Sexual Health Appreciation of one’s body Appropriate and respectful interaction with both genders Appropriate expressions of love and intimacy Avoiding exploitative relationships Identification of values Responsibility for one’s own behaviour Enjoying sexual feelings without necessarily acting on them

Sexual Health cont’d Understand consequences of sexual activity (talk with partner about sexual activity, limits, contraception) Practice health promoting behaviours (regular check- ups, pap smears) Understanding the impact of media messages Seek information about sexuality as needed Able to negotiate and communicate sexual limits.

What is reproductive health?

Reproductive Health Anything pertaining to, or affecting reproduction The physical ability to produce offspring Awareness of what is normal and abnormal in regards to reproductive organs Pre-conceptual health (nutrition, activity) Prenatal health (nutrition, physical activity)

Activity Define the effect of one of the assigned factors that affects reproductive health in males and females.

Factors that affect reproductive health in males and females 1. Environmental – chemical exposure 2. Nutritional - anorexia 3. Hormonal – imbalance affecting the cycle 4. Sexual History - STIs 5. General Health - cancer 6. Physiological Response to stress – may disrupt menstrual cycle, change in sexual interest, change in appetite

What is infertility? No contraception after 12 months of unprotected regular intercourse. Infertility affects about 10% of young adults In 40% of the cases, the fertility problem is with males, in 40% of the cases the problem is with the female, and 20% of the cases the problem is unknown.

What are some possible causes of infertility in males? Sperm quality (radiation, tight clothing, heat) Frequency of ejaculation (sperm not ejaculated within 1 month dies and mixes with new sperm thereby decreasing the count of live sperm) Healthy weight Healthy nutrition (deficiencies can effect development of sperm) Alcohol (excess lowers sperm count and interferes with ability to maintain erection)

What are some possible causes of infertility in females? PID (Pelvic Inflammatory Disease – scarring of fallopian tubes) Endometriosis (uterine tissue growing outside the uterus, often on the ovaries) Cycle irregularities Smoking – interferes with egg production Healthy weight and nutrition – % below health weight can interfere with menstrual cycle and obesity can decrease frequency of ovulation

Factors causing egg and sperm disorders EGG Inadequate hormone signals from the brain Stress Excessive exercise Excessive weight gain Smoking, caffeine, alcohol, drugs Poor nutrition STI’s Illness such as diabetes

SPERM Genetic failure of sperm Undescended testes Infection of prostate or seminal vessicle Smoking, caffeine, alcohol, drugs Exposure to chemicals, radiation, etc Poor nutrition STI’s Injury to testes

What issues do people need to deal with who are experiencing difficulties with infertility? Individual reactions and emotions Impact on relationship The decision to have or not to have a child

What issues would a couple need to consider if they were experiencing infertility problems? Solving or treating the underlying problem if possible ( chemical, sperm wash, Invitrofertilization) Adoption Surrogate mother

Treatment for Infertility 1. Ovulation Induction - involves hormonal treatments like fertility pills to stimulate the production of eggs by the ovaries.

2. Intrauterine Insemination - Involves isolating healthy male sperm than injecting them into the female uterus to increase the chances of successful conception.

3. Donor Sperm - Obtaining healthy sperm from a third party donor and injecting it into the female. 4. Donor Egg - Obtaining healthy eggs from a third party donor and implanting them into the female.

5. Tubal Surgery - Involves surgery to repair or open up damaged fallopian tubes to allow the egg to travel down fallopian tubes to the uterus.

6. Invitro Fertilization - Involves removing a female egg and fertilizing it with male sperm in a test tube, then reimplanting the fertilized egg back into the uterus of the female.

Fertility Issues Fertility problems can be very stressful for couples trying to have children. Although no ones fault, the inability to have children can lead to feeling of inadequacy and guilt among the partners in a relationship. Infertility is not an uncommon problem as it affects 10% of all young adults. As we get older the infertility rate rises significantly especially for women.

Today there are an amazing variety of medical treatments that can be used to address the problem of infertility among couples. Regardless of the steps a couple takes to have children it is important that they talk things out with each other and get proper counseling and advice to deal with their problems or a breakdown in the relationship is likely.

Fertility Is the viability of a male and female to conceive. It involves the fertilization of female egg by male sperm. Infertility Is the inability of male and female partners to conceive. You are considered infertile if not pregnant after 1 year of trying to conceive.

Diagnosed Reasons for Infertility Ovulation Defect30% Sperm Defect22% Tubal Defect17% Unexplained14% Other Disorders12% Endometriosis5%

Documentary: The Disappearing Male ppearingmale/

Health Assignment 1. Adopt the role of an advice columnist. 2. Respond to the following letter from a person seeking advice about infertility and its effects on their relationship. 3. In your response, identify the differences between sexual and reproductive health, some possible causes of infertility, possible solutions and sources of information available. 4. You will be evaluated on your communication skills.

Health Assignment Dear Abby…It has been well over a year now, and my husband and I are unable to conceive. There seems to be pregnant women all around us. I can’t stand to look at them, or be around them. I feel angry and depressed. My husband is telling me that things will be okay, and that we can adopt. But I really want to have my own child. I feel as though this is putting strain on out relationship. What can we do?

Discuss What are the types of relationships that exist in a variety of settings? With a partner, think of couples you know who are in a healthy relationship. List the characteristics you feel make those relationships healthy. What do we think are the top 10 characteristics of a healthy relationship?

The Ten Characteristics of a Good Relationship 1. Trust- can confide openly 2. Togetherness –sense of intimacy & autonomy 3. Expressiveness – able to say what you feel, need 4. Staying Power – bond strong through tough times 5. Security – strong enough to absorb conflict/anger 6. Laughter - humour

Cont’d 7. Support – continuously offer encouragement 8. Physical Affection – desire can fluctuate but is retained 9. Personal Growth – bring out the best in each other 10. Respect – aware of each other’s boundaries and need for space.

Identifying Unhealthy Relationships Discuss with a partner 1. Why is it sometimes difficult for someone to acknowledge that they are in an unhealthy relationship? 2. Why do people stay in unhealthy relationships? 3. If someone is in an unhealthy relationship what can she/he do about it?

Why is it sometimes difficult for someone to acknowledge that they are in an unhealthy relationship? Love is Blind Someone may feel they are so in love that they do not look deeply at the problems and stay in the relationship

Why do people stay in an unhealthy relationship? People often believe that: Things will get better The problems are just a phase They can change their partner They have seen this type of behaviour in another relationship and do not realize it is unhealthy Teens often feel that having a boy/girl friend is more important than getting our of an unhealthy relationship. They may be scared to break it off

If someone is in an unhealthy relationship what can they do about it? It is important to acknowledge the unhealthy characteristics before they become abusive. Emotional abuse can turn into physical or sexual abuse. Talk to you partner if you feel your relationship is unhealthy and make it clear that unless things change the relationship will end Talking to friends or others you trust can provide insight.

Characteristics of an unhealthy relationship 1. Finding fault 2. Attempts to change partner 3. Changes in behaviour – due to pressures from partner 4. Jealousy 5. Lies, manipulates 6. Fearful of expressing your feelings 7. Abusive behaviour – verbal, emotional, physical, sexual 8. Self esteem diminished

1) Most teens do not get along with their parents - MYTH Most teens report that they get along okay with their families. The media tends to portray teens as very disrespectful and parents as being totally out of touch with reality. Friends tend to talk to each other about the problems they are having at home, but typically don’t talk about average times because it is boring!

2)What people want in friend and dating relationships often changes during adolescence - FACT Adolescence is the stage where people spend a lot of time thinking about the kind of adults they want to be. As teens, they become much more critical of ideas and opinions and challenge some of the things they have preciously accepted.

3) Teens who grow up in families where there is violence will be violent adults. - MYTH Teens who witness violence are at a greater risk for experiencing violent relationships as adults. However, young people have choices.

4) Relationship skills can be taught the same way basketball skills or math can be taught. - FACT Teens and adults who learn skills for relationships, communication and problem solving are more effective in getting what they want in relationships in respectful ways. They feel more confident and happy about their relationships.

5) If one of my friends chooses to be in an abusive relationship, there is nothing I can do to help him or her. - MYTH More people are starting to realize that what you say and do does matter, even if you are not involved in the relationship.

6) Use of alcohol and/or drugs causes violence - MYTH It is often associated with violent incidents, it is not an excuse for violence. The choice to use drugs or alcohol does not mean that you are not responsible for your behaviour.

7) Excluding someone from a group or spreading rumours about that person can be as harmful as physical violence. - FACT Many teens have reported that the daily psychological abuse of this type has long lasting effects and can be worse than physical violence.

8) Teens in gay/lesbian relationships face the same kinds of issues as teens in heterosexual relationships - FACT These issues are no different that heterosexual teens face.

9) Bullying usually happens when someone abuses his/her power over someone else. - FACT There is a power imbalance that exists between the people. It is know as bullying when it is seen as a repeated behaviour. With bullying there is intent to harm the other person.

10) Bullying is mainly something that happens in elementary school - MYTH Often a person who is a bully when they are younger will continue on to abuse their dating partner when they get into a relationship.

11) Bullying is usually something done by males - MYTH Females bully equally. Females often engage more in social bullying than males.

A Healthy Friendship/Relationship Looks like, Sounds like, Feels like… Looks like…. Smiling Fun Doing things together but also apart Having own interests Content Independent Not always alone together Equality respectful

Sounds like…. Laughter Positive, supportive comments Encouraging Close friends

Feels like… Content Trusted and trustworthy Within comfort zone Respected Independent Cared for Own interests and needs are being met

An Unhealthy Friendship/Relationship Looks like, Sounds like, Feels like… Looks like… Scared Depressed Always fighting Unhappy Controlling Jealousy No other friends Dependent on each other Do everything together Own interests are not being met

Sounds like… Arguments Crying Anger Pain Sadness complaints

Feels like… Empty Scared Sad Hopeless Controlled Isolated hurt

Rights and Responsibilities of a Friendship/Relationship You have certain rights but you also have responsibilities for your actions. Complete the following chart by outlining some of the rights and responsibilities involved being in a friendship/relationship. For example: In a friendship/relationship, I have the RIGHT to state my opinion. In a friendship/relationship, I have the RESPONSIBILTY to respect the opinion of others.

Cont’d In a Friendship/relationship I have the RIGHT to: State my opinion Set my boundaries Be heard Say no Have other friends Spend time with people I care about Have friends of the opposite sex

Cont’d In a friendship/relationship I have the RESPONSIBILITY to: Accept the opinions of others Respect the boundaries of others Listen Respect other people’s limits Encourage my partner/friend to have other friends Give my partner/friend space to spend time with people who are important to him/her Accept that my partner has friends of the opposite sex

Day 5

Active Listening Skills Get into a group of 3. One person will be the speaker, one will be the active listener, and the third person will be the recorder/observer. The speaker will speak for 30 sec about one of the topics below. The active listener will try to actively listen using good body language and will then try to summarize what is being said for 20 secs. The person observing will watch for good active listening skills and will have the opportunity to give feedback to the speaker at the end. TOPICS A) Talk about what you would do if you won a million dollars B) Talk about a movie that you have seen recently Switch roles so all have a chance.

Active Listening – How can you relate this to your own lives? It is important to learn skills for healthy relationships (such as active listening), but it is equally important to learn to recognize unhealthy relationships.

Definitions Violence = any action by a person or group of people that directly or indirectly causes physical and or emotional harm to another person.

Types of Violence Psychological/Emotional Direct verbal threats or abuse directed towards another Can include intimidation and harassment Controlling behaviour in a relationship Indirect Excluding someone from a group Rumour spreading Cyber harassment

Physical Abuse Threatened or actual use of force to injure or hurt another Financial Abuse Extortion (threat of violence so they have to pay) Blackmailing Continuously borrowing money Sexual Abuse Rape, incest, unwanted sexual touching, date rape, harassment Bullying Repeated and intentional attacks on others that can be perpetrated by individuals or groups

Roles People Can Play in Potentially Violent Situations Perpetrator Person or persons acting in a violent or aggressive way Victim Person being targeted by perpetrator in that particular situation Passive Bystander People who watch the events unfolding and do not intervene The presence of bystanders can increase the intensity of the violence because it creates an audience effect

Cont’d Instigator Someone who helps to start a conflict, or encourages a peer to be violent, but may not be directly involved in the conflict themselves Defender or Victim Someone who tries to stand up for somebody being bullied, harassed or targeted by someone else. This can include direct defending or indirect (invite victim to join a different group) Help Seeker Someone who tries to get help from an adult or other peers Mediator Someone who tries to help problem solve a conflict or situation typically before it becomes violent.

Day 6

Contributers to Violence Sports Images It is unclear as to what the exact effects are but one would think that if a person looked up to a professional athlete who displayed violent behaviours, that the child might model similiar behaviours. Media Violence Evidence links FREQUENT exposure to violent media with aggression later in life. The three main effects of violence in the media are aggression, desensitization and fear

Group/Gang Violence Feeling accepted by others, feeling safe and protected, fear of what might happen if they go against the group and meeting new friends. Traditional Roles Females sometimes grow up submissive and are more concerned about pleasing others. Men believe they need to bet the bread winners. Witnessing Violence Boys who witness violence may be more likely to use violence as a means of conflict resolution. Girls may use more internal coping mechanisms like depression.

Power Imbalances What is power? Responses may include having financial wealth, being successful, being popular, being able to persuade others, being strong, being educated, etc Is power good or bad? It can be either depending on how it is used. If power is abused it often leads to conflict and unhealthy friendships or relationships. Power can be a positive thing when it is used to help others.

Cont’d Powerful Coach Rich Educated Able-bodies Teacher Athlete Men bully Less Powerful Athlete Poor Non-educated People with disabilities Student Non-athlete Women Bullied person

Cont’d How might one of the above individuals abuse their position of power? A coach would have an unrealistic expectations for the athletes. A bully could exclude someone from a group, verbally harass the victim. What impact would this have on the less powerful? Athlete could perform below potential, quit the team, skip school etc. A person being victimized could skip school, suffer serious emotional issues, low self esteem.

Rights and Responsibilities when ending a friendship or relationship When you are the person ending a friendship/relationship I have the RIGHT to: Choose to end the relationship Not be harassed because of my choice I have the RESPONSIBILITY to: Tell the person that I want to end the relationship Be honest with the other person Tell the person I want to end it instead of having them try to figure it our for themselves.

When you are the person who has had the friendship/relationship ended by the other person. I have the RIGHT to: Ask ‘Why?” Feel sad I have the RESPONSIBILITY to: Respect the other person’s decision Not make the other person feel guilty Handle my disappointment in a non-violent way Not try to turn others against the person Continue to respect the privacy of personal things that may have been shared in the relationship Not spread rumours

When you are a friend of the person who is ending the friendship/relationship I have the RIGHT to: Remain friends with the other person I have the RESPONSIBILITY to: Listen to your friend and support their decision

When you are a friend of the person whose friendship/relationship was ended by their friend/partner. I have the RIGHT to: Remain friends with the other person Support your friend Be angry or sad about your friends distress I have the RESPONSIBILITY to: Listen and be supportive of your friend Not act in abusive ways to the person who ended the relationship with your friend Not gang up on the person who decided to end the relationship

Getting out of an Abusive Relationship Why do people stay in abusive relationships? Is very apologetic afterward and promises to never behave like that again You believe that if only you could make them happy they wouldn’t be abusive anymore Your dating partner threatens to make things worse for you if you break up They threaten to commit suicide if you break up Belief that any boyfriend/girlfriend is better than none

How could you help a friend who is in an abusive relationship? Think about your own safety before intervening Talk to your friend Be a good listener Try to be supportive and non-judgmental, even if you feel frustrated Use other friends for support Help your friend recognize excuses for the behaviour Encourage your friend to seek help Keep in touch with your friend if they seem withdrawn.

Relationship Violence Stats collected by the Canadian Red Cross show that 40% of females and 30% of males report being violent at some point in their dating careers. In high school, 25% of females and 10% of males reported violence in a relationship. 1 in 10 teens experience physical violence in a dating relationship. The average age of a first violent relationship experience is around 15 years of age.

Note: Safety Plans for teens Stay in touch with friends and involved with activities Keep important phone numbers with you at all times Set up a code word with friends or parents for danger Talk to police and/or shelter about your situation Try not to be alone with your dating partner When with your partner, keep in mind: Warning signs that things will become abusive Make sure someone knows where you are and when you’ll be home Always have change for the phone If you decide to break up, do it in a public place

Sexual Limits Why is it important to set sexual limits?

Note: Sexual Limits Refers to sexual behaviour that is acceptable or unacceptable to an individual They are personal and should result from careful consideration of personal values

Note: Importance of setting sexual limits Discussing and setting sexual limits ahead of time with a boyfriend/girlfriend will help to ensure that: - you are not taken by surprise -your actions fall in line with your values -misunderstandings are avoided

Handout: An important decision Read Matt’s story and then list and explain the steps he used to make his decision.