Relationships

1. YSGOL STANWELLSCHOOL ABCH (PSE) Blwyddyn11 BC & LJe 2012-2013 Relationships Enw: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dosbarth: 11 . . . Athro/athrawes: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Relationships Relationships with other people, whether family, friends, lovers or others, are the most essential thing in our lives after food, drink, shelter and warmth and can be the happiest moments that we ever experience. But also, sadly, what we may want from relationships is not always what we get. We have to learn how to be friends and have friends and how to be close and have relationships - by experiencing them. These can be both totally and absolutely the greatest things that we ever experience in our lives but also the most traumatic and emotionally painful as well

3. Work in pairs and complete the following table: Healthy relationship traits Unhealthy relationship traits Trust Violence

4. Responsible Fairness Violent Respect Able to communicate Supportive Trust Passion Faithful Controlling Caring Honesty Reliable Thoughtful Affection Values Humour Caring Friendship Jealous Possessive Pressure Embarrassed Aggressive Ignore Emotion Blame Deny Intimidation Isolate

5. Word search – Relationships W C J N N P A S S I O N Y H S J L X S K P F Z P Z Y Z O C P O S S E S S I V E L G V Q K V S A E I E H S O M J Y N J R L D T U G I U O P R M B I R H N Z R I L M E M E W C B N R W Q X F P Q A D R U S E L F A K L U M G V K O A D U L X M T H T T N S D C Z X A Z H O N N Z I Y D I P S V J E H J Q E S N O U K O Q T J N I T F X Z R L H T E A F G E S E E N P M V I Q T T A C D Q U E Q E M A V F A U S R I T B C O K J H D Y W A O Q E Q D R L S E G H O P R R H N I O M I Z U S M T P W E M T O J H F S P H F O L G J K M H J Z U T C E N V H Y U C B O Y K B T L P O N I Z D E H H S N Y O A W V S T D K N Q K G L F Y T I A H N C Q E P W N F M L K V B T G E Y P I B N B G R F V V W U H N L F W Z I P T L M E S R N I O L H C A F L C L E I M H C O H C S B V L I T G Z T A F V H C E O A W X D V L P E Z A I D L H R Y F B M E D T C G C V O U B E K P G R S O U H I F K C J E X A R X Z B T X D N O S U R S O C H W V B H E V I T R O P P U S I C J E U A E Y P A Q H J P H F Z R L W X N N Y V E O R J S R F M M U B A E L H U T D B M E T S X S A R N S G E W Z Z Z I A T F H E I T A I D O J H J Y E E G I H H D S N S Q Z S I R E S P O N S I B L E D A I G N O R E I R N J F K L U F H T I A F O W W V Z P C J A W M S V E N W U O Z G E T A L O S I T L E I T W Y F W Q O O I B C List all the words you find here:

6. Domestic Abuse • We tend to think of Domestic Abuse as physical violence or assault on a partner. In reality, however, domestic abuse is the summary of physically, sexually and psychologically abusive behaviours directed by one partner against another, regardless of their marital status or gender. • Domestic Abuse does not just affect people of a certain race, age, gender or background. It knows no ethnic, cultural or personal borders. • Generally, when one type of abuse exists, it is coupled with other forms as well, they might just not be quite so noticeable unless you are aware of the types of abuse and how the belief systems associated with abusive behaviour manifest themselves.

7. Myths MYTH Abuse only happens in certain "problem" families, ethnic minorities, uneducated or poorer areas. FACT Abuse pervades every ethnic, social strata. White collar workers are just as likely to abuse their wives as are blue-collar workers; financially independent people are just as likely to suffer abuse as are people on low incomes. It is not the social standing, the amount of stress lived under or the company kept which makes an abuser, but the internal need for power, the belief that they have the right to control someone else. MYTH Lesbians, men and gay men don’t get battered or abused. FACT Sexual orientation doesn’t make any difference. Abuse is about control within a relationship and can occur within any relationship where one partner believes they have the right to control the other. Whether they are married or living apart, of the same or opposite gender, have been together for a few weeks or many years really doesn’t make much difference – abuse can and does occur. MYTH It can’t be that bad, or she/he would leave FACT There are many emotional, social, spiritual and financial hurdles to overcome before someone being abused can leave. Very often the constant undermining of the victims self-belief and self-esteem can leave him/her with very little confidence, socially isolated, and without the normal decision-making abilities. Leaving or trying to leave will also often increase the violence or abuse, and can put both the victim and her children in a position of fearing for their lives. Leaving is the ultimate threat to the abusers power and control, and he will often do anything rather than let her go. MYTH Some people ask for it, provoke it, want it or even deserve it. FACT NOBODY deserves to be beaten or abused. People often have to walk on eggshells and try their best to avoid another incident. The abuser WANTS to abuse. This domestic violence myth encourages the blame-shifting from the abuser to the abused and avoids the stark reality that only the abuser is responsible for his/her own actions.

8. Read the following report from the NSPCC • In 2011, The NSPCC produced a report about violence in teenage relationships. The survey included the responses of 1,353 teenagers. This included 91 detailed responses. The results were as follows: • Girls, compared to boys, reported greater incident rates for all types of violence. Girls, compared to boys, experienced violence more frequently and reported a greater negative impact on their welfare. • 25% of girls and 18% of boys had experienced some form of physical violence. • 1 in 9 girls and 4% of boys had experienced severe physical maltreatment. • 75% of girls and 14% of boys stated it had a negative impact on their welfare. • 75% of girls and 50% of boys had experienced emotional abuse. • Most commonly this took the form of “being made fun of” and “constantly being checked up on” • 1 in 3 girls and 13% of boys reported some form of sexual violence • 70% of girls reported a negative impact on their welfare. • A minority group reported that sexual violence was a regular feature of their relationship. • Coercion was most often experienced by girls. Even when they thought the behaviour may be caring, some of the respondents were too scared of their partners to challenge the behaviour. • Phones and other online technologies were used to monitor the partner’s behaviour – where they went, who they spoke to. This affected girls more often. • Girls who had older boyfriends were more likely to experience violence. • Girls between 13 and 15 were as likely to experience violence as those who were 16.

9. Answer the following questions 1. What is domestic abuse? _________________________________________________________________________________________________________________________________________ 2. Why do you think the % of boys experiencing domestic violence is smaller compared to girls? _________________________________________________________________________________________________________________________________________ 3. Why do you think girls with older boyfriends are more likely to experience violence? _________________________________________________________________________________________________________________________________________ 4. Identify 5 ways a violent relationship could effect someone? _________________________________________________________________________________________________________________________________________

10. Respect in relationships The final years at school fly by. Days are packed with activity, and life is lived at a great pace in close contact with other young people. Change is happening too. The hormonal changes in your body at puberty bring visible changes to your body that you will be familiar with. What’s often overlooked though is that these hormones also bring emotional changes. It’s easy to swing from one emotional extreme to another with friends at school and home. Combined with the space of life and the stresses of exams it’s easy to make the decision to start a sexual relationship that you later regret or that carries life-long consequences, damaging yourself, your partner and possibly potential children. It’s common to think that having sex is healthy even at 14 or 15 years of age. After all, puberty has taken place and this is nature’s way of saying the body is prepared isn’t it? OK, it might be illegal under 16 (17 in Northern Ireland) and there is the issue of getting pregnant, but having a sexual relationship at an early age isn’t damaging is it? The age of consent is the minimum age at which a person is considered to be capable of legally giving informed consent to having sex. It is key therefore to the legal position. In Great Britain it is 16 years of age (Northern Ireland is slightly higher at 17). The age of consent varies from country to country usually between the ages of 13 and 21 years. Many countries including Britain also make sex illegal even if one of the partners is above the age of consent so long as the other partner is in a position of trust and authority over the other person. Though the ages differ, there are age of consent laws in almost every country in the world. This reflects the widely held view that the decision to have sex is a big, often life-changing step. It requires an emotional maturity that only develops slowly in teenage years. Most importantly, the age of consent laws are there to help you.

11. Pressure to conform It’s OK to say no to sex or any intimate contact at all. Don’t be pressured into turning friendships into sexual relationships. Pressure sex is a form of abuse that could damage you emotionally. Boyfriend/girlfriend behaviour can become obsessive and threatening and increasingly involves mobile phones, internet and other technologies.

12. I guess you don’t know everybody, because many of Britain’s teenagers are virgins If you were a real friend you wouldn’t say something like that. Promises weren’t made to be broken. Neither were condoms. But the fact is that it happens to both all too often. Aids, HPV, gonorrhea, syphilis, chlamydia, herpes and about 20 other STIs. If you loved me, you wouldn’t ask. That’s exactly what I’m afraid of. I’d rather save myself for someone who will love me for life. No, it’s what’s right with me. I care about the future. Apparently you don’t. I’ll know and that’s one too many people for me

13. Teenage sex, birth control and sexually transmitted disease Hopefully in the first pages of this booklet you’ve seen how starting to have sex at an early age can have powerful emotional consequences. Now you will look at the physical consequences of sex. The government’s strategy to reduce teenage pregnancy is to provide easier and increased access to birth control including for boys and girls under the age of consent. The government’s view receives widespread support because on the face of things it seems logical that more birth control should produce less unplanned pregnancies. As we shall see later in this section the facts are rather different. Before that though, it’s important to understand about the different methods of birth control. The conception/implantation distinction Think back to what you learned at key stage 3 about reproduction. It’s important to remember the difference between conception and implantation in understanding how different birth control methods work. Conception is the moment when the mother’s egg and father’s sperm fuse to form the first cell of a distinct and completely new human being. Implantation takes place between 6 and 13 days after conception when the small developing embryo implants in the lining of the mother’s womb. True contraceptives prevent conception – they do not end the life of a young human being. In contrast some so-called “contraceptives” act to prevent the young human embryo implanting in the mother’s womb. Without implantation, the young human being cannot develop further and dies. So the term contraception is sometimes used inaccurately. Birth control methods would be a more accurate definition. While all methods aim to stop a baby from developing as a result of having sex, they do not all work to prevent conception. Some methods work to prevent implantation. Anything that deliberately stops implantation causes an early abortion.

14. Combined Contraceptive pill What is the combined contraceptive pill? The combined oral contraceptive pill is usually just called the pill. There are many different types, but all contain two hormones - oestrogen and progestogen. These are similar to the natural hormones women produce in their ovaries. How does the pill work? The main way the pill works is by stopping the ovaries releasing an egg each month (ovulation). It also: Thickens the mucus in the cervix, making it difficult for sperm to reach an egg Makes the lining of the womb thinner so it is less likely to accept a fertilised egg How reliable is the pill? The pill's effectiveness depends on how carefully it's used - it's more than 99 per cent effective when taken according to instructions. This means that fewer than one woman in 100 using this method for a year will get pregnant. Myths about the pill: The pill makes you put on weight. Not true - Research has shown there is no evidence to suggest this, although some women find their weight changes during their cycle due to fluid retention. However we do know that poor diet, lack of exercise and drinking too much alcohol contribute to weight gain. The pill makes you infertile. Not true – women who stop the pill get pregnant as easily as those who've never used the pill and you don't need regular breaks off the pill. However some women find it may take a few months for their periods to return or settle into a regular pattern. How do you use the pill? The pill can be started up to and including the fifth day of a period. If taken at this time it is effective straight away. If started at any other time, additional contraception has to be used for seven days. The pill is taken every day for 21 days until the pack is finished. You then have a break of seven days when you have a 'withdrawal bleed', which is usually shorter and lighter than a normal period. Everyday pills have 21 active pills and seven placebo tablets. These are taken without a break and must be taken in the order listed on the pack. Advantages and disadvantages The advantages of using the pill include: It usually makes your bleeds regular, lighter and less painful, It may help with premenstrual symptoms, It reduces the risk of cancer of the ovary, womb and colon, It reduces acne in some women, It may protect against pelvic inflammatory disease, It may reduce the risk of fibroids, ovarian cysts and (non-cancerous) breast disease.

15. Combined Contraceptive pill The disadvantages of the pill include possible temporary side-effects such as: Headaches, nausea, breast tenderness and mood changes, Breakthrough bleeding (unexpected bleeding on pill-taking days) and spotting If these don't stop within a few months, changing the type of pill may help. The pill can have some serious side-effects, but these aren't common. They may include: Raised blood pressure A very small number of women may develop a blood clot, which can block a vein (venous thrombosis) or an artery (arterial thrombosis, heart attack or stroke). A small increase in risk of being diagnosed with breast cancer. A small increase in the risk of cervical cancer if the pill is used continuously for more than five years Other things to consider include: Initially, you'll be given three months' supply of the pill. If there are no problems, such as a rise in your blood pressure, you will then be given up to a year's supply. You don’t need a cervical screening test or an internal examination to have the pill. The pill does not protect you against sexually transmitted infections Who can use the pill? The pill may not be suitable for all women, but for most the benefits outweigh the possible risks. The pill may be unsuitable if you: Think you might already be pregnant, Smoke and are over 35, or are over 35 and stopped smoking less than a year ago, Are very overweight, Take certain medicines - always check, Have had a previous thrombosis, Have a heart abnormality, circulatory disease or high blood pressure, Have very severe migraines or migraines with aura, Have breast cancer now or within the last five years, Have active liver or gall bladder disease, Have diabetes with complications, or have had diabetes for more than 20 years What if I forget to take the pill? It's important to take the combined pill at a regular time each day. You have 'missed a pill' if you take it more than 24 hours later than your usual time. Missing one pill anywhere in the pack, or starting your pack one day late, is not a problem, but missing more than one pill or starting the packet more than one day late could affect your contraceptive cover - seek advice as you may not be protected until you have been taking the pill again for seven or even nine days with some types of pill. If you're sick within two hours of taking the pill it will not have been absorbed properly. Take another pill as soon as you feel well enough. If you continue to be sick, seek advice. If you have severe diarrhoea for more than 24 hours, this makes your pill less effective - seek advice. Where can I get the pill? The pill is free on the NHS from contraception clinics, sexual health clinics and your GP.

16. Condoms What are condoms? Condoms are a barrier method of contraception, which means they prevent the sperm meeting an egg. There are male and female condoms. Condoms are made of latex (rubber) or polyurethane (plastic). How reliable are condoms? Effectiveness depends on how carefully they're used. Male condoms are 98 per cent effective when used according to instructions. This means that using this method, two women in 100 will get pregnant in a year. Female condoms are 95 per cent effective. This means five women in 100 will get pregnant in a year. Myths about condoms: Condoms are restrictive and uncomfortable. Not true - condoms come in different textures, shapes and types. Find a brand that suits you. Condoms may have holes in them. Not true - all condoms are tested and carry the CE quality mark. Many brands also have a kite mark to show they're reliable. How to use male condoms Male condoms fit over a man's erect penis. They should be used before any close genital contact. Once the man has ejaculated but before the penis goes soft, he must withdraw holding the condom firmly in place to avoid spilling any sperm. The condom is then removed and should be disposed of carefully. How to use female condoms Female condoms are put into the vagina and line it loosely when in place. The closed end of the condom is inserted high into the vagina. The open, outer ring lies just outside the vagina. After sex, the condom is removed by twisting the outer ring to keep the sperm inside and pulling it out. It should be disposed of carefully. Advantages and disadvantages The advantages of condoms include: They're very effective, Male condoms are easily available, You only need to use them when you have sex, They help to protect against some sexually transmitted infections (STIs), including HIV, Male condoms come in many different varieties, shapes and sizes Female condoms can be put in at any time before sex, The disadvantages of condoms include: Male condoms can slip off or split if used incorrectly, When using the female condom, care is needed to ensure the penis goes inside the condom and not down the side between the condom and vagina, Some people are sensitive to the chemicals in latex condoms, although this isn't common, Oil-based lubricants, such as body oils or lotions, should not be used with latex condoms as the oil can dissolve the latex within minutes causing tears and holes

17. Condoms Condom allergy Although in the past condom allergy was thought to be a poor excuse used by men when they didn't want to use a condom, it has become clear recently that the problem is real. In many cases the problem seems to be an allergy to rubber. Hypoallergenic condoms are now available made from polyurethane instead of latex. Another possibility is a sensitivity to the spermicide that lubricates the condom. If you experience any rash or irritation after intercourse, try using a condom without nonoxynol-9 or 11 spermicide to see if that helps. For many people, a lack of lubrication is the underlying cause of the irritation. The friction caused by dry skin surfaces makes sex uncomfortable. The solution is to use extra lubricant during foreplay and intercourse. This should be water-based. Oil-based lubricants react with the condom, breaking down and weakening the latex. To avoid dryness and the friction it brings, 'jel-charge' the condom. Expel the air from the tip of the condom, put lubricant inside the top and massage it over the penis as you role the condom on. This not only solves the problem of dryness but also heightens the sensation experienced during intercourse. Where can I get condoms? Condoms are available free on the NHS. Male condoms are free and easily available from contraception clinics, sexual health clinics, genitourinary medicine (GUM) clinics and some general practices. They can be bought from pharmacies, supermarkets, vending machines and via mail order. Female condoms are free from some contraception and sexual health clinics. They can be bought from some pharmacies and via mail order.

18. Contraceptive implant What is the contraceptive implant? The implant is a small, flexible tube about the size of a hairgrip. It's inserted under the skin in the inner upper arm. It slowly releases the hormone progestogen and works for three years. It's a long-acting reversible method of contraception. There has been only one implant available in the UK since December 2010, called Nexplanon which contains etonogestrel and is visible on x-ray. However many women will still have older implants which are still working, such as Implanon, but these did not show up on x-ray. How does it work? The main way the implant works is by stopping the ovaries from releasing an egg each month (ovulation). It also: Thickens the mucus in the cervix, making it difficult for sperm to reach an egg. Makes the lining of the womb thinner so it's less likely to accept a fertilised egg. How reliable is it? The contraceptive implant is more than 99 per cent effective. This means that using this method, fewer than one woman in 100 will get pregnant in a year. All long-acting reversible methods of contraception are very effective because while they're being used you don't have to remember to take or use contraception. Myths about the contraceptive implant: It will move around your body: not true. Once fitted in the arm, just under the skin, it does not move from that general area. In very rare cases it can shift a centimetre or two along. However, the implant is far too large to get into the blood stream, and cannot move outside the compartment between skin and muscle that it has been placed in. No harm comes from this small movement. The implants show up on X-ray, so if one can't be found underneath the original scar, an X-ray can locate it when it needs to be changed. It's less effective if you weigh more than 70kg. Not true - it's effective whatever weight you are. How to use the contraceptive implant The implant can be inserted up to and including the fifth day of a period. If fitted at this time it's effective straight away. If it's fitted at any other time, additional contraception has to be used for seven days. Once it's in place there's nothing to remember until it needs to be changed or you want it removed.

19. Contraceptive implant Advantages and disadvantages The advantages of using the contraceptive implant include: It's very effective It works for three years It can be used by women who cannot use estrogens or who are breastfeeding Your normal fertility returns as soon as it's removed It may give you some protection against cancer of the womb It offers some protection against pelvic inflammatory disease It may reduce heavy, painful periods The disadvantages of using the contraceptive implant include: Your periods may become irregular, longer or stop Acne may occur Some women report mood changes and breast tenderness It requires a small procedure to fit and remove it Other things you may want to consider: Once you've had the implant fitted, you can forget about it You don't need a cervical screening test or an internal examination to have the implant The implant does not protect you against sexually transmitted infections Who can use the contraceptive implant? Most women who want to use an implant can have one fitted. But it may be unsuitable if you: Think you might already be pregnant Do not want your periods to change Take certain medicines - always check Have active liver disease Have breast cancer now or within the past five years Have thrombosis, heart or circulatory disease Have migraines with aura Where can I get the implant? The implant is free on the NHS from contraception clinics, sexual health clinics and general practice.

20. Contraceptive patch What is the contraceptive patch? The contraceptive patch is a small, thin, beige, sticky skin patch that contains the same hormones as the combined contraceptive pill - oestrogen and progestogen. These are similar to the hormones women produce in their ovaries. How does it work? The patch delivers a constant daily dose of hormones into the bloodstream through the skin. This stops the ovaries from releasing an egg (ovulation) each month. The patch also: Thickens the mucus in the cervix, making it difficult for sperm to reach an egg. Makes the lining of the womb thinner so it's less likely to accept a fertilised egg. How reliable is the contraceptive patch? Effectiveness depends on how carefully it's used. The patch is more than 99 per cent effective when used according to instructions. This means that, using this method, fewer than one woman in 100 will get pregnant in a year. It is less effective in women weighing 90kg (14st) and over. Myths about the contraceptive patch: It's more reliable than the pill. Not true - the effectiveness of the patch is the same as the combined contraceptive pill. It patch falls off easily. Not true - it's very sticky. How to use the contraceptive patch The patch is used for three weeks out of every four. A new patch is used each week. The patch can be started up to and including the fifth day of a period. If used at this time, it's effective straight away. If started at any other time, additional contraception has to be used for seven days. After 21 days you have a break of seven days, when you have a bleed. This withdrawal bleed is usually shorter and lighter than normal periods. You can use the patch on most areas of the body as long as the skin is clean, dry and not very hairy. You shouldn't put it on skin that is sore or where it can be rubbed by tight clothing. Don’t put it on your breasts. The patch is very sticky and should stay on in the shower, bath or sauna, during swimming and exercise. However, in some cases it may fall off. If the patch has been off for fewer than 48 hours, just reapply it as soon as possible or use a new one, then continue as normal. If it has been off for more than 48 hours, start a new patch cycle by applying a new one as soon as possible. Use additional contraception for seven days. Seek advice about emergency contraception if you had sex in the previous few days and didn't use a condom. Initially, you'll be given three months' supply of the patch. If there are no problems such as an increase in your blood pressure, you will then be given up to a year's supply You don’t need a cervical screening test or an internal examination to have the patch

21. Contraceptive patch Advantages and disadvantages Advantages of the contraceptive patch include: You only need to remember to replace the patch once a week It doesn’t interrupt sex. Unlike the combined contraceptive pill, the hormones don't need to be absorbed by the stomach, so the patch isn't affected if you vomit or have diarrhoea The patch usually makes your bleeds regular, lighter and less painful It may help with premenstrual symptoms It may reduce the risk of cancer of the ovary, womb and colon It may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease Disadvantages of the contraceptive patch include: It's visible It may cause skin irritation in a small number of women Like the combined contraceptive pill, temporary side effects may include headaches, nausea, breast tenderness and mood changes Breakthrough bleeding (unexpected bleeding while using the patch) and spotting can be common The patch can have some serious side effects, but these aren't common. They may include: Raised blood pressure A very small number of women may develop a blood clot, which can block a vein (venous thrombosis) or an artery (arterial thrombosis, heart attack or stroke) Possible increase in risk of being diagnosed with breast cancer Possible increase in risk of cervical cancer if used continuously for more than five years The patch doesn't protect you against sexually transmitted infections. Can anyone use it? The patch may not be suitable for all women. But for most women, the benefits of the patch outweigh the possible risks. It may be unsuitable for you to use the patch if you: Think you might be pregnant, Smoke and are over 35, or are over 35 and stopped smoking less than a year ago, Are very overweight Take certain medicines - always check, Have had a previous thrombosis, Have a heart abnormality, circulatory disease or high blood pressure, Have very severe migraines or migraines with aura, Have breast cancer now or within the past five years, Have active liver or gall bladder disease, Have diabetes with complications, or have had diabetes for more than 20 years Where can I get the contraceptive patch? The patch is free on the NHS from contraception clinics, sexual health clinics or general practice

22. Contraceptive injection What is it? The contraceptive injection contains the hormone progestogen. There are two types of injection: Depo-Provera provides contraception for three months (12 weeks), Noristerat provides contraception for two months (eight weeks) Depo-Provera is the most used injectable method in the UK. Injectable contraception is a long-acting method of contraception. How does it work? The main way it works is by stopping the ovaries releasing an egg (ovulation) each month. It also: Thickens the mucus in the cervix, making it difficult for sperm to reach an egg Makes the lining of the womb thinner so it's less likely to accept a fertilised egg Myths about the contraceptive injection: It makes you infertile. Not true - but normal fertility can take up to a year to return after using Depo-Provera You can only use it for two years. Not true - it can be used for longer providing you do not have any risk factors for osteoporosis (being over 45, poor diet, low exercise or family history of osteoporosis) How reliable is it? It's more than 99 per cent effective. This means that using this method, fewer than one woman in 100 will get pregnant in a year. All long-acting reversible methods are very effective because while they're being used you don't have to remember to take or use contraception. How to use the contraceptive injection The hormone is injected into a muscle, usually in your bottom. Depo-Provera can also sometimes be given in the leg or arm. The injection can be started up to and including the fifth day of your period. If started at any other time, additional contraception has to be used for seven days. Advantages and disadvantages The advantages of the contraceptive injection include: It's very effective You can use it if you can't use oestrogens or are breastfeeding It may reduce heavy painful periods and help with premenstrual symptoms for some women It may give you some protection against cancer of the womb It may give you some protection against pelvic inflammatory disease It isn't affected by other medicines

23. Contraceptive injection The disadvantages include: Your periods may change in a way that is not acceptable to you, or they may stop Irregular bleeding may continue for some months after you stop the injection You may put on weight when you use Depo-Provera Some women report having headaches, acne, mood changes and breast tenderness The injection lasts for eight or 12 weeks, so if you have side effects they will continue during this time and for some time afterwards Your periods and normal fertility may take some time to return - more than a year for some women The evidence about the risk of breast cancer in women using hormonal contraception is contradictory, but research suggests that women who use hormonal contraception may have a slightly increased risk of being diagnosed compared to women who don’t use it Other things you may want to consider include: Once you've had the injection you don't need to think about it until it needs replacing You don't need a cervical screening test or internal examination to have the injection It doesn't protect you against sexually transmitted infections Depo-Provera affects your normal oestrogen level, which may cause thinning of the bones, but once you stop, any risk is reversed - women aged under 18 and over 45 will be carefully counselled about this Can anyone use it? Most women can have the contraception injection, but it may be unsuitable if you: Think you might already be pregnant Want a baby within the next year Don't want your periods to change Have thrombosis, heart or circulatory disease Have active liver disease Have breast cancer now or within the past five years Have migraines with aura Have diabetes with complications or have had diabetes for more than 20 years Have risk factors for osteoporosis Where can I get it? Injectable contraception is free on the NHS from contraception clinics, sexual health clinics and general practice.

24. Diaphragms and caps What are they? Diaphragms and caps are barrier methods of contraception, which means they prevent the sperm meeting an egg. They fit inside the vagina and cover the cervix (entrance to the womb). They're made of latex (rubber) or polyurethane (plastic). They come in different shapes and sizes. Vaginal diaphragms are circular domes with flexible rims. Caps are smaller than diaphragms. To be effective they need to be used with spermicide - a special cream or pessary that kills sperm. Myths about diaphragms and caps: Only women who've had children can use this method. Not true - diaphragms and caps come in different sizes and types to suit all women. You can use them without spermicide. Not true - to be effective they need to be used with a spermicide. How reliable are they? Their effectiveness depends on how carefully they're used. They are 92-96 per cent effective when used according to instructions. This means that using either method, between four and eight women in 100 will get pregnant in a year. The silicone cap - Femcap - has a higher failure rate. How do I use a diaphragm or cap? Firstly you need to see your doctor or family planning nurse to be examined, assessed for size and shown how to use one. Diaphragms and caps need to be used each time you have sex. Spermicide is applied to the diaphragm or cap, which is then inserted into the vagina to cover the cervix. They can be inserted any time before sex, but if it's more than three hours before sex you must use more spermicide. The cap or diaphragm needs to be left in place for at least six hours after the last time you had sex. It can be left in longer if necessary.

25. Diaphragms and caps Advantages and disadvantages The advantages of diaphragms and caps include: You only have to use them when you have sex There are no serious health risks There's a choice of different types They can be put in at any convenient time before sex They may give some protection against cervical cancer The disadvantages include: Putting them in at the time of sex can be an interruption Some people find the spermicide messy Some diaphragm users find they get cystitis (changing to a smaller diaphragm or cap can help) Some people are sensitive to the chemicals in latex diaphragms or caps or to the spermicide Oil-based lubricants such as body oils or lotions should not be used with latex diaphragms or caps Other things to consider include: You can buy diaphragms and caps if you know your size You may need a different size if you gain or lose more than 3kg (7lb) in weight, have a baby, miscarriage or abortion Who can use a diaphragm or cap? Diaphragms and caps don't suit everyone. They may not be suitable if you: Have vaginal muscles that can't hold a diaphragm Have a cervix of an unusual shape or in an awkward position or you can't reach it Have had repeated urinary infections Have had toxic shock syndrome in the past Don't feel comfortable touching your genital area Where can I get a diaphragm or cap? They're free on the NHS from contraception clinics, sexual health clinics and from your GP (if your surgery offers contraceptive services). You can buy them from a pharmacy, if you know your size.

26. IUD The intrauterine contraceptive device, or IUD, is a small plastic or copper device that's put into the womb. There are many different types, which are effective for five to ten years, depending on type. The IUD is a long-acting reversible method of contraception. How does it work? The main way is to stop sperm reaching an egg. An IUD does this by preventing sperm from surviving in the cervix, womb or fallopian tube. It may also work by stopping a fertilised egg from implanting in the womb. An IUD does not cause an abortion. Myths about the IUD include: It causes infection and makes you infertile. Not true - having unprotected sex with someone who has an infection causes infection, but the IUD doesn't cause infection or make you infertile. Young women can't use it. Not true - most women of any age can use the IUD. How reliable is an IUD? It's about 99 per cent effective, depending on which IUD is used. This means, using this method, on average fewer than one to two women in 100 will get pregnant in a year. Newer IUDs contain more copper, which acts as a spermicide, and are the most effective. They're more than 99 per cent effective. All long-acting reversible methods of contraception are very effective because while they are being used you don't' have to remember to take or use contraception. How to use an IUD The IUD can be fitted at any time in your menstrual cycle if you're certain you're not pregnant. It will be effective immediately. Sometimes your doctor or nurse will check for any possible existing infection. This will be done before the IUD is fitted. In some circumstances, antibiotics may be given at the same time as fitting the IUD. The IUD has two soft threads at one end, which hang through the cervix into the top of the vagina. These are so you can check the IUD is in position. You should check after fitting and then about once a month.

27. IUD Advantages and disadvantages The advantages of the IUD include: It works as soon as it is put in It works for five to ten years, depending on type It doesn’t interrupt sex It can be used if you're breastfeeding Your normal fertility returns as soon as the IUD is removed It's not affected by other medicines The disadvantages include: Your periods may be longer, heavier or more painful - this may improve after a few months You'll need an internal examination to check if it's suitable, and when it is fitted There is a very small chance of infection in the first 20 days after the IUD is put in The IUD may come out (expulsion) or it may move (displacement) - this is more likely to happen shortly after it has been put in The IUD may go through (perforate) the cervix or womb when it's put in, but the risk is low when it's put in by an experienced doctor or nurse If you do become pregnant, there is a small increased risk of you having an ectopic pregnancy (a pregnancy occurring outside the womb, normally in the fallopian tube). This risk is less than in women using no contraception Other things you may want to consider include: Young women or women who've never been pregnant can use the IUD Once it has been fitted, you can forget about it until it needs replacing Women with HIV can use an IUD It doesn't protect you against STIs. Can anyone use an IUD? Most women can do so, but it may be unsuitable if you: Think you might already be pregnant Have an untreated sexually transmitted infection (STI) or pelvic infection If you and your partner are at risk of getting an STI Have problems with your cervix or womb Have unexplained bleeding from your vagina (for example, between periods or after sex) Where can I get an IUD? IUDs are free on the NHS from contraception clinics, sexual health clinics or general practice.

28. IUS What is the IUS? The intrauterine system, or IUS, is a small T-shaped plastic device that slowly releases the hormone progestogen. It's effective for five years. The IUS is a long-acting reversible method of contraception. There's only one IUS available in the UK, called Mirena. How does the IUS work? By making the lining of the womb thinner, so it's less likely to accept a fertilised egg. By thickening the mucus in the cervix, making it more difficult for sperm to reach an egg. In some women it stops the ovaries releasing an egg (ovulation); most women who use an IUS will ovulate. How reliable is the IUS? The IUS is more than 99 per cent effective. This means using this method, on average fewer than one woman in 100 will get pregnant in a year. All long-acting reversible methods of contraception are very effective because while they're being used you don't have to remember to take or use contraception. Myths about the IUS: The IUS is the same as the IUD. Not true - the IUD is a plastic and copper device, while the IUS releases the hormone progestogen. It causes infection or infertility. Not true - the IUS doesn't cause infection or infertility. How to use the IUS The IUS can be fitted up to and including the fifth day of your period. It will be effective immediately. If it's fitted after this time you'll need to use additional contraception for the first seven days. Sometimes your doctor or nurse will check for any possible existing infection. This will be done before the IUS is fitted. In some circumstances, antibiotics may be given at the same time as fitting the IUS. The IUS has two soft threads at one end, which hang through the cervix into the top of the vagina. These are so you can check the IUS is in position. You should check these after fitting and then about once a month. Advantage and disadvantages The advantages of the IUS include: It works for five years. Your periods usually become much lighter, shorter and less painful, and they may stop completely after the first year of use, so the IUS is helpful if you have heavy, painful periods. It can be used if you're breastfeeding. Your normal fertility returns as soon as the IUS is removed. It can be used by women who cannot use estrogens. It's not affected by other medicines.

29. IUS The disadvantages include: Your periods may change in a way that's not acceptable to you. Some women get acne. Some women report mood changes, headaches or breast tenderness. Some women develop small fluid-filled cysts on their ovaries - these aren't dangerous and don't usually need treatment. There's a very small chance of infection in the first 20 days after the IUS has been put in. The IUS may come out (explusion) or it may move (displacement), but this is most likely to happen shortly after it has been put in. The IUS may go through the cervix or womb (perforate) when it is put in, but the risk of this is low when it's put in by an experienced doctor or nurse. If you do become pregnant, there's a small increased risk of you having an ectopic pregnancy (a pregnancy occurring outside the womb, normally in the fallopian tube), but this risk is less than in women using no contraception. Other things to consider include: Young women or women who've not been pregnant can use the IUS. Once it has been fitted, you can forget about it until it needs replacing. The IUS is very good for women with heavy, painful periods and can also be used as the progestogen part of HRT for women going through the menopause. The IUS does not protect you against sexually transmitted infections. Can anyone use it? Most women can, but it may be unsuitable if you: Think you might already be pregnant Have cancer of the womb or ovary. Have breast cancer now or within the past five years. Have any other problem with your womb or cervix. Have an untreated sexually transmitted infection or pelvic infection. Have migraines with aura. Have active liver disease. Currently have thrombosis, heart or circulatory disease. Have unexplained bleeding from your vagina (for example, between periods or after sex). Where can I get an IUS? They're free on the NHS from contraception clinics, sexual health clinics or your GP.

30. Natural family planning What is natural family planning? Natural family planning, or NFP, involves being able to identify the signs and symptoms (fertility indicators) of fertility during the menstrual cycle, so you can plan or avoid pregnancy. How reliable is it? Its effectiveness depends on how carefully it's used. If used according to teaching and instructions it is over 98 per cent effective. This means that using this method as contraception, fewer than two women in 100 will become pregnant in a year. It's most effective when taught by a specialist NFP teacher and when more than one fertility indicator is used. There are also a number of different fertility devices that work by monitoring changes in temperature, urine or saliva. In the UK, the main product is called Persona. This is about 94 per cent effective. This means, using this method, at least six women in 100 will become pregnant in a year. Myths about natural family planning include: It isn't effective. Not true - NFP is highly effective when used correctly. It's difficult to use. Not true - NFP is easy to use once you have been taught correctly and have good support. How do you use natural family planning? NFP works by observing and recording your body’s different natural signs or fertility indicators on each day of your menstrual cycle. The main fertility indicators are: Recording your body temperature - your body temperature changes through the menstrual cycle under the influence of oestrogen and progesterone. It rises slightly after ovulation. Charting these changes each day will show when ovulation has occurred. Monitoring cervical secretions (cervical mucus) - the amount of oestrogen and progesterone varies during the menstrual cycle, which alters the quantity, texture and appearance of cervical mucus, seen as vaginal secretions. Charting these changes can help you identify the start and end of your fertile time. Calculating how long your menstrual cycle lasts - charting how short or long your menstrual cycles are over six months can give you an idea of your cycle length. Combining these different fertility indicators acts as a double-check and increases the effectiveness of NFP.

31. Natural family planning Advantages and disadvantages of natural family planning The advantages of natural family planning include: It makes you more aware of your fertility and helps you plan or prevent pregnancy. It doesn't involve any hormones or devices. There are no physical side-effects. It's acceptable to all faiths and cultures. It can help recognise normal and abnormal vaginal secretions. The disadvantages include: It takes time to learn to use the method. You have to keep daily records. Some events such as travel, illness, lifestyle or stress can make fertility indicators harder to interpret. Natural family planning does not protect you against sexually transmitted infections. Can anyone use natural family planning? Most women can as long as they receive good instruction and support. It can be used at all stages of your reproductive life, whatever age you are. It may take longer to recognise your fertility indicators and to start to use NFP if you have irregular menstrual cycles, or at certain times - for example, after stopping hormonal contraception, after having a baby or when approaching the menopause. Advice and support You can ask about NFP at your contraception clinic, sexual health clinic or GP surgery.

32. Sterilisation What is sterilisation? Sterilisation is a permanent method of contraception, suitable for women or men who are sure they never want children or don't want more children. Male sterilisation is called vasectomy. How does it work? Sterilisation works by stopping the egg and the sperm meeting. This is done by blocking the fallopian tubes (which carry the egg from the ovary to the womb) in women or the vas deferens (the tube that carries sperm from the testicles to the penis) in men. Myths about sterilisation: It can easily be reversed. Not true - vasectomy and female sterilisation are difficult to reverse, involving major surgery that isn't available on the NHS. Vasectomy is like castration. Not true - vasectomy only involves cutting the tubes that carry sperm to the penis, nothing else is touched. Male sterilisation Usually under local anaesthetic, a small cut is made in the skin of the scrotum. The vas deferens are cut and tied or sealed with heat. The operation takes about 15 minutes and can be carried out in a clinic, hospital outpatient department or some general practice settings. Vasectomy is very effective - about one in 2,000 male sterilisations fails. Female sterilisation Under local or a light general anaesthetic, a small cut is made in the lower abdomen. The fallopian tubes are cut and tied, or sealed or blocked, usually with clips. Around one in 200 females sterilisations fails. The clip method is more effective. Women considering sterilisation should always be given information about long-acting reversible contraception as these methods are as effective, or more effective, than female sterilisation. When can I stop using other contraception? Women should use contraception up to the operation and for four weeks afterwards. Men will need to use contraception after vasectomy until a semen test shows there are no sperm. This test is usually done around eight weeks after vasectomy.

33. Sterilisation Advantages and disadvantages The advantages of sterilisation include: After sterilisation has worked you don’t need to think about contraception ever again. There are no known serious long-term health risks. The disadvantages of sterilisation include: The tubes may rejoin and you will be fertile again - although this isn't common. It cannot be easily reversed. It takes at least two months for vasectomy to be effective. Other things to consider include: Sterilisation doesn't protect you against sexually transmitted infections. After sterilisation your sex drive and enjoyment of sex should not be affected. Can anyone be sterilised? Sterilisation is only for women and men who are sure they don't want children or any more children. It is a permanent method. Although sterilisation isn’t 100 per cent reliable, and also a reversal can be attempted (although not on the NHS), it should be considered permanent and irreversible for anyone undergoing it. You shouldn't consider sterilisation if you're unsure, under any stress (for example after birth, miscarriage or abortion) or have any family or relationship crisis. Research shows that more women and men regret sterilisation if they were sterilised when they were under 30, had no children or were not in a relationship. Where can I be sterilised? Sterilisation is free on the NHS from contraception clinics, sexual health clinics or general practice.

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39. Sexually Transmitted Infections (STI) The person you think you love, the person who you are prepared to give yourself to sexually in what you think will be a lasting relationship, may not be thinking like you. They may have had sex with someone else (or several others) before they hitch up with you. A Radio 1 online poll of 16-24 year olds in 2010 revealed the following: • 75% had had more than one sexual partner • Almost 1 in 5 young people (18%) had had more than 10 sexual partners • More than half (57%) of young people had had one night stands A sexually transmitted infection (STI) is an infectious disease which is passed from one person to another through intimate sexual contact. The more sexual partners a person has, the greater the risk of contracting a STI. With the figures about sexual activity among young people from the Radio 1 poll above it’s easy to see how sexually transmitted disease figures have rocketed. There are over 25 different types of sexually transmitted infections. You can catch a sexually transmitted disease without going “all the way”. Any intimate sexual contact puts you at risk. The Health Protection Agency estimate that more than one in ten teenagers has a STI. You will probably not be able to tell if someone has a sexually transmitted disease just by looking at them and they may not tell you. It’s also the case that a lot of people with STI's do not show symptoms and don’t know that they are infected. Some STI’s are ticking time bombs. You may not know you are infected, but left untreated some STIs can have long term complications such as infertility and cancer.

40. Chlamydia What is chlamydia? Chlamydia is one of the most common sexually transmitted infections (STIs). It's a bacterial infection, which is found in semen and vaginal fluids. Causes of chlamydia Chlamydia is usually passed from one person to another during vaginal, oral or anal sex, or by sharing sex toys. It can live inside cells of the cervix, urethra, rectum and sometimes in the throat and eyes. Chlamydia can also be passed from a pregnant woman to her baby. Symptoms of chlamydia Chlamydia is often referred to as the 'silent infection', as most men and women don't have any obvious signs or symptoms, or they're so mild they go unnoticed. Symptoms can appear one to three weeks after you've come into contact with chlamydia, or many months later, or not until the infection spreads to other parts of your body. Women may notice: unusual vaginal discharge bleeding between periods or during or after sex pain with sex or when passing urine lower abdominal pain Men may notice: white/cloudy, watery discharge from the tip of the penis pain when passing urine or painful testicles If the infection is in the eye or rectum, you may experience discomfort, pain or discharge. Chlamydia in the throat is uncommon and usually has no symptoms.

41. Chlamydia Chlamydia testing If you think you might have chlamydia, it's important to be tested quickly. Testing is free on the NHS from genitourinary medicine (GUM) clinics, sexual health clinics, many contraception clinics, your GP and pharmacies. In some areas, testing kits may also be available by post. The National Chlamydia Screening Programme in England is being extended to ensure all sexually active women and men under 25 can access chlamydia testing - this includes testing in other settings such as youth clubs and colleges. You can also buy home chlamydia testing kits, but the accuracy of these tests varies so it's important to get good advice from a pharmacist. Women having intrauterine contraception (IUD or IUS) fitted, or having an abortion, will be offered a chlamydia test. The test is simple and painless. Either a urine test is done or a swab (like a cotton bud) is used to take a sample of cells from the vagina or urethra. If you've had anal or oral sex, a swab will be taken from the rectum or throat. Your eyes will be tested if you have symptoms of conjunctivitis (discharge from the eye). Treatments for chlamydia Chlamydia is easy to treat with antibiotics, either as a single dose or longer course for up to two weeks. Tell your doctor or nurse if you're pregnant, or think you might be, or you're breastfeeding - this might affect the type of antibiotic you're given. The antibiotics used to treat chlamydia interact with the combined oral contraceptive pill and the contraceptive patch, making them less effective, so check this with the doctor or nurse. To avoid reinfection, any sexual partners should be treated too. Every time you have a new sexual partner you need to be tested. If complications occur, another treatment might be needed. Without treatment, the infection can spread to other parts of the body causing damage and long-term health problems, including infertility. In women, chlamydia can cause pelvic inflammatory disease. This can lead to: ectopic pregnancy (when a pregnancy develops outside the womb, usually in the fallopian tube) blocked fallopian tubes (the tubes that carry the egg from ovary to womb) long-term pelvic pain In men, chlamydia can lead to painful infection in the testicles and possibly reduced fertility. Rarely, chlamydia can lead to inflammation of the joints in both men and women. This is known as reactive arthritis. When this involves the urethra and the eyes, it is known as Reiter's syndrome.

42. Genital Herpes What is genital herpes? There are two types of genital herpes virus, HSV I and HSV II - both can infect the genital and anal area (genital herpes), the mouth and nose (cold sores), fingers and hand (whitlows). Causes of genital herpes The virus enters the body through small cracks in the skin or through the moist soft lining (mucous membranes) of the mouth, vagina, rectum and urethra. It may cause an outbreak of genital herpes or become dormant (inactive) and hide around the nerves in the body where you were infected. It can be dormant for long periods, and during this time it's not infectious. Some people can shed the virus from their skin or mucous membranes without any symptoms of genital herpes. This is called asymptomatic or viral shedding. It's possible to pass the virus during this time, but for most people the risk is low. Symptoms of genital herpes Many people don't have any visible signs or symptoms, or are unaware of them. Symptoms can occur within four to five days of coming into contact with the virus, but it can be weeks, months or even years before they appear. This means that when symptoms occur, it doesn’t necessarily mean you've recently come into contact with the virus. If you get symptoms, they usually follow a pattern. You may have some or all of the following: Feeling generally unwell, with flu-like symptoms such as fever, tiredness, headache, swollen glands, aches and pains in the lower back, down the legs or in the groin. Stinging, tingling or itching in the genital or anal area. Small, fluid-filled blisters anywhere in the genital or anal area, on the buttocks and tops of the thighs; these burst within a day or two leaving small red sores, which can be very painful. Pain when urinating (caused by urine touching the sores). The first episode of genital herpes is often the most painful. Recurrent episodes are usually milder and clear up quickly.

43. Genital Herpes Testing for genital herpes If you think you have herpes, get tested as soon as you have any symptoms. Tests are free on the NHS from genitourinary medicine (GUM) clinics, sexual health clinics or from your GP. Blood tests can be used to detect a herpes infection when someone doesn’t have symptoms, but are only used in certain cases. A test involves a general examination of the genital area to look at any blisters or sores. To confirm you have herpes, a swab (like a cotton bud) is used to take a sample of fluid and cells from the blister. They may have to gently break a blister to get a sample of the fluid inside. This is then sent to the laboratory to check for the virus. When someone doesn’t have symptoms (such as blisters or sores) a blood test may be used to look for antibodies to the virus. However there are a number of problems with these tests, and they may give false positive or false negative results, so they are not routinely used everywhere in the NHS to diagnose genital herpes. They may be offered in some centres, or to certain patients, and may become more widely used as they improve. Treatments for genital herpes Treatment is usually recommended for a first episode, aiming to relieve pain and prevent the virus from spreading. It involves taking antiviral tablets daily for five days and should be taken within five days of the first episode. If you're pregnant or trying to get pregnant, tell the doctor or nurse so they can talk to you about pregnancy and herpes. Over-the-counter treatments for cold sores from a pharmacy will not treat genital herpes. Self-help treatments can relieve pain or discomfort and may speed up healing. They include: applying an ice pack to the sores for an hour or so (but don’t put unwrapped ice directly on your skin) putting cold, wet tea bags on the sores, having cool showers, applying local anaesthetic ointment, such as lidocaine, bathing in warm, salted water, drinking lots of fluids, especially water or soft drinks wearing loose clothing ,It isn't essential to have treatment as flare-ups will clear by themselves, but treatment can help speed up the healing process.

44. Pubic lice What are pubic lice? Pubic lice are tiny parasitic insects that live in: pubic hair, underarm hair, hair on the body and eyebrows and eyelashes (although this is rare) They are yellowy-grey and about 2mm long. They have a crab-like appearance, so are often known as crabs. The eggs are called nits and appear as brownish dots fixed to coarse body hair. Pubic lice don't live on the hair on your head and are different from head lice. How pubic lice are transmitted Pubic lice are easily passed from one person to another through close body contact or sexual contact. Both men and women can catch them and pass them on. Pubic lice can live for up to 24 hours off the body, but because they depend on human blood for survival, they'll rarely leave the body unless there's close body contact with another person. They move by crawling from hair to hair - they can't jump or fly. Pubic lice can be spread by sharing clothing, bedding or towels. Symptoms of pubic lice Some people have no symptoms, or may not notice the lice or eggs, so you may not know whether you or a partner are affected. It can take several weeks after coming into contact with them for any symptoms appear. You may notice: itching in the affected areas black powdery droppings from the lice in underwear brown eggs on pubic or other body hair irritation and inflammation in the affected area, sometimes caused by scratching sky-blue dots (which disappear within a few days) or very tiny specks of blood on the skin Sometimes you may notice the lice move, but they're tiny and keep still in the light.

45. Pubic lice Treatments for pubic lice The lice won't go away without treatment, so get checked if you think you've been in contact. In most cases you can tell if you have them by looking closely. Testing is free on the NHS - you can go to your GP, a genitourinary medicine (GUM) clinic, sexual health clinic, or ask a pharmacist. Treatment is simple and involves using a special cream, lotion or shampoo, which can be bought from a pharmacy. Your doctor, nurse or pharmacist will advise. Lotions tend to be more effective than shampoos, and sometimes the treatment has to be repeated after three to seven days. All bedding, clothing and towels need to be machine washed on a hot cycle. Tell the doctor, nurse or pharmacist if you might be pregnant, are pregnant or are breastfeeding, as this will affect the type of treatment you're given. Everyone in your household should be treated at the same time, as well as any sexual partners.

46. Genital warts What are genital warts? Genital warts are the most common sexually transmitted virus infection. They are caused by a virus known as the human papilloma virus (HPV). There are more than 100 different types of HPV, some of which cause visible and invisible warts on the hands, feet or elsewhere in the body. About 30-40 of these virus strains can cause problems in the genital area but the vast majority of genital warts are caused by just two types, HPV-6 and HPV-11. A few types of HPV are also linked to cancers of the ano-genital area including cancer of the cervix, penis and anus. Although the HPV types which cause warts (6 & 11) aren't usually the types which cause cancer (known as "high-risk" HP - mostly HPV-16 and HPV-18) there is some overlap. All girls in the UK are offered vaccination against HPV at the age of 12-13, to prevent cervical cancer. The vaccine now in use (Gardasil) protects against all 4 main strains (6, 11, 16 & 18) so will also give some protection against genital warts. However the vaccine initially used from 2008 until 2012 (Cervarix) only protected against HPV-16 & HPV-18, so these women are not protected against genital warts. Because Gardasil offers protection against the HPV strains which cause warts, there is a good reason to offer boys the vaccination too. However this is not currently available on the NHS. Causes and risk factors Genital warts can be passed from one person to another during sex and by skin-to-skin contact with someone who has the wart virus. The virus can remain in the body and be passed on before warts become noticeable, or after they have disappeared. Warts can be external or internal. In women, warts can be found on or in the vagina, vulva (the lips around the opening to the vagina), cervix and anus. In men, warts can be found on or around the penis, scrotum and urethra, and on or inside the anus. The virus can spread if you have sex. Sometimes the virus can be passed on just by close intimate contact. It's possible, but unusual, to develop warts in the mouth or on the lips from oral sex. In rare cases, it is possible for a pregnant woman to pass the virus to her baby at birth. You can't get genital warts from hugging, sharing baths or towels, from swimming pools, toilet seats, cups or cutlery.

47. Genital warts Symptoms of genital warts Most people infected will not have any visible signs or symptoms at all. It can take from two weeks to several months after coming into contact with the virus before warts appear. You might notice small, fleshy growths, bumps or skin changes which may appear anywhere in the genital or anal area, either externally on the skin or internally. You or your partner might see or feel them. They can be smooth, flat, large or small and appear singly or in groups. They’re usually painless, but sometimes may itch and cause inflammation which can bleed. Treatment and recovery If you think you could have the virus, go for a check-up. Testing is free on the NHS from genitourinary medicine (GUM) clinics, sexual health clinics or general practices. You can be checked any time after you think you may have been in contact with the virus. If there are no visible warts, you may be asked to come back at a later time. If warts are suspected, you will have an examination of the whole genital area, including the anus. The nurse or doctor might use a solution of weak vinegar over the area as this can help detect warts. Women with abnormal cells found during a cervical screening test will be tested for HPV too and if the high-risk strains linked to cancer are found, they will be offered more intensive follow-up. There are a range of treatments for visible warts depending on where and how many warts there are, including: Special cream or liquid put onto the warts. This can be done at the clinic or at home. Do not use wart preparations that you can buy from the pharmacy, these will not work on genital warts. Heat treatment to burn them off, freezing them or using a laser. Surgery to remove them. Injecting a drug directly into the wart - this is less common. The treatments can be uncomfortable but should not be painful. If you are pregnant, or trying to get pregnant, tell the doctor so they can choose a treatment that won’t be harmful to the developing baby. Although the treatment is simple it may have to be repeated several times as warts can be stubborn. As the virus cannot be removed completely from the body, warts may recur. If left untreated, warts may disappear, stay the same or grow larger in size or number. They remain infectious. Prevention is increasingly important especially as a vaccine against HPV is now in use, although the vaccine is only routinely given to girls on the NHS to prevent cervical cancer (prevention of genital warts is an additional bonus). New vaccines, which cover a broader range of HPV strains, are under development and may one day be offered to boys too. Meanwhile practising safe sex will help to protect you from all types of STI, including genital warts.

48. Gonorrhea Causes of gonorrhoea Gonorrhoea is a sexually transmitted infection. It's caused by a bacteria found mainly in semen and vaginal fluids. It’s usually passed from one person to another sex. It can live inside the cells of the: Cervix Urethra Rectum Throat Eyes (although this is rare) Gonorrhoea can also be passed from a pregnant woman to her baby. Symptoms of gonorrhoea About 50 per cent of women and 10 per cent of men who are infected will not have any obvious signs or symptoms. Symptoms can appear any time from one to 14 days after coming into contact with gonorrhoea, or many months later, or not until the infection spreads to other parts of you body. Women may notice: Unusual vaginal discharge - this may be thin, watery, yellow or green Pain when urinating Lower abdominal pain or tenderness Bleeding between periods Men may notice: Unusual discharge from the tip of the penis - this may be white, yellow or green, and there may be inflammation of the foreskin Pain when urinating Painful or tender testicles If the infection is in the rectum or eye, you may experience discomfort, pain or discharge. Gonorrhoea in the throat usually has no symptoms.

49. Gonorrhea Testing for gonorrhoea It's important to be tested quickly if you think you might have gonorrhoea. Testing's free on the NHS from genitourinary medicine (GUM) clinics, sexual health clinics, some contraception clinics and your GP. The test for gonorrhoea is simple and painless. Either a urine test is done or a swab (like a cotton bud) is used to take a sample of cells from the vagina or urethra. If you've had sex, a swab will be taken from your rectum or throat. Your eyes will be tested if you have conjunctivitis (discharge from the eye). Treatments for gonorrhoea Gonorrhoea is easy to treat with a single dose of antibiotics, either by tablets or injection. The antibiotics used to treat gonorrhoea interact with the combined oral contraceptive pill and the contraceptive patch making them less effective, so check this with your doctor or nurse. To avoid reinfection, any sexual partners should be treated too. If complications occur, another treatment might be needed. Without treatment, the infection can spread to other parts of the body causing damage and long-term health problems, including infertility. In women, gonorrhoea can spread to the reproductive organs causing pelvic inflammatory disease. This can lead to: Long-term pelvic pain Ectopic pregnancy (when a pregnancy develops outside the womb, usually in the fallopian tube) Blocked fallopian tubes (the tubes that carry the egg from ovary to womb) In men, gonorrhoea can lead to painful infection in the testicles and the prostate gland. It may reduce fertility. Less commonly, gonorrhoea can cause inflammation of the joints and tendons. Rarely, it can cause inflammation of the brain, spinal cord and heart.

50. Syphilis Causes of syphilis Syphilis is a sexually transmitted infection caused by a bacteria known as Treponema pallidum. Syphilis is usually passed from one person to another during vaginal, oral or anal sex. It can be passed on by direct skin contact with someone who has syphilis sores or a syphilis rash, and by sharing sex toys. Syphilis can also be transmitted by blood transfusion. All blood donors in the UK are screened to detect this before blood is used. Syphilis can be passed from a pregnant woman to her unborn baby - this is known as congenital syphilis. All pregnant women are tested for the condition. Symptoms of syphilis The signs and symptoms are the same in women and men, but they can be difficult to recognise and you might not notice them. Syphilis can develop in three stages, known as primary, secondary and tertiary syphilis. If you do get symptoms, you may notice the following: Primary syphilis: One or more sores (chancres) - usually painless, they appear where the bacteria entered the body, two to three weeks after you've come into contact with syphilis. The sores can appear anywhere on the body - in women they're found mainly in the genital area and on the cervix, in men they're found mainly in the genital area and on the penis. Less commonly, they may be found in the mouth, lips, tonsils, fingers or buttocks. The sores are very infectious and can take up to six weeks to heal. By this time, the bacteria will have spread to other parts of the body, becoming known as secondary syphilis.