Sexual and Reproductive Health For Your Information booklet

Sexual and Reproductive Health For Your Information

ABOUT The Sexual and Reproductive Health For Your Information Campaign You need to know about sexual health so that you are able to make responsible and informed decisions. #SRHFYI has information on: • Menstrual • Safer Sex • Contraception • Abortion and where to get all services DISCLAIMER: THE INFORMATION IN THIS BOOKLET IS INTENDED FOR PERSONS 16 YEARS OF AGE AND OLDER. THE CONTENT HOWEVER CAN BE APPLICABLE TO PERSONS BELOW THE LEGAL AGE OF SEXUAL CONSENT (16). SHOULD THEY WISH TO UTILISE THIS BOOK THEY WILL REQUIRE ADULT SUPERVISION FOR GREATER CLARITY AND CONTEXT.

MENSTRUATION Menstruation (also known as having your period) is when blood and tissue from your uterus drips out of your vagina for a few days every month. You start getting your period during puberty, usually when you’re around 9-15 years old. As a woman gets older, her fertility will decrease until she will not get her period at all.

You can use different types of menstrual products: 1.

2.

3.

4.

Pads Tampons Menstrual cups Period panties

Phases of the menstrual Cycle You menstrual cycle helps your body prepare for pregnancy every month. You have 2 ovaries that hold a bunch of eggs. During your cycle, hormones make your eggs mature. When an egg is mature it means it is ready to be fertilized by a sperm cell. These hormones also make the lining of your womb thick and spongy (out of tissue and blood).

If your egg is fertilized (you are pregnant) it has a soft place to land. If your egg is not fertilized (not pregnant) the womb sheds the lining hence the menstrual bleed.

1

Let’s Talk About SEX Once you hit your teenage years the changes in your body also come with sexual urges. This is totally normal and nothing to feel guilty about. Just remember; you get the final say over what happens with your body.

Let’s start with CONSENT Consent means actively agreeing to be sexual with someone.

Consent lets someone know that sex is wanted. Sexual activity without consent is rape or sexual assault.

•

Freely given. Consenting is a choice you make without pressure, manipulation, or under the influence of drugs or alcohol.

•

Reversible. Anyone can change their mind about what they feel like doing, anytime. Even if you’ve done it before, and even if you’re both naked in bed.

•

Informed. You can only consent to something if you have the full story. For example, if someone says they’ll use a condom and then they don’t, there isn’t full consent.

2

•

Enthusiastic. When it comes to sex, you should only do stuff you WANT to do, not things that you feel you’re expected to do.

•

Specific. Saying yes to one thing (like going to the bedroom to make out) doesn’t mean you’ve said yes to others (like having sex).

WHAT IS ABSTINENCE?

SB W L

Abstinence refers to the act of refraining from something. Sexual abstinence has been promoted as a way to prevent premature sexual intercourse debut, unplanned pregnancy, sexually transmitted infections.

Should you want to delay your sexual intercourse debut, there are a few options: Masturbation: in the streets they say ‘playing with yourself’- touching your own genitals for pleasure. It’s totally normal to masturbate.

Masturbation also helps you figure out what you like sexually for now and when you are ready to have sexual intercourse.

Kissing and Fondling: is stimulation by kissing and touching, rubbing each other with NO sexual intercourse.

SHOULD YOU WANT TO DELAY SEXUAL INTERCOURSE DEBUT

Masturbation: in the streets they say ‘playing with yourself’- touching your own genitals for pleasure. It’s totally normal to masturbate.

Masturbation also helps you figure out what you like sexually for now and when you are ready to have sexual intercourse.

Kissing and Fondling: Is stimulation by kissing and touching, rubbing each other with NO sexual intercourse.

3

SEX Sex is a different experience for everyone, but mostly it should be fun. People engage in sex for pleasure, for pregnancy and for work.

No matter what kind of sex you are having, it is very important to have good communication and consent. Sex can lead to pregnancy and/or STI’s USE A CONDOM.

Different kinds of sexual intercourse: •

Vaginal – this refers to the penetration of the vagina by a penis, sex toy or finger.

•

Oral – this refers to the penetration of the mouth by a penis, sex toy.

•

Anal –this refers to the penetration of the anus by a penis, sex toy or finger

•

Whatever sex means to you, being sexual with another person comes with a lot of responsibility. Before you have sex, think about what things you feel comfortable doing, ask what the other person feels comfortable doing, and think about any risks involved — like STIs or pregnancy — and how to help prevent them.

4

SEXUALLY TRANSMITTED INFECTIONS

An STI is a Sexually Transmitted Infection. You can get an STI by vaginal, anal and oral intercourse or contact with bodily fluids such as sperm, semen saliva, blood, and vaginal discharge. Very few STI’s can be transmitted through skin contact outside of the genital area.

5

6

HOW DO YOU GET IT?

By having vaginal or anal sex without a condom with someone who has the infection; from mother-to-baby (eye and chest infection)

By having vaginal, anal or oral sex without a condom with someone who has the infection; from mother-to-baby across placenta during pregnancy (congenital syphilis).

By having vaginal, anal or oral sex without a condom with someone who has the infection; from mother-to-baby (eye infections).

INFECTION

Chlamydia: Bacterial infection of genitals can lead to inflammatory disease (PID) in women and infertility in men and women.

Syphilis: Bacterial infection entering the body through breaks in skin or linings of the genital area; over time, goes on to damage internal organs (heart, brain, spinal cord)

Gonorrhoea: Bacterial infection of genitals, throat or anus, can lead to infertility particularly in women.

Women usually have no symptoms, but may have pain with sex, vaginal discharge and lower abdominal pain. Men may have no symptoms or discharge from penis, discharge from anus, pain in testicles, and pain on urinating.

Painless ulcer (chancre) usually on genitals; later swollen glands, rash, hair loss.

Women often have no symptoms or may have pain with sexual intercourse, lower abdominal pain, changes in bleeding pattern. Men may have no symptoms or may have watery or thick discharge from penis, pain or urinating.

SYMPTOMS

SOME OF THE MOST COMMON STI’s:

Antibiotics

Antibiotics with follow-up blood tests.

Antibiotics

TREATMENT

Sexual partners must be tested and treated if positive. Avoid sex until 7 days after treatment is completed.

Condoms provide some protection, but not totally.

Sexual partners must be tested and treated if positive. Current health regulations advise no sex until you are cleared.

Recent sexual partners need treatment. Don’t have sex until 7 days after starting treatment and until sexual contacts have been treat

PARTNERS

7

HOW DO YOU GET IT?

HPV transmitted by direct skin-to-skin contact, usually during sex; from mother-to-baby. Sometimes no identifiable source of transmission.

Close skin contact with someone with the virus; from mother-to-baby.

By close body contact, usually during sex with an infected person. Can be spread via infected bedding and clothing

INFECTION

Genital warts Human papillomavirus (HPV) causes fleshy or flat lumps – may be present even if not visible

Genital erpes Herpes simplex virus causes skin infection usually on mouth and lips (cold sores or on genitals.

Pubic lice – crabs Small lice that live in the pubic hair and cause irritation.

Intense itching in the pubic area, small nits (eggs) on pubic hair.

Painful, red blisters, little sores or ulcers, flu-like symptoms, and sometimes a discharge.

Fleshy or flat lumps on or around genitals, anus, groin or thigh.

SYMPTOMS

Special shampoo, cream or spray applied to pubic area.

Wash all clothing and bed linen.

Anti-herpes drugs and pain relief can be given to treat symptoms, but the infection cannot be cured. Some may need medication to prevent further outbreaks.

Visible warts can be treated, but the infection cannot be cured. On 1 January 2017, HPV immunisation became free for everyone, male and female, aged 9 to 26, including non-residents under the age of 18.

TREATMENT

Treat partners of the last 3 months in the same way at the same time.

Partners may or may not catch herpes. Do not have sex when open sores are present. Condoms provide some, but not complete, protection.

Condoms provide some protection, but not total.

PARTNERS

8 It may be brought on by anything that changes the balance in the vagina, eg, new sexual partners, increased sexual activity.

Bacteria from around the anus getting into the urethra and bladder, not emptying the bladder properly. Much more common in women than men.

Cystitis Bacteria cause inflammation of the bladder lining; can spread to kidneys and cause damage to kidney function.

Bacterial vaginosis If the control of the normal bacteria in a healthy vagina fails, an overgrowth of certain bacteria can occur. The acid/alkaline balance is upset and irritation results.

HOW DO YOU GET IT

INFECTION Burning sensation when urinating, needing to urinate urgently and more often than usual, cloudy, bloodstained or smelly urine, aching in lower abdomen or back.

SYMPTOMS

Antibiotics after urine test if symptoms last longer than a day, drink plenty of water, use pain relief and using alkalisers, e.g.

UralÂŽ, CitravesentÂŽ, etc

TREATMENT

CONTRACEPTION Contraception is the use of various devices, drugs or agents that are used to prevent pregnancy.

There are different methods of contraception, including: • long-acting reversible contraception, such as the implant or intrauterine device (IUD) • short-term reversible contraception, such as the pill or injection • barrier methods, such as condoms • emergency contraception • permanent contraception, such as vasectomy and tubal ligation.

Long-acting Reversible Contraception: There are two types of long acting reversible contraception namely: Intra-uterine device (IUD): a tiny device that is inserted into the uterus, last up to 10 years and are 99% effective.

Efficacy: Less than one pregnancy per 100 women using it for a year.

What is it? A T-shaped device inserted into a woman’s uterus.

There are two types of IUDs – one made from copper and another which secretes the hormone progestin.

Advantages: The copper device can protect a woman from pregnancy for up to 5 years; the hormone versions last between three and five years, depending on the brand.

Drawbacks: It has to be inserted by a qualified health professional.

The hormonal versions should not be used by women with liver disease or breast cancer.

9

IMPLANT: made up of two small rods the size of a matchstick put under the skin in the inside of your arm. They slowly release a hormone called progestin and work for 3 or 5 years.

Efficacy: Less than one pregnancy per 100 women using it for a year.

What is it: It is a matchstick-sized rod inserted under the skin of the upper arm. It works by secreting the hormone progestin in small amounts.

Advantages: The implant is considered one of the most effective birth control methods available protecting a woman from pregnancy for up to three years. One of the reasons it is effective is because a woman does not need to return to a health facility for a replacement for years, unlike other contraceptive methods like the pill or injection.

Drawbacks: A health worker is needed to insert the device and recent research has found that the implant is less effective for people taking certain medications, for example, some HIV and tuberculosis drugs. Some women report heavy menstrual periods.

10

Short-term Reversible Contraception: The two popular short terms contraceptives: • •

two or three injectables oral contraceptive pills

Injectables Efficacy: Between six and 12 pregnancies per 100 women using it for a year.

What is it: The injectable contraceptives usually contain the hormone progestin and are given via a shot in the arm every two to three months.

Advantages: The user does not need to remember to take a pill at the same time every day as she would with contraceptive tablets, and it is private – there is no leftover packaging should the woman need to hide the fact she is on birth control.

Drawbacks: It takes between one and three weeks after the first shot for the injectable to properly protect from pregnancy — it is recommended another form of birth control be used in this period, such as a condom. This method is only effective if a woman returns to a health facility every two to three months to receive a repeat injection.

The Pill Efficacy: Between six and 12 pregnancies per 100 women using it for a year.

What is it: There are a number of different types of contraceptive pills. Most contain the hormones oestrogen and progestin but some use progestin alone. If taken at the same time every day, without skipping a dose, the pill can be as effective as the implant.

11

Advantages: Reduces the severity of menstrual cramps.

Drawbacks: Research has shown that women often forget to take it regularly or struggle to get to a pharmacy every month for a repeat prescription, lowering the effectiveness significantly.

External (male) condom Efficacy: 18 pregnancies per 100 women using it for a year What is it: A sheath made from latex (rubber), polyurethane and tactylon (both are types of plastic) which covers the penis during sex.

Advantages: Latex condoms, when used correctly every time a person has sex, are 98% effective, according to a review by the NHS. Drawbacks: Users sometimes do not place condoms over the penis correctly, which increases the risk of pregnancy. Oil-based substances, often used for lubrication, like moisturising cream or vaseline, lower the efficacy of latex condoms. Some people are allergic to latex, which is the most common type of male condom available.

12

Emergency contraception “MORNING AFTER� PILL: Emergency contraception can prevent pregnancy after unprotected sex or if the contraception you have used has failed i.e.; a condom breaking or you have missed a pill. . The morning after pill is a form of emergency contraception that needs to be taken up to three to five days after sex.

Permanent contraception: This is a method of sterilisation that prevent pregnancy permanently. The procedure for men is a vasectomy and for women it is tubal ligation. These procedures are generally available at regional hospital because of their specialized nature.

13

PREGNANCY Let’s face it, sometime contraceptives fail, condoms burst or you are stuck in moments where you struggle to negotiate for safer sex. The next period shows but it is light or maybe it does not show at all. Your breast are terribly tender and you suddenly cannot stand your favourite food. You might wake up feeling a bit nauseous and your partners face might make you angry.

Go and test for pregnancy as soon as possible. It is best to get a diagnosis from a healthcare professional. Early detection is extremely important as it helps you navigate your options. If the pregnancy test is negative, you should consider contraceptive options, if you are not on one. If you are on a contraceptive find out why it failed. Talk to a health care professional to see which one would be suitable for you and always do your own research. P.S: USE THE EMERGENCY “MORNING AFTER” PILL should you have unprotected sex.

If the pregnancy test is positive; you have a choice to keep the pregnancy.

Look for antenatal care facilities where you can receive advice and care for the duration of your pregnancy as well as shortly after. Pregnancy usually lasts between 38 and 40 weeks.

Should you not wish to continue the pregnancy; look for facilities that offer safe abortion services. Many public hospitals and clinics can assist with Medical Abortions. Medical Abortion is administered until 10 weeks of pregnancy. You have the right to request a referral to a service should the facility not have the services or a healthcare provider no want to administer the abortion. After the termination, go for contraceptive counselling and consider options.

14

CHOICE ON TERMINATION OF PREGNANCY Abortion is a safe and legal way to end a pregnancy. There are two different kinds of abortions: a medical abortion and a surgical abortion. Both kinds of abortion are safe and effective. South Africa has one of the most liberal laws and allows termination up to 20 weeks.

My Body, My Choice South Africa

There is no risk to your ability to have children in the future or to your overall health after having a safe abortion. Having an abortion doesn’t increase your risk for breast cancer or affect your fertility.

Medical Abortion A medical abortion uses drugs to empty the contents of the uterus instead of a surgical procedure. A medical abortion involves two medications taken orally to end a pregnancy. A woman who takes these drugs must be prepared to have a surgical abortion if the medical abortion is unsuccessful. A follow-up exam is usually done one or two weeks after to make sure that the abortion has happened.

Surgical Abortion/ Manual or Vacuum Aspiration Surgical abortions involve a medical professional that can conduct a same-day procedure in a clinic or hospital. Surgical abortion, also known as Manual Vacuum Aspiration, can be performed in one day if the pregnancy is 12 weeks and less. The procedure is done in a health facility with local anesthesia and oral pain-relieving medications.

15

COMPREHENSIVE ABORTION CARE Abortion is a medical procedure.

As any procedure: 1.

You have the right to privacy and confidentiality.

2.

You have the right to counselling so that you know your options.

3.

You have the right to information so that you know what to expect.

4.

You have a responsibility to declare any medical conditions you suffer from or medication you may be taking.

5.

You have a responsibility to ask questions.

6.

You have the right to a safe abortion procedure.

7.

You have the right to pain management.

8.

You have the right to post-abortion care.

16

17

FACILITIES The SRHFYI campaign has activator working with communities from six different districts in Gauteng and Limpopo.

The areas covered are: Tshwane Ekurhuleni Westrand Sedibeng Johannesburg Mopani (Limpopo) The facilities in the communities we are working with comprise of public institutions: Tshwane: • Laudium Community Health Centre • Kgabo Health Centre • Dr George Mukhari Hospital • Phedisong 4 Clinic • Kalafong Hospital • Odi Community Hospital • Soshanguve Clinic 3 • Jubilee District Hospital

Central Johannesburg: • Chris Hani Academic Hospital • South Rand Hospital • Lenasia South Community Health Centre • Hillbrow Community Health Centre • Charlotte Maxeke Johannesburg Academic Hospital • Chiawelo Community Health Care Centre • Zola Jabulani Hospital

18

Ekurhuleni: • Tembisa Hospital • Thelle Mogoerane Regional Hospital • Jabulane Dumane Clinic

Westrand: • Leratong Hospital • Dr. Yusuf Dadoo Hospital • Carletonville Hospital

Sedibeng: • Kopanong Provincial Hospital • Sebokeng Hospital • Johan Heyns Community Health Centre • Heidelberg Hospital

19

Mopani (Limpopo): • Kgapane Hospital • Dr CN Phatudi Hospital • C N Phatudi hospital • Kgapane hospital • Letaba hospital • Khensani hospital • Sekororo hospital • Seloana Clinic • Shivuleni Clinic • Letsitele Clinic

Sekhukhune ( Limpopo) • Botlokwa hospital • Helena Franz hospital • Lebowakgomo Hosp • Zebediela Hospital • Rethabile CHC • Seshego Zone 04 clinic • W.F. Knobel Hospital • Blouberg CHC • Matlala Clinic • Mankweng Hospital • Seakamela Clinic

20

Are you a student looking for discounted sexual and reproductive health services?

Become a member and start benefitting from the following DISCOUNTED services Safe abortion care

Emergency contraception

Ultrasound Only Pregnancy Test

Tablets/ Morning After Pill

MARIE STOPES MEDICAL PROCESS Safe Abortion Consultation Less than 9 weeks 9 to 12 weeks 13 to 20 weeks Conscious Sedation

Well woman screenings Pap smear STI Screening (Syphilis, Chlamydia, Gonorrhoea) STI Screening and Treatment Comfort cream

IUCDs

Non-hormonal IUCD (with consultation) Non-hormonal IUCD removal Non-hormonal IUCD Check up

Implants Implant (3 year) (with consultation) Implant (3 year) removal

Register online at studenthealthcard.org.za or contact us on 0800 11 77 85 for any queries

Children by choice, not chance

REFUSAL OF SERVICES AND LEGAL RECOURSE Did you know that the Choice on Termination of Pregnancy Act, 1996 protects your right to seek termination of pregnancy services?

It is stated in the Act that “any person who prevents the lawful termination of a pregnancy or obstructs access to a facility for the termination of a pregnancy, shall be guilty of an offence and liable on conviction to a fine or to imprisonment for a period not exceeding 10 years” Should you or someone you know encounter refusal of services at a public health facility you can report the incident and lodge a complaint at the facility or with the following organisations: South African Human Rights Commission: Tel: 011 877 3600 https://www.sahrc.org.za/index.php/what-we-do/lodgecomplaints Women’s Legal Centre Tel: 021 424 5660 Email: info@wlce.co.za The Legal Resources Centre Tel: 011 836 9831 Email: info@lrc.org.za

22

WHEN REPORTING PLEASE TAKE NOTE OF THE FOLLOWING: 1.

2.

3.

4.

5.

6.

Name of the facility; Area in which the facility operates (Province and town); Person who refused assistance (name and position); Any policy of abortion service provision made available or communicated at the facility; If there was a referral to another health facility to access abortion services; and Reason given for refusal of service.

23

The Sexual and Reproductive Health For Your Information campaign aims to educate women and girls about their sexual and reproductive health and rights.

THIS BOOKLET WAS CURATED IN PARTNER WITH: IPAS South Africa, ACTIVATE! Change Drivers and the Gauteng Department of Health RESOURCES USED TO CURATE THIS BOOKLET: National Department of Health South Africa Ipas South Africa Planned Parenthood Bhekisisa Centre for Health Journalism CURATED BY: KANYISA BOOI

DINEO MOKWENA RAMMOLOTSI SOTHOANE RAEEZ EDWARDS (Graphic Design)