think that everyone is OK with the term 'gay' nowadays. It says something about lifestyle and identity as well as sexual behaviour which homosexual doesn't seem to do. I describe myself as 'straight' so I would use the word 'gay' in the classroom. Anyway it's what the kids would say. But they do need to be clear about what all the terms mean otherwise telling off for being homophobic doesn't make any sense to them. They say; 'it's just a word sir'.' - Teacher

Some men and women generally describe themselves as either 'gay' or 'straight'. Using these words gets away from the negative overtones of terminology like 'homosexual' or 'heterosexual' which for these people can feel too "medical". However, words like 'homosexual' and 'heterosexual' can have advantages in other contexts. Communication is a complex affair in which not only what words are used matters but also who is saying them, about whom and in what context.

For example, in school the term 'gay' is used a lot as an insult, and is not a word with positive overtones. A person called 'gay' by homophobic bullies in school might find it abusive because of the way it is said but the same person might happily call themselves 'gay' when they are with friends.

Defining homosexuality

How do you define homosexuality? Although the answer would appear to be simple, on closer examination it is more complex. People writing to magazine problem pages seem to define homosexuality using three criteria:

having sexual feelings towards other people of the same sex;
sexual behaviour with people of the same sex;
and describing oneself as homosexual.

It can be helpful to think of these elements of a person's sexuality in a visual way. It is possible to conceive of sexual feelings, identity and behaviour as three circles which overlap to varying degrees depending on the individual.

Thinking first of sexual feelings and behaviour we can imagine a situation in which two different people might be represented by the diagrams below. In the first diagram the circles overlap about halfway. This person might be attracted to people of the same sex without acting on it - equally they might be having sex with people of the same sex but feeling like most of their sexual feelings are directed to people of the opposite sex. In the second diagram this person's sexual feelings and behaviour go together so that they feel attracted to people of the same sex and have sex with people of the same sex.

In the next situation, thinking of sexual feelings and identity, we can imagine how different people might be represented by these diagrams below. The first represents a person who is attracted to people of the same sex but does not always choose to call themselves gay. In the second diagram this person's sexual feelings and how they describe themselves are completely related.

Thinking of these diagrams it is clear that they could apply equally to defining homosexual or heterosexual behaviour. They also show that defining sexuality depends very much on the individual in question, their sexual feelings, behaviour and how they describe themselves. There is a wide spectrum of potential relationships between the three elements. In other words it can be helpful to think of a spectrum of experience from exclusively homosexual to exclusively heterosexual with many people in between. Sometimes people who feel equally attracted to men and women and have sex with both, choose to place themselves in between and call themselves bisexual.

The main points to bear in mind when defining heterosexuality or homosexuality are:

The three main factors are sexual attraction, sexual behaviour and identity. For most people the factors go together in congruent way. So people tend to behave sexually in line with their sexual feelings. i.e. People tend to be sexually active with people they are attracted to.
However, sexual identity and behaviour may be quite fluid over a period of time and they may not always coincide with each other as people's feelings change. For example, a person may have at some point in their life a partner of the opposite sex and then later on someone of the same sex.
Applying labels to people is not necessarily a good or accurate way of describing them. There may be phases in a person's life when their sexual feelings and behaviour are very clearly homosexual or heterosexual. However, at other times, labelling them as heterosexual or homosexual does not fit exactly with their sexual behaviour or feelings.

However, falling back on simple dichotomising definitions of homosexuality and heterosexuality can be appealing because it keeps the distinctions between them clear. Some common beliefs involve doing precisely this by showing homosexuality as a kind of reflection of heterosexuality. For example:

Believing that some occupations and interests are more attractive and more suitable for heterosexual and others more attractive and suitable for homosexual people. For example, regarding sports as predominantly heterosexual and performing arts as homosexual.
Assuming that when two lesbian women or two gay men are in a sexual relationship they will adopt roles which are traditionally masculine and feminine.
Believing that lesbian and gay people can be identified by the way they look and talk. Thinking, for example, that gay men look more effeminate than straight men and lesbian women look more masculine than straight women.

Any examination of homosexuality inevitably brings into the open implicit assumptions about what heterosexuality is. Stereotypes of heterosexuality and homosexuality and the rigid boundaries between them can be explored by asking questions like:

Do a homosexual couple in love and a heterosexual couple in love experience the same feelings?
If a person who calls themselves heterosexual has sex with someone of the same sex are they heterosexual, homosexual or bisexual?

Coming out - what does coming out mean?

2008-10-20T08:19:00.000-07:00

Coming Out

Identifying yourself as lesbian or gay and disclosing this to other people is often referred to as 'coming out'. There are three main issues associated with coming out:

'Coming out' is a necessary and usually positive experience for most people who grow up lesbian or gay. It can take place in the early to mid teenage years. In this period, coming to terms with confusion about identity can affect a young person's social relationships, school work and self-esteem both negatively and positively.
Many young lesbian and gay people experience critical times when they have to decide who to tell about their sexuality. In making this disclosure they are often fearful of negative reactions, rejection and causing upset and distress to the person they are telling. Sometimes a young person may try 'coming out' to a supportive teacher or a school friend as a precursor to talking to parents in order to rehearse their own part and to judge reactions. Receiving a negative reaction can be very distressing.
Support and guarantees of safety are valuable to people 'coming out'. The availability of secure and confidential groups or contacts can be instrumental in reducing anxiety which is only magnified by feelings of isolation. The presence of role models in the shape of adults who 'come out' and those who offer non-judgmental support and help young people access these groups can be important. Positive treatment by, and contact with, role models can also encourage them to feel confident about their future.

There are several theories about the elements of the 'coming out' process. Each has its own emphasis but all of them are developmental models which regard 'coming out' as a series of stages. These stages do not necessarily last the same length of time and there is no one age when the whole process begins and ends. These stages can be described as follows:

Sensitisation

'I remember feeling very upset when the teacher in our sixth form called me and my friends the 'gay young men'. We were interested in art and hated sport. He thought we were wimps. It is funny, so far about four out of the eight of us have since come out. I don't know whether the teacher knew more about us than we did about ourselves.' - Peter

'I felt as if I had nothing in common with people. There was no conversation - I don't like sport, I don't like any of this stuff.' - Tom

In this stage a person generally begins to feel 'different' to other people of the same sex. Sometimes they recognise that they are not very interested in people of the opposite sex but more often they feel they are not really interested in things which are supposed to be appropriate for their sex. Most people report just feeling unusual when they compare themselves to other people of their sex. Commonly this happens before or in early adolescence when friendships and relationships between the sexes begin to change.

Confusion about identity

'I didn't even know what a lesbian was. It was a sort of tradition that girls in the lower end of the school had crushes on older girls. They were everything you wanted to be and admired. I did wonder once if my crush was just a bit stronger than it ought have been but I was brought up to believe I would meet Mr Right and settle down to 2.4 kids so I just expected it to go away when we started to go out with boys.' - Katie, 21

There are usually four elements which contribute to confusion about identity:

Feeling that perceptions of the self are altering;
Feeling and experiencing heterosexual and homosexual sexual arousal;
Sensing the stigma surrounding homosexuality;
Lacking knowledge about homosexuality.

Research indicates that most young gay men first decide they are probably gay between the ages of 12 and 17, and most young lesbian women first decide they are probably lesbian between the ages of 16 and 20. At this time they have to deal with feeling that they have changed as have their relationships with other people around them. Some also have to combat the potentially powerful feelings of self-recrimination and disgust that come from describing themselves as homosexual. There are various strategies for coping with this emotional upheaval.

Some young people who think they are lesbian or gay will try to deny it to themselves and even seek help to eradicate their feelings. Others will try and avoid thoughts and feelings which remind them that they have homosexual inclinations. In these situations young people can avoid getting any information about sexuality in order to avoid confirming their suspicions about their orientation.

Some young people have great difficulty in managing their relationships with peers and family. They may avoid situations in which they may encounter opportunities for heterosexual pairing so that they are not forced to deal with their lack of sexual interest in members of the opposite sex or have it exposed. They may, alternatively, persevere with heterosexual relationships to try and 'convert' themselves and/or conceal their homosexuality from others.

National coming out day

'You'd keep her for a while, just to keep your mates happy. And then after a bit you just dropped her, saying, 'Ah, didn't really like her, broke down. So you constantly went through the heterosexual bit until you found you were strong enough to go out on your own and tell people.' - Rod

In some extreme cases young people may try to avoid confronting their feelings by expressing strong homophobia or turning to drink and drugs in order to find temporary relief from them.

Finally, some young people fall back on a strategy of redefining their feelings and behaviour in such a way as to convince themselves that it is not really homosexual. For example, they may describe their experiences as a 'phase' or a 'one-off' or they may put them down to extreme emotional or physical circumstances such as the break-up of a relationship or drunkenness at a party. In this stage feelings are becoming more concrete. Young people may well have partners of both sexes and may well find their moods and feelings shifting as they feel more or less certain about their identity. This period often lasts throughout adolescence.

Assuming a lesbian or gay identity

Clearly, living with confusion about identity is emotionally exhausting and potentially destructive. For some people this period is followed quite quickly by a stage in which they come to accept their lesbian or gay identity and are able to express it in a positive way. For both young men and women growing up mixing with other young gay people - in social settings or through support groups - can help them feel able to accept who they are. For some people, particularly in larger towns and cities, lesbian and gay support groups provide a safe environment for 'coming out'. Elsewhere local and national lesbian and gay telephone helplines provide a listening ear for people who want support.

Commitment

'I think when I fell in love it all became so much more concrete for me. I was suddenly very certain of what I wanted and why I wanted it. I mean, I still found myself thinking every now and then, 'why am I gay?', but I came more and more to think, 'I am gay because I love another man'. And I'm proud of that. I am proud of him and I'm proud of me and I don't care who knows it.' - Martin

The final stage in the process of 'coming out' involves becoming openly lesbian or gay and recognising that it is a central aspect of, 'who I am', and, 'how I want to live my life'. People begin to feel that homosexuality is a valid way of life and develop a sense of contentment with being lesbian or gay. They often have the experience of being in a relationship or falling in love at this time and, perhaps as a result, feel more confident, fulfilled and able to combat the social stigma that they may suffer.

At this time some lesbian and gay people begin to feel proud of their sexuality. The expression of this pride in being lesbian or gay is a powerful force in challenging the stigma attached to homosexuality by people with prejudiced attitudes and provides positive role models to others less sure about 'coming out'.

How many gay people are there?

2008-10-20T08:18:00.000-07:00

It is very difficult to calculate even the approximate number of gay people, and in estimating even roughly how many gay people there are anywhere, the following points have to be kept in mind:

How many people we estimate are homosexual depends on how we define homosexuality.
Many more people experience sexual feelings for someone of the same sex than report recent sexual experience with someone of the same sex.
Because homosexuality is stigmatised it is more likely to be under than over reported.

How many gay people are there in Britain?

As of 2008, the most recent statistics regarding numbers of gay and lesbian people in Britain come from surveys done in 1990 and again in 2000. Between 1989-1990, a National Survey of Sexual Attitudes and Lifestyles (NATSAL) of nearly 19,000 people was undertaken in Britain. The survey examined a cross section of people throughout the country, and looked at their sexual attitudes and behaviour, including people's same sex sexual experiences. The NATSAL survey was repeated between 1999-2001; this time the subject group involved less people, at just over 11,000. The results of the study provide us with an interesting comparison of how same sex sexual behaviour is changing in Britain.

Among men they found the following results:

	NATSAL I (%) 1990	NATSAL II (%) 2000
Ever had a sexual experience, not necessarily including genital contact, with a partner of the same sex?	5.3	8.4
Ever had sex with a same sex partner, including genital contact?	3.7	6.3
Have you had a same sex partner in the last five years?	1.4	2.6

And among women they found these results:

	NATSAL I (%) 1990	NATSAL II (%) 2000
Ever had a sexual experience, not necessarily including genital contact, with a partner of the same sex?	2.8	9.7
Ever had sex with a same sex partner, including genital contact?	1.9	5.7
Have you had a same sex partner in the last five years?	0.6	2.6

The differences in the two NATSAL surveys clearly indicate the changes that have been occurring in people's same sex sexual attitudes and behaviours. The greatest change is highlighted in the increase in women who have indicated that they have had a same sex sexual experience, not necessarily including genital contact, as this increased from 2.8% in 1990 to 9.7% in 2000. More men said that they had had a same sex sexual experience too, up from 5.3% in 1990 to 8.4% in 2000, thus showing that either same sex sexual behaviour is either on the increase or that people are more willing to report it.

When looking at same sex sexual attraction, and not necessarily sexual experience, the figures have also changed over the ten-year period, with women showing the most significant difference. In 1990, 93.3% of men said they had only ever had sexual attraction towards the opposite sex, whilst by 2000 this had fallen to 91.9%. 93.6% of women in 1990 said they had only ever been attracted to men, but by 2000 this had dropped to 88.3%. From this we can therefore deduce that 11.7% of women and 8.1% of men have felt a sexual attraction towards the same sex at least once in their lives.¹ ²

How many young gay people are there in Britain?

Among men they found the following results:

	NATSAL I (%) 1990	NATSAL II (%) 2000 16-17 yrs	18-19 yrs	20-24 yrs	NATSAL II Average, 16-24 years
Ever had a sexual experience with a same sex partner?	4.3	1.2	5.6	6.3	4.3
Ever had sexual intercourse/genital contact with a same sex partner?	2.4	1.2	2.3	4.2	2.6

And among women they found these results:

	NATSAL I (%) 1990	NATSAL II (%) 2000 16-17 yrs	18-19 yrs	20-24 yrs	NATSAL II Average, 16-24 years
Ever had a sexual experience with a same sex partner?	3.0	5.1	9.7	12.6	9.1
Ever had sexual intercourse/genital contact with a same sex partner?	1.4	2.5	4.6	6.5	4.5

By adding the three figures for each category in NATSAL II, and getting an average percentage, we can at least gain some comparison between the two sets of data. The differences are again most apparent in women, especially in the sexual experience category, with the figure rising from only 3.0% in 1990 to 9.1% in 2000. The differences in men are less obvious, with the average for sexual experience for 2000 being the same as 1990, at 4.3%. What you can deduce from the male data is that same sex sexual experience does increase more rapidly over the age of 18 years; the data for 18-19 years and 20-24 years, at 5.6% and 6.3% respectively, is higher than the whole 16-24 year average of 4.3%.

How many gay people are there in America?

As well as the problems outlined above in estimating the number of gay people, the geographical size and dense population presents an additional problem for anybody trying to calculate the number of gay people in America.

However, Alfred Kinsey carried out research in the 1940s and 1950s into the sexual behaviour of 12,000 men and women in America. Although his work has been heavily criticised it remains a rare and relatively authoritative study of sexual behaviour in America.

Amongst the men he found:

37% reported some homosexual contact;
13% reported more homosexual than heterosexual contact;
4% reported exclusively homosexual contact.

Amongst the women he found:

13% reported some homosexual contact;
4% reported more homosexual than heterosexual contact;
1% reported exclusively homosexual contact.

From these results Kinsey realized that not only were few people exclusively homosexual, but also far from the vast majority, particularly of men, were exclusively heterosexual. This led him to develop an orientation scale, which had exclusively heterosexual and exclusively homosexual at opposite ends with a wide middle range to cater for the majority of people who were neither.

More recently, data has been collected in America, during the ten-year national census, on married and unmarried-partner households. They did not ask the actual sexual orientation of the respondents, so there is no measure of single gay people, nor is their a measure of those gay people in committed relationships but not living together. Whilst the census cannot give us a figure for the number of people who are gay in America, it can inform us on how many same-sex partnership households identified themselves in the survey. The 2000 census tells us that

there are 105.5 million households in the USA;
5.5 million of these consist of unmarried partnerships;
of these, 595,000 consist of same sex partners.

This can be interpreted as there being nearly 1.2 million gay people living with a same sex partner in America. This is a huge increase from the 1990 census, which identified only 145,000 same sex unmarried households. As with the NATSAL survey in the UK, there is undoubtedly a large amount of under reporting in these sorts of surveys. Possible explanations of this include continued prejudice and discrimination against gay people.³

There have been various other surveys in the US that have tried to measure numbers of gay people. An analysis of these surveys by the Human Rights Campaign came up with this conclusion:

"In the last three elections, the Voter News Service exit poll registered the gay vote between 4 percent and 5 percent. While concluding that the Census 2000 undercounted the total number of gay or lesbian households, for the purposes of this study, we estimate the gay and lesbian population at 5 percent of the total U.S. population over 18 years of age, (209,128,094). This results in an estimated total gay and lesbian population of 10,456,405. A recent study of gay and lesbian voting habits conducted by Harris Interactive determined that 30 percent of gay and lesbian people are living in a committed relationship in the same residence. Using that figure, we suggest that 3,136,921 gay or lesbian people are living in the United States in committed relationships in the same residence." ⁴

So, if we accept that the data presented by the Human Rights Commission is indeed indicative of the real numbers, then it shows that the census data is only showing up a small percentage of the actual number of gay people living in America. Until, however, a nationwide survey is done, asking questions on sexual attitudes and behaviour, then we can only use data and analyses, such as the ones above, to work out an answer to the question of gay people living in America.

Is homosexuality more common now?

Throughout history there have always been people who have had homosexual feelings and experiences. In fact, in some cultures, at some times, these feelings have been celebrated or at least accepted rather than stigmatised. However two major changes in most of Europe and America have taken place, which may have given the impression that homosexuality is now more prevalent than at any other time.

Images of gay and lesbian people, their lifestyles and the issues they face have become very much more visible in recent years. There are gay and lesbian characters and story-lines in soap operas – for example, ER (US), Queer as folk, The OC (US), Hollyoaks (UK) – as well as situation comedies like Will and Grace (US), Sex in the City (US) or Absolutely Fabulous (UK), and popular programmes like The Simpsons. There have also been very powerful gay, lesbian and bisexual images and image-makers in popular music and culture, such as Elton John, K.D. Lang, Pet Shop Boys, Will Young, REM and George Michael. Programs where contestants rely on public telephone votes to remain or to win have been won by out Gay and Lesbian people, for example Big Brother (UK), Fame Academy and Popstars (UK).
At the same time there have been a series of important struggles for gay and lesbian equality, and to counter homophobia. In Britain this has been marked by demands for the right to be parents (adoptive and natural), the right to fair treatment at work and so on. These have, as has often been intended, attracted considerable media, political and legal

Gay at School

2008-10-20T08:16:00.000-07:00

When asked, it seems that many gay men and lesbians remember their school days with very mixed feelings – a time when, in addition to the growing pains that all teens suffer, they suffered additionally at the hands of a homophobic education system, and of their classmates. Furthermore, not only do gay pupils often have an unpleasant school experience, but they also are often denied sexual health information that is relevant to them. An education system that fails gay pupils in terms of both their social and their educational experience is clearly unacceptable – and, denying gay pupils appropriate HIV education could ultimately cost their lives.

Whilst in most cases it wasn’t all bad, there were certainly things that could have been done to make things better, and here we look at what can go wrong, and discuss what could be done – and what should be done to make sure new generations have a better experience, are able to protect themselves against HIV and STD infection, and look back fondly on their schooldays.

Prejudice and bullying

It is unacceptable for young gay men and lesbians to experience levels of prejudice and discrimination that mar their developing years and their school experiences. They, just as much as anyone, should be able to look back warmly on their school days, without remembering bullying, name-calling, and exclusion.

Even among children who have not yet developed an awareness of their sexuality, prejudice is already a problem. They might not actually know what ‘gay’ means – just as they don’t have a concept of ‘straight’ – but they do have the impression that it means something negative.

"You picked up (homosexuality) wasn't accepted ... and it wasn't liked."

- Tom -

The word ‘gay’ is still used by schoolchildren as a negative adjective – which shows that they aren’t even clearly aware of what the word actually means, let alone the concepts it represents. The word ‘gay’ is often employed negatively in the playground, perhaps because pupils have picked up from older friends or family that there are negative attitudes attached to the word. They are too young to have much understanding of sexuality when they are first exposed to these attitudes, so prejudice has already taken root when they develop to a point where they are aware of the varieties of human sexuality. Not only does this result in unpleasant behaviour towards gay pupils, but in an intolerance to any deviation from gender roles. Any pupil who displays characteristics associated with the opposite gender – girls who show ‘boyish’ character traits and boys who show ‘feminine’ behaviour – risk being identified as ‘gay’, and bullied.

“I guess from a young age I knew I was different from the other guys, because I used to hang around with the girls at break and lunchtimes, and I absolutely despise sport! I was also bullied at school, mainly because I liked reading and watching documentaries. I don’t see anything wrong with that, but it wasn’t seen as ‘cool’ or ‘something guys did’”.

- Steven -

“The only mention of gay men was jokes. Even the teachers made jokes at my expense because of the rumours about me. Which is something that I found really hurtful.”

- Daniel -

Young people can often be very intolerant of anyone who doesn’t fit in, and these prejudices, already well-established by puberty, can cause great distress for gay or lesbian pupils, who, gradually becoming aware of their sexuality, come to realise that they are a member of a despised group. This can effect self-esteem badly and be a very upsetting time. As they grow older, gay pupils are faced with the very difficult decision of whether to ‘come out’ at school – or whether to try to hide their sexual identity from their peers.

“I want to come out the closet but I'm too scared. My whole school is filled with people that just take the piss out of gays, and I wouldn't be able to stand it.”

- Dani -

“When I started to realize in 5th grade that being gay wasn't accepted, and that most people believed it wasn't real, I started my hiding.”

- Cody -

Young people can be just as cruel and prejudiced as can adults – being ostracised or becoming a target for the bullying that is so often aimed at lesbian and gay pupils can mean that there can be very negative consequences to coming out.

"I'd say don't tell a school friend first unless they're the closest, closest, closest most trustworthy friend you know. One of the people I told let slip and suddenly the whole year knew. Nobody said anything directly to me but I did notice a lot of the boys suddenly weren't friends and they'd ignore me and they'd be laughing when I was around. Other people I know have had a much worse time than that, but it was bad enough."

- Andy -

Prejudice clearly needs to be addressed in schools, both amongst pupils and teachers. Prejudice comes from ignorance, and can best be tackled with exposure and education.

“I kept myself to myself so I got the grief of being bullied. I twice nearly killed myself cos of the bullying. . . I still get the usual ‘Hey puffter what u doing still alive?’ and crap like that”

- Gary -

When prejudice comes from other pupils, it comes in the forms of bullying, name-calling, harassment, sometimes physical violence. Today, many schools will have developed an anti-bullying policy which presents a strategy for the prevention of bullying before it happens, offers avenues through which bullied pupils can seek help and advice, and lays down guidelines for dealing with cases of bullying that do arise. An anti-bullying policy should recognise that pupils may be bullied because of their sexuality – or because of inferences that have been made about their sexuality.

Even more insidious, however, is prejudice that might also be felt by the school staff. Pupils look to their teachers for example, and if they see the teachers engaging in prejudicial behaviour then this sends the message that such behaviour is to be emulated. If teachers have homophobic attitudes, this can truly make the school an utterly hostile environment for gay or lesbian pupils. Additionally, discriminatory behaviour from teaching staff can have a negative impact on a gay pupil’s academic success – which can impact hugely on their later lives.

“The only mention of gay men was jokes. Even the teachers made jokes at my expense because of the rumours about me. Which is something that I found really hurtful.”

- Daniel -

The young people who are exhibiting prejudice also need to be helped, just as much as those who are on the receiving end of it. Prejudice comes from ignorance and fear, and if these problems can be resolved in young people while they are still in school, their chances are increased of growing up as healthy, accepting individuals, free from hate and fear.

AVERT.org has more about homophobia, predudice & attitudes to Gays and Lesbians.

Lack of information

Young gay men are disproportionately affected by various sexual health issues – specifically HIV, as we discuss on our AIDS and young gay men page. They need to be given the information that will enable them to identify risks, and to take action to protect themselves – before they reach an age when they will become sexually active. An education system that fails in this regard is one that puts lives at risk.

Education, however, unfortunately does not always do enough to address these problems – and, in some cases, may even add to them. All too often, even if sexual health education does exist, it doesn’t even mention gay people.

"We used to have discussions in biology about the birds and the bees and if you come out and said, 'well what about gay people', they'll look around and think 'oh, he's gay'. So you just keep quiet."

- Mark -

Many teachers, uncomfortable with the subject, actively attempt to keep sexual issues out of their classes, but issues surrounding relationships and family life come up in many more subjects than only sex ed or biology. In most cases, wherever the lesson touches on these matters and an example is used, an assumption of heterosexuality is made. From Geography to English Language, gay pupils learn that they are excluded.

"Occasionally the teacher would bring up the idea of homosexuality and being gay and then it was such an amazement to the rest of the class because no-one else would bring it up. And then some really ignorant remarks would come from the boys, the lads at the back of the class."

- Kevin -

Not only are issues affecting gay people often not covered by the curriculum in terms of sexual health education, but the sex ed that pupils do receive is also heterosexually orientated, and therefore inappropriate and of little value to gay pupils.

It is important for gay pupils to know how to protect themselves in the event that they choose to have a heterosexual encounter at some point in their future lives; it is similarly important for straight pupils to be able to protect themselves, should they have sex with a person of the same gender.

"I was waiting and expecting to hear something about homosexuality, safe sex and different things in sex education. Maybe some information that could help me. But I got nothing. There was nothing."

- Tim -

Learning the right lessons

The educational emphasis should ideally be on a pupils primary mode of sexual expression, but it is faintly ridiculous to expect a pupil to decide whether they want to put themselves down for gay or straight sex education classes! The solution is to ensure that sexual health education involves discussion of gay and straight issues.

When schools do offer practical advice in avoiding HIV / STI infection, it is commonly aimed at straight pupils, with no mention of prevention methods for gay pupils.

This may be because STI / HIV prevention for gay men and lesbians involves discussion of specific prevention methods, which means, in turn, discussion of ‘gay sex’. Teachers, often, are too embarrassed to discuss ‘what gay people do in bed. ’

No sexual health education class can be even remotely adequate without including this type of information, however, and the discomfort of teachers and parents has been, for too long, allowed to frustrate the needs of pupils both gay and straight. If regular teachers are too uncomfortable dealing with sexual issues, however, then an external specialist teacher should take some sessions.

Given that gay men are disproportionately vulnerable to HIV infection and certain STIs, any comprehensive sexual health course should offer information about how gay men can protect themselves from disease transmission. It should also offer an explanation of gay sexuality and lifestyles, which should be of benefit to gay pupils – and should also help to dispel ignorance, and thus fear of the unknown and prejudice, found amongst other pupils.

Sexual health education, if it exists, offers the opportunity to begin providing education about different sexualities and different lifestyle options. This needn’t be restricted to a sexual health class, though – any lesson can begin to make clear that, where they refer to family systems or relationships – that these don’t have to be heterosexual to be successful.

“ I told a few other close friends but one day in an AS level history class we ended up discussing HIV/AIDS rather than the German Reformation. Well one person said 'Its all them who spread it- those gays' to which in outrage I shouted ‘WE DON'T SPREAD IT THANK YOU!’

- Tom -

Some academic planners seem to fear that pupils who are taught about gay sexuality will want to rush out and try it! In fact, this fear seems to apply increasingly to education about heterosexual lifestyles and sexual activity, too. This is obviously not the case, and, time after time studies indicate that sex education reduces teenage pregnancies and STI infection. Gay pupils need to be able to protect themselves from infection, too. And giving someone information about something certainly doesn’t encourage them to do it – the converse, often, if the risks are openly and sensibly presented.

“ I told a few other close friends but one day in an AS level history class we ended up discussing HIV/AIDS rather than the German Reformation. Well one person said 'Its all them who spread it- those gays' to which in outrage I shouted ‘WE DON'T SPREAD IT THANK YOU!’ ”

- Tom -

This is a problem that needs to be addressed by society as a whole – parents are often uncomfortable talking to their children about sex, and are little happier about the idea of their teacher providing the necessary information. Parents need to know that sex and HIV education is ‘safe’, and that it won’t encourage any ‘immoral’ behaviour in their offspring, whether gay or straight.

Teachers also need to learn this. In some schools, sex ed classes will be covered by a regular school teacher who has volunteered – someone who is normally the English teacher, for example. Other schools have no sex ed on their curriculum, and what little information the students do receive comes under the umbrella of the Biology syllabus, and is covered, often reluctantly, quickly, and awkwardly, by the Biology teacher. And some schools choose to have someone come in from outside the school to cover these classes.

Lessons might include a range of topics, from social issues, such as rights of gay spouses, and same-sex parents, to topics that need to be more explicit, such as safer sex for gay men. It is not possible to teach about safer sex without mention – and, ideally, discussion – of different sexual practices.

Some schools have no sex ed on their curriculum – sometimes because the political climate forbids it, sometimes because the school itself, perhaps a religious organisation – prefers not to discuss such matters. These are the organisations where the pupils will receive information only in their Biology classes under the heading of ‘reproduction’. Sometimes these classes can be about – literally – the ‘birds and the bees’ , and will leave young people confused and ignorant. The teacher, often uncomfortable with the topic him/herself, will have managed to communicate little more than that human sexuality is embarrassing, and you don’t discuss these things.

This not only means that homosexuality is unlikely to be adequately discussed (if at all), but furthermore, a teacher who communicates to the class that these topics are uncomfortable, unmentionable ones will damage the self-respect of gay class-members, and amplify the prejudice they already experience.

Talking to pupils about sexual health issues, or issues surrounding sexuality, can be awkward for some staff members, and for them to feel more comfortable, they need to know that they are teaching pupils the right information – for the right reasons. They shouldn’t feel uncomfortable about their topic, and certainly shouldn’t, themselves, be prejudiced against gay men and lesbians.

Teaching the teachers

Teachers who feel ignorant about the issues involved will be embarrassed by a discussion of heterosexual issues, and may find discussion of gay sexuality and behaviour even more difficult. Teachers need to be prepared for any possible questions that they may be asked, and need to have a good knowledge of the facts and issues surrounding human sexuality. A teacher who knows his/her topic well is much more comfortable in the classroom – and thereby makes pupils much more comfortable with the topic.

This is important in terms of having functional lessons – students need to be able to get on with group work, to engage with their topic enthusiastically, and to indulge their natural interest in learning about issues that ultimately will affect them. Often, in a well-managed class, they will need no encouragement to learn – their own interest will stimulate this.

An uncomfortable teacher will have a dysfunctional class, with students giggling together behind cupped hands, whispering at the back of class, and one or two students trying to embarrass the teacher further by asking awkward questions. At the end of this class, students will be no better informed than they were at the beginning of it. If untrained in sexual health education, an Biology teacher, for example, when asked to teach a safer-sex lesson which involves topics such as ‘oral sex’, ‘anal sex’, and ‘sex between women’, is likely to be extremely uncomfortable. The teacher is likely to communicate this discomfort to the class, and will try to brush over those topics that make him/her feel uncomfortable.

Teacher training is one obvious answer to this problem – a teacher who is to discuss issues of sexuality in their class should first feel comfortable with the issues themselves. Appropriate training for teachers can familiarise them with questions that they might have to deal with, and ensure that their knowledge of the subject is complete.

Another solution would be for the school to import teachers from outside the school to teach HIV / sexual health / sexuality education topics, or to have one teacher in the school who is designated with responsibility for these topics. They must not become an afterthought to the curriculum. Certainly, social education such as the awareness of prejudice should be present throughout the curriculum.

Very few schools employ openly gay teachers, but this would provide both positive role-models for gay pupils, and, by showing good examples of gay men and lesbians, would help to disperse ignorance amongst pupils as a whole, and thereby prevent prejudice from taking root.

Too often, however, staff receive no specific training, and any limited explanation of sexual health and behaviour that they give their students will contain no information for gay pupils. Of course, there are other issues relevant to gay pupils in addition to just sexual health. Schools often also fail to present any information that might give pupils an idea of the experience of living as a gay person in the wider world outside the classroom.

What is needed?

The school system exists to educate and prepare young people for a place in adult society, and, if it does not provide gay pupils with the information they need to have safe sexual relationships, if it allows heterosexual pupils to leave school with prejudice and lack of understanding of this social group – then the school system has failed.

Fortunately, this doesn’t happen in all cases – some schools offer sexual health education that contains a component for gay pupils, and try to make their lessons anti-discriminatory. They may employ openly gay teachers, and have an anti-bullying policy that caters to the needs of pupils who are targeted because of their sexuality.

These schools are often in the minority, though. Often, even if a school wishes to do so, it feels unable to institute such policies because it is worried about negative reactions from local government, from parents, or from local media. This suggests a need for legislation to ensure that comprehensive education is just that – education that caters for all pupils, regardless of their sexual orientation.

Am I gay? Are you born gay? Can you stop being gay?

2008-10-20T08:15:00.000-07:00

Am I gay?

Sexuality can be confusing

Many people have feelings towards other people of the same sex, and wonder whether this means that they are gay. For many people these feelings can be very intense and alienating. Some people who are attracted to other people of the same sex are gay and go on to have sexual relationships with people of the same sex. But other people who have gay feelings find that these change over time and they become attracted to people of the opposite sex.

Other people are attracted to both men and women, and have relationships with both. Some people are not attracted to anyone and wonder if this is a sign of homosexuality. Often it is only time that will resolve these feelings. If you think you might be gay and feel you need to talk to someone most countries have telephone helplines and organisations that can provide information and support for you.

When do people know that they are gay?

There is no simple answer or standard answer to this question, as it varies from person to person. Generally it can be said that being gay is not something a person suddenly begins to consider, and it may not be something they can initially put a name to. Research published in 1996 showed how the young gay men interviewed had described a set of feelings which they gradually realised made them 'different' in some way, and a set of feelings they thought maybe every teenage boy has.

“I thought, well, this is just the phase bit. Sooner or later I'm going to start finding women attractive. I never did. As I became more attracted to men, and I still wasn't getting attracted to women, I thought, shit, you're gay. And it was really quite a shock when it hit me.” - Luke

Eventually all people who are gay realise that not only are they sexually attracted to members of the same sex, but that this attraction is not transitional. This realisation could come at any time during their lives. Some may keep their sexuality a secret, while others may decide to come out.

Is homosexuality a phase young people go through?

For some people yes, and for others no. Some people do not have their first homosexual feelings or experience until they are well into adulthood. In a national survey in Britain carried out in the 1990s, nearly the same number of women reported their first homosexual experience had happened in their twenties as did in their thirties, forties or fifties. But, there is evidence that for some people homosexual experiences may well be part of a transitional or experimental phase in their youth. This is hardly surprising given that adolescence is a period of change in which many people find who they are and what they want for themselves in adult life. This kind of behaviour is perfectly normal.

Are you born gay? What causes people to be gay?

“One of the things I can remember thinking a lot about is ... why am I like this? Is it someone's fault?”

- Rob

There is no simple answer to the question, 'Are some people born lesbian or gay?' There are some theories which stress biological differences between heterosexual and homosexual adults, suggesting that people are born with their sexuality already determined.

In 1993 the American researcher Dean Hamer published research that seemed to prove that homosexual orientation could be genetically transmitted to men on the x chromosome, which they get from their mothers. However when this study was duplicated it did not produce the same results. A follow-up study which Hamer collaborated on also failed to reinforce his earlier results. Most recently research published in April 1999 by George Rice and George Ebers of the Universty of Western Ontario has cast doubt on Hamer's theory. Rice and Ebers' research also tested the same region of the x chromosome in a larger sample of gay men, but failed to find the same 'marker' that Hamer's research had produced. Claims that the part of the brain known as the hypothalamus is influential in determining sexual orientation, have yet to be substantiated. At the moment it is generally thought that biological explanations of sexuality are insufficient to explain the diversity of human sexuality.

“How can science tell you what I am? I mean I've had boyfriends, and was happy with them, had girlfriends and may have boyfriends again for all I know. If it's a gay gene what's going on? Is it just turning itself on and off in my head? It doesn't feel like biology it feels like love.” - Jo

Psycho-social explanations offer a variety of factors that could contribute to the development of a person's homosexuality. For example, a female dominated upbringing in a gay man's past, with an absence of a male role model. Others stress adherence or deviance from conformity to gender roles, and individual psychological makeup. While none of these factors alone completely answers the question 'what causes homosexuality?', they rule out some things. For example, lesbian and gay young people are not 'failed' heterosexuals. Also, homosexual partners are generally of the same age proving wrong the assumptions that young people are 'turned gay' by older people.

What is clear is that people's behaviour is influenced by their family environment, their experiences and their sense of themselves. Beliefs about sex are initially shaped by family values. Later on these beliefs may be shaped by pleasant and unpleasant experiences of sex and also shape their choice of activities and partners. Throughout their life a person's sense of who and what they are has a strong impact on their sexual development and experience.

Can you stop being gay?

There is now growing general support for the belief that sexuality is pre-determined and may change over time, or remain fixed. However, many people are interested in whether sexuality can be altered solely by a person's desire to change. Organisations that help homosexuals attempt to change their sexuality can be generally divided between those that use psychological 'reparative' methods and those that use religious 'healing' methods.

Some people believe homosexuality is an illness and believe it can and should be cured. Many of these 'cures' revolve around psychological therapies (often called reparative therapy) which endeavour to re-orient a homosexual sexuality to heterosexual. Although there is little scientific data to evaluate, what is available seems to indicate that reparative therapy is ineffective. American Psychological Association (APA), the world's largest association of psychologists has stated that:

“Homosexuality is not a mental disorder and the APA opposes all portrayals of lesbian, gay and bisexual people as mentally ill and in need of treatment due to their sexual orientation.”

Some strongly religious groups believe that homosexuality is sinful and is in direct breach of the bible and other religious texts. As with reparative therapy there has been little to no scientific evaluation of the healing and prayer techniques used. What evidence is available suggests that the success of these techniques is restricted to three areas:

Convincing bisexuals to limit their sexual activities to members of the opposite sex.
Convincing homosexuals to become celibate.
Convincing gay men and lesbians to attempt to maintain heterosexual relationships, whilst retaining their homosexual orientation.

Tellingly two founders of a ministry established to 'heal' homosexuals later described their programme as 'ineffective ... not one person was healed'.

Recently the issue of changing homosexual orientation has been drawn into political debate in America. Although this is partly due to an issues shortage in American politics, the subject of 'curing' homosexuality has apparently captured the imagination of many Americans. Controversial full page newspaper adverts by Christian political organisations have appeared three days in a row. The adverts, which firmly promote the theory that homosexuality can be changed through force of will alone claim that 'thousands are leaving their homosexual identity for sexual celibacy, and even marriage'.

This appears to have been sparked from a speech by the Senate Majority leader in June 1998 that described homosexuals as people who are sick and can be cured - but only if they want to

Gay men and lesbians, Sex, Relationships and AIDS

2008-10-20T08:14:00.000-07:00

Why should lesbians think about HIV?

Generally, lesbians are at low risk of HIV infection, unplanned pregnancy and becoming infected with STDs. However, even though sex between women has a reduced likelihood of transmitting HIV, transmission can still occur. Sex between women is not always safe, and therefore women need to know the risks and how to protect themselves.

HIV and AIDS

Lesbian or bisexual women are not at high risk of becoming infected with HIV through woman-to-woman sex.

However, like many women:

Some lesbians have unsafe sex with men
Some lesbians inject drugs and share needles
Some lesbian sexual practices are risky (see underneath for more details)
Lesbians wanting to get pregnant face decisions about semen donors

What is ‘safe sex’?

‘Safe sex’ is any activity through which you are at no risk of becoming infected with HIV or a sexually transmitted infection (STI). HIV is found in the blood and the sexual fluids of an infected person, and in the breast-milk of an infected woman. HIV transmission occurs when sufficient of these fluids get inside the body of an uninfected person. Sexual transmission of HIV is most common between men, and between men and women, but it does also happen between women – something that’s often ignored in sexual health information.

So safe sex is sex that doesn’t allow any infected body fluid to enter your body – and doesn’t allow you to infect your partner, either. Activities that are safe include hugging, touch, massage, masturbation. Sex toys, whatever, are fine, too – just put a condom over them, and if you switch them from one person’s body to another’s then change the condom.

What are the risks?

HIV - the virus that causes AIDS - is in the blood, breast milk, vaginal fluid or semen of someone with HIV, so you are at risk if you get any of these fluids in your bloodstream.
The risks of sexually transmitting HIV between women are very low. Very few women are known to have passed HIV on to other women sexually.
The risk of HIV being passed on through oral sex is low - but there is increased risk if a woman has cuts or sores in her mouth, or if her partner receiving oral sex has sores on her genitals or is having her period.
Oral sex is safer if you use a 'dental dam' (a square of latex or cling film) to stop any vaginal fluid or menstrual blood getting into your mouth. A condom cut open and spread flat can also be used for this.
Sharing sex toys (for example vibrators) can be risky if they have vaginal fluids (juice), blood or faeces on them. Always clean them well and have one each. This is one area of sex where sharing is a bad idea!
Any sexual activity that can lead to bleeding or cuts/breaks in the lining of vagina or anus is risky, including 'fisting' or certain S&M activities.
If you are thinking of donor insemination to get pregnant, be sure you are aware of your possible donor's detailed medical history and any possible risk factors - including drug use and sexual history. If you want to be sure, you may want to suggest your donor takes an HIV test before you go ahead.

Other Sexually transmitted Infections (STIs or STDs)

Although we have seen that lesbian and bisexual women are at low risk of getting HIV from sex with another woman, many other sexually transmitted infections - such as herpes or thrush - are just as common for lesbians as for women who have sex with men.

Thrush is an overgrowth of yeast causing vaginal itching and soreness, often with a white discharge. It is possibly passed via sex between women, though oral sex is low risk.
Bacterial Vaginosis/BV or Gardnerella is an overgrowth of vaginal bacteria causing a smelly discharge, which lesbians often experience. There is a possible link with perfumed soaps and bath oils.
Genital Warts are painless bumps on the vulva, in the vagina, on the cervix or round the anus. They can be passed through contact with the wart, for example by touching, rubbing or sharing sex toys. It is unlikely non-genital warts, such as on hands, can be transferred to the genitals.
Trichomonas vaginalis (TV) gives a frothy, itchy vaginal discharge and is passed on by contact with the vagina only, for example by touching or sharing sex toys.
Herpes can cause painful sores on the inside of the vulva/vagina or anus (these are genital herpes) or on the mouth (cold sores). Herpes can be passed on through contact with a sore, for example by touching, fondling or sharing sex toys. Oral sex when a cold sore is present can also transmit the virus. It can be possible to have the herpes virus, be infectious and yet never have had any symptoms.
Crabs/Pubic Lice cling to pubic and other body hair causing itching and sometimes blood spots from bites. They are spread through naked body/skin contact.
Chlamydia and Gonorrhea are rare in lesbians but if they are present may be passed on through sharing sex toys or rubbing vulvas together. Often there are no symptoms, though there may be a discharge. The first sign of both infections may be pain in the pelvic region (pelvic inflammatory disease or PID). There is a risk of infertility for women who have had untreated chlamydia.
Syphilis is very infectious and close skin contact during sex can pass it on.
Hepatitis B is a viral infection that in its most infectious forms can easily be passed on in sex - for example by touching or sharing sex toys. There are often no symptoms, though it can cause jaundice (yellow skin) or nausea.

Treatment is available for all the sexually transmitted infections mentioned above, often with antibiotics, and most can be cleared up quite rapidly. It is vital you seek help as soon as you notice any symptoms and that you do not have sexual contact that could pass on any infection until it has been dealt with.

Smears

Looking after yourself also means having regular cervical smears, even if you have never had sex with a man, or not for years. The reason for this is because sex between women can transmit HPV, the virus associated with cervical cancer. These tests can detect pre-cancerous cells and early treatment can mean cancer never develops. Your doctor can help with this.

HIV, AIDS and men who have sex with men

2008-10-20T08:11:00.000-07:00

Sex between men happens in every part of the world. Some men who have sex with men (MSM) label themselves as gay, others as bisexual, while a large number – particularly outside western countries – simply see themselves as ‘normal’ males who just happen to have sex with other men.

"I’m not gay… I just like having sex with men." - Noun, Cambodia ¹

In the context of the global AIDS epidemic, sex between men is significant because it involves anal sex – a practice that, when no protection is used, carries a higher risk of HIV transmission than unprotected vaginal sex. Historically, AIDS was first discovered among self-identified young gay men in the USA, and throughout the course of the global epidemic, consistently high levels of HIV infection have been found among MSM in many countries.

Organisations representing MSM have also played an active and outspoken role in the response to AIDS. In the USA and the UK for example, gay men’s organisations have raised a great deal of awareness about HIV and AIDS. These groups continue to provide many services to both prevent people becoming infected with HIV, and to help those who are HIV-positive. Another example is Brazil, where groups of gay men exerted a lot of pressure on the government to protect the rights of HIV-positive people in the early years of the nation’s AIDS epidemic.

In many countries however, MSM are not so visible. Sex between men is stigmatised, officially denied and criminalised in various parts of the world. This adds to the vulnerability of MSM, making it difficult to monitor them, and making it near impossible to carry out relevant HIV prevention campaigns in some countries. In places where homosexuality is not tolerated, MSM often hide their same-sex relations from their friends and families to avoid persecution. Many have wives, or have sex with women as well as men, and this means that they may transmit HIV to their female partners if they become infected. The significant impact that HIV is having on MSM is therefore not an isolated problem, but one that is very much linked to countries’ wider HIV epidemics.

MSM and HIV – the global picture

A centre for men who have sex with men in India

Worldwide, it’s estimated that sex between men accounts for between 5 and 10% of HIV infections. The situation varies between countries however, and in much of the developed world – including the USA, Canada, the UK, Australia and New Zealand – more people have become infected with HIV through male-male sex than through any other transmission route.

Sex between men is also a prominent feature in the spread of HIV in less developed regions. In Latin America, sex between men accounted for a quarter of new HIV infections during 2005. In Asia, HIV prevalence levels among MSM have reached as high as 18% in Andhra Pradesh, India, 15% in Phnom Penh, Cambodia, and 28% in Bangkok, Thailand – figures that are many times higher than those found among these countries’ overall populations. In Japan, around 60% of HIV-positive people are MSM.² In Africa – a region not commonly associated with male-male HIV-transmission – there’s evidence from some countries that transmission through this route is a significant problem. In Senegal for instance, one study recorded that 22% of MSM were living with HIV.³

Although statistics like these give an idea of the impact that AIDS is having on MSM, data is still extremely scarce in many countries. This is largely due to the fact that MSM often have no separate social identity, and are simply counted as part of the general population. It is also due to the reluctance of governments to acknowledge MSM, and to monitor this group.

Another factor blurring statistics is that it’s not always possible to tell how a man became infected. If he is having sex with women as well, he may well report that HIV was transmitted to him from a woman (or even if he is only having sex with other men, he may lie because of stigma). This can distort figures.

From the information that is available, it’s clear that HIV is a significant burden to communities of MSM around the world. But why is this the case? To answer this question, we need to look at the factors that put MSM at risk.

What makes MSM vulnerable to HIV?

Biological factors

It’s easier for HIV to be transmitted through unprotected anal sex than through unprotected vaginal sex.
If a man has another sexually transmitted infection (STI), this can be an extra biological factor that increases his risk of becoming infected with HIV. STIs are relatively common in some communities of MSM, and because men do not always think – or are not always encouraged – to be tested for STIs that are present rectally, these infections often go undiagnosed and untreated. In many cases, fear of discrimination stops MSM from accessing testing services.

Behavioural factors

Certain behaviours increase MSM’s risk of becoming infected with HIV, such as having multiple sex partners, not using condoms consistently, not learning about HIV or having a complacent or negative attitude towards safer sex.
Alcohol and drugs are a common part of socialising in some communities of MSM. Drink and drugs can make it more likely that people will have unprotected sex and a higher number of sexual partners. In the U.S. for instance, a study in Los Angeles found that MSM who used the drug crystal meth were three times more likely than non-drug using MSM to be infected with HIV.⁴

Social/cultural factors

Some governments and societies are in denial about the fact that sex between men happens, and it is a taboo subject in many cultures. As a result, HIV prevention campaigns often only talk about the risks of heterosexual sex, and there is little appropriate information available to MSM, which can give them the false impression that they are not at risk. There is evidence that this has happened in some Asian countries, for instance.⁵
In countries where sex between men is criminalised, MSM are excluded from sexual health services and might find it hard to access condoms and lubricants to protect themselves from HIV.
A certain proportion of sex between men in most countries is commercial. As with female sex workers, male or transgender sex workers may find it difficult to persuade their clients to use condoms, or may be offered more money to have unprotected sex, increasing the risk that they will become infected with HIV. In some countries there are HIV programmes aimed at female sex workers, but none targeting male sex workers.⁶
In countries where antiretroviral drugs are widely available, a climate of optimism about the effectiveness of this treatment may lead some MSM to take more risks.⁷

Responding to HIV among MSM: the challenges

In the early years of the global AIDS epidemic, it was widely acknowledged that HIV was having a severe impact on MSM in the US and other developed countries where there were visible communities of self-identified gay, lesbian and bisexual people. This led to swift grassroots responses from gay activists, often with support from national governments who realised that carrying out HIV prevention campaigns aimed at gay people was not only the right thing to do on humanitarian grounds, but also something that made sense as a wider public health measure. These early prevention efforts (which included condom promotion and educating men about AIDS) were very successful, and helped to reduce the number of MSM becoming infected with HIV in a number of countries.

HIV prevention poster aimed at MSM in New Zealand

In recent years however, the impact of these interventions has leveled off and HIV is becoming common among MSM in many developed countries. It has also become increasingly clear that there is a desperate need for HIV prevention initiatives aimed at MSM in developing regions such as Asia, Latin America and Africa. However, very few countries in these regions are making sufficient (if any) efforts to stem rising rates of HIV among MSM. Globally, fewer than one in twenty MSM have access to appropriate HIV prevention, treatment, care and support services.⁸

A major reason for this shortcoming is the fact that many countries (87 according to a 2007 report ⁹) have laws banning same sex relations. Where such laws are in place, governments are unlikely to promote any sort of HIV interventions aimed at MSM. Groups or individuals who do try to carry out such campaigns, as much as MSM themselves, may face violence or arrest:

"The police caught me and hit me. They didn’t even give me a chance to explain... I said I was working for HIV/AIDS prevention. They asked to see my ID card but I had forgotten it that day. They took me to jail. After I promised that I would never go to cruising spots again, they let me go." - HIV prevention worker working with MSM in Bangladesh ¹⁰

This kind of discrimination from authorities is sometimes also apparent when MSM who are already living with HIV try to access testing or treatment facilities:

“Our biggest problems are the police and doctors. Many [MSM] people we work with are poor – daily wage-earners – and cannot afford expensive private doctors. When they go to a government health clinic, the doctors taunt them about their sexual preferences. Many prefer to remain untreated rather than suffer discrimination and humiliation." - Christopher Jayakumar, head of the Andhra Pradesh Male Minorities Association, India¹¹

Discrimination such as this stops MSM from revealing their same-sex relations, and may force them to meet potential partners in places that are hidden from the general public. This can make it very difficult to reach them with HIV prevention campaigns.

Experts argue that governments and societies need to adopt a less discriminatory approach if HIV prevention efforts aimed at MSM are to work. This includes repealing laws that criminalise sex between men, introducing laws to reduce human rights violations, and making greater efforts to change public perceptions of MSM. Even in countries where the rights of MSM are legally respected, there is generally a greater need for more commitment towards tackling the problem by donors and governments, as the amount of money put towards campaigns aimed at MSM is often disproportionate to the scale of the problem.

Crucially, more research into the impact of HIV on MSM – particularly in developing countries – would lead to a much greater understanding of the situation and make it much easier to take appropriate action.

"The frightening truth is that, in many parts of the world, we simply do not know how bad the epidemics among MSM groups may be… transmission among MSM is still not tracked in most countries, resulting in a significant research gap. More research is urgently needed to inform more effective HIV prevention efforts.” - Dr. Chris Beyrer, director of the Johns Hopkins Fogarty AIDS International Training and Research Program ¹²

HIV prevention that works

When MSM are targeted by HIV prevention campaigns, it can be extremely effective. One study of 33 behavioural interventions aimed at MSM around the world showed that these efforts reduced the number of men having unprotected anal sex by one quarter, and increased condom use by 61%.¹³

One of the most important prevention responses is to make high-quality condoms, along with water-based lubricants, available and accessible to MSM (if suitably strong condoms are not used then they may break, and if oil-based lubricants are used they can damage condoms). In some countries gay bars and other known meeting places for MSM, such as bathhouses, provide and promote condoms and lubricants. Successful prevention work has also been carried out by outreach workers and peer educators, who meet with MSM personally and provide them with condoms, lubricants, and information.

Prevention work with men who have sex with men in India

As is the case with sex workers (another marginalised group who are heavily affected by HIV), many of the most successful programmes aimed at MSM empower this group and actively involve them.

"Empowering MSM and other marginalized groups to protect themselves from HIV is one of the world's most urgent health priorities." - Peter Piot, UNAIDS ¹⁴

Even in countries where homosexuality is not widely recognised, and where HIV services for gay men are severely lacking, groups of MSM have made a substantial difference in some areas. In India for instance, the use of peers to distribute condoms among MSM has resulted in a significant increase in condom use in the city of Mumbai, where a study found that more than two-thirds of condoms used by MSM were those handed out by peer educators.¹⁵

In some countries it has been understood that fighting prejudice and changing public attitudes towards MSM are important prevention measures. In Mexico, the government has appointed Jorge Saavedra, an openly gay, HIV-positive man, as head of its national AIDS council. He has been the driving force behind a large nationwide media campaign to reduce homophobia.¹⁶

Another successful approach has been to introduce ‘safe spaces’ where MSM can meet, talk openly and receive sexual health services, including testing facilities and treatment. MSM have specific STI-related needs but often feel uncomfortable going to conventional public sector health services with their problems.¹⁷

The internet can be another effective means of reaching out to MSM, as increasing numbers of MSM are meeting online – not just in developed nations, but also in countries such as the Philippines¹⁸ and Peru¹⁹. Some websites used by MSM place health advisors in chatrooms, display animated characters to educate people about HIV, and encourage users to be open about their HIV-status.²⁰

The way forward

Evidence and experience shows that providing AIDS programmes and services to those who are most at risk can be hugely beneficial to a country’s fight against AIDS. Yet MSM, like other ‘key affected groups’ in the global AIDS epidemic (such as sex workers and injecting drug users) are all too often being neglected by governments and international donors. Stigma and cultural intolerance of same-sex relations are largely to blame for this situation, and until these issues are addressed it will be difficult to make headway in reducing HIV infection levels among MSM – which, in turn, will hinder the wider global fight against AIDS.

"The lack of HIV-related services for MSM] is a massive failure, and setting it right has to be among the highest priorities for the increasingly strong global AIDS response as we aim to achieve universal access to HIV prevention, treatment, care and support for all groups, including men who have sex with men and transgender people." - Purnima Mane, UNAIDS ²¹

The Female Condom

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The female condom is a thin sheath or pouch worn by a woman during sex. It entirely lines the vagina and helps to prevent pregnancy and sexually transmitted diseases (STDs) including HIV. Two types of female condom are available.

The FC / FC2 female condom

The FC female condom has been available in Europe since 1992 and was approved by the US Food and Drug Administration (FDA) in 1993. It is available in many countries, at least in limited quantities, throughout the world. This female condom carries various brand names in different countries including Reality, Femidom, Dominique, Femy, Myfemy, Protectiv’ and Care.

An FC female condom

The FC female condom is a polyurethane sheath or pouch about 17 cm (6.5 inches) in length. At each end there is a flexible ring. At the closed end of the sheath, the flexible ring is inserted into the vagina to hold the female condom in place. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath bunching up inside the vagina.

There is silicone-based lubricant on the inside of the condom, but additional lubrication can be used. The condom does not contain spermicide.

In 2005 the makers of the FC female condom announced a new product called FC2. This has the same design as the original version but is made of nitrile, which may make it cheaper to produce. The FC2 began large-scale production in 2007. The United Nations Population Fund (UNFPA) is already procuring the FC2. The United States Agency for International Development (USAID) plans to switch to the new product if it gains FDA approval.

The VA w.o.w. Condom Feminine

A VA w.o.w. Condom Feminine

The VA w.o.w. Condom Feminine (or VA for short) has been distributed as part of HIV prevention efforts in South Africa since 2004. More recently it has become available in Brazil, Indonesia and through government clinics in Portugal. Having gained the “CE mark” for European marketing, its manufacturer plans to expand its availability in European shops and clinics. One more trial is needed before the product can gain FDA approval for sale in the USA.

Like most male condoms, the VA is made of latex. When not stretched it is much shorter than the FC – around 9 cm (3.5 inches) – though it is highly elastic. It has a rounded triangular frame at the open end and a sponge inside the closed end, which helps to anchor it inside the vagina.

The VA is lubricated and does not contain spermicide. Oil-based lubricants should not be used with this female condom as they can damage latex.

How do you use the female condom?

Open the package carefully. Choose a position that is comfortable for insertion - squat, raise one leg, sit or lie down. Make sure the condom is lubricated enough.

If you are using the FC or FC2 female condom, make sure the inner ring is at the closed end of the sheath, and hold the sheath with the open end hanging down. Squeeze the inner ring with thumb and middle finger (so it becomes long and narrow), and then insert the inner ring and sheath into the vaginal opening. Gently insert the inner ring into the vagina and feel it go up. Place the index finger inside the condom and push the inner ring as far as it will go. Make sure the condom is inserted straight, and is not twisted inside the vagina. The outer ring should remain on the outside of the vagina.

To begin inserting the VA, hold the sponge and frame close together and place the closed end in front of the vagina. Use two fingers to push the closed end containing the sponge inside the vagina as far as it will go. Make sure the sponge is opened up flat once it has been inserted. The frame should remain on the outside of the vagina.

The penis should be guided into the condom in order to ensure that the penis does not slip into the vagina outside the condom. Use enough lubricant so that the condom stays in place during sex. The female condom should not be used at the same time as a male condom because the friction between the two condoms may cause the condoms to break.

If the condom slips during intercourse, or if it enters the vagina, then you should stop immediately and take the female condom out. Then insert a new one and add extra lubricant to the opening of the sheath or on the penis.

To remove the condom, twist the outer ring or frame gently and then pull the condom out keeping the sperm inside. Wrap the condom in the package or in tissue and throw it away. Do not put it into the toilet. It is generally recommended that the female condom should not be reused.

The female condom may feel unfamiliar at first. The female condom may feel different and some people find it difficult to insert. Some women find that with time and practice using the female condom becomes easier and easier.

What are the benefits?

Opportunity for women to share the responsibility for the condoms with their partners
A woman may be able to use the female condom if her partner refuses to use the male condom
The female condom will protect against most STDs and pregnancy if used correctly
The FC or FC2 female condom can be inserted up to 8 hours before intercourse so as not to interfere with the moment
The FC and FC2 female condoms are made of polyurethane and nitrile, which are less likely to cause an allergic reaction than latex. These materials can be used with oil-based as well as water-based lubricants. No special storage requirements are needed because polyurethane and nitrile are not affected by changes in temperature and dampness. In addition, these materials are thin and conduct heat well, so sensation is preserved.

What are the disadvantages?

The outer ring or frame is visible outside the vagina, which can make some women feel self-conscious
The FC and FC2 female condoms can make noises during intercourse (adding more lubricant can lessen this problem)
Some women find the female condom hard to insert and to remove
It has a higher failure rate in preventing pregnancy than non-barrier methods such as the pill
It is relatively expensive and relatively limited in availability in some countries
It is recommended that the female condom be used only once

Can I reuse the female condom?

It is believed that limited availability and high cost have led some women to reuse female condoms in some countries. The World Health Organisation (WHO) recommends use of a new male or female condom for every act of intercourse for those people who use condoms for pregnancy prevention and/or STD/HIV prevention.

WHO does not recommend or promote reuse of female condoms but has released a document together with guidelines and advice for programme managers who may consider reuse of FC female condoms in local settings.¹ There are no guidelines for reusing VA and FC2 female condoms.

Using the female condom for anal sex

Some people use the female condom for anal sex. Although it can work effectively, it is difficult to use and can be painful. There is also the risk of rectal bleeding which increases the risk of contracting HIV. So it’s better to use the male condom for anal sex with plenty of lubricant NOT containing Nonoxynol 9.

Support for the female condom

WHO and UNAIDS are encouraging wider access to the female condom as a method of preventing both pregnancy and sexually transmitted infections. Many governments and non-governmental organisations provide female condoms for free or at subsidised prices as part of their HIV prevention and family planning programmes.

Worldwide use and availability

The female condom is used in public health programmes in more than 90 countries and is commercially marketed directly to consumers in ten countries.² It is quite widely used in some places where it is actively promoted, such as South Africa, Zimbabwe and Brazil. However in many parts of the world it is hardly available at all.

In 2007, the makers of the FC female condom sold around 25.9 million units worldwide, up from 14 million in 2005.³ Many of these condoms were purchased by donor agencies such as USAID and UNFPA. The VA currently sells in much smaller quantities. Altogether, female condoms account for only around 0.2% of global condom use.

In 2005, nearly two thirds of all female condoms were used in Africa, while the next largest shares went to North America and Europe. Asia accounted for less than 1% of the global total in 2005, though figures for later years may be higher due to growth in India.⁴

Future of the female condom

Vending machines for both male and female condoms in France

The two female condom manufacturers hope that demand for their products will grow substantially in the near future. However both are small companies with limited promotional resources, and it remains to be seen whether FC2 or VA will prove much more popular than the original female condom – even if they are cheaper.

New female condoms are being developed by the non-governmental organisation PATH and by a Belgian company called MEDITEAM. These are still a long way from becoming widely available and their future prospects are uncertain.⁵

The benefits of expanding female condom use could be very great. A study in 2006 found that countrywide distribution (equivalent to 10% of condom sales) of the FC2 female condom in Brazil and South Africa would be “useful and cost-effective” for preventing HIV. The cost savings could be greatly increased if 300 million FC2s were acquired through a global purchasing mechanism, which would cut the price per condom by two thirds.⁶

Wider use of the female condom in developing countries depends on the commitment of governments and other major donors. To achieve its full potential, much greater efforts need to be made worldwide to promote the female condom, to make it more accessible and acceptable.

Why do I need to use a condom?

2008-10-20T08:08:00.000-07:00

Why do I need to use a condom?

Condoms are the only form of protection that can both help to stop the transmission of sexually transmitted diseases (STDs) such as HIV and prevent pregnancy.

Getting ready, Choosing the right condom

A number of different types of condom are now available. What is generally called a condom is the 'male' condom, a sheath or covering which fits over a man's penis, and which is closed at one end.

There is also now a female condom, or vaginal sheath, which is used by a woman and which fits inside her vagina. The rest of this page is about the male condom.

What are condoms made of?

Condoms are usually made of latex or polyurethane. If possible you should use a latex condom, as they are slightly more reliable, and in most countries they are most readily available.

Latex condoms can only be used with water based lubricants, not oil based lubricants such as Vaseline or cold cream as they break down the latex. A small number of people have an allergic reaction to latex and can use polyurethane condoms instead.

Polyurethane condoms are made of a type of plastic. They are thinner than latex condoms, and so they increase sensitivity and are more agreeable in feel and appearance to some users. They are more expensive than latex condoms and slightly less flexible so more lubrication may be needed. However both oil and water based lubricants can be used with them.

It's not clear whether latex or polyurethane condoms are stronger – there are studies suggesting that either is less likely to break. With both types however, the likelihood of breakages is very small if used correctly.

The lubrication on condoms also varies. Some condoms are not lubricated at all, some are lubricated with a silicone substance, and some condoms have a water-based lubricant. The lubrication on condoms aims to make the condom easier to put on and more comfortable to use. It can also help prevent condom breakage.

Spermicides and Nonoxynol 9

Condoms and lubricants sometimes contain a spermicide called Nonoxynol 9. Adding Nonoxynol 9 to condoms was thought in the past to help to prevent pregnancy and the transmission of HIV and other STDs, but it is now known to be ineffective.

Some people have an allergic reaction to Nonoxynol 9 that can result in little sores, which can actually make the transmission of HIV more likely. Because of this, you should only use condoms and lubricants containing Nonoxynol 9 if you are HIV negative and know that your partner is too. However, using a condom (even if it contains Nonoxynol 9) is much safer than having unprotected sex.

What shapes are there and which should I choose? What about flavoured condoms?

Condoms come in a variety of shapes. Most have a reservoir tip although some do have a plain tip. Condoms may be regular shaped (with straight sides), form fit (indented below the head of the penis), or they may be flared (wider over the head of the penis).

Ribbed condoms are textured with ribs or bumps, which can increase sensation for both partners. Condoms also come in a variety of colours.

It's up to you which shape you choose. All of the differences in shape are designed to suit different personal preferences and enhance pleasure. It is important to communicate with your partner to be sure that you are using condoms that satisfy both of you.

Some condoms are flavoured to make oral sex more enjoyable. They are also safe to use for penetrative sex as long as they have been tested and approved.

What about the condom size?

Condoms are made in different lengths and widths, and different manufacturers produce varying sizes.

There is no standard length for condoms, though those made from natural rubber will in addition always stretch if necessary to fit the length of the man's erect penis.

The width of a condom can also vary. Some condoms have a slightly smaller width to give a "closer" fit, whereas others will be slightly larger. Condom makers have realised that different lengths and widths are needed and are increasingly broadening their range of sizes.

The brand names will be different in each country, so you will need to do your own investigation of different names. There is no particular best brand of condom.

So when do you use a condom?

You need to use a new condom every time you have sexual intercourse. Never use the same condom twice. Put the condom on after the penis is erect and before any contact is made between the penis and any part of the partner's body. If you go from anal intercourse to vaginal intercourse, you should consider changing the condom.

Where can I get condoms?

There are no age limitations on buying condoms. Buying a condom no matter how old you are shows that you are taking responsibility for your actions. Family planning and sexual health clinics provide condoms free of charge. Condoms are available to buy from supermarkets, convenience stores and petrol/gas stations. Vending machines selling condoms are found in toilets at many locations. You can also order then online from different manufacturers and distributors.

How can I check a condom is safe to use?

Condoms that have been properly tested and approved carry the British Standard Kite Mark or the EEC Standard Mark (CE). In the USA, condoms should be FDA approved, and elsewhere in the world, they should be ISO approved.

Condoms have an expiration (Exp) or manufacture (MFG) date on the box or individual package that tells you when it is safe to use the condom until. It's important to check this when you use a condom. You should also make sure the package and the condom appear to be in good condition.

Condoms can deteriorate if not stored properly as they are affected by both heat and light. So it's best not to use a condom that has been stored in your back pocket, your wallet, or the glove compartment of your car. If a condom feels sticky or very dry you shouldn't use it as the packaging has probably been damaged.

How do you use a condom?

Open the condom package at one corner being careful not to tear the condom with your fingernails, your teeth, or through being too rough. Make sure the package and condom appear to be in good condition, and check that if there is an expiry date that the date has not passed.

Place the rolled condom over the tip of the hard penis, and if the condom does not have a reservoir top, pinch the tip of the condom enough to leave a half inch space for semen to collect. If the man is not circumcised, then pull back the foreskin before rolling on the condom.

Pinch the air out of the condom tip with one hand and unroll the condom over the penis with the other hand. Roll the condom all the way down to the base of the penis, and smooth out any air bubbles. (Air bubbles can cause a condom to break.)

If you want to use some extra lubrication, put it on the outside of the condom. But always use a water-based lubricant (such as KY Jelly or Liquid Silk) with latex condoms, as an oil-based lubricant will cause the latex to break.

The man wearing the condom doesn't always have to be the one putting it on - it can be quite a nice thing for his partner to do.

What do you do if the condom won't unroll?

The condom should unroll smoothly and easily from the rim on the outside. If you have to struggle or if it takes more than a few seconds, it probably means that you are trying to put the condom on upside down. To take off the condom, don't try to roll it back up. Hold it near the rim and slide it off. Then start again with a new condom.

When do you take off the condom?

Pull out before the penis softens, and hold the condom against the base of the penis while you pull out, so that the semen doesn't spill. Condom should be disposed properly for example wrapping it in a tissue and throwing it away. It's not good to flush condoms down the toilet - they're bad for the environment.

What do you do if a condom breaks?

If a condom breaks during sexual intercourse, then pull out quickly and replace the condom. Whilst you are having sex, check the condom from time to time, to make sure it hasn't split or slipped off. If the condom has broken and you feel that semen has come out of the condom during sex, you should consider getting emergency contraception such as the morning after pill.

What condoms should you use for anal intercourse?

With anal intercourse more strain is placed on the condom. You can use stronger condoms (which are thicker) but standard condoms are just as effective as long as they are used correctly with plenty of lubricant. Condoms with a lubricant containing Nonoxynol 9 should NOT be used for anal sex as Nonoxynol 9 damages the lining of the rectum increasing the risk of HIV and other STD transmission.

Is using a condom effective?

If used properly, a condom is very effective at reducing the risk of being infected with HIV during sexual intercourse. Using a condom also provides protection against other sexually transmitted diseases, and protection against pregnancy. In the laboratory, latex condoms are very effective at blocking transmission of HIV because the pores in latex condoms are too small to allow the virus to pass through. However, outside of the laboratory condoms are less effective because people do not always use condoms properly.

How do you dispose of a used condom?

All condoms should be disposed of by wrapping in tissue or toilet paper and throwing them in the bin. Condoms should not be flushed down the toilet as they may cause blockages in the sewage system and pollution.

Latex condoms are made mainly from latex with added stabilizers, preservatives and vulcanizing (hardening) agents. Latex is a natural substance made form rubber trees, but because of the added ingredients most latex condoms are not biodegradable. Polyurethane condoms are made from plastic and are not biodegradable. Biodegradable latex condoms are available from some manufacturers.

How can I persuade my partner that we should use a condom?

It can be difficult to talk about using condoms. But you shouldn't let embarrassment become a health risk. The person you are thinking about having sex with may not agree at first when you say that you want to use a condom when you have sex. These are some comments that might be made and some answers that you could try...

EXCUSE	ANSWER
Don't you trust me?	Trust isn't the point, people can have infections without realising it
It does not feel as good with a condom	I'll feel more relaxed, If I am more relaxed, I can make it feel better for you.
I don't stay hard when I put on a condom	I'll help you put it on, that will help you keep it hard.
I am afraid to ask him to use a condom. He'll think I don't trust him.	If you can't ask him, you probably don't trust him.
I can't feel a thing when I wear a condom	Maybe that way you'll last even longer and that will make up for it
I don't have a condom with me	I do
It's up to him... it's his decision	It's your health. It should be your decision too!
I'm on the pill, you don't need a condom	I'd like to use it anyway. It will help to protect us from infections we may not realise we have.
It just isn't as sensitive and I can't feel a thing	Maybe that way you will last even longer and that will make up for it
Putting it on interrupts everything	Not if I help put it on
I guess you don't really love me	I do, but I am not risking my future to prove it
I will pull out in time	Women can get pregnant and get STDs from pre-ejaculate
But I love you	Then you'll help us to protect ourselves.
Just this once	Once is all it takes

There are many reasons to use condoms when having sex. You could go through these reasons with your partner and see what she/he thinks.

Reasons to use condoms

Condoms are the only contraceptive that help prevent both pregnancy and the spread of sexually transmitted diseases (including HIV) when used properly and consistently.
Condoms are one of the most reliable methods of birth control when use properly and consistently.
Condoms have none of the medical side-effects of some other birth control methods may have.
Condoms are available in various shapes, colours, flavours, textures and sizes - to increase the fun of making love with condoms.
Condoms are widely available in pharmacies, supermarkets and convenience stores. You don't need a prescription or have to visit a doctor.
Condoms make sex less messy.
Condoms are user friendly. With a little practice, they can also add confidence to the enjoyment of sex.
Condoms are only needed when you are having sex unlike some other contraceptives which require you to take or have them all of the time.

Here are also some tips that can help you to feel more confident and relaxed about using condoms.

Confidence tips

Keep condoms handy at all times. If things start getting steamy - you'll be ready. It's not a good idea to find yourself having to rush out at the crucial moment to buy condoms - at the height of the passion you may not want to.
When you buy condoms, don't get embarrassed. If anything, be proud. It shows that you are responsible and confident and when the time comes it will all be worthwhile. It can be more fun to go shopping for condoms with your partner or friend. Nowadays, it is also easy to buy condoms discreetly on the internet.
Talk with your partner about using a condom before having sex. It removes anxiety and embarrassment. Knowing where you both stand before the passion stands will make you lot more confident that you both agree and are happy about using a condom.
If you are new to condoms, the best way to learn how to use them is to practice putting them on by yourself or your partner. It does not take long to become a master.
If you feel that condoms interrupt you passion then try introducing condoms into your lovemaking. It can be really sexy if your partner helps you put it on or you do it together.

Condom Questions

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Why should you use a condom when you have sexual intercourse?

If you are going to have sex, using a condom is the best way to protect both partners against becoming infected with a sexually transmitted disease. They also protect against pregnancy.

Are condoms effective against HIV and other STDs?

Condoms are very effective at preventing HIV transmission, and will also help to prevent the transmission of any other infection that's spread through semen or vaginal fluids. However, they are only effective if they're used properly every time you have sex.

How do I use a condom?

Condoms are quite simple to use, but like anything, it can take a bit of practice to get it right. To fully understand how to use one, please visit our Using Condoms page.

What is a female condom?

A female condom is similar to a male condom, but is wider and longer and is worn inside a woman's vagina rather than over the penis. It is also made of polyurethane rather than latex. The condom has two rings - the ring at the closed end of the female condom is pushed up inside the vagina, while the ring at the open end surrounds the entrance to the vagina. The man's penis is guided into the condom through this ring. AVERT has more about the female condom.

How are condoms tested?

There are a range of tests performed by both regulatory agencies and the condom manufacturers to ensure that they're safe and strong enough to use during sex. These include electronic testing, the water leak test, the air burst test and the strength test.

How can I check a condom is safe to use?

You need to check that they have not expired, that they carry a standards approval mark (either FDA, ISO, CE or the British Standard Kite Mark depending on where you are), and that they have been properly stored. Visit our Using Condoms page for more information.

How often do condoms fail?

Studies have shown that where used properly, less than 2 in every 100 condoms fails.

Is it true that condoms have tiny holes in them?

Some people have claimed that condoms have tiny pores or holes in them through which sexually transmitted infections such as HIV can pass. This is not true. Many studies have shown that condoms do not have pores big enough for HIV to travel through, and even if such pores did exist, most latex condoms have walls that are approximately .05 mm thick – a virus such as HIV would therefore have to pass through a barrier around 500 times thicker than itself to reach the outside.

What are condoms made of?

Condoms are usually made of latex or polyurethane. Latex condoms are more widely available and cheaper, although some people can be allergic to them, in which case a polyurethane condom may be more appropriate. To understand more about these two types of condoms and the correct lubricant to use with them visit our Using Condoms page.

What is the history of the condom?

Condom use can be traced back several thousand years and were once simply strips of linen. Animal intestines have also provided an alternative to today's more practical latex and polyurethane varieties.

How can I persuade my partner to use a condom?

It can be difficult to talk about using condoms, but you shouldn't let embarrassment become a health risk. The person you are thinking about having sex with may not agree at first when you say that you want to try and use a condom when you have sex. These are some excuses that might be made and some answers that you could try:

EXCUSE	ANSWER
Don't you trust me?	Trust isn't the point, people can have infections without realising it
I can't feel a thing when I wear a condom	Maybe that way you'll last even longer and that will make up for it
I don't stay hard when I put on a condom	I'll help you put it on, that will help you keep it
I don't have a condom with me	I do
I'm on the pill, you don't need a condom	I'd like to use it anyway. It will help to protect us from infections we may not realise we have.
But I love you	Then you'll help us to protect ourselves.
Just this once	Once is all it takes

How much protection do condoms give against pregnancy? If a condom breaks what are the risks of pregnancy?

When used properly (ie. the condom doesn't split or burst) condoms can be very effective in preventing both pregnancy and STDs. If a condom breaks and no other from of contraception such as the birth control pill is being used then there is a risk that a woman may become pregnant.

Is it possible to get different sizes of condoms?

Condoms are made in different lengths and widths, and different manufacturers produce varying sizes. There is no standard length for condoms, though those made from natural rubber will in addition always stretch if necessary to fit the length of the man's erect penis.

The brand names will be different in each country, so you will need to do your own investigation of different names. There is no particular best brand of condom.

Is using two condoms better than one to avoid pregnancy?

Using two condoms at the same time - either two male condoms or a male and female condom - is not a good idea as the friction of them rubbing together may result in one or both of the condoms tearing. If you want to take extra precautions against pregnancy when having sex, and are concerned about the possibility of a condom breaking, it is better to use another form of contraception. For example, using the birth control pill as well as a condom will ensure that you have double protection against pregnancy as well as protection against STDs.

If I use a condom I seem to lose my erection…

It is a good idea to get some condoms before having sex and practice using them. That way you can get used to the feel of condoms and putting them on, which should help you feel more relaxed about using them when having sex and less likely to lose your erection.

Can you use a condom under water?

If you are going to use a condom under water it is important that you put the condom on before you get into the water. Also, if the water contains chemicals such as chlorine, or additives such as soap, bath oil or bubble bath then this may affect the latex.

What is the best way to get condoms?

It will depend on which country you are in, but in the most countries you can buy condoms from chemists and supermarkets. Condoms are often available from vending machines in public toilets. In some countries condoms are available free or at low-cost from clinics, and they can also be purchased from a variety of sites online.

Spermicide Questions

What are spermicides and how do they work?

Spermicides are chemical products that inactivate or kill sperm to prevent pregnancy. They are available in a variety of formats such as a cream, jelly, foam or foaming tablet that is inserted into the vagina before having sex. Some condoms also come lubricated with spermicide.

The most common spermicide is Nonoxynol 9. Recent research on Nonoxynol 9 has found that it does NOT protect against STDs or HIV as previously thought. So spermicides or condoms containing spermicide should only be used by HIV negative women who are sure that their partner is HIV negative as well.

Where can you get spermicides from? Do you need a prescription?

Spermicides can be bought over the counter at the chemists or you can get them from clinics. You do not need a prescription to get them.

The history of condoms

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Where and when were condoms first used? Are condoms effective? Do condoms fail? How are condoms tested? What are the levels of condom availability in low income and developing countries?

The history of condoms

1000 BC

The use of condoms can be traced back several thousand years. It is known that around 1000 BC the ancient Egyptians used a linen sheath for protection against disease.¹

100 - 200 AD

The earliest evidence of condom use in Europe comes from scenes in cave paintings at Combarelles in France.² There is also some evidence that some form of condom was used in imperial Rome.³

1500s

The syphilis epidemic that spread across Europe gave rise to the first published account of the condom. Gabrielle Fallopius described a sheath of linen he claimed to have invented to protect men against syphilis.⁴ Having been found useful for prevention of infection, it was only later that the usefulness of the condom for the prevention of pregnancy was recognised.

Later in the 1500s, one of the first improvements to the condom was made, when the linen cloth sheaths were sometimes soaked in a chemical solution and then allowed to dry prior to use. These were the first spermicides on condoms.⁵

1700s

The first published use of the world 'condum' was in a 1706 poem.⁶ It has also been suggested that Condom was a doctor in the time of Charles II. It is believed that he invented the device to help the king to prevent the birth of more illegitimate children.⁷

Even the most famous lover of all, Casanova, was using the condom as a birth control as well as against infection.⁸

Condoms made out of animal intestines began to be available. However, they were quite expensive and the unfortunate result was that they were often reused. This type of condom was described at the time as "an armour against pleasure, and a cobweb against infection".

In the second half of the 1700's, a trade in handmade condoms thrived in London and some shops where producing handbills and advertisements of condoms.⁹

1800s

The use of condoms was affected by technological, economic and social development in Europe and the US in the 1800s.

Condom manufacturing was revolutionised by the discovery of rubber vulcanisation by Goodyear (founder of the tyre company) and Hancock. This meant that is was possible to mass produce rubber goods including condoms quickly and cheaply. Vulcanisation is a process, which turns the rubber into a strong elastic material.¹⁰

In 1861,the first advertisement for condoms was published in an American newspaper when The New York Times printed an ad. for 'Dr. Power's French Preventatives.'

In 1873, the Comstock Law was passed. Named after Anthony Comstock, the Comstock Law made illegal the advertising of any sort of birth control, and it also allowed the postal service to confiscate condoms sold through the mail.

1900s

Until the 1920s, most condoms were manufactured by hand-dipping from rubber cement. These kinds of condoms aged quickly and the quality was doubtful.

In 1919, Frederick Killian initiated hand-dipping from natural rubber latex in Ohio. The latex condoms had the advantage of ageing less quickly and being thinner and odourless. These new type of condoms enjoyed a great expansion of sales. By the mid-1930s, the fifteen largest makers in the U.S. were producing 1.5 million condoms a day.¹¹

In 1957, the very first lubricated condom was launched in the UK by Durex.¹²

From the early 1960s, the use of condoms as a contraceptive device declined as the pill, the coil and sterilisation became more popular.¹³

The use of the condom increased strikingly in many countries following the recognition of HIV/AIDS in the 1980's. Condoms also became available in pubs, bars, grocery stores and supermarkets.

The female condom has been available in Europe since 1992 and it was approved in 1993 by the US Food and Drug Administration (FDA). Find out more information about female condoms.

In 1994, the world's first polyurethane condom for men was launched in the US.

The 1990s also saw the introduction of coloured and flavoured condoms.

Present day

In more recent years, improved technology has enabled the thickness of the condom to decrease. Also, condom manufacturers have recognised that one size of condom does not fit all. You can now find condoms that are different shapes, widths and lengths.

Are condoms effective? Do condoms fail?

Are condoms effective at preventing infection with the HIV and sexually transmitted diseases (STDs)?

Yes. Studies have shown that if a latex condom is used correctly every time you have sex, this is highly effective in providing protection against HIV.¹⁴

The evidence for this is clearest in studies of couples in which one person is infected with HIV and the other not. i.e. "discordant couples". In a study of discordant couples in Europe, among 123 couples who reported consistent condom use, none of the uninfected partners became infected. In contrast, among the 122 couples who used condoms inconsistently, 12 of the uninfected partners became infected.¹⁵

In addition, correct and consistent use of latex condoms can reduce the risk of other STDs.¹⁶

As these studies indicate, condoms must be used consistently and correctly to provide maximum protection. Consistent use means using a condom from start to finish with each act of intercourse. Correct condom use should include:¹⁷

Use a new condom for each act of intercourse
Put on the condom as soon as erection occurs and before any sexual contact (vaginal, anal or oral).
Hold the tip of the condom and unroll it onto the erect penis, leaving space at the tip of the condom, yet ensuring that no air is trapped in the condom's tip.
Adequate lubrication is important, but use only water-based lubricants on latex condoms. Oil-based lubricants such as petroleum jelly (vaseline), cold cream, hand lotion or baby oil can weaken the latex condom and are not recommended. However, oil-based lubricants can be used with condoms made of polyurethane.
Withdraw from the partner immediately after ejaculation, holding the condom firmly to keep it from slipping off.

Find more information about using condoms.

How often do condoms fail?

There is no one answer to this, as different studies have shown different results. Many studies of condom effectiveness have counted how often women have become pregnant when their partners have used condoms for birth control. This "failure rate" includes cases where the couple did not use a condom every time they had sex, or they did not use the condom correctly. Some studies have included the times the condom was torn accidentally by people using it.¹⁸

The main reason that condoms sometimes fail to prevent HIV/STD infection or pregnancy is incorrect or inconsistent use, not the failure of the condom itself. Using oil-based lubricants can weaken the latex, causing the condom to break. Condoms can also be weakened by exposure to heat or sunlight or by age, or they can be torn by teeth or fingernails. Also, remember to check the expiry date of your condom!¹⁹

How often do condoms break or slip off?

In the United States, most studies of breakage caused by fault in the condom itself have shown breakage rate is less than 2 condoms out of every 100 condoms. Studies also indicate that condoms slip off the penis in about 1-5% of acts of vaginal intercourse and slip down (but not off) about 3-13% of the time.²⁰

How are condoms tested?

In the United States, the Food and Drug Administration (FDA) regulates condoms to ensure their safety and effectiveness. Different countries have different regulatory agencies. For example, condoms in Europe that have been properly tested and approved should carry the CE Mark. Elsewhere in the world, you can find that condoms are ISO approved. Also, individual countries may have their own approval marks for condoms, for example, the Kitemark in the UK.

In the US, each condom is electronically tested for holes and defects.²¹ Also, condom manufacturers sample each lot of finished packaged condoms and visually examine them for holes using a water leak test. Condom manufacturers also tests lots for physical characteristics using the air burst test and the tensile (strength) test.

The FDA, for example, recognises domestic and international standards that specify that the rate of sampled condoms failing the water leak test, for each manufacturing lot of condoms, be less than 1 condom in 400.²²

Condom availability

How many condoms are used each year?

According to the United Nations Population Fund (UNFPA), an estimated 10.4 billion male condoms were used worldwide in 2005. Of these, around 4.4 billion were used for family planning and 6.0 billion for HIV prevention.²³

Donor support for condoms

In most countries where the HIV prevalence rate is high many people cannot afford to purchase condoms. Sexually active adults and teenagers must rely on condoms that are provided for free or sold at a subsidised low price. Governments often supply and promote condoms, but the poorest countries rely almost entirely on donations from outside agencies such as the UNFPA and the U.S. Agency for International Development (USAID).

The UNFPA records information on the quantities of condoms donated to countries worldwide by a range of organisations. Analysis of data collected between 1990 and 2005, as displayed in the graph, shows that the number of condoms donated has risen. Before 1996 however, the supply of condoms was always able to meet the demand, yet in recent years that has not been the case.

The UNFPA estimates that at least 13.1 billion condoms were needed in 2005 to significantly reduce the spread of HIV, and another 4.4 billion were required for family planning. The number of condoms donated in 2005 was only 1.8 billion - representing just 10% of the need.

Between 2000 and 2005, fourteen countries received an average of more than 10 donated condoms per man per year. All of these countries have widespread HIV epidemics and, with the exception of Haiti, all of them are in sub-Saharan Africa. At the very top of the list were Congo, Zimbabwe, Namibia and Cape Verde, each of which received more than 20 condoms per man per year.

Developing countries outside sub-Saharan Africa tend to receive much lower numbers of donated condoms per man, with an average below one condom per man per year.²⁴

Oral Sex

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What is oral sex?

Oral sex involves giving or receiving oral stimulation (i.e. sucking or licking) to the genitalia. Fellatio (also known as a 'blow job') is the term used to describe oral sex given to a man. Cunnilingus is the term which describes oral sex given to a woman.

Is oral sex common practice?

Many studies have shown that oral sex is practised by men and women of all ages, both gay and straight. It is a very common practice and may be performed on its own, or before or after sexual intercourse.

Is oral sex safe?

A number of studies have demonstrated that oral sex is not necessarily safe sex. Both giving and receiving oral sex can lead to the transmission of sexually transmitted infections (also known as STIs or STDs).

Which STDs are transmitted via oral sex?

The most common STD transmitted via oral sex is herpes. There are two main types of herpes simplex virus (HSV): HSV type 1 and HSV type 2. HSV type 1 usually causes cold sores around the mouth, while HSV type 2 generally causes genital herpes sores. However, oral sex can sometimes cause HSV type 1 around the mouth to be transmitted to the genital area causing genital sores in the other person. This process can also work in reverse, with HSV-2 transmitted from the genitals to the mouth of the other person during oral sex, though this is rare.

The human papillomavirus that causes genital warts can very occasionally be transmitted through oral sex, causing warts to appear around or inside the mouth in anyone who has given oral sex to an infected person.

Gonorrhoea has been shown to infect the throat of some people who have given oral sex to an infected person. This infection can then be passed on from the throat to the genitals of any future partners. The body will almost always naturally clear the throat of the bacteria that cause gonorrhoea within three months, although infections in the genital tract will usually require antibiotics to cure. Chlamydia can also infect the throat in a similar way, although this is less common. Both infections may result in a sore throat, although many people will remain asymptomatic and unaware they are infected.

Syphilis may be passed on during oral sex if a person’s mouth comes into contact with an open sore or a skin rash caused by the infection.

Gastrointestinal infections and parasites may be passed on during oral contact with the anus.

The hepatitis A virus is also contained in human faeces, and may be passed on during anal-oral sex.

Hepatitis B is contained in sexual fluids and blood and may be transmitted during oral sex in a similar way to HIV (see below).

Hepatitis C is generally only contained in blood, and will only be transmitted if there is blood present during oral sex.

Can HIV be transmitted during oral sex?

HIV can pose a small risk for both the active (person giving the oral stimulation) and receptive (person receiving oral stimulation) partner.

Transmission from an HIV positive receptive partner to an HIV negative active partner may occur when the active partner gets sexual fluid (semen or vaginal fluid) or blood (from menstruation or a wound somewhere in the genital or anal region) into a cut, sore, ulcer or area of inflammation somewhere in their mouth or throat. The linings of the mouth and throat are very resistant to viral infections such as HIV, so infection is unlikely if they are healthy.

Transmission from an HIV positive active partner to an HIV negative receptive partner is generally believed to be less common. This is because HIV is normally only present in saliva in very low levels that are not sufficient to cause infection. The only risk in this scenario would be from bleeding wounds or gums in the HIV positive person’s mouth or on their lips, which may transfer blood onto the mucous membranes of the other person’s genitals or anus, or into any cuts or sores they may have. Hepatitis C can also be transmitted this way.

What is the risk of HIV transmission via oral sex?

The risk of HIV transmission from an infected partner through oral sex is much smaller than the risk of HIV transmission from anal or vaginal sex. Because of this, measuring the exact risk of HIV transmission as a result of oral sex is very difficult. In addition, since most sexually active individuals practice oral sex in addition to other forms of sex (such as vaginal and/or anal sex) when transmission occurs, it is difficult to determine whether or not it occurred as a result of oral sex or other more risky sexual activities. Finally, several co-factors can increase the risk of HIV transmission through oral sex, including oral ulcers and wounds, bleeding gums, genital sores, genital or oral piercings, and the presence of other STDs.

When scientists describe the risk of transmitting an infectious disease, like HIV, the term "theoretical risk" is often used. Very simply, "theoretical risk" means that passing an infection from one person to another is possible, even though there may not yet be any actual documented cases. "Theoretical risk" is not the same as likelihood. In other words, stating that HIV infection is "theoretically possible" does not necessarily mean it is likely to happen - only that it might. Documented risk, on the other hand, is used to describe transmission that has actually occurred, been investigated, and documented in the scientific literature.

Various scientific studies have been performed around the world to try and document and study instances of HIV transmission through oral sex. A programme in San Francisco studied 198 people, nearly all gay or bisexual men. The subjects stated that they had only had oral sex for a year, from six months preceding the six-month study to its end. 20 per cent of the study participants (39 people) reported performing oral sex on partners they knew to be HIV positive. 35 of those did not use a condom and 16 reported swallowing semen. No one became HIV positive during the study, although the small number of participants performing oral sex on HIV positive partners meant the researchers could only say that there was a less than 2.8 per cent chance of infection through oral sex over a year.¹ In 2000, a different San Francisco study of gay men who had recently acquired HIV infection found that 7.8 per cent of these infections were attributed to oral sex.² However, the results of the study have since been called into question due to the reliability of the participants' data.

Measuring the exact risk of HIV transmission as a result of oral sex is very difficult.

In June 2002, a study conducted amongst 135 HIV negative Spanish heterosexuals, who were in a sexual relationship with a person who was HIV positive, reported that over 19,000 instances of unprotected oral sex had not led to any cases of HIV transmission.³ The study also looked at contributing factors that could affect the potential transmission of HIV through oral sex. They monitored viral load and asked questions such as whether ejaculation in the mouth occurred and how good oral health was. Amongst HIV positive men, 34 per cent had ejaculated into the mouths of their partners. Viral load levels were available for 60 people in the study, 10 per cent of whom had levels over 10,000 copies. Nearly 16 per cent of the HIV positive people had CD4 counts below 200. The study, conducted over a ten year period between 1990 and 2000, adds to the growing number of studies which suggest varying levels of risk of HIV transmission from oral sex when compared to anal or vaginal intercourse.

At the 4th International Oral AIDS Conference held in South Africa, the risk of transmission through oral sex was estimated to be approximately 0.04 per cent per contact.⁴ This percentage figure is a lot lower than the two American figures, because this figure is a risk per contact percentage, whereas the other figures are percentage risks over much longer time periods. Oral sex is still regarded as a low-risk sexual activity in terms of HIV transmission, but only when more work is done will we be clearer as to the risks of oral sex.

Are there any individual documented cases of HIV transmission during oral sex?

While it is very difficult to ever know how HIV transmission occurred, according to a factsheet on oral sex produced by the CDC in 2000⁵, there have been a few documented cases of transmission during oral sex. These have occurred in both receptive and active partners during fellatio, cunnilingus and anilingus.

How do I protect myself and my partner during oral sex?

The already low risk of becoming infected with HIV from oral sex can be reduced still further by using condoms. Flavoured condoms are available for those who don’t like the taste of latex or spermicide. For cunnilingus or anilingus, plastic food wrap, a condom cut open, or a dental dam (a thin square of latex) can serve as a physical barrier to prevent transmission of HIV and many other STDs.

Worldwide ages of consent

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This table lists different countries around the world, and shows the ages at which people of different sexualities can legally have sex.

If you're a young person, and you want to find out more, read our page on teens, sex and the law. You might also like to have a look at our "Am I ready for sex?" page.

This table should only be used as general guide - please also read the notes at the bottom of this page.

Country		Male-Female Sex	Male-Male Sex	Female-Female Sex
Afghanistan		18/Married	Illegal	Illegal
Albania		14	14	14
Algeria		16	Illegal	Illegal
American Samoa		15?	15?	15?
Andorra		16	16	16
Angola		12/15	Illegal	Illegal
Antigua and Barbuda		16	16	16
Argentina		13/16	13/16	13/16
Armenia		16	16	16
Aruba		16	16	16
Australia	ACT	16	16	16
Australia	NSW & Norfolk Is.	16	16	16
Australia	NT	16	16	16
Australia	Queensland¹	16/18	18	16
Australia	SA	17	17	17
Australia	Tasmania	17	17	17
Australia	Victoria	16	16	16
Australia	WA	16	16	16
Austria²		14/16	14/16	14/16
Azerbaijan		16	16	16
Bahamas		16	18	18
Bahrain		16/Married	Illegal	Illegal
Bangladesh		?	Illegal	Illegal
Barbados		16	Illegal	Illegal
Belarus		16/18	16	16
Belgium		16	16	16
Belize		16	?	?
Bermuda		16	18	16
Benin		?	Illegal	Illegal
Bhutan		18	Illegal	?
Bolivia		14f/16m	?	?
Bosnia		16	16	16
Botswana		16f/14m	Illegal	?
Brazil³		14/18	14/18	14/18
Brunei		14/16	Illegal	Illegal
Bulgaria		14	14	14
Burkina Faso		13	13	13
Burma/Myanmar		?	Illegal	?
Burundi		18	Illegal	?
Cambodia (Kampuchea)		16	?	?
Cambodia		16	?	?
Cameroon		Must be married	Illegal	?
Canada⁴		16/18	18	16
Cape Verde		?	?	?
Cayman Islands		?	?	?
Central African Republic		?	?	?
Chad		?	21	21
Chechenya		?	?	?
Chile		14	18	18
China		14	14	14
China - Hong Kong		16	16	16
China - Macao		16/17	?	?
Chinese Taipei (Taiwan)		16	16	16
Colombia		14	14	14
Cook Islands		16	Illegal	16
Costa Rica		15	15	15
Cote D'Ivoire		15	15?	15?
Croatia		14	14	14
Cuba		16	16	16
Cyprus		13/17	17 (Illegal in north)	17
Czech Republic		15	15	15
Democratic Republic of the Congo		?	Illegal	?
Denmark		15	15	15
Dominica		16	?	?
Dominican Republic		18	18	18
Dutch Antilles		16	16	16
Ecuador		14	14	14
Egypt		18	Illegal	18
El Salvador		18	?	?
Equatorial Guinea		?	?	?
Eritrea		18	Illegal	Illegal
Estonia		14	14	14
Ethiopia		15	Illegal	Illegal
Falkland Islands (Malvinas)		16	16	16
Faroe Islands		15	15	15
Fiji		16	16 (unofficial)	16
Finland⁵		16	16	16
Former Yugoslav Republic of Macedonia		16	16	16
France		15	15	15
French Guiana		15	15	15
French Polynesia (Tahiti)		16	16	16
Gabon		18	18	18
Gambia		?	Illegal	?
Georgia (country)		16	16	16
Germany⁶		14/16	14/16	14/16
Ghana		16	Illegal	Illegal
Greece		15	15/17	15
Greenland		?	?	?
Grenada		17	Illegal	17
Guam		16	16	16
Guadelope		15	15	15
Guatemala		18	18	18
Guinea		15	Illegal	Illegal
Guyana		16	Illegal	16
Haiti		18	18	18
Honduras		14/17	14	14
Hungary		14	14	14
Iceland		15	15	15
India⁷		14/16	Illegal	Illegal
Indonesia		16f/19m	18	18
Iran		Must be married	Illegal	Illegal
Iraq		18	?	?
Ireland		17	17	17
Israel		14-16	14-16	14-16
Italy		14	14	14
Jamaica		16	Illegal	16
Japan⁸		13-18	13-18	13-18
Jordan		16	16	16
Kazakhstan		18	?	?
Kenya		16	Illegal	16
Kuwait		Must be married?	Illegal	Illegal
Kyrgyzstan		?	?	?
Laos		15	?	?
Latvia		14/16	14/16	14/16
Lebanon		15/18/Married	Illegal	Illegal
Lesotho		?	?	?
Liberia		16	Illegal	Illegal
Liechtenstein		14	14	14
Lithuania		14	14	14
Luxembourg		16	16	16
Madagascar		21?	21	21
Mali		16	?	?
Malta		18	18	18
Malaysia		16/Married	Illegal	16
Marshall Islands		16	16	16
Martinique		15	15	15
Mauritius		15	Illegal	Illegal
Mexico⁹		12-18	12-18	12-18
Moldova		14	14	14
Monaco		15	15	15
Mongolia		16	?	?
Montenegro		14	14	14
Morocco		15	Illegal	Illegal
Mozambique		?	Illegal	?
Namibia		16	Illegal	16
Nepal		16	?	?
Netherlands		16	16	16
Netherlands Antilles		16	16	16
New Caledonia		16	16	16
New Zealand		16	16	16
Nicaragua		?	?	?
Niger		?	21	21
Nigeria		13	Illegal	Illegal
North Korea		Undefined	Undefined	Undefined
Norway⁵		16	16	16
Oman		Must be married	Illegal	Illegal
Pakistan		Must be married	Illegal	Illegal
Panama		18	Illegal (not enforced)	?
Papua New Guinea¹⁰		16f/14m/Illegal	Illegal	16
Paraquay¹¹		14/16	16	16
Peru		14	14	14
Philippines¹²		12/18	12/18	12/18
Poland		15	15	15
Portugal¹³		14/16	14/16	14/16
Puerto Rico		14	14	14
Qatar		Must be married	Illegal	Illegal
Reunion		16	16	16
Romania		15	15	15
Russia		16	16	16
Rwanda		18	18	18
San Marino		14/16	14/16	14/16
Saudi Arabia		Must be married	Illegal	Illegal
Senegal		?	Illegal	Illegal
Serbia		14	14	14
Singapore		16	Illegal	16
Slovakia		15	15	15
Slovenia		15	15	15
Somalia		?	Illegal	Illegal
South Africa		16	16	16
South Korea		13	13	13
Spain		13	13	13
Sri Lanka		16	Illegal	16
St. Kitts and Nevis		14/16	?	?
St. Martin		?	?	?
Sudan		Must be married	Illegal	Illegal
Suriname		16	18	18
Sweden		15	15	15
Swaziland		18	Illegal	Illegal
Switzerland		16	16	16
Syria		13/15	Illegal	Illegal
Tajikistan		17	?	17
Tanzania		18	Illegal	Illegal
Thailand¹⁴		15/18	15/18	15/18
Togo		14	Illegal	Illegal
Tonga¹⁵		16/Illegal	Illegal	16
Trinidad & Tobago		16	Illegal	Illegal
Tunisia		20	Illegal	Illegal
Turkey		18	18	18
Turkmenistan		16	Illegal	16
Tuvalu		?	Illegal	?
Uganda		18	Illegal	18
Ukraine		16	16	16
United Arab Emirates		18/Married	Illegal	Illegal
Uzbekistan		16	Illegal	16
Uruguay		15	15	15
Vanuatu		15	18	18
Venezuela		16	16	16
Vietnam		18	18	18
Western Samoa		16	Illegal	Illegal
Yemen		Must be married	Illegal	Illegal
Zambia		?	Illegal	?
Zimbabwe		12/16	Illegal	12/16
United Kingdom	England, Scotland, Wales Jersey, Isle of Man	16	16	16
United Kingdom	Northern Ireland	17	17	17
United Kingdom	Guernsey and Gibraltar	16	18	16
USA	Alabama	16	Law invalidated	Law invalidated
USA	Alaska	16	16	16
USA	Arizona	18	Law repealed	Law repealed
USA	Arkansas¹⁶	14/16	Law invalidated	Law invalidated
USA	California	18	18	18
USA	Colorado¹⁶	15/17	15/17	15/17
USA	Connecticut	16	16	16
USA	D.C.	16	Law repealed	Law repealed
USA	Delaware¹⁶	16/18	Law repealed	Law repealed
USA	Florida¹⁶	16/18	Law invalidated	Law invalidated
USA	Georgia	16	16	16
USA	Hawaii	16	Law repealed	Law repealed
USA	Idaho¹⁶	16/18	Law invalidated	Law invalidated
USA	Illinois	17	17	17
USA	Indiana¹⁶	14/16	14/16	14/16
USA	Iowa¹⁶	14/16	Law repealed	Law repealed
USA	Kansas	16	Law invalidated	Law invalidated
USA	Kentucky	16	Law invalidated	Law invalidated
USA	Louisiana¹⁶	17	Law invalidated	Law invalidated
USA	Maine	16	16	16
USA	Maryland	16	Law invalidated	Law invalidated
USA	Massachusetts	16	Law invalidated	Law invalidated
USA	Michigan	16	Law invalidated	Law invalidated
USA	Minnesota	16	Law invalidated	Law invalidated
USA	Mississippi	16	Law invalidated	Law invalidated
USA	Missouri¹⁶	14/17	Law repealed	Law repealed
USA	Montana	16	Law invalidated	Law invalidated
USA	Nebraska	17	Law repealed	Law repealed
USA	Nevada	16	Law invalidated	Law invalidated
USA	New Hampshire	16	Law invalidated	Law invalidated
USA	New Jersey	16	16	16
USA	New Mexico	17	17	17
USA	New York¹⁶	15/17	15/17	15/17
USA	North Carolina¹⁶	16	Law invalidated	Law invalidated
USA	North Dakota	18	Law repealed	Law repealed
USA	Ohio	16	Law repealed	Law repealed
USA	Oklahoma	16	Law invalidated	Law invalidated
USA	Oregon	18	18	18
USA	Pennsylvania	16	16	16
USA	Rhode Island	16	Law repealed	Law repealed
USA	South Carolina¹⁶	14/16	Law invalidated	Law invalidated
USA	South Dakota	16	Law repealed	Law repealed
USA	Tennessee	18	Law Invalidated	Law Invalidated
USA	Texas¹⁶	17	Law invalidated	Law invalidated
USA	Utah¹⁶	16/18	Law invalidated	Law invalidated
USA	Vermont	16	Law repealed	Law repealed
USA	Virginia	18	Law invalidated	Law invalidated
USA	Washington¹⁶	16/18	16/18	16/18
USA	West Virginia	16	Law invalidated	Law invalidated
USA	Wisconsin	18	18	18
USA	Wyoming	16	Law repealed	Law repealed
USA	Traveling Citizens	18	18	18
USA	Military personnel¹⁷	16	Illegal	Illegal
Average age*		16	16	16

General notes

If more than one age is given then the law within that country or state varies according to region or circumstances. In particular, some countries have regional laws that may overrule the federal law. Also in some cases the age of consent is lower when partners are of a similar age. Where the symbol ? is used, information is either incomplete or unavailable.

In some countries the age of consent is higher for those taking part in commercial sex. In many countries the age of consent is higher when one partner is in a position of trust with regard to the other, or when one partner takes advantage of the other's immaturity. Age of consent laws often do not apply when the partners are married.

In this table, male-female sex is defined as vaginal or anal sex, and male-male sex is defined as anal sex. Other sexual activities may be legal at a lower age.

* The average age of consent does not include countries where it is illegal.

Footnotes

In Queensland, the legal age of consent for anal intercourse is 18 (regardless of gender), while for vaginal intercourse it is 16.
Although the Austrian age of consent is basically 14, it is illegal to have sex with someone under 16 by "exploiting their lack of maturity".
In Brazil, authorities may not choose to prosecute if the younger partner is aged 14 to 17 and does not lodge a complaint.
In Canada, unmarried persons under 18 cannot legally consent to anal sex according to national law, although provincial laws may vary.
In Finland, sex with someone under 16 is not deemed sexual abuse of a child if "there is no great difference in the ages or the mental and physical maturity of the persons involved." Similarly in Norway, a prison sentence may not be imposed "if those who have committed the act of indecency are about equal in age and development." In both countries, lesser punishments may nevertheless be imposed.
In Germany, sexual intercourse is legal from the age of 14 in most cases. An exception is when the older partner is aged over 18 and is "exploiting a coercive situation" or offering compensation, in which case the younger partner must be over 16. In addition, it is illegal for someone aged over 21 to have sex with someone under 16 if they "exploit the victim's lack of capacity for sexual self-determination".
India's age of consent for heterosexual sex is 16 except in Manipur, where it is 14. If the partners are married then a lower age of consent applies (13 in Manipur and 15 elsewhere). A law banning "carnal intercourse against the order of nature" may be used to prosecute people for having anal or oral sex, though prosecutions are rare.
Although the age of sexual consent in Japan is 13 years of age, prefecture law usually overrides federal law, raising the age up to 18.
In Mexico the federal law varies according to the age gap between partners and is often overruled by regional laws.
In Papua New Guinea, anal sex is illegal in all cases. The age of consent for vaginal sex is 16 for females and 14 for males.
Paraguay sets the age of consent at 14 within marriage and 16 outside of marriage.
The age of sexual consent in the Philippines is 12 for all, but contacts with minors (under 18) are an offence if the minor consents to the act for money, gain or any other remuneration or as the result of an influence of any adult person.
In Portugal it is illegal to perform a sexual act with a minor between 14 and 16 years old "by taking advantage of their inexperience".
Although Thailand's age of consent is usually said to be 15, the laws can be interpreted to allow prosecution for sex with someone under 18.
Anal sex is illegal in Tonga regardless of age and gender.
In some U.S. states a lower age applies when the age gap between partners is small, or when the older partner is below a certain age (usually 18 or 21).
Under some circumstances it is possible for members of the U.S. military to also be charged under state laws.

Notes on U.S. laws

The Supreme Court in the USA has recently struck down laws that outlawed consensual, same-sex adult sexual activity. In general this means that the ages of consent for male-male and female-female sex are the same as the age for male-female sex. However in some states it is not entirely clear how the decision will be applied to their laws. If you are unsure about the age of consent in your state then it is a good idea to seek clarification from your state government.

"Law invalidated" means that the legislation was struck down in court and that the law is 'null and void'. It does not mean that the law has been removed.

"Law repealed" means that the law was removed and changed.

Age of consent

2008-10-20T07:59:00.000-07:00

There are some important laws regarding sex and young people, which often vary in different countries or states.

What does the age of consent mean?

The age of consent is the age at which a young person is legally able to understand and agree to consensual sex. In most countries, until you reach this age it is illegal for somebody to have sex with you, however old they may be. Sometimes the law is slightly different when the partners are of a similar age, but there is usually still a minimum age below which sex is always illegal.

Why do we have the age of consent?

Although some young people may feel that they are mature enough to engage in a sexual relationship, others may lack the emotional development to deal with this or to feel confident enough to say 'no'. Age of consent laws are there to protect young people from being sexually exploited by adults.

What is the age of consent?

The age of consent is different, depending on where you live, and in some places, the age of consent is different for boys and for girls. To find out about the age of consent in your country or state, please see our age of consent chart.

Does the age of consent apply to gay men and lesbians?

Yes. In some places there are different age of consent laws for gay men and lesbians, and in other places this type of sexual relationship is illegal. Check our age of consent chart for more detailed information.

What counts as 'sex'?

This, too, is different, depending on the laws in the place where you live. Some places count things like kissing as sexual contact, and other places only count sexual intercourse. Check out the laws in your state or country.

What is statutory rape?

Statutory rape is the crime that someone can be charged with if they have sex with a person who has not reached the age of consent but who agrees to have sex. Some countries have different names for this. Some states in the US for example call it 'unlawful sexual penetration' or just 'rape'.

What is sexual abuse?

Sexual abuse is the term for an adult using their age or authority over a young person to make any type of sexual contact. There is a difference between this and two young people who are in a consenting relationship.

If you are worried because you know of a young person who you think is in an abusive sexual relationship, please think carefully about what would be the right thing to do. Telephone helplines and sources of help in your country will be able to advise you.

Teens sex and the law

2008-10-20T07:58:00.000-07:00

It seems to many teens that adults are always making a big deal about people having sex under the age of consent. Many young people think that if they feel ready to have sex and they use protection, it is nothing to do with anyone else. But every teen needs to know the laws and what they mean.

So what does the age of consent mean?

The age of consent is the age when the law says you can agree to have sex. In most countries, until you reach this age you can't legally have sex with anyone, however old they are. Sometimes the law is slightly different when the partners are of a similar age, but there is usually still a minimum age below which sex is always illegal.

But our parents say it's okay. . .

That doesn't make any difference - your parents don't make the law. Teens can't get around the laws for smoking, drinking or driving because their parents say so, and it's the same with this. The age of consent laws always apply, whether you're in love, or you've been together for ages, or you've had sex before.

But it's no-one else's business. Why do we have these laws?

Although many young people are mature enough to know how to deal with it if someone tries to get them to have sex, some teens are not grown up enough to know what to do. Age of consent laws are there to stop young people from being exploited by adults.

What is the age of consent?

What the age of consent is depends on where you live - there are different age limits in different places, and in some places the age of consent is different for boys and for girls. To find out about the age of consent in your country or state, please see our age of consent chart.

Is there an age of consent for gay men and lesbians?

Yes. Some places have different age of consent limits for gay men and lesbians, and in other places this sort of relationship is against the law. To find out about your area, check our age of consent chart.

What is 'statutory rape'?

If you are under the age of consent and you choose to have sex with someone who is over the age of consent, then they can be charged with the crime of 'statutory rape'. Some countries have different names for this crime, and some states in the US call it 'unlawful sexual penetration' or just 'rape'.

And what's sexual abuse?

This is when a person is pressured into any type of sexual contact that they do not agree to. If you know anyone who is being pressurised in this way, you should tell an adult that you trust what's going on. Telephone helplines in your country should also be able to give you advice and information about what you should do and who you should contact.

Drink , Drugs and sex

2008-10-20T07:57:00.000-07:00

Alcohol, drugs and sex. Sound like fun? Well, they can be, and often are. But they can also carry risks, especially when they’re mixed together.

Drink and drugs both go hand in hand with socialising. People usually do these things at parties, hanging round with friends, at bars or at clubs. Why? Because drink and drugs can make you feel more relaxed, confident, and less inhibited. When you're feeling this way in a social situation, it’s more likely that you’ll meet someone who you like and want to hook up with – maybe even have sex with. The trouble is, that person may be someone that you wouldn’t have gone near if you’d been sober. Even worse, you might be so drunk or high that you forget (or simply don’t bother) to use a condom, which could lead to unwanted pregnancy, or a sexually transmitted infection (STI) being passed on.

“We had sex at New Year, which was very blurred as we were both extremely drunk... I do remember that we didn't use anything and I was not on the birth control pill.” - 17 year-old girl

“I got really drunk a couple of weeks ago and ended up having unprotected sex… it is the first time I had sex and I am really worried.” - 17 year-old boy - ¹

Do alcohol and drugs make sex better?

Young people drinking alcohol at a party

A lot of people seem to think this, but in many cases it’s not actually true. Drink and drugs might make you feel less nervous about sex – but then if you need these things to feel comfortable, you’re probably not with the right person, or you may not be ready to start having sex yet.

"My boyfriend wants me to do sex things with him but the only way I can manage is when I get drunk because otherwise I am too scared or embarrassed.” - 16 year-old girl - ²

What’s more, sexual performance can actually diminish after a night out. Alcohol is an anaesthetic. It numbs the genitals' nerve cells, making it more difficult to reach orgasm. Alcohol can also makes it harder for boys to achieve an erection. Drugs can have a similar affect. Some people take drugs like ecstasy (E, MDMA), cocaine (coke, charlie, blow) and amphetamines (speed) to make them more sexually excited, to make them 'last longer' in bed, or because they think that it will give them a more pleasurable orgasm. However these drugs can actually cause erection and orgasm problems. You may hear stories about people having sex for hours while taking drugs, but that’s probably because they can't reach an orgasm – it doesn't necessarily mean that they're having better sex!

What does alcohol actually do to you?

Alcohol is a depressant. This means that it temporarily slows down your central nervous system (the brain and the spinal cord), which controls your bodily functions, blocking out some of the messages trying to get through to your brain. Your reactions slow down and you may feel more relaxed and less anxious. Keep on drinking and you eventually become intoxicated – i.e. drunk, wasted, hammered, sloshed. At this point people often get blurred vision, slur their speech and become uncoordinated. Sometimes people get friendly, happy and carefree when they’re drunk, at other times they may become aggressive or angry. It depends on their personality, and what situation they’re in. Their ability to react to the world slows down, and this is why people are told not to drink and drive.

Some people find it fun to get a bit drunk and lose their inhibitions once in a while. At the same time, it’s generally harder to make sensible judgements when you’ve been drinking – which is why alcohol is famous for making people say or do things that they later regret!

Because alcohol loosens you up so much, it’s not uncommon for people to run into trouble when they’re drunk, getting into fights or accidents. In the U.S. for example, around 5,000 people under 21 die every year from alcohol-related injuries. ³

How about drugs?

A young person smoking cannabis at a party

Drugs vary greatly in strength and the effect that they can have on you. Some drugs are depressants (like alcohol), and make you drowsy and more relaxed. Marijuana (weed, pot, cannabis) falls into this class. Marijuana is one of the most common drugs used by teens and is often perceived to be relatively safe, but this isn’t necessarily the case. The strains of marijuana available today are generally much stronger than those around during the hippie-era of the 60’s and 70’s, which is when it gained its reputation as a harmless herb. While smoking a spliff can make you feel more chilled out, it can also induce feelings of anxiety and paranoia, or simply make you feel sick. There’s also increasing evidence that smoking marijuana regularly is linked to long-term mental health problems such as memory loss and depression in some people.

Other drugs are stimulants. They make you feel more awake and alert, and give you loads of energy. Ecstasy, speed and cocaine are examples of stimulants. These drugs increase your heart rate, body temperature and blood pressure. They can make you feel confident and euphoric. In high doses though, they can make you feel confused or dazed, overheat, have a heart attack or even suffer brain damage.

LSD (acid, trips) and magic mushrooms are examples of another class of drug called hallucinogens. They change your perceptions of reality, and can make you see, hear or feel things that aren’t really happening. These hallucinations might be funny or enjoyable, but they can also be very scary and upsetting. You hear all sorts of stories about people having ‘bad trips’, where they’ve freaked out after taking hallucinogens, and in some cases these bad trips can have long-lasting effects.

Heroin is one of the strongest and most dangerous drugs available. It’s highly addictive and easy to overdose on, which often leads to death. Since heroin is often injected into the body, users risk becoming infected with blood-borne diseases and viruses such as HIV if they share needles with other people.

Everyone I know is drinking, taking drugs or having sex…

It might feel as though this is true, but it probably isn't. Most teens don’t drink, and even a lot of adults choose not to. It’s even less common for people to do most other recreational drugs. As for sex, although a lot of teens brag about losing their virginity young, they’re not always telling the truth: the average global age for first having sex is around 19, and in some countries it’s as high as 23. ⁴ The point is that if you don’t want to drink, take drugs or have sex, then you’re certainly not alone.

“If you only want to try drink, drugs or sex because of peer pressure, then this is totally the wrong reason”

A lot of teens feel pressured into trying alcohol, drugs and sex by their friends, schoolmates and other people of the same age group – their peers. When this happens, it's called peer pressure. Peer pressure is the pressure that you feel to be like everyone else and fit in. It can be about all kinds of things, from fashion to dating and beyond. It's not always a bad thing, and it plays a big role in helping to shape our identities, how we talk, act and dress. But peer pressure can also cause people to do things that go against their will or beliefs – and with drink, drugs and sex, this is often what happens.

You might find yourself at a party where everyone’s drinking or taking drugs, and feel like people will think you’re a loser if you don’t join in. Or you might feel like you’re not cool because you’re still a virgin, and have sex with someone simply because you don't want to feel like you’re the only person who hasn’t.

“I remember a party with my sister. I was very scared, thinking: I have to drink. These people are so much older. I have to impress them.” - Megan - ⁵

“When I was in year 9, my friends pressured me into smoking marijuana or "pot". I really didn't want to but I thought life is short, and I gave into peer pressure. The first time, I suddenly spaced out and got high. I didn't know what to do, I wanted to beat people up. I hated it, but I kept on trying it whenever we were at parties.” - Simone - ⁶

“At 16 I was not ready to lose my virginity, I didn't have a steady boyfriend, I had little confidence in myself and I had no idea what I was getting myself into. All my friends were having sex. They acted as if losing your virginity was no big deal. It is! Trust me! I now know that I lost my virginity to the WRONG guy! He was a sleaze and I was just another girl to him.” - Fi - ⁷

At the end of the day, you can be in control. You may have your own reasons for wanting to try drink, drugs or sex… but if you’re only doing these things because of peer pressure, then this is totally the wrong reason. It’s not always easy to say ‘no’ to people, but if the people you’re with are really your friends, they’ll respect your decisions. Stand your ground and do what feels right for you, not anyone else.

“You don't need to drink just because somebody's telling you to drink. You have your own ways. That's what you got to tell them: My way is to stay the way I am, and I don't want to drink. If they can't respect that, then you need to leave them.” - Ilton - ⁸

“One morning, I had a wake up call and decided to not hang around these friends. I knew after this whole experience with pot, I would not give in to peer pressure again. My experience helped me realize what not to do.” - Simone - ⁹

I’m only having a few drinks. That’s fine, right?

It might be, but you should still be careful. Alcohol tolerance varies greatly between different people, and for some, a few drinks is all it takes to get drunk.

Even if you’re only planning on having a small amount of alcohol, or sticking to soft drinks, you still need to keep your wits about you. It’s possible that someone could spike your drink with 'date rape' drugs like Rohypnol or GHB, which take as little as 15 minutes to kick in and can wipe out your memory of what happens in the next eight hours, leaving you open to sexual assault and rape. The most common drug used to spike people’s drinks is actually alcohol. Extra alcohol can be added to people’s drinks without them knowing, or attackers may simply buy someone more and more drinks until they get drunk beyond the point where they know what they’re doing. They might put vodka into someone’s drink for instance, or buy them double measures of spirits when they’ve only asked for singles.

The intention of drink spiking isn’t always sexual assault. Sometimes it might be done as a joke, out of anger or spite, or to rob you. It happens to both boys and girls and is alarmingly common in some countries.

Young people drinking alcohol at a party

This doesn’t mean that you can’t go out and enjoy yourself; if you take a few simple precautions, you should be OK. Make sure you never leave your drink unattended, and if you do have to, leave it with a friend that you know and trust. Don’t swap or share drinks and think twice about accepting a drink from someone you don’t know well. If you suddenly start to feel unusually drunk or unwell without knowing why, it’s possible that your drink has been spiked; ask a trustworthy friend to help you and take you home. In the same way, if one of your friends starts acting strangely then keep an eye on them.

Another thing to remember is people who are looking to take advantage of you don’t always have to spike your drink – they may simply wait till you get drunk or high of your own accord. If you are going to drink, the key is not getting so out of your head that you don’t know what you’re doing! If you do think you’re going to get wasted, always make sure that you’ve surrounded by trustworthy friends who will look out for you.

I’m going to do drugs, but only once…

It’s human nature to want to experiment once in a while, and in many cases this can be harmless. But it’s worth bearing in mind that there are lots of people out there who say “only once” and end up doing drugs regularly or even getting addicted. No one starts taking drugs with the intention of becoming an addict or using them regularly. It’s always a case of ‘I’ll just try them’ or ‘I’m just an occasional user’. But often people enjoy the experience so much that they stop thinking about the risks and start using regularly. Before they know it, the drugs have caused changes to the structure and function of their brains, and they feel the urge to keep taking those drugs.

"It hit me like a tidal wave. It was incredible... it was no wonder I wanted to feel that way again soon. Before long I started popping ecstasy every other saturday night... soon I was using every Thursday, Friday and Saturday... All this partying took its toll on me. My body ached from the hours of dancing. My eyes were bloodshot with big, dark circles around them. I was always sick and depressed. I began to hate everything... Now it seemed that even ecstasy couldn't numb the pain. So I began to move on to other drugs.” - ¹⁰

Another thing to remember is that you only have to take some drugs once for them to have a serious effect, or even kill you. There are many cases where people have died after doing drugs like ecstasy, solvents (inhalants) or heroin for the first time.

We’ll fool around, but won’t go all the way with sex…

It can be fine if you and your boyfriend/girlfriend want to experiment with touching one another, or try pleasuring each other without having full on sex. Just remember that oral sex can lead to STIs being passed on if you don’t use a condom, as can anal sex.

Sometimes people make the mistake of thinking that if a couple start having unprotected sex, but stop before the boy ejaculates (comes), then this will prevent pregnancy. This isn’t necessarily true. Before and while he has sex, a boy’s penis releases a lubricating liquid called pre-come, and this substance can contain sperm. Even if a small amount of this substance gets inside the vagina, it can be enough to make a girl pregnant.

If you use a condom when necessary, then in most cases, you should be fine.

The final word

We’re not going to tell you that you shouldn’t drink, take drugs, or have sex, and equally we’re not going to encourage you to do these things – it’s ultimately up to you to assess the risks and make decisions in the context of your own life. What we will say that is that if you are going to drink, take drugs or have sex, be aware of the problems they can cause and take measures to minimise the risks to yourself and those around you.

If you’re going to drink, do it responsibly and make sure you’re around people that you can trust.
If you’re going to do drugs, the same applies, and you should also make sure that you know the score about what you’re taking – read more about drugs on information sites like Frank.
With sex, make sure that you use a condom to prevent STIs and pregnancy, or if you’re with a regular partner who you’re certain doesn’t have an STI, other birth control methods that can prevent pregnancy.
Keep in mind the law. Almost all recreational drugs are illegal, and they usually carry heavy penalties. The legal drinking age varies between countries but is generally at least 18, and 21 in some countries, such as the U.S. Laws about sex also differ between countries, so make sure that you know the age of consent.
Combining drink and drugs with driving is illegal in almost every country and is always a bad idea.
Don’t let peer pressure dictate your decisions. Work out what’s best for you as an individual, and stand up for yourself. If you don’t want to drink, take drugs or have sex, then it’s perfectly fine, and you shouldn’t let anyone tell you differently.

Casual Sex

2008-10-20T07:54:00.000-07:00

What is casual sex?

"A sexual activity where those involved do not define it as romantic or their partner as boyfriend or girlfriend."

This could be a definition of casual sex but many people have many different definitions of what casual sex might be. Here are some terms for casual sex that you might come across:

No strings attached	F*ck buddy	One night stands	Chance encounters

Hook-ups	Anonymous sex	Sociosexuality	Friends with benefits	Booty call

It's easy to give casual sex lots of different names, but at the end of the day it's all about doing the same thing. It is about one off sexual encounters with strangers or agreements that can stretch over a longer period of time between two people who have sex together.

What links them all is that the sex is normally conducted by people who tend to focus more specifically on the physical satisfaction rather than the emotional. Casual sex also doesn't necessarily mean heterosexual intercourse; it can involve any sexual act with anyone. The point is that it is done in the context of an agreement where the sex is an activity that mainly satisfies a sexual desire or physical attraction.

Casual sex lacks the emotional ties that come with relationships, and sex without any commitment or ties may sound very appealing, and it can be for any number of reasons.

The reason for a lot of people though is more often than not simply because it can seem attractive.

What's attractive about casual sex then?

"It was like heaven. When he was done, he simply rolled over next to me and hugged me." - Grace

Firstly it's important to make the point that casual sex is not for everyone and there are many who would say it is wrong or simply don't want to do it. Agree with it or not, this is not the point.

"As a gay young male I didn't really know who I was and found myself craving the company of men and having sex with them without knowing their name or who they were. Sex with them gave me a momentary fill."

- Chris

Whatever you think, it is a fact that casual sex is very popular and for a lot of people it's something that either satisfies a desire or serves a purpose. It is therefore an issue that affects many young people today.

It could be said that because we are often brought up to see sex outside of a long term, serious relationship as wrong, we develop a sense of casual sex being more exciting, a feeling that it is naughty or an act of rebellion that can be very appealing.

The excitement of mystery and unfamiliarity can add to the appeal of casual sex and, as often there is a low chance of meeting again, inhibitions can be cast aside. It is also made easier by the fact that the majority of the time both parties are aware that the sex is not going to lead to a relationship and are therefore more likely to be able to relax and just have sex for the pure pleasure of the actual act.

No matter how much we analyse the reasons why though, if you were to ask most people they would simply say that casual sex is attractive simply because it can be a bit of enjoyment.

So, what's the worry?

There is nothing wrong with thinking that sex should be fun. Due to the nature of casual sex though it's quite likely that you won't know the sexual history of your partner and what Sexually Transmitted Diseases they could potentially have. It could also be the case that they are unaware themselves of any infection they might have or, possibly, are just not going to tell you.

"I thought I was invincible and that nothing could ever go wrong. I was aware of the risks, but sometimes during the act I didn't care enough to stop." - Sincerely, Resilient

Sex should be enjoyable for all concerned, whether it be in a long and loving relationship or in a one off drunken mistake with some vague face from your college. What's important is to remember that just because you may approach the situation as 'just a bit of fun' it doesn't mean you don't need to think about what you are doing.

You have to be realistic and unfortunately there are these diseases and infections around and if you are going to have casual sex then you are as likely to get them as anyone else.

But everyone's doing it

"Before i knew it i was on top of her with a condom on. I asked her if she was sure that she wanted this. She said yes. I knew that i wasnt ready, but i didnt want to look like a pussy to all my friends, so i did it."

- Jeremy

There is probably a very strong chance that either directly or indirectly there has been pressure to have sex from those around you.

When there is a lot of pressure around you to have sex it's very easy to just do it because you think everyone else is and it's the normal thing to do. It can take a lot of will power and a strong sense of self-respect to not give in to peer pressure and there is strong evidence around to support the view that it is often better to wait.

It's also quite often not true that 'everyone is doing it' and even if everyone is 'doing it' it doesn't mean you have to. A lot of people don't want casual sex and will make a point of abstaining from it.

This can be for moral or religious reasons, or for the fact they simply prefer sex in a loving relationship and want to wait for that.

So what if you are someone who has casual sex?

Love it or loath it, either way what's important is that if you are going to go and have casual sex you approach it in the right way.

As a young person exploration and experimentation can be very appealing and you have a right to have fun when you're young and to experience things that are unfamiliar and different. The key to doing this though is to go into these situations prepared. Being prepared will also allow you to carry on enjoying yourself and not have to stop due to some horrible STD, or becoming infected with HIV. Quite often casual sex is a result of being drunk or doing drugs, or it could just be that you are on holiday, at a party or at university and just generally feel uninhibited and care free. Whatever the reason for having casual sex, just make sure you protect yourself.

Being responsible doesn't mean being boring!

But if we use a condom, there's no problem right?

It's very easy to go on about the very real physical consequences of casual sex such as pregnancy, STDs and HIV but casual sex can also have emotional repercussions. People often think that as casual sex doesn't have the emotional ties that a long-term relationship does, there is less chance of getting hurt emotionally.

With casual sex you need to think not just about physical harm but emotional harm also.

Casual sex offers only a moment of emotional intimacy. It does not provide the trusting and meaningful ties that you get with someone from being in a serious relationship.

It has been seen in various studies that not having these close emotional bonds and only pursuing casual encounters with various partners can lead to signs of depression and low self-esteem, especially amongst young women.¹

Important skills are not developed, like trust and communication. There is security and less anxiety in long term relationships, where each partner makes the other feel more valued.

If you wait until you are in love, it will be a much better experience." - Dawn

After a while people who have been in casual sex relationships may not feel worthy of being loved in long term relationships, they are used to being abandoned or moving on after a short period of time and therefore can lack the skills and faith in themselves that are needed to have a long term relationship.²

Take this into consideration - in a recent study by the condom makers Durex, they found that while Norway was the country that had the most casual sex in the world, they were also the nation least satisfied with their sex lives. This could be a coincidence but there is a lot of evidence to suggest it's not.

"It was the worst experience of my life. I felt like I was missing a part of me. I didn't love her. Not at all. It was horrible." - Jeremy

A look at our 'first time' stories will give you an idea of what some of the emotional consequences can be when you're just having sex for the sake of it. A lot seem to echo a general feeling of emptiness and regret, something that applies to not only first time experiences but also casual sex in general.

Have Confidence. Have Respect.

These are some useful things that would be worth thinking about if you want to remain active, healthy and having sex!

Respect yourself and respect your body

Only you can do this.
Unprotected sex will put your body at risk.
The risks involved can have very serious consequences.

Respect others you meet

Make sure you are in it for the same reasons as each other.
Make sure all involved are happy with the situation.
Think not just about your emotions but the other person's also.

Have the confidence to make the right choices

Don't do anything that you don't want to do.
If you're not comfortable with something don't do it.
Protect yourself; be confident enough to suggest using a condom.

If you follow these simple suggestions you are more likely to be able to continue having fun and enjoyment.

You make the choice

This page is not here to dictate to people how to live their lives, but is here to provide information.

Casual sex can be risky, to not only a persons physical health but to their mental health also. People who have casual sex need to take these things into account when making decisions regarding their sex lives and personal health.

Teens and Sexually Transmitted Disease

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What are STDs?

STD stands for Sexually Transmitted Disease (sometimes called Sexually Transmitted Infection). This is an infection which can be caught by having sexual contact with someone who is infected. This can be vaginal, oral or anal sex, although other types of touching can pass some STDs - for example, some STDs (such as Herpes and HPV) can be caught by caught by touching the infected areas of someone's body and then touching your own genitals (private parts). There are quite a lot of different STDs. We have more information about the different STDs and HIV and AIDS.

Aren't STDs only a problem for older people who sleep around?

No. In fact, some STDs like chlamydia and gonorrhea are actually more common among teens than among older men and women. And you don't have to sleep around to get an STD, although it can increase your chances of having sex with someone with an STD.

I think I've got an STD! What should I do?

"Someone I've slept with says they have an STD. . ." "I've got some strange symptoms. . ."

Most of the symptoms of STDs can be found either on the genitals or in and around the mouth. Our STD pages will give you more information about symptoms.

If you think you have an STD you should have a test and get treatment. Untreated STDs can be dangerous - if you don't get help, you may not be able to have children later in life, or it can increase your risk of cancer. You may also pass it on to your partner.

Who can I talk to?

It may help you to talk to an adult - perhaps a parent, school nurse or teacher may be able to advise you where you can have an STD test. Or you could ask your family doctor about STD testing.

I'm too shy to go to a clinic for an STD test!

Don't worry. The doctors and nurses who work there are professionals and they do this all the time.

Will they tell my parents?

Most (but not all) clinics have a confidentiality policy, and will not tell anyone, although some places will want you to bring a parent to give consent. You can phone the clinic before you go and find out.

What will they do?

They may take a urine sample, a blood sample or a swab from the vagina or penis. Not all STD testing requires you to have a physical examination, and you might not even have to undress. Ask what they are testing for - it may be a good idea to be tested for everything, if you can. Some places can give you the results on the same day, in other places you may have to wait for a week or more. While you wait, you shouldn't have sexual contact with anyone.

If you find that you do have an STD, it's important that you don't pass on the infection to anyone else. Don't have sexual contact with anyone until you have been treated and are no longer infectious.

If you think that you may already have passed on the infection to someone else, it is important that you tell them so that they can have a test, too. If the clinic gives you antibiotics or medication, make sure that you follow the instructions and complete the course of treatment - otherwise the STD may come back.

So how can I protect myself?

Using condoms during vaginal, oral and anal sex will help to protect you, (see our condoms page). You could also use a female condom (although you shouldn't use both male and female condoms together). However, some STDs (such as oral herpes) can be transmitted in other ways, such as kissing. You shouldn't have sexual contact with anyone who has visible sores or genital rashes.

You can only catch an STD by having sexual contact with someone else who already has an STD. This means that someone who does not have an STD can't infect you, and you can't infect yourself by masturbation.

How can I tell if someone has an STD?

You can't. Some people with STDs may have symptoms that you can see, but many people have no symptoms at all. Someone could have an STD and have no symptoms for months or even years, but still be infectious. Using condoms correctly will reduce your risk of infection.

Aids , Sex & Teens

2008-10-20T07:51:00.000-07:00

What's the big deal about HIV/AIDS?

It's easy to think that AIDS is something for other people to worry about - gay people, drug users, people who sleep around. This is wrong - all teens, whoever they are, wherever they live need to take the threat of HIV seriously. To be able to protect yourself, you need to know the facts, and know how to avoid becoming infected.

Isn't it only a problem for adults?

No. HIV is a big problem for young people, as well as adults. In 2007, it is estimated that there were 2.5 million people under 15 living with HIV.

"I am 15 years old and my best friend who is a male has AIDS and we were really close so one night we experimented and after the fact that we "did it" he told me that he had AIDS." - Monica

What's the difference between HIV and AIDS?

HIV is the virus that causes AIDS. HIV stands for the 'Human Immunodeficiency Virus' and AIDS stands for the 'Acquired Immune Deficiency Syndrome'. AIDS is a serious condition in which the body's defences against some illnesses are broken down. This means that people with AIDS can get many different kinds of diseases which a healthy person's body would normally fight off quite easily.

How long does it take for HIV to cause AIDS?

The length of time between being infected with HIV and being diagnosed with AIDS depends on lots of different things. These days, there are many drugs that can be used to help people with HIV, and most doctors believe that a lot of people can be treated for a very long time. Many people do not know exactly when they were infected with HIV, and the length of time between this happening and them being diagnosed with AIDS can be very variable.

So how do you get infected with HIV?

HIV is passed on in the sexual fluids or blood of an infected person, so if infected blood or sexual fluid gets into your body, you can become infected. This usually happens by either having sexual intercourse with an infected person or by sharing needles used to inject drugs with an infected person. People can also become infected by being born to a mother who has HIV and a very small number of people become infected by having medical treatment using infected blood transfusions.

HIV can't be caught by kissing, hugging or shaking hands with an infected person, and it can't be transmitted by sneezes, door handles or dirty glasses.

What is 'safe sex'?

Safe sex means sexual activities which you can do even if one person is infected with HIV, and they definitely won't pass it on to the other person. Loads of activities are completely safe. You can kiss, cuddle, massage and rub each other's bodies. But if you have any cuts or sores on your skin, make sure they are covered with plasters (band-aids). Nothing you do on your own can cause you to get HIV - you can't infect yourself by masturbation.

What about using drugs?

The only way to be safe around drugs is not to take them. If you are on drugs you may take risks you normally wouldn't take, and you may have unsafe sex when you would normally be more careful. If you take drugs, you might find it more difficult to use a condom, or you might forget altogether. One of the most common drugs this can happen with is alcohol - if you're drunk, you might not always know what you're doing, or you might not care.

If you inject drugs, you should always use a clean needle, syringe and spoon, water, etc each time you inject, and never share any of these with anyone else. If you snort drugs, and you use a note or a straw to snort through, you shouldn't share it with anyone else, as blood can be passed from the inside of one person's nose to another.

If you have a tattoo or a piercing, you should make sure that the needles and equipment used are sterile. Ask the staff at the place you have it done about what precautions they use.

What is safer sex?

Safer sex also means using a condom during sexual intercourse. Using a condom is not absolutely safe as condoms can break, but condoms can be effective if they are used correctly. To find out more about this, see our condoms page.

Oral sex (one person kissing, licking or sucking the sexual areas of another person) does carry some risk of infection. If a person sucks the penis of an infected man, for example, infected fluid could get into the mouth. The virus could then get into the blood if you have bleeding gums or tiny sores somewhere in the mouth. The same is true if infected sexual fluids from a woman get into the mouth of her partner. But infection from oral sex alone seems to be very rare.

Can you get infected your first time?

Yes, if your partner has HIV and you have unsafe sex, then you can become infected.

Is there a cure?

There is no cure for HIV. HIV is a virus, and no cure has been found for any type of virus. Recently, doctors have been able to control the virus once a person is infected, which means that a person with HIV can stay healthy for longer, but they have not managed to get rid of the virus in the body completely.

How can I tell if someone's infected with HIV?

There is no way to tell just by looking at someone whether they are infected with HIV. Someone can be infected but have no symptoms and still look perfectly healthy. They might also feel perfectly healthy and not know themselves that they are infected. The only way to know if a person is infected or not is if they have a blood test.

How can I get tested?

You may find it helpful to talk to an adult - perhaps a parent, school nurse or teacher may be able to advise you where you can have a test. It's much better to talk to someone than to worry on your own. The clinic will suggest that you wait three months (or six in the US) after your last risky sexual contact before having a test. This is because the virus is difficult to detect immediately after infection.

Will they tell my parents?

The clinics in different places have different policies. Most (but not all) clinics have a confidentiality policy, and will not tell anyone, although some places will want to bring a parent to give consent. You can phone the clinic before you go and find out.

What will they do?

Before they do anything, the doctor or nurse will ask if you're sure you want to have a test. They will usually take a sample of blood from you to examine. If you also want to be tested for STD's, they may take a urine sample, or they might ask if they can take a swab from the vagina or penis. Some places can give you the results on the same day, in other places you may have to wait for a week or more. While you wait, you shouldn't have sexual contact with anyone.

I have HIV - what should I do?

If you have found that you have HIV, you will need to tell the people who you have had sex with and anyone you have shared needles with so that they can decide if they want to have a test. This can be a very difficult thing to tell someone. If you think you can't tell them, your doctor or nurse may b

AIDS Around The World

2008-10-20T07:50:00.000-07:00

When AIDS first emerged, no-one could have predicted how the epidemic would spread across the world and how many millions of lives it would change. There was no real idea what caused it and consequently no real idea how to protect against it.

Now we know from bitter experience that AIDS is caused by the virus HIV, and that it can devastate families, communities and whole continents. We have seen the epidemic knock decades off countries' national development, widen the gulf between rich and poor nations and push already-stigmatized groups closer to the margins of society. We are living in an 'international' society, and HIV has become the first truly 'international' epidemic, easily crossing oceans and borders.

However, experience has also shown us that the right approaches, applied quickly enough with courage and resolve, can and do result in lower national HIV infection rates and less suffering for those affected by the epidemic. We have learned that if a country acts early enough, a national HIV crisis can be averted.

The child of an HIV positive mother, Tanzania

It has been noted that a country with a very high HIV prevalence rate will often see this rate eventually stabilise, and even decline. In some cases this indicates, among other things, that people are beginning to change risky behaviour patterns, because they have seen and known people who have been killed by AIDS. Fear is the worst and last way of changing people's behaviour and by the time this happens it is usually too late to save a huge number of that country's population.

Already, more than twenty-five million people around the world have died of AIDS-related diseases. In 2007, around 2.1 million men, women and children lost their lives. 33.2 million people around the world are now living with HIV, and most of these are likely to die over the next decade or so. The most recent UNAIDS/WHO estimates show that, in 2007 alone, 2.5 million people were newly infected with HIV.

It is disappointing that the global numbers of people infected with HIV continue to rise, despite the fact that effective prevention strategies already exist.

Africa

It is in Africa, in some of the poorest countries in the world, that the impact of the virus has been most severe. At the end of 2005, there were 10 countries in Africa where more than one tenth of the adult population aged 15-49 was infected with HIV. In four countries, all in the southern cone of the continent, at least one adult in five is living with the virus. In Botswana, a shocking 24.1% of adults are now infected with HIV, while in South Africa, 18.8% are infected. With a total of around 5.5 million infected, South Africa has more people living with HIV than any other country.

A first step in publicly admitting the AIDS crisis:

a road sign in Botswana.

Rates of HIV infection are still extremely high in sub-Saharan Africa, and an estimated 1.7 million people in this region became newly infected in 2007. This means that there are now an estimated 22.5 million people living with HIV/AIDS. In this part of the world, particularly, women are disproportionately at risk. As the rate of HIV infection in the general population rises, the same patterns of sexual risk result in more new infections simply because the chances of encountering an infected partner become higher.

Whilst West Africa is relatively less affected by HIV infection, the prevalence rates in some large countries are creeping up. Côte d'Ivoire is already among the twelve worst affected countries in the world, and in Nigeria nearly 4% of adults have HIV. In West Africa the epidemic displays a diversity not seen to such an extent in other parts of the continent. National prevalence rates can remain low, while infection rates in certain populations can be very high indeed.

Infection rates in East Africa, once the highest on the continent, hover above those in the West but have been exceeded by the rates now seen in the southern cone. In 2005, the HIV prevalence rate among adults in Kenya, Tanzania and Uganda exceeded 6%.

It is widely though that North Africa managed to sidestep the global AIDS epidemic - perhaps due to its strict rules governing sexual behaviour. However, the latest UNAIDS estimates indicate that 35,000 people in North Africa and the Middle East acquired an HIV infection in 2007, bringing the total number of people living with HIV/AIDS in the Middle East and North Africa to an estimated 380,000. AIDS killed a further 25,000 people in 2007.

Increasing prevalence rates are not inevitable. In Uganda the estimated prevalence rate fell to around 5% from a peak of about 15% in the early 1990s. This trend is thought in part to have resulted from strong prevention campaigns, and there are encouraging signs of the same effect happening in parts of Zambia, Kenya and Zimbabwe. Yet the suffering generated by HIV infections acquired years ago continues to grow, and a drop in HIV prevalence is generally associated with a massive number of AIDS deaths. Barely one in four Africans in need of antiretroviral treatment were receiving it at the end of 2006.

Asia

The diversity of the AIDS epidemic is even greater in Asia than in Africa. The epidemic here appears to be of more recent origin, and many Asian countries lack accurate systems for monitoring the spread of HIV. Half of the world's population lives in Asia, so even small differences in the infection rates can mean huge increases in the absolute number of people infected.

Following new surveys conducted in 2005-2006, India is now thought to have between 2 million and 3.1 million people living with HIV. Other large epidemics are present in China (700,000), Thailand (580,000) and Myanmar (360,000). The total number of people living with HIV in Asia is thought to be around 4.8 million.

A camel in Jodhpur, India wearing a banner

that says "protect yourself from AIDS"

National adult prevalence is still under 1% in the majority of this region's countries. However some of the countries in this region are very large and national averages may obscure serious epidemics in some smaller provinces and states. Although national adult HIV prevalence in India, for example, is below 1%, some states have an estimated prevalence well above this level.

In most Asian countries the epidemic is centred among particular high-risk groups, particularly men who have sex with men, injecting drug users, sex workers and their partners. However the epidemic has already begun to spread beyond these groups into the general population. Some Asian countries, such as Thailand, have responded rapidly to the epidemic with extensive campaigns to educate the public and prevent the spread of HIV – and have succeeded in cutting prevalence. Other very populous regions, such as China, have only recently admitted that the spread of HIV threatens their populations, and as a result their prevention work is lagging behind the spread of the virus. Unless rapid and effective action is taken in this part of the world, then the size of the epidemic to come will dwarf the many deaths that have already occurred.

The epidemic in Asia has ample room for growth. The sex trade and the use of illicit drugs are extensive, and so are migration and mobility within and across borders. The fluidity in international markets and especially the lack of economic stability in Asia has erupted into non-stop movement within countries and among countries, mirrored in the growing prevalence of HIV. India, China, Thailand and Cambodia, to name only a few, have highly mobile populations within their borders, with people moving from state to state and from rural to urban areas. In China, permanent and temporary migrants may total as many as 120 million people.

Eastern Europe & Central Asia

A doctor councils at an AIDS helpline

in Prague, Czech Republic

The AIDS epidemic in Eastern Europe & Central Asia is rapidly increasing. In 2007, some 1.6 million people were living with HIV, compared to 630,000 in 2001. AIDS claimed an estimated 55,000 lives during 2007, which is nearly seven times as many as in 2001.

In any country where rates of injecting drug use and needle sharing are high, a fresh outbreak of HIV is liable to occur at any time. This is especially true of the countries in Eastern Europe where the HIV epidemics are still young and have so far spared some cities and sub-populations. Heroin smuggled into the West crosses through a number of Eastern European countries, and its path is marked by a high concentration of injecting drug users, and a high HIV prevalence.

The Russian Federation, Ukraine, and the Baltic states (Estonia, Latvia, and Lithuania) are the worst effected, although HIV continues to spread in Belarus, Moldova and Kazakhstan, and more recent epidemics are emerging in Kyrgyzstan and Uzbekistan. An estimated 940,000 HIV-infected people were living in the Russian Federation at the end of 2005. However, as reporting of HIV cases in many areas of Russia is at best patchy, it is difficult to determine a precise figure. The epidemic in Eastern Europe is primarily driven by injecting drug use, and the criminalisation of this practice makes it difficult to gain an accurate picture of the proportion of drug users who are living with HIV.

Caribbean

HIV is ravaging the populations of several Caribbean island states. Indeed some have worse epidemics than any other country in the world outside sub-Saharan Africa. In the most affected countries of the Caribbean, the spread of HIV infection is driven by unprotected sex between men and women, although infections associated with injecting drug use are common in some places, such as Puerto Rico.

Haiti, where the spread of HIV may well have been fuelled by decades of poor governance and conflict, is the worst affected nation in the region. An estimated 3.8% of Haitian adults were living with HIV at the end of 2005, though rates vary considerably between regions. HIV transmission in Haiti is overwhelmingly heterosexual, and both infection and death are concentrated in young adults. Many tens of thousands of Haitian children have lost one or both of their parents to AIDS. Among pregnant women in urban areas, HIV prevalence appears to have fallen by half between the mid-1990s and 2003-2004. Probably much of this decline is due to an increase in the AIDS death rate, though behaviour change might also have played a part. There is still an urgent need for intensified prevention efforts in Haiti.

On the Caribbean coast of South America, Suriname and Guyana had adult HIV prevalence rates of 1.9% and 2.4% respectively at the end of 2005. There are only limited data on HIV in Guyana, but it appears the country has a rapidly growing epidemic, which is becoming established within the general population.

The heterosexual epidemics of HIV infection in the Caribbean are driven by the deadly combination of early sexual activity and frequent partner exchange by young people. A study published in 2005 found that in Trinidad and Tobago, HIV infection levels are six times higher among 15-19 year old females than among males of the same age. In another survey in Barbados, one quarter of 15-29 year old women said they had been sexually active by the age of 15, and almost one in three men aged 15-29 years reported multiple sexual partnerships in the previous year.

AIDS is now high on the agendas of many governments in this region, as they are beginning to notice the significant impact of the epidemic on their medical systems and labour force. Cuba's comprehensive testing and prevention programmes have helped to keep its HIV infection rate below 0.2%, and the country provides free AIDS treatment to all those in need. In Barbados and Bermuda, wider access to antiretroviral treatment has cut AIDS deaths in half. Other countries are now seeking to emulate such successes.

Latin America

Around 1.6 million people were living with HIV in Latin America at the end of 2007. During that year, around 58,000 people died of AIDS and an estimated 100,000 were newly infected. The HIV epidemics in Latin America are highly diverse, and are fuelled by varying combinations of unsafe sex (both between men, and between men and women) and injecting drug use. In nearly all countries, the highest rates of HIV infection are found among men who have sex with men, and the second highest rates are found among female sex workers.

The Central American nations of Honduras and Belize have well-established epidemics, with adult HIV prevalence rates above 1%. AIDS is the leading cause of death among Honduran women and is believed to be the second-biggest cause of hopitilisation and death overall in the country. In these countries the virus is mainly spread through unprotected sex, particularly commercial sex and sex between men.

Commercial sex and sex between men are the major drivers of smaller epidemics elsewhere in Central America, where national HIV prevalence rates vary between 0.2% and 0.9%. Men who become infected via these routes are likely to pass the virus on to their wives and girlfriends.

Brazil had an adult HIV prevalence rate of 0.5% at the end of 2005, but, because of its large overall population, this country accounts for nearly half of all people living with HIV in Latin America. In Brazil, heterosexual transmission, sex between men and injecting drug use account for roughly equal numbers of infections.

HIV in Argentina was initially seen as a disease of male injecting drug users and men who have sex with men. But now the virus is spread mostly through heterosexual intercourse, and is affecting a rising number of women. The other Andean countries are currently among those least affected by HIV infection, although risky behaviour has been recorded in many groups.

Awareness raising among young people in Mexico

One of the defining features of the Latin American epidemic is that several populous countries, including Argentina, Brazil and Mexico, are attempting to provide antiretroviral therapy to all those who need it. The governments of these countries have invested and encouraged local pharmaceutical manufacturers to produce generic copies of expensive patented medicines. This allows them to distribute drugs to a much greater proportion of their population that they would otherwise be able to help.

Treatment coverage still varies widely, but these efforts are having a definite impact. While they are improving both the length and the quality of people's lives, they are also increasing the proportion of people living with HIV, and thus HIV prevalence figures. Some concern has been voiced over the risk that HIV prevention activities may suffer if much effort and money is devoted to providing treatment.

High-income countries

In high-income nations, HIV infections have historically been concentrated principally among injecting drug users and gay men. These groups are still at high risk, but heterosexual intercourse accounts for a growing proportion of cases. In the United States, more than a quarter of people diagnosed with HIV in 2004 were female, and more than three quarters of these women were probably infected as a result of heterosexual sex. In several countries in Western Europe, including the United Kingdom, heterosexual contact is the most frequent cause of newly diagnosed infections.

Very early in the epidemic, once information and services for prevention had been made available to most of the population, the level of unprotected sex fell in many countries and the demand rose for reproductive health services, HIV counselling and testing and other preventive services. However prevention activities are now lagging behind as the epidemics move beyond their traditional at-risk groups.

Prevention work in high-income countries has declined, and sexual-health education in schools is still not universally guaranteed, in spite of the fact that the risks of HIV are well-known to governments. Political factors have been allowed to control the HIV prevention work that is done, and politicians are commonly keen to avoid talking about any sexual issues. Furthermore, it is very hard to show that a number of people are not HIV positive who otherwise would be – and politicians like the electorate to see results.

Among gay men, the virus had spread widely before it was even identified and had established a firm grip on the population by the early 1980s. With massive early prevention campaigns targeted at gay communities, risk behaviour was substantially reduced and the rate of new infections dropped significantly during the mid- and late 1980s. Recent information suggests, however, that risky behaviour may be increasing again in some communities. People think that the danger is over because of lack of media coverage of the issues around HIV and AIDS - and many new infections continue to occur.

Some communities and countries have initiated aggressive HIV prevention efforts, particularly among high-risk groups such as injecting drug users. But in many places the political cost of implementing needle-exchange and other prevention programmes has been considered too high for such programmes to be started or maintained. As a result, there are continuing high prevalence rates among injecting drug-users in many high-income countries, particularly Italy, Spain and Portugal.

Many high-income countries suffer from the belief that HIV is something that affects other people, not their own populations. On a national level, this belief prevents policy-makers and budget-setters from seeing the epidemic on their own door-steps, looking instead to the situation in areas such as Africa. Some high-income countries fund medication provision for low-income countries whilst failing to provide medicines for their own citizens who have AIDS. Even in the US, there are people who are unable to afford to buy the drugs they need.

Where do we go from here?

Spending

Money is finally being spent on both treating the disease and on preventing new infections from occurring. This spending needs to increase both in its magnitude and its effectiveness. Many people fail to realise that actually spending money, in the very large sums the fight against HIV requires, is a difficult task, and one of which many organisations have little experience.

The Global Fund, an organisation created to channel money to where around the world it is most needed, is an already-existing way of effectively spending money. Many governments, however, wish to exert control over how their donations are spent and on what projects, so they prefer to channel their funding through other channels.

In January 2003, President Bush announced a bold new initiative known as PEPFAR, through which the USA will spend $15 billion over five years on HIV/AIDS prevention, treatment and care programmes in other countries.

Prevention and education

Education has already been proved to be effective and necessary, both for people who are not infected with HIV, to enable them to protect themselves from HIV, and for people who are HIV+, to help them to live with the virus. There is a huge wealth of educational resources available around the world, and yet in many places people still lack the knowledge they need to protect themselves.

AIDS is a preventable disease, but to avoid HIV infection people need more than just factual information. People need empowerment to negotiate safe and responsible sexual relationships; gender inequalities must be confronted; and those who choose to have sex need access to condoms. Needle exchanges should be encouraged, as they have proven highly effective at preventing HIV transmission among injecting drug users.

Medication

Antiretroviral AIDS medication is now being distributed to low-income, high prevalence countries, but it is taking a long time to actually reach the people who need it. Access to treatment must greatly improve if millions of deaths are to be avoided. When treatment finally reaches the areas where it is needed, trained nurses must be available to carry out HIV tests, administer the medicines, and teach people how to use them.

Conclusion

HIV has now finally been recognised as a global threat, and people are beginning to take action to prevent it killing many more millions than those who have already died. This action needs not only to continue, but to be speeded up considerably. The HIV epidemic is growing, and efforts to fight it need to grow at an even greater rate if they are to be successful.

An ever-growing AIDS epidemic is not inevitable. However, unless action against the epidemic is scaled up drastically, the damage already done will seem minor compared with what lies ahead. This may sound dramatic, but it is hard to play down the effects of a disease that stands to kill more than half of the young adults in the countries where it has its firmest hold. Entire families, communities and countries will begin to collapse if this situation is allowed to occur.

Puberty Periods And Girls

2008-10-20T07:49:00.000-07:00

What is puberty?

Between the ages of 10 and 14 most boys and girls begin to notice changes taking places to their bodies. These changes which take place over a number of years also include emotional changes and are sometimes referred to as puberty.

The changes take place in all boys and girls but they will start at different times. Generally the changes start later for boys than girls. In some people they start before the age of 10. Other people will only start to change after the age of 14. The changes also take place at a different rate in different people. In some people all the changes take place in 2 years. In other people they can take as long as 4 years.

Puberty starts when extra amounts of chemicals called hormones start to be produced in the body. These hormones guide the changes that take place in the body. As well as causing physical changes these hormones also cause emotional changes to occur.

What are the physical changes that take place in girls during puberty?

A girl's breasts will start to grow and her hips get rounder. Hair will start to grow under her arms. Hair, often called pubic hair, will also grow between her legs. She will also start to have periods.

What is a period?

When a girl "has her period", a small amount of bleeding (a few spoonfuls) takes place from her vagina. The vagina is a small opening that girls have between their legs. The bleeding will last for a few days and usually happens every month. This bleeding is sometimes referred to as menstruation and is not something to be scared of. Some girls get a white stain in their panties before they have had their first period, and this means their first period may begin soon.

Most girls will have their first period between the ages of 11 and 14. But some girls will start as early as 8, whilst others may be as late as 17.

Once a girl has had her period a few times she may notice that her body or mood changes slightly beforehand. For example, her breasts may feel sore, or become larger, or she may get spots on her face. But no one can tell if a girl has her period just by looking at her.

How does a girl stop blood getting on her clothes during her period?

When a girl has her period she can use sanitary towels or tampons to soak up the blood. Most girls start by using sanitary towels.

Sanitary towels are thin pads made of a soft cotton-like material. They are worn by a girl inside her panties. Most towels have a sticky strip on them that sticks the pad to the inside of the girl's panties.

A tampon is like a small rolled up piece of cotton wool with a string at one end. A girl pushes a tampon into her vagina leaving the string hanging outside her body. The string is then used to pull the tampon out. Some tampons also come with cardboard or plastic applicators that insert the tampon for you. As a tampon is put into the vagina there is no problem about going to the toilet when using a tampon.

Sanitary towels and tampons can both be bought in supermarkets and chemists. They usually come in packets of about 10 or 15. Towels and tampons come in different thicknesses so you can use a thicker one when the bleeding is heavier, and thinner ones for lighter bleeding.

In areas where tampons and towels are not available, or are too expensive to afford, many women will use rags or old strips of cloth or towelling to soak up the blood. "Menstrual cups" (small latex or silicone cups that are inserted into the vagina to collect the blood) are also available from chemists in some countries, and most can be washed and reused many times.

How often does a sanitary towel or tampon need to be changed and how do you dispose of them?

A sanitary towel should be changed every few hours during the day, even if the flow of blood is not very great. A sanitary towel can be used overnight without changing. Tampons should be changed several times a day and a tampon should not be used overnight. Changing tampons is particularly important because if a girl forgot to change a tampon for a long time, perhaps 24 hours or more, then it could make her ill.

Used sanitary towels and tampons should be wrapped up and put in a bin. In most women's public toilets there is a special bin in each cubicle which used sanitary towels and tampons can be put in.

Do periods hurt?

Some girls feel uncomfortable or have cramp-like pains when they have periods. For some girls the pain can be quite intense and it may be necessary to talk to a doctor about it. Usually the pain is not very bad and does not last very long. If you have any difficulty you should talk to an adult, as there are a number of things that can be done to help.

When a girl has her period she can do the things she normally does including having a bath or shower. Washing the vaginal area daily helps prevent infections developing. But it's a good idea to wash and dry from front to back to avoid spreading germs to the vagina.

When having a bath the amount of blood will not be enough to change the colour of the water. If a girl is using a tampon she should take it out before having a bath or shower and use a new one afterwards. If a girl wants to go swimming whilst she has her period she should use a tampon rather than a sanitary towel.

When does a girl need to start wearing a bra?

There is no set time when a girl needs to start wearing a bra and some girls go through life never wearing one. Girls who wear a bra usually do so because they feel more comfortable wearing one. Some girls wear a bra only when they are doing sports, others wear one all the time except when sleeping. Bras are made with different size cups for different breast sizes.

Often one breast grows faster than the other. Some girls' breasts remain small throughout their adult lives. Some girls find that their breasts or nipples start to tingle or itch whilst they grow. But these feelings stop when the breast stops growing.

It is not necessary to wear a bra to keep breasts healthy.

What can a girl do if...

She gets spots?

Almost everybody has spots at some time during their life. Most young people get spots around puberty. Washing your face more often with mild unperfumed or antiseptic soap and warm water may help. Some people find that not eating certain foods such as chips and chocolate can help. Other people say this won't help because it is the higher level of hormones in the body that is causing the spots to occur. For some people drinking lots of water can be very effective in helping prevent spots.

It is important to try not to pick at, or squeeze, the spots as this can cause them to become infected. It may help to use some special anti-acne cream or lotion. You can buy this from chemists and some supermarkets. If you get very bad spots it might be acne which your doctor can help with by giving you pills or special creams.

Her period starts and she doesn't have a sanitary towel or tampon?

A girl can always use something soft like tissues, or rolled-up toilet paper inside her panties to soak up the blood until she can get a sanitary towel or tampon.

Her period starts when she is at school?

If you are at school you should ask a friend or a teacher or other adult if they could help. There might be some sanitary towels in the school office as it quite often happens that a girl's period starts unexpectedly.

Someone says she smells?

As boys and girls' bodies develop during puberty so too do their sweat glands. These glands are to help control the body's temperature and result in more sweat being produced. The best way to reduce the risk of smelling is to wash and change your clothes regularly and perhaps use anti-perspirant deodorant on especially smelly areas, e.g. under your arms. However, most girls do not need to use a vaginal deodorant, and these may cause irritation.

Her period doesn't start when she expects it to?

When a girl first starts having periods they can occur at very irregular intervals. It can often take a couple of years before a girl's periods settle down and occur at regular intervals. The interval between periods is then usually about 28 days (a month).

Changes in your emotions can also cause changes to your periods. For example, worry about a period starting can sometimes cause further delay to the period.

However if you have had sexual intercourse you could be pregnant if your period does not start when you expect it to. You must in these circumstances talk to an adult or see a doctor as soon as possible.

She is being bullied because of her size?

If a girl is being bullied because of her size or for any other reason, then she should talk to an adult.

She is unhappy about the way she looks?

Height and weight are the two things that can particularly worry young people. But try and think about things you like about yourself and the way you look. Also remember that your body is changing and will keep changing.

Puberty, Pregnancy And Sex

2008-10-20T07:46:00.000-07:00

Growing up and making babies - puberty

Puberty is the name given to the physical and emotional changes which take place in most boys and girls between the ages of 10 & 14. Puberty occurs so that one day the boy or girl will be able to make a baby.

Reproduction, the technical term for making babies, can only occur when a boy and girl are sexually mature. One of the main physical changes of puberty therefore is the growth and development of the sex organs – the parts of the body that are used to have sex and make babies. Sex organs that can be seen on the outside of the body are called ‘genitals’ while those that are inside the body are usually called ‘reproductive organs’.

Some more about a girl’s sex organs

Between a girl’s legs there are three small holes. At the front is the urethral opening which a girl urinates through, and at the back is the anus which she defecates from. In between these two holes is a third hole, her vaginal opening. From the vaginal opening there is a small passageway or tube, called the vagina, which leads to the reproductive organs inside the body.

When a girl has her period the blood comes out through her vagina. Inside the vagina there is a small piece of thin skin called the hymen. The hymen partly covers the vaginal opening, but there is still enough of a gap for blood to get through. Sometimes the hymen breaks and bleeds slightly when a girl has sex for the first time.

Some other important parts of a girl’s sex organs are:

The clitoris, which is at the front of a girl’s outside sex organs and is about the size of a pea
The outer lips (labia) of a girl’s sex organs

The labia, the clitoris and the vaginal opening are together known as the vulva.

Some more about a boy’s sex organs

The boy’s sex organs outside his body are his penis and testicles (testes).

A boy’s penis hangs down between his legs at the front of his body. The main parts of a penis are:

The shaft - the main, long part of the penis
The glans - the tip or end of the penis
The foreskin - skin which covers the glans

The foreskin can usually be pulled back quite easily. If it is tight it can be stretched by gently pulling it over the glans. All boys are born with a foreskin, but some have it removed when they are a baby, or later in life. The removal of the foreskin is called circumcision.

Underneath the penis is the scrotum – a loose, wrinkly pouch of skin that hangs down behind a boy’s penis. It contains his testicles. As a boy goes through puberty his testicles move lower down his scrotum. One of the testicles usually hangs lower than the other.

Eggs and Sperm

Inside a girl’s body are two small organs called the ovaries. Contained in these ovaries are hundreds of tiny sex cells or eggs, each no bigger than the head of a pin. At some point during puberty, the ovaries will begin to release these eggs. Usually one egg is released every month. This process is called ovulation.

A boy’s sex cells are called sperm and they are even smaller than a girl’s eggs. At puberty a boy's testicles will start making sperm. Sperm leaves a boy's body through his penis when it is hard and erect. This is known as ejaculation and it happens when a boy reaches the height of sexual excitement and has an orgasm. When a boy ejaculates, millions of tiny sperm are sent from his testes, up through his penis and out through the end. The sperm are contained in a sticky white fluid called semen.

When a boy’s sperm meets with a girl’s egg they usually join together, and a baby will begin to grow.

How do egg and sperm meet? – Sexual intercourse

The most common way that sperm get inside a girl’s body is through sexual intercourse. Sexual intercourse is when a boy puts his hard penis inside a girl's vagina. It is also often called having sex or making love.

Having sex (which usually involves moving the penis in and out of the vagina) is usually very pleasurable for both a boy and a girl, and it will often result in an orgasm for one or both partners. If a boy ejaculates while his penis is inside the girl’s vagina, (or semen gets inside the vagina any other way) the millions of tiny sperm in the semen will swim up the vagina, through the cervix (the entrance to the uterus) and into the uterus. From there they will then swim into the fallopian tubes. In one of the fallopian tubes the sperm may find an egg that has recently been released by the ovary. The sperm will surround this egg and try to get inside it. Eventually just one sperm cell will succeed, and the egg and sperm will join. This joining is also known as fertilisation or conception.

This joined sperm and egg then travel back down to the uterus, where they will settle in the thick, blood-rich lining and start to grow into a baby. It is at this point that we say a girl is pregnant.

What happens if the sperm and the egg don’t meet? - Periods

Girls generally only release an egg once a month, and it will normally take a few days to travel down the fallopian tube. If sperm don’t meet with the egg during this time, then she won’t become pregnant.

Without a new baby to nourish, the thick lining of the uterus is no longer needed. So, approximately 14 days after a girl’s egg is released, the bloody lining of the uterus will begin to come away, and will flow down through the cervix and out of the vagina. This process is called menstruation, and this is the blood that a girl will notice when she has her period. During puberty, a girl’s first period is a sign that she has released her very first egg, and is now able to have children.

Periods will usually last somewhere between 3 and 10 days. Around 14 days after the start of her last period, a girl will ovulate (release an egg) again, and will once again have the chance to become pregnant. This process of period, then ovulation, then period, is known as the menstrual cycle. On average, the whole menstrual cycle (from the first day of the period to the day before the next) will last 28 days, although variations between 21 and 35 days are quite normal.

More about pregnancy

Though an egg is usually released about the same time each month, this doesn’t mean that a girl can predict exactly when she will (or won’t) become pregnant. This is because girls usually have no way of knowing exactly when they are ovulating. Not only can the day of ovulation vary from girl to girl, it can vary from month to month in an individual girl.

In addition, sperm can survive for several days within the body, so they can ‘hang around’ waiting for an egg to be released if there isn’t one there already.

All this means that if a girl wants to avoid pregnancy but still have sex, she and her partner will need to use contraception. Some contraceptives, like the contraceptive pill, are used by girls. Boys can use condoms. Condoms also prevent sexually transmitted diseases from being passed from an infected person to another person during sexual intercourse.

Using contraception every time you have sex is very important if you want to avoid pregnancy. It is also important to remember that a girl can become pregnant even if:

It is the first time she has sexual intercourse
She has sex before she has her first period (it could be that she is ovulating for the first time)
She has sex during her period (sperm can stay alive for several days)
A boy withdraws his penis before he ejaculates (precum, the fluid that leaks out the penis before a boy ejaculates, can sometimes contain sperm)
She has sex standing up (sperm can swim in any direction – up or down!)

Because periods stop during pregnancy, the first sign that a girl may be pregnant is usually a missing period. If a girl doesn’t start her period at the usual time, it is probably a good idea for her to talk to her doctor or another adult as soon as she can. Periods can come late for other reasons (for example when a girl is stressed, on a very strict diet or has been unwell), but if she has had sex in the past month, then it may be a good idea to take a pregnancy test to be sure.

Sexual feelings during puberty

It isn’t just the body that changes during puberty - our feelings can change too, and like the changes to the sexual organs, these feelings prepare us to have sex and make babies.

What are the main physical signs of sexual feelings?

The main sign for boys that they are getting sexually excited is when they get erections.

The main sign for girls is when their vagina begins to get moist. The clitoris gets bigger too.

For both boys and girls when they are sexually excited or "turned on", extra blood comes to the surface of the skin, particularly around the penis and vagina. You can feel warm and sensitive and sexy just about anywhere on your body.

At what age do boys and girls start to get sexual feelings?

A person can have sexual feelings any time in their life, but these change around puberty. You might find some sexual feelings just seem to happen to you. But sexual feelings mostly come about from things you choose to do, either on your own or with someone else.

A main way that people express their sexual feelings is by touching their own genitals. This is called masturbation. Some people don't masturbate at all, or hardly ever. Other people masturbate every day. Masturbation does not cause you any harm.

Some girls enjoy touching their clitoris. Many boys enjoy touching their penis, particularly the tip.

When a person is masturbating they become more and more sexually excited. They may then reach a peak of sexual excitement which is called having an orgasm or "coming". This is when all the tension and excitement that has built up is suddenly released. Boys ejaculate when they have an orgasm and their penis will then go limp. For many people masturbation is their first sexual experience.

Sexual feelings in relationships

When people have sexual feelings for each other they will usually want to do sexual things together. There is no set time or order in which to do things.

They often want to kiss and cuddle and hold hands. When people kiss they sometimes 'French kiss'. This is when both people open their mouths when they are kissing and their tongues touch together.

People also like to touch each other through their clothes or put their hands inside to stroke or touch each other's genitals.

There are a variety of other sexual activities that people will also do including sexual intercourse.

It can seem natural to bring sexual feelings into a relationship. But it can also change how people feel about each other and about themselves. You might want to do something because you feel curious about it. Or because you think it will make you feel good. And you might want to do it because you feel very close to someone.

But it's important not to do any of these things because you feel under pressure. And that you think about the consequences and how you'll feel afterwards.

Am I Ready For Sex ?

2008-10-20T07:45:00.000-07:00

Am I ready for sex?

This is a question that almost everyone will ask themselves at some point in their lives, but unfortunately not many people will be able to answer it with a definite "yes" or "no".

Having sex for the first time can be a very special experience, but it can also lead to all sorts of complications. Sex without a condom or other form of contraception can result in pregnancy, and if your partner has HIV or a sexually transmitted infection (and you might not always know they do), you can become infected too. There can also be emotional consequences to having sex with someone – it can really change a relationship, and not always for the better. Sex can be enjoyable with the right person, but it’s very easy to make mistakes and end up hurt, which is why people advise you: "don’t have sex until you’re ready!"

Of course it's all very well saying this, but how do you know when you’re ready? Legally, you aren’t allowed to have sex with anyone until you’re over the age of consent. But it takes more than just being a legal age to make you ready for sex – you need to be emotionally ready too.

We obviously don't know you, so you're the only person who can truly judge if you're ready to have sex. But we can suggest some questions that will hopefully help you to work it out:

1) Are you doing this because YOU want to?

Or are you thinking about doing it because someone else wants you to? Maybe you’re not sure you’re ready, but your partner is keen? Or perhaps there a bit of ‘peer pressure’ – all your friends seem to be doing it, so you feel you should be too?

Do any of the following sound familiar? -

“You would if you loved me!”
“It’s only natural!”
“Everyone else is doing it!”
“Don’t you want to make our relationship stronger?”
“You’ll have to do it sometime – why not now, with me?”
“I'll be gentle, and it'll be really great, I promise!”
“I'll only put it in for a second...”

If you recognise any of these phrases, then you should think carefully! These are not the right reasons to have sex. A partner who says things like this is probably trying to put pressure on you and might not really care whether you’re ready or not – this person doesn’t respect your feelings, and they’re probably not the right person to have sex with.

Nor should you have sex just because your friends are saying things like :

“You mean you’ve never done it?!?”
“I lost it when I was twelve. . .”
“Yeah, I’ve had sex loads of times. . . ”
“You’re a virgin, you wouldn’t understand. . . ”
“No-one’ll be interested in you if they hear you’re frigid.”
“It's amazing - you don't know what you're missing!”

It may feel like your friends are all more experienced and knowledgeable, but we guarantee they're probably not! Many of them will only be saying this sort of thing because they think everyone will laugh at them if they admit they’ve never really done anything! Besides, being sexually experienced at a young age doesn’t necessarily make someone mature or sensible - in fact, it usually indicates the opposite.

2) Do I know my partner well enough?

If you’ve only just met your partner, haven’t been going out with them very long, or perhaps don’t even really know them, then sex is never going to be a really good experience because there won't be much trust between you. If you've never even kissed the person you're with, then you're definitely not ready to have sex with them!

Sex can leave you feeling very vulnerable afterwards in a way you might not be prepared for, so it’s better to be with someone that you know is likely to be sticking around. Usually, you’ll have better sex with someone you know really well, are comfortable with, and who you can talk to openly about relationships and feelings. Sex will be best with someone you love.

3) Is it legal?

The age of consent differs between countries. In most states of the U.S, for instance, it ranges between 16 and 18. In the UK and India it's 16. In Spain, it's 13 while in some Muslim countries, sex is illegal unless you're married. Have a look at our age of consent page to find out exactly what it is where you live.

So why do countries have a legal age for having sex? Because this is the age when the government believes young people are mature enough to handle the responsibilities that come with having sex. All too often people think they are ready when they’re not. Age of consent laws are also designed to prevent older people from taking advantage of children and young teenagers who may not understand the consequences of having sex, or even what sex is.

4) Do I feel comfortable enough with my partner to do this, and to do it sober?

It’s natural to feel a little embarrassed and awkward the first time you have sex with someone because it’s not something you’ve ever done before. Your boyfriend or girlfriend will probably feel the same. But if you don’t trust your partner enough not to laugh at you or you don’t feel you can tell them you’ve never had sex before, then it’s far better to wait until you can.

And if you think you’ll have to drink a lot of alcohol before you do it so you feel relaxed enough, or you only find yourself thinking about having sex when you’re drunk, then that suggests you’re not ready. A lot of people lose their virginity when they’re drunk or on drugs, and then regret it. So if you’re worried that you’re going to be in a situation where you might be tempted to do something you wouldn’t do normally, restrict your drinking, keep off the drugs, or make sure you stick with a sober friend who can look after you! Have a look at our drink, drugs and sex page for more information.

5) Do I know enough about sex?

Do you know what happens during sex? Do you know how it works, what it's for and how and why a woman can get pregnant? Do you know about sexually transmitted infections? Lots of people worry that they’re going to make a fool of themselves or do something wrong. Well, you shouldn’t have to worry if you’re with a partner who cares about you - (s)he won’t laugh. And if you’re not with a partner who cares, you probably shouldn’t be doing it! Physically, sex is actually quite simple, but the more you know, the more comfortable you’ll feel. Have a look at our teens’ pages for more information.

6) Will I be glad when I’m older that I lost my virginity at the age I am now?

Imagine that you’re looking back at yourself in ten years time. What do you think you’ll think then about how and when you lost your virginity? Is there any way in which you might regret it? The answer should be ‘no’ – if it’s not, you’re probably not ready yet.

7) Can I talk to my partner about this easily?

If you can’t talk about sex, then you’re not ready to have sex. It’s as simple as that. Being honest about how you’re feeling will make it easier for both of you, and will make sex better in the future.

8) Do I know how to have sex safely?

It’s really important that you know how to protect against pregnancy, STIs and HIV. Again, this is something you need to talk to your boyfriend or girlfriend about before the event, so you’re both okay about what you’re going to use. Have a look on our teens’ contraception options page for more details.

Especially with things like condoms, it’s good to have a bit of practise putting them on, and to feel okay about doing it – it’s not enough just to get a condom if you’re not confident enough to use it – they’re no good if they stay in your pocket the whole time!

9) Do we both want to do this?

You may decide that you are ready, but it might be that your partner isn’t, even if they have had sexual partners before. For sex to work, you both have to be willing to do it. Don’t ever pressure anyone to have sex if they’re not sure – this is very wrong, and it’ll cost you your partner’s respect and the respect of other people.

Also - there’s a fine line between pressuring someone to have sex and forcing someone to have sex – if you put too much pressure on someone, it can become force – and if you force someone into sex, you can be prosecuted for rape.

10) Does sex fit in with my/their personal beliefs?

It may be that you, your partner or your family have beliefs that say sex at a young age (or before marriage) is wrong. Do you feel comfortable going against these views? Will it cause you unnecessary worry and guilt if you do (or frustration and heartbreak if you don’t!)? Some young people will have sex simply because their family has banned them from doing so, even if they don't realise that this is the reason. Having sex as an act of rebellion may feel great at the time, but if anything goes wrong, you face a very difficult situation, as you may not be able to rely on your family's support.

Even if everything goes well, keeping sex (and all the emotions that go with it) a secret can be very hard – so, if possible, you should make sure you have someone else to talk to that you can trust to keep it to themselves. But remember, the decision to have sex should be an agreement between you and your partner, and while other people may help or influence your decision, they shouldn’t make it for you.

So, how did you do? If you answered “Yes!” to all ten of these questions, then you’re probably pretty much ready, as long as BOTH of you feel okay about it.

If you didn’t, then there’re probably some issues you need to work through first, because all of these questions are important.

First time sex is always going to be scary whatever age you are when you have it. It can sometimes seem like losing your virginity is the most important thing in the world. But you can’t get your virginity back once it's gone, so what is really important is that you have enough respect for yourself to wait until you’re truly ready, and can truly trust the person you’re with.

Good luck, have fun, and stay safe!

Having sex for the first time

2008-10-20T07:42:00.000-07:00

There can be lot of pressure to lose your virginity - that is, to have sexual intercourse for the first time. Having sex with someone just because you want to lose your virginity, or because you think all your friends are doing it, is something you may regret later.

You might feel lots of anxieties, especially the first time you 'go all the way' - have sex. You may feel embarrassed about how you look without your clothes on, or worried about your privacy being disturbed. It's natural to feel some worries but good communication will really help to prevent you feeling embarrassed or worried. You should be able to talk to your partner about how you feel about having sex for the first time, and about any concerns you may have. Your partner might be worried, too. Being relaxed and able to share things with your partner will really ease the tension. And if you're too shy, or you're not able to talk about these things with your partner - then you probably shouldn't be having sex!

Having sexual intercourse - when a boy's hard penis goes inside a girl's vagina, or even just touches the outside of her vagina - is what leads to pregnancy. So, before having sexual intercourse you should think about whether you need to use contraception to prevent unwanted pregnancy, and condoms to prevent Sexually Transmitted Diseases (STDs).

Can a girl become pregnant the first time she has sexual intercourse?

Yes, a girl can become pregnant the first time she has sexual intercourse. So, you must use contraception the first time you have sexual intercourse, if you don't want to risk becoming a parent.

What about the law?

The age of consent, that is the age at which it is legal to have sex, depends on which country you are in, and in the United States the law is different in different states (see our teens, sex and the law page for further details).

In England and Wales, the law says it's illegal for a boy or a girl to have sex with a girl or a boy who is under sixteen.

Sex and love

For some people sexual feelings are bound up with love and close relationships. Some people think sex should only happen within marriage. For some people sex and love are two different things.

What is important is that you feel good about yourself and what you are doing, and that you keep yourself safe. Being safe means not only thinking about physical risks such as pregnancy and sexually transmitted diseases (STDs). But also emotional risk such as the regret you may feel afterwards.

When are you ready for sex?

There is no absolute right age to start having sex. What matters is whether it is the right time for you. It also depends on what you mean by 'having sex'. There are many ways in which you can give and receive sexual pleasure without having sexual intercourse.

Giving each other massages, kissing and hugging can be very passionate. It's a way of sharing and showing love. For some people these activities can be more fulfilling than sexual intercourse.

You get pressure from people talking about sex. You think, 'I've got to go and see what it's like'. It's hard, but you've got to resist and do what you want.

It's very important not to feel pressurised into having sex when you don't really want to. Just because your friends say they are 'doing it' doesn't mean they are.

Thinking through all the implications of having sex can be a useful way of helping you arrive at a decision. There are lots of reasons why people don't want to have sex. You may feel that you are not ready emotionally. Being pushed into having sex could mean you regret it later on. Some people have quite strong religious or cultural beliefs. Others just want to wait.

Some people call this decision to wait 'abstinence'. The decision to abstain from having sex can be either a long-term decision or a short-term one. Some people decide that they do not want to start having sex until they are married or in a significant long-term relationship. Other people may decide that having sex isn't the right thing for them at this particular time. Later on they may meet a person who they want and feel ready to have sex with. The decision whether to have sex or not is an important one. You should do what is right for you. It should be an informed decision, and not one based on fear or pressure from others.

But when a boy and girl do decide they want to have sexual intercourse, they should think about using a contraceptive unless they want to become parents. Gay men should also think about using condoms. Condoms can help stop infections like HIV as well as reducing the risk of getting pregnant.

How exactly do you have sexual intercourse? What position is best?

Sexual intercourse between a boy and a girl starts with both of them getting sexually excited as a result of kissing, stroking, caressing rubbing and touching each other. This sexual excitement will result in certain physical signs of sexual excitement. For the girl, the vagina, the sexual opening between the legs begins to moisten. The boy will get an erection, which means his penis will get bigger and harden. It is important that this stimulation goes on for long enough, because if the girl is not sexually excited enough, then her vagina will not be lubricated and moist enough, and it will be difficult for the boy's penis to enter the girl's vagina.

When the couple are both ready to have sexual intercourse (and this includes the boy putting a condom on if he is going to use one), it is probably easiest if either the boy or the girl uses their hand to guide the penis into the vagina. Then, once the penis is inside, the couple need to move their bodies so that the penis pushes into the vagina and then pulls partly out again. After a while this movement can lead to orgasm (coming or climaxing) for one or both of them.

There are quite a number of different positions in which you can have sexual intercourse. One very common position involves both the boy and the girl lying down, with the boy lying on top (This is often referred to as the missionary position). Alternatively the girl can be on top or both the boy and the girl can lie on their sides. It is probably easiest to choose one of these positions if you are having sexual intercourse for the first time. However, you can also have sexual intercourse with both the boy and the girl sitting down, one on the other, or both can be standing up. What is most important about whichever position you choose, is that it provides stimulation and enjoyment for both of you.

Will first time sex hurt?

Many boys and girls are concerned that it will hurt the first time they have sexual intercourse. It can hurt and some girls do bleed a little bit. The bleeding usually occurs because the girl has a hymen which breaks the first time she has sexual intercourse.

The hymen is a small piece of thin skin which goes across the opening of the vagina and protects it when she is young. It has some gaps in it where the blood can come out when she has her period. Sometimes a girl might already have broken her hymen without knowing about it. For example, this can happen as a result of playing sports or horse riding.

At their house

"I lost my virginity when I was 13 and I still am 13 today. It hurt bad and I was so scared. I knew I couldn't tell anyone except my friend who was there. The worst part of my story is that the guy was 18. This is how my story goes.

"One night I stayed the night at my friend's house. We were talking to these guys I had only known for like a couple of months. They said that they would come and pick us up from her apartment. So we got ready and then they came. I didn't think that anything would happen because I had gone and hung-out with them before at their house. But this time it was different. My whole life was about to change.

"When we got to their house we just hung out and watched T.V. Then I laid on his bed and he jumped on me while my friend and his brother were watching a movie and making out. He started to finger me and then all the sudden I realize I am having sex. I think what made me not say no was because my friend had already had it and I wanted to, but I didn't think it would ever happen in a million years and especially when my friend and his brother were in the room.

"Well me and my friend haven't told anyone and I am too scared to say anything to anyone because I don't want people to think I am a hoe or I am easy or anything. But now I have to live with the guilt of not being able to tell my mom or anyone at that. Me and my mom have talked about sex and I said that I would never do it unless I was like older but I lied to myself and my mom. It made and still makes me feel so bad. I feel like kind of dirty now, but I think eventually I will get over it in time."

Deciding to wait

"When we'd been going out a while everyone started treating us like a couple. People assume because you're going out you have to do everything together. And, once you're an item its only a matter of time before they assume that you're having sex.

"But you see, we've sort of decided to wait a bit longer before we do it. I mean, we have kissed and felt each other and all that sort of thing, you know, maybe just going a little bit further each time, and sometimes I have just wanted to get it over with. You know, the first time - I've heard people say, 'you might as well get it over with, it isn't very good so why wait?'"

Simon

"I'd known Simon for ages, but it wasn't until Year 11 that we started going out. That was two years ago now and we've been together ever since. After about a year we both felt we wanted to have sex, go all the way. We'd nearly done it anyway what with all the snogging and fumbling we'd done on sofas and at discos. Because we were friends and talked a lot we talked about sex too.

"I know we were both really nervous, but talking and laughing really helped. Plus we were able to make sure nothing drastic happened. Although we loved each other loads we certainly didn't want a baby at seventeen or to put our health at risk. So we went together to the clinic, sorted things out so that there wouldn't be any worries.

"We made sure we picked the right time and the right place too. It would have been awful for someone to walk in on us, during our private time. What was it like? - Well it's difficult to describe because I'd never felt anything like it before really. I'd had orgasms through masturbation before, but sharing yourself with someone you love and respect was really good. It brought us closer together."

A great party?

"I was round at Terry's. It was a great party. Loads of people were there. I was just standing around with