( By Dr. Vithal Prabhu )

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Guidelines For Sex Education To Adolescents

These guidlines are for providing framework to create a programme and not a curriculum. The guidelines provide a comprehensive approach to human sexuality education. It is organised in a list of topics. A need based sexuality education programme can be generated by listing the topics along with the relevant messages.

The details and supportive information regarding topics will be found in Part I and II of this book. The messages therein once introduced need to be reinforced repeatedly at different levels of age group.

Growth and Development

  1. Anatomy and Physiology of Reproductive System

  2. Puberty and Adolescence.

  3. Reproduction

  4. Conception and Delivery

  5. Body Image

  6. Gender Identity and Gender Role

  7. Sexual Orientation

  8. Healthy Sexuality

  9. Adolescent Sexual Behaviour

  10. Masturbation

  11. Shared Sexual Behaviour

  12. Abstinence

  13. Comparison of Male and Female Sexuality

  14. Values

  15. Decision Making

  16. Communication

  17. Assertiveness

  18. Negotiation

  19. Seeking Help During Distress

  20. Family Relationship

  21. Peer Relationship

  22. Girl-Boy Relationship

  23. Love

  24. Marriage

  25. Nutrition

  26. Exercise

  27. Reproductive Health

  28. Family Planning

  29. Sexual Abuse

  30. Substance Abuse

  31. Problems of Adolescents

  32. Sexually Transmitted Diseases (STD)

  33. HIV/AIDS

  34. Society and Sexuality

  35. Myths and Misconceptions in Sexuality

  36. Sexuality and Law.

Level I : Std. VI to X – Age 11 to 15 years
Level II : Junior and Senior College – Age 16 to 20 years

Topic 1 : Anatomy and Physiology of Reproductive System Level - I Men have Penis, testicles, Vasa deferentia (plural of Vas deferens.) seminal vesicles, prostate and Cowper's glands. Women have vulva, clitoris, vagina, uterus, Fallopin tubes, overies and breasts. Maturation of internal and external organs begins at puberty. Boys begin to ejaculate and girls begin to menstruate at puberty. Level - II Sex chromosomes determine the sex of the child. Hormones influence growth, development as well as sexual and productive function. Man can reproduce throughout life, while woman's ability to reproduce ceases at menopause.

Topic 2 : Puberty and Adolescence Level - I Puberty is beginning of transition from childhood to adulthood. Reproductive organs start maturing during puberty. Human beings are able to have babies after puberty. Puberty begins at different ages in different individuals. Girls begin to show pubertal changes earlier than boys. The girls begin to ovulate and menstruate and the boys begin to produce sperms and ejaculate during puberty. In the boys, testosterone hormones are responsible for hair growth on pubis and face, deep voice, growth of penis, and testes, and production of seman. In girls oestrogen hormone is responsible for development of breasts, pubic hair, rounding of hips and menstruation. Level - II Adolescence is the period of transition from childhood to adulthood Boys and girls feel uncomfortable, clumsy, confuse, self- conscious and develop romantic feelings. Boys have much more sex drive than girls and seek outlet through masturbation. Boys and girls are attracted towards each other They like to fantacise and fall in love; they experience mood swings, some become irresponsible and stubborn. Boys can ejaculate at any time; girls menstruate after about every twenty-eight days. Men can ejaculate throughout life. The menstruation stops during pregnancy and after menopause at the age of about 45 years.

Topic 3 : Reproduction Level - I Reproduction means production of giving birth to new life like that of parents Reproduction is very essential for existence of life on the earth. Two methods of reproduction in animals : "Asexual" and "sexual." In human beings, reproduction is "sexual" and requires both a man and a woman. Men and women have specific reproductive organs and produce specific reproductive cells. The child grows inside the uterus of a female. Women have breasts to provide milk for the baby. Level - II Reproduction is associated with sexual intercourse. Sexual intercourse provides pleasure. Sexual intercourse occurs when a man places his penis inside the vagina of a woman and ejaculates semen. Sexual intercourse should take place after the marriage and is associated with responsibilities. Sexual intercourse requires mutual consent and should be pleasurable to both. Sexual intercourse leads to pregnancy in female. Parenting is a responsibility.

Topic 4 : Conception and Delivery Level - I Conception takes place when a sperm from man unites with a ovum in woman. This process is called "fertilization." The menstruation stops when the conception occurs. The baby grows in the uterus (womb) of woman for 280 days, counting from the first day of her last menstruation. The baby is supplied oxygen and nutrition through umbilical cord. Baby comes out through the vagina of the woman. Women have breasts to provide milk to the baby. Level - II The sperm determines the sex of the baby. The release of ovum from ovary (called ovulation) mostly occurs midway between the menstrual periods. Ovulation can occur at any time during the month, therefore, a woman can become pregnant anytime. Even a single intercourse can cause pregnancy. Intercourse in standing position can also cause pregnancy. Marriage amongst blood relatives (consanguinous marriage) increases the chances of abnormal babies. Pregnancy should occur ideally after 19 and before 35 years of age.

Pregnant woman should avoid tobacco, alcohol, drugs and exposure to x-ray. Pregnant woman should attend antenatal care unit periodically. She should take nutritious diet and two injections Tetanus Toxoid. Pregnancy and delivery are physiological processes; therefore, nature assists in every respect. About 95% deliveries are normal. Only a few need Caesarian operation. During the process of delivery, the mouth of the uterus dilates, the water bag ruptures, the baby comes out of vagina with its head first, and lastly the umbilical cord and placenta come out. About 10 % women cannot conceive (infertility). They can be helped by medical procedure. The cause of infertility may be in male, in female or in both. People who cannot have child can go for adoption.

Topic 5 : Body Image Level - I Image of the body affects feelings and behaviour. Individual bodies are different in shape, size, height and colour. Male and femal bodies are different and special. The look of the body is hereditary and therefore, depends upon the parents. All bodies are unique and special including those of disabled. Each person can be proud of his body. Level - II The value of person is not determined by appearance. The media project beautiful people but most people do not fit in them. The size, shape of penis or the size of breasts do not affect fertility or ability to be a good partner for sex. Every one should accept and feel good about one's body. Physical appearance alone should not be a measure factor in choosing a friend or a life partner.

Topic 6 : Gender Identity and Gender Role Level - I One is born a male or a female. Gender identity is a feeling "I am a boy" or "I am a girl." Gender role is the outward expression of maleness or femaleness. Children behave as boys or as girls by observing the behaviour of their respective gender. Level - II Boys and girls receive messages from their family, friends society and media about how they should behave. people often expect boys and girls to behave stereotypically. Boys and girls have many similarities and a few differences. Boys and girls share equal talents, strength and hopes fro their future. There are no jobs that are only for boys or only for girls. Almost all adult jobs and careers are open to men and women. Boys and girls can be friends and respect each other. Sometimes, girls receive unequal or negative treatment because they are female. Women should be given the same opportunities as men.

Topic 7 : Sexual orientation Level - I Boys and girls grow and develop into men and women. As they grow and develop they are attracted to other people. People fall in love with someone of opposite sex. They are called "heterosexuals." Some men and women are attracted and fall in love with someone of the same sex. They are called "homosexuals." "Sexual orientation"refers to whether a person is homosexual, heterosexual or bisexual (attracted to both men and women). Homosexuals are also known as "Gay men" and "Lesbian women." A homosexual cannot be identified by his appearance or social behaviour. Homosexuals do not admit being so because they are mistreated. Homosexuals, bisexuals and heterosexuals are alike except for their mutual sexual attraction. Level - II People do not choose their sexual orientation. Sexual orientation cannot be changed by therapy or medicines. A small percentage of people in every culture are homosexuals. No one knows the definite cause of homosexuality. Theories about the cause include genetics, prenatal influences, socio-cultural influences, psychological factors and a combination of all these factors.

Topic 8 : Healthy Sexuality Level - I All people are sexual beings. Sexuality is a natural and healthy part of life. Sexual feelings, fantasies and desires are natural and occur in all stages of life. Children should be encouraged to talk to their parents about sexuality. Level - II Sexuality is more rewarding and positive when expressed in a sharing, enhancing and non-exploitative way. Healthy sexuality enhances total well being. Sexuality is multifaceted. It has biological, social, psychological, ethical and cultural dimension. Sexuality is an integral, joyful and natural part of human being. Sexual functioning is equated with reproductive ability. The traditional gender roles are changing.

Topic 9 : Adolescent sexual behaviour Level - I Sexual fantasies and dreams are common and normal in adolescence. The main sexual activity is masturbation. Some adolescents engage in petting (kissing, hugging, necking without sexual intercourse) Some adolescents have homesexual experiences. Most adolescents with homosexual experience do not go on to homosexual orientation in adulthood. Level - II Sexually erotic thoughts (fantasies) are common and is a type of sexual expression. Many people's sexual fantasies include bhaviours not actually acted upon. Some engage in sexual intercourse. The first experience of intercourse is invariably of worry, discomfort, disappointment or guilt rather than of pleasure and intimacy. Some adolescent females find themselves with unplanned and unwanted pregnancy. Teenage pregnancy creates psychological anguish, health risks, and social and familial consequences.

Marriage as result of pregnancy is likely to be unhappy or end in desertion or divorce. The impact of teenage pregnancy is nearly nil on males. Many teenagers do not know that intercourse leads to pregnancy. A single intercourse or intercourse in standing position also can lead to pregnancy. Adolescents must show a responsible sexual behaviour by observing abstinence from sexual intercourse or by using a contraceptive. Only condom, if properly used, can prevent pregnancy, STD and HIV infection. Other contraceptives do not prevent STD/HIV infection.

Topic 10 : Masturbation Level - I Touching and rubbing one's own genitals is called "Masturbation". Many boys and some girls masturbate to experience sexual pleasure. Some boys and girls never masturbate. Masturbation is done in private. Masturbation does not cause physical or mental harm. The frequency of masturbation varies for every individual. Level - II Most people have masturbated at some time in their lives. Masturbation is one way a person can enjoy and express his sexuality without risking pregnancy or STD/HIV infection. Many people find masturbation associated with fantasies as a safe, harmless and equally pleasurable sexual outlet. Masturbation is not an addiction forming behaviour. There are many negative myths about masturbation (e.g., it causes loss of vitality, weakness, pimples, backache, impotence, T.B.). People who are single, married or in committed relationship may masturbate.

Topic 11 : Shared Sexual Behaviour Level - I Adults engage in sexual behaviour with one another to show caring and to share sexual pleasure. Couples have different ways of sharing sexual pleasure Being sexual with another person involves more than sexual intercourse. When two people express their sexual feelings, they usually give and receive pleasure. Sexual relationship is enhanced when a couple communicates with each other about what forms of sexual behaviour they like or dislike. A person has the right to refuse any sexual behaviour. Level - II Some sexual expressions are prohibited by law and disapproved by the society. Disabled people have the same sexual feelings and the same need as all people for love, affection and sexual intimacy. There are many pleasurable sexual behaviorus without putting an individual at risk of unintended pregnancy or STD/HIV infection. Some common sexual behaviours shared by partners include touching, hugging, kissing, caressing, massaging, bathing, oral and genital intercourse. Individuals are responsible for their own sexual behaviour.

Topic 12 : Abstinence Level - I Most adults feel intercourse as a pleasurable activity. Teenagers are not mature enough for sexual intercourse. Saying "NO" to sexual intercourse is the best method of preventing unwanted pregnancy and STD/HIV. Level - II People need to respect sexual limits, set by their partner. There are several ways of giving and receiving sexual pleasure without engaging in intercourse. Sexual intercourse is not a way to achieve adulthood. Abstinence from intercourse has benefits for teenagers. Many adults experience periods of abstinence. Teenage pregnancy is a physical, emotional, psychological and familial hazard. Engaging in sexual intercourse when the partner says "NO" is a crime.

Topic 13 : Comparison of Male and Female Sexuality Level - I Man and woman are alike in many respects and different in some respects. Men and women are equal but not similar. Nature made differences in man and woman to serve the purpose of reproduction. Level - II The changes during sexual response are nearly similar in males and females. Men are sexually stimulated by seeing other's sexual activity and they may react to a variety of objects associated with their sexual activity. Women are not attracted to such stimuli. Man gives love to get sex. Woman gives sex to get love. Sexual outlets are more in males than in females. Men like variety in sex, may seek extra-marital relationship, while women have less interest in sex and are loyal to one partner. Men and women are not opposite sexes, they are complementary sexes. Sexual preferences and sexual behaviour are not influenced by hormones in both males and femals.

Topic 14 : Values Level - I Values are strong feelings or beliefs about important issues in life. Values decide how to behave and interact with others. Individuals may have different values. Parents want children to develop values similar to their values. Level - II Childern receive values from parents, members of the family, community, religious teachings, teachers and peers. People who behave according to their values, feel good and comfortable Values influence important decisions about friends, sexual relationship, work and money. Relationships are stronger if the two people share similar values.

Topic 15 : Decision–making Level - I Everybody has to make decisions. Decisions have consequences that are either temporary or lasting. Decision-making is a skill learnt by trial and error. Decision-making skill can be improved. Friends influence each other's decisions. Parents and trusted adults can help children make decisions. Level - II People need information about each choice, so as to make wise decisions. The best decision is the one that is consistent with one's values, does not involve risking one's healh or breaking the law and has no negative social implications. Decision about sexuality can affect one's future health and life plans. Decision to have sexual intercourse poses risk of pregnancy and STD/HIV infection. Decision in sexual relationships have life-long effect. Use of alcohol and drugs lead to poor decision–making.

Topic 16 : Communication Level - I "Communication" is sharing information, feelings and attitudes effectively with others. Communication can be verbal, non verbal, or written. Communication is necessary in human relationship. Many disagreements and misunderstandings in the families and friends occur because of poor communication. Careful listening and frank speaking are required by both the parties for communication. Level - II A good communication includes careful listening, making eye contact, sharing feelings, understanding the other person's point of view, offering possible solutions and giving positive non verbal messages. A bad communication includes not listing, yelling, blaming, making other person feel guilty, giving negative non-verbal messages and interrupting. – People feel uncomfortable in discussing sexuality in an open manner. Communication on sexual feelings, desires and limits improve the sexual relationship.

Topic 17 : Assertiveness Level - I Assertiveness is communicating feelings and needs while respecting rights of others. Everyone has rights. Assertiveness is a skill and can be learnt and improved. It is all right to tell about one's feelings and needs. Assertiveness is different than aggressiveness or passiveness. Most women and childern are not assertive in our culture. Men and women should be assertive. Level - II Assertive behaviour includes being honest, direct and spontaneous in communicating feelings and needs, using assertive body language, speaking for oneself, and taking responsibilities for one's feelings and needs. In assertive response the individual gives reason for saying "NO", suggests an alternative, stands straight, maintains eye contact, speaks clearly and sounds confident. Assertive people are respected and have better relationship. People have right to refuse any request for any sexual behaviour or use of alcohol, tobacco and drugs. Successful people are assertive in their personal and work relationship. Sexual partners need to communicate clearly about their needs and limits.

Topic 18 : Negotiation Level - I Negotiation allows people to solve problems or resolve a conflict. Negotiation requires give and take on the part of both the persons. Negotiation is a way to get one's need met without using anger, guilt or intimidation. Negotiation works best when a problem or a conflict is addressed in its early stages. Good negotiation can enhance relationships. Level - II Effective negotiation requires certain skills such as a) careful observation of the person b) use of positive body language c) good verbal communication d) imagining oneself in other person's position e) identifying all the options in a situation f) reaching a mutual agreement To negotiate one must decide what alternatives can be accepted and what issues cannot be compromised. Many relationships and sexual concerns can be resolved through negotiation.

Topic 19 : Seeking help during distress Level - I People with problems seek help from family, friends or professionals If parents can't help, one should ask teacher, clergy, or another trusted adult. Counsellors, Doctors, Psychologists, Psychiatrists, Advocates can help. Community agencies also provide help. Level - II It is difficult for people to admit that they need help. Some communities have telephone crisis line (help line) so that people can talk to someone about their problem. Some families face problems, such as alcohol, drugs, money, sex, violence, abuse etc. The services provided include counselling, education, therapy, legal assistance, family planning, foster care etc. To seek professional help can be a sign of strength.

Topic 20 : Family Relationship Level - I A family could be large and extended or could be of two people. Family members take care of each other. Family members love and support each other. Family members have rules to help people live together. Family members have rights and responsibilities, values and ethics. Level - II Family plays important role in personality development. When crisis occurs family members need to support each other. Members of the family sometimes disagree, but continue to love each other. Conflicts in the family are normal. Every member should create more sunshine than thunder. Communication in the family is important.

Topic 21 : Peer Relationship Level - I Friends spend time together and get to know each other. Friendship needs honesty, sincerity, loyalty, acceptance and common interests. Friends can help each other. Friends can be either male or female. Friends sometimes feel angry or hurt each other's feelings but they forgive each other. Level - II Group activities allow teenagers to learn about others. Friendships are necessary to feel good about themselves. For close friendship one has to offer love, time, energy and commitment to others. Friendship could be positive or negative. When adolescents allow their friends to decide things for them, it is called "Peer pressure." Saying "NO" to peer pressure requires courage. If the friendship is negative, create a positive change or end the friendship.

Topic 22 : Girl-Boy Relationship: Level - I Boys and girls can have friends of both genders. Wide circle of friends of both gender help development of personality and better understanding of opposite sex. Girl-boy relationship is more of friendship rather than intimacy. Meeting for boys and girls for exchange of views and ideas is usually encouraged by parents and teachers. Level - II Meeting in groups rather than singly, preferably at homes is encouraged. Learn the concepts about the member of the opposite sex. Clear up the fallacies and prejudices. Teenagers should avoid single dates. Do not expect every relationship to end in marriage. If a friend is leading you to behave in a way that will harm you, be courageous to break off the friendship. Falling in love is no crime, but should be a timely and a mature decision.

Topic 23 : Love Level - I Love means having deep and warm feelings for some one. People are capable of giving and receiving love. Loving relationships are of many types. People express love differently to parents, children, friends and to spouse. Loving relationships are important throughout the life. Level - II Love is not the same as sexual attraction (infatuation). It is natural to be infatuated towards a person of the opposite sex during the adolescence. Love glorified through the media is, in reality, infatuation. If infatuation-relationship culminates into marriage, it often is difficult to survive. Love relationship is honest, sincere, loyal and long lasting. Not all teenagers or adults fall in love or date.

Topic 24 : Marriage Level - I Marriage is a social and legal commitment that two people make to share their lives and family responsibilities. People choose the person they want to marry. In some cultures parents choose the partner. People who marry intend to have lifelong relationship People who marry are committed to love one another, live together, help and support each other. Both partners decide how to share roles and responsibilities in their lives. Marriage partners require characteristices such as friendship, shared values, similar interests and goals, mutual support, loyalty, sexual attraction, and ability to adjust and solve the problems. Efforts are required to make the marriage work. People have childern after the marriage as and when desired. Level - II Legal age for marriage is 18 years for girls and 21 years for boys. Marriage at early age, can affect one's future health and life plans. Height, external appearance, horoscope matching, caste, love/arranged marriage do not attribute much for the success of marriage.

Continued committment, love, sharing and caring for each other help marriage survive. Matching of blood groups of partners need not be a prerequisite for marriage. Physical and mental health should be sound for getting married. Individuals who were loved by their parents in their childhood, who have had happily married parents, make their marriage happy and love the partner. To assess the compatibility and to know each other well, the two individuals must meet at each other's home frequently before marriage. People get married for love, parenthood, sexual satisfaction, security, support and companionship.

After engagement (or during courtship), and before marriage, time should be used to find out the attitudes, values, similarities and differences about each other. They must come to terms in issues like housing, food habbits, hobbies, in-laws, financial budgeting, plans, goals, household chores, children (when and how many) women's freedom and career etc. Both must get information about sexual act, since failure is a rule on the first wedding night and may lead to disappointment, frustration or misunderstanding. There is no proved sign of virginity in a woman or in a man. In a combined family (and in arranged marriage) it may take a year or two to build up relationship and to make adjustments. Perfection and idealism is seen only in novels and films. No marriage can be perfect. Partners of today will be parents of tomorrow. They need to have qualities of good parents, i.e., ability to love and protect, discipline and forgive, be honest and regularit. Marriage is not for everyone. It is not compulsory that everyone should marry. If the marriage does not work inspite of all efforts, divorce is the answer.

Topic 24 : Nutrition Levels - I and II Adolescents need good nutrition. Adolescents should take food frequently. The diet should include cereals, pulses, milk, egg, fruit, fish, mutton, vegetables, roots, nuts, sugar, vegetable oil, fats. Adolescents should take less of chocolates, ice-creams and cold drinks. Steamed food (e.g., Idli), is better than fried food. Milk, egg, groundnuts, jaggery, soyabeans and gram contain good amount of nutrients.

Topic 25 : Physical Exercise Level - I Boys and girls under 14 years need to take part in outdoor sports, plays, running, climbing or swimming for their physical fitness. Level - II Adolescent boys and girls above 14 years need exercise for physical fitness. The four components of exercise are 1) cardio-respiratory efficiency, 2) flexibility of joints, 3) endurance and 4) power of muscles. Jogging, running, cycling, swimming improves cardio-respiratory efficiency. Yoga and swimming improves flexibility of joints. Sit ups, push ups, weight lifting, Bull Worker improve endurance and power of muscles.

Topic 27 : Reproductive Health Level - I Boys and girls should keep their genitals clean. Smoking, drinking and substance use are harmful. Teenage pregnancy is harmful to the mother and to the child and hence should be avoided. Level - II After breast development, girls should self examine breasts every month. While cleaning girls should first wash the genitals prior to cleaning of the anus. Boys should retract foreskin of penis and clean the smegma on the glans. During pregnancy, the women should take nutritious diet (milk, cereals, pulses daal, jaggery, vegetables, nuts and fruits), go to the doctor for periodic check up, keep the body clean, take two Tetanus Toxoid injections and avoid drugs, tobacco, alcohol, x-ray.

Genetic abnormality in the family, if any, should be informed to the doctor. A woman has a right to terminate the unwanted pregnancy. Termination of pregnancy (abortion) before 10 weeks is much safer than termination done later. Abortion is to be done at the medical centre approved by the government. Abortion after 20 weeks of pregnancy is illegal. A pregnat woman who does not want a baby can give the child for adoption when born. Persons in Fertility problems, having desire to have a child, have several medical options. Abortion should not be used as a method of contraception. STD/HIV infection can result in damage/death of the unborn/newly born baby.

Topic 28 : Family Planning Level - I Family planning includes several topics concerning family welfare. However, it is loosely used for contraception. Contraception enables people to have sexual intercourse without unintended pregnancy. All children are loved. The aim of contraception is to have children as and when required. Decisions about having children is based on age, income, accommodation, time and personal wishes. Level - II There are several different methods of contraception. Condom (for males), Copper T and Pill (for females) are reliable methods that are used for postponing pregnancy and for spacing between two childern. Each contraceptive method has advantages and disadvantages. The use of contraception and the method of contraception should be talked to the partner. While choosing the contraceptive, people should consult their doctor to find out most suitable contraceptive for them. People should choose contraceptive method that they will use effectively and consistently. Condom can also be used to prevent transmission of STD/HIV. Pills and Copper T do not help in preventing transmission of STD/HIV.

Topic 29 : Sexual abuse Level - I A person's body belongs to him. Every one has a right to tell others not to touch his/her body when he/she does not want to be touched. No adult should thouch childs sexual parts except for health reasons by a doctor or for giving a bath by a parent. Sexual abuse occurs when an older, stronger, more powerful person touches a child's genitals. The perpetrator may telll the child to keep the behaviour secret, but the child should tell about it to a trusted adult (parent). If a stranger tries to get a child to go with him, the child should leave quickly and inform the parent, teacher, neighbour or a trusted adult.

A child is never at fault when sexually abused. Both, boys and girls, can be sexually abused. Level - II Sexual abuse is common, though many do not want to talk about it. Sexual abuse is most often committed by some one known to or related to the person. Rape is sexual intercourse with a woman against her wish and without her consent. Sexual intercourse with a woman even with her consent amounts to rape when: The consent is obtained by putting her in fear of death; The consent is given under the influence of alcohol or drug. The consent is given by a woman under the age of 16 years. Rape is a crime. The survivor (victim) often knows the rapist. People who are raped are not at fault. Not all rapes can be prevented. People can help protect themselves against the possibility of rape by learning self defence, assessing situations that may be dangerous, avoiding alcohol and drugs and developing assertive skills. Victims of rape and sexual abuse should seek prompt medical attention. People who are sexually abused may suffer serious emotional difficulties and need support and treatment.

Topic 30 : Substance abuse Level - I "Substance" is a name given to alcohol, tobacco and drugs. Tobacco smoking leads to cough, cramps, palpi-tation,loss of appetite, lung cancer or gangrene. Alcohol is addictive, alters the mind, impairs health, produces ulcers in the intestine. tremors, cirrhosis of liver and death. Level - II Marijuana (Pot, Hashish) harms brain cells. It alters personality. Heroin (Brown sugar), Methedrine, Mandrex, Cocaine are some of the drugs abused. All these are addictive, harmful to the body and mind, and lead to death. Substance abuse related suicides and accidents are common in adolescents. Substance abuse leads to repeated failures in school examinations, school drop outs, crimes and ill health. Adolescents should develop assertiveness skill and say "NO" to negative peer pressure. Adolescents' best defence against drug abuse is a loving supportive family. People involved in substance abuse should seek professional help.

Topic 31 : Problems of the Adolescents Level - I Getting pregnant before marriage is a social stigma. Pregnancy at 13 years is possible, but teenage pregnancy leads to illhealth of mother and child. Small and large breasts are normal. Menstrual periods are irregular in early years of adolescence. Some girls get pain in lower abdomen and become emotionally disturbed before or during the menstruation. A colourless odourless discharge through vagina is normal after puberty. Wet dreams are normal in boys. Penises are in all sizes. Swelling of male breasts at puberty is normal and subsides without treatment. Level - II Masturbation is a normal and healthy sexual outlet in boys and girls. Many girls are unaware that insertion of penis in vagina and ejaculation of semen therein is called "intercourse" and that it leads of pregnancy.

Getting pregnant during adolescence is risky. It hampers personal growth and development of personality and career. Breasts are for the production of milk for the babies. Smaller breasts also produce enough milk. Menstrual cycle remains irregular during adolescence. Cycles of 21 to 35 days and bleeding for 2 to 6 days are normal. Irritability, tired feeling, nausea, white discharge, pain in lower abdomen, backache, tender breasts just before menstruation or thereafter are normal symptoms. Pimples (acne) should not be squeezed. Keep the face clean. Nutritious diet and fresh air helps. Pornographic films and literature misinform and misguide the adolescents. Loving, understanding and supportive family is adolescent's best defence against adolescent problems like school drop out, addiction or suicide.

Topic 32 : Sexually Transmitted Diseases (STDs) Level - I STDs are caused by bacteria and viruses. STDs include the diseases such as Syphilis, Gonorrhoea, Chancroid, LGV, Granuloma Inguinal, Herpes Progenitalis and Venereal warts. STDs are acquired only through sexual intercourse with infected person. A person can acquire more than one STD Masturbation or hugging does not cause STD. Level - II STD can be acquired through vaginal, oral or anal intercourse with the infected person. By just looking at the person it is not possible to determine whether he/she has STD. The signs of STD sometimes remain hidden, absent or unnoticed especially in women.

Symptoms of STD include genital discharge, ulcer on the genitals, burning at urination, genital itching, swelling of lymph glands in the groins. Persons suffering from STD should promptly see the doctor and take complete treatment. Most STDs can be cured. Person having STD should stop sexual intercourse so as to prevent infection to others. Proper use of condom can greatly reduce the chance of getting STD but cannot eliminate the risk. Abstinence from sexual intercourse is the right way to avoid STD. Using public latrin, utenils, or clothes of infected persons does not transmit STD.

Topic 33 : HIV/AIDS Level - I "HIV" means Human Immunodeficiency Virus–the name of the organism that causes HIV infection. "AIDS" means Acquired Immune Deficiency Syndrome, a group of symptoms that arise as a result of HIV infection. When HIV infection has done enough damage to the body, other diseases invade and is called AIDS. The virus remains in blood and is excreted through body fluids like semen and vaginal fluid. Person with HIV infection looks normal for a long time and can infect others. Level - II HIV infection is transmitted through sexual intercourse (oral, anal or vaginal), blood transfusion, sharing unsterile needles and through mother to the child. The blood test for detecting presence of HIV/AIDS is called ELISA Test. Person with HIV infection shows no symptoms for 2 to 10 years.

Person with AIDS has symptoms such as tiredness, fever, loss of appetite, loss of weight, diarrhoea, night sweats, swollen lymph glands. He may suffer from herpes, pneumonia, tuberculosis or thrush. There is no cure for HIV/AIDS though some medicines can slow the development of the disease. Proper use of condom can greatly reduce the chance of getting HIV infection, but does not eliminate the risk.

Abstinence from sexual intercourse is the best way to avoid HIV infection. Masturbation, hugging, kissing does not cause HIV/AIDS Touching or shaking hands with HIV infected person, using his utensils or clothes or toilet seat does not transmit HIV infection. HIV infection is not spread by insects. Giving blood does not cause AIDS.

Topic 34 : Society and Sexuality Level - I Every culture communicates norms and taboos about sexuality. Boys and girls receive messages from their family, friends, media and society about how they should behave as boys or as girls. Attitudes about proper behaviour for boys and girls differ amongst different cultures. Boys and girls have many similarities and a few differences. Every society has diversity of sexual attitudes and behaviour. Considering several influences that shape the sexuality of an individual, a great variance in sexual attitudes, values and behaviour exists. All people should receive fair and equal treatment. Level - II It is important to understand the diversity of views about sexuality. People need to communicate their views on sexual values and beliefs to their partners in order to negotiate behaviour that are acceptable. People sometimes are discriminated because of sexuality factors like gender, sexual orientation, appearance, or living arrangements.

Discrimination can lead to lower self esteem, unequal opportunities and stress. The media have a profound effect on sexual information, values and behaviour. Religious views about sexuality affect people's sexual attitudes. Many religions, cultures teach that sexual intercourse should occur only after marriage. Social problems related to sexuality are: teenage pregnancy, STD and HIV / AIDS infection, gender discrimination, premium on virginity, child marriages, dowry deaths, sexual abuse, quackery, prostitution and Deodasees. Cultivation of values like gender equality, freedom, respect for others and sexuality education would minimise the sexuality related social problems.

Topic 35 : Myths and Misconceptions in Sexuality Level - I Sex is considered as obscene. Therefore, it is not publicly discussed. This leads to ignorance. Ignorance leads to myths and misconceptions. Information from friends regarding sexuality may not be scientific. Level - II Pornorgraphic books and blue films do not provide scientific information on sexuality. Myths and misconceptions about sexuality are propagated from generation to generation. There are misconceptions about breasts, genitals, menstruation, semen, fertility, contraceptives, intercourse, STD, HIV and many others. Myths and misconceptions are not harmless. They may cause anxiety, fear, guilt, shame, sexual dysfunction, marital disharmony, depression, suicide or homicide. Some may become victims of quacks and pornography that further enhance misconceptions.

Topic 36 : Sexuality and Law Level - II Consent for sexual relationship given by an individual under the age of 16 years in not valid. The legal age for marriage is 21 years for boys and 18 years for girls. People have the right to make personal decisions concerning abortion, contraception, sterilization and other reproductive matters. Incest (sexual activity between family members) is illegal. Medical termination of pregnancy (abortion) is legal up to 20 weeks of pregnancy. It should be done at government approved medical centres. Prostitution is illegal. Producing and possessing obscene materials is illegal. Obscene materials are defined as those that violate community standards of decency and without having any social, artistic or scientific merit. People have different viewpoint on what is obscene.

Sexual abuse is a crime. Rape is a severely punishable offence. Oral and anal intercourse are illegal in this country. Sexual deviations like sadism, fetichism, exhibitionism, voeyeurism, Frotteurism are crimes under Indian Penal Code. Taking dowry, dowry deaths, cruelty to wife, amniocentesis for sex detection of foetus, abortion of female foetus, infanticide are crimes.

(Adapted from "Guidelines for Comprehensive Sexuality Education by National Guidelines Force, published by Sexuality Information and Education Council of U.S.)

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