3.5 Sexual Health

Learning Objectives

  1. Explain the importance of understanding your sexual values and making wise decisions regarding your sexuality.
  2. Describe guidelines for sexually active university students to protect themselves against sexually transmitted infections and unwanted pregnancy.
  3. List actions some can take to protect against sexual assault.

Sexuality is a normal, natural human drive. As an adult, your sexuality is your own business. Like other dimensions of health, however, your sexual health depends on understanding many factors involving sexuality and your own values. Your choices and behavior may have consequences. Learning about sexuality and thinking through your values will help you make responsible decisions.

Sexual Values and Decisions

It’s often difficult to talk about sexuality and sex. Not only is it a very private matter for most people, but also the words sexuality and sex are often used loosely, resulting in misunderstandings. Surveys might ask you if you have been ‘sexually active’ in the past—but survey questions rarely specify exactly what that phrase means. To some, sexual activity includes passionate kissing and fondling, while to others the phrase means sexual intercourse. Manual and oral sexual stimulation may or may not be included in an individual’s own definition of being sexually active.

We should therefore begin by defining these terms. First, sexuality is not the same as sex. Human sexuality is the capacity of humans to have erotic experiences and responses[1]. Since all people are sexual beings, everyone has a dimension of human sexuality regardless of their behavior. Someone who practices complete abstinence from sexual behavior still has the human dimension of sexuality.

Sexuality involves gender identity, or how we see ourselves in terms of maleness and femaleness, as well as sexual orientation, which refers to the gender qualities of those to whom we are attracted. The phrase sexual activity is usually used to refer to behaviors between two (or more) people involving the genitals—but the term may also refer to solo practices such as masturbation or to partner activities that are sexually stimulating but may not involve the genitals. For the purposes of this chapter, with its focus on personal health, the term sexual activity refers to any behavior that carries a risk of acquiring a sexually transmitted disease. This includes vaginal, oral, and anal intercourse. The term sexual intercourse will be used to refer to vaginal intercourse, which also carries the risk of unwanted pregnancy. We’ll avoid the most confusing term, sex, which in strict biological terms refers to reproduction but is used loosely to refer to many different behaviors.

There is a stereotype that sexual activity is prominent among university students. One survey found that most university students think that other students have had an average of three sexual partners in the past year, yet 80 percent of those answering said that they themselves had zero or one sexual partner. In other words, university students as a whole are not engaging in sexual activity nearly as much as they think they are. Another study revealed that about 20 percent of eighteen- to twenty-four-year-old university students had never been sexually active and about half had not been during the preceding month.

In sum, some university students are sexually active and some are not. Misperceptions of what others are doing may lead to unrealistic expectations or feelings. What’s important, however, is to be aware of your own values and to make responsible decisions that protect your sexual health.

Information and preparation are the focus of this section of the chapter. People who engage in sexual activity in the heat of the moment—often under the influence of alcohol—without having protection and information for making good decisions are at risk for disease, unwanted pregnancy, or abuse.

What’s “Safe Sex”?

It has been said that no sexual activity is safe because there is always some risk, even if very small, of protections failing. The phrase “safer sex” better describes actions one can take to reduce the risk of sexually transmitted infections and unwanted pregnancy.

Sexually Transmitted Infections (STIs)

About two dozen different diseases can be transmitted through sexual activity. People between the ages of 18 and 25 will have friends who have or had a sexually transmitted infection (STI), and many STIs will have no symptoms. If you are sexually active, get regular testing. The most common STIs that the U of S Student Health and Counselling has seen reported are chlamydia, genital warts, and genital herpes.

STIs range from infections that can be easily treated with medications to diseases that may have permanent health effects to HIV (human immunodeficiency virus), the cause of AIDS, a fatal disease.  Saskatchewan double the rate of HIV when compared to the rest of Canada, it cuts across race, class, and gender. Despite decades of public education campaigns and easy access to protection, STIs still affect many millions of people every year. Often a person feels no symptoms at first and does not realize he or she has the infection and thus passes it on unknowingly. Or a person may not use protection because of simple denial: “It can’t happen to me.”

Table 10.2 “Common Sexually Transmitted Infections” lists facts about common STIs for which university students are at risk. Although there are some differences, in most cases sexual transmission involves an exchange of body fluids between two people: semen, vaginal fluids, or blood (or other body fluids containing blood). Because of this similarity, the same precautions to prevent the transmission of HIV will prevent the transmission of other STIs as well.

Although many of these diseases may not cause dramatic symptoms, always see a health-care provider if you have the slightest suspicion of having acquired an STI. Not only should you receive treatment as soon as possible to prevent the risk of serious health problems, but you are also obligated to help not pass it on to others.

Table 10.2 Common Sexually Transmitted Infections[2]

Infection Incidence Transmission Symptoms Risks
HIV (Human Immunodeficiency Virus) Causing AIDS As of 2014, 75,000 Canadians living with HIV. Rates are highest in Saskatchewan. A fifth are unaware they have it. Contact with infected person’s blood, semen, or vaginal secretions during any sexual act (and needle sharing) Usually no symptoms for years or decades. Later symptoms include swollen glands, weight loss, and susceptibility to infections. Because medical treatment can only slow but not cure AIDS, the disease is currently eventually fatal.
Chlamydia Bacteria The most common bacterial STI. 200 per 100,000 women and 360 per 100,00 men in Canada (2010), a 72% increase since 2001. Vaginal, anal, or oral sex with infected person Often no symptoms. Symptoms may occur 1–3 weeks after exposure, including burning sensation when urinating and abnormal discharge from vagina or penis. In women, pelvic inflammatory disease may result, with permanent damage to reproductive tissues, possibly sterility. In men, infection may spread and cause pain, fever, and rarely sterility.
Genital HPV (Human Papilloma Virus) Causing Genital Warts HPV is not nationally reported in Canada, but rates are known to be very high. Genital contact, most often during vaginal and anal sex Most infected people have no symptoms at all and unknowingly pass on the virus. Warts may appear in weeks or months. Of the 40 types of HPV, many cause no health problems. Some types cause genital warts; others can lead to cancer. Vaccine is now recommended for girls and young women and protects against cancer-causing HPV.
Genital Herpes Virus Genital-genital or oral-genital contact Often no symptoms. First outbreak within 2 weeks of contact may cause sores and flu-like symptoms. Outbreaks occur less frequently over time. Many adults experience recurrent painful genital sores and emotional distress. Genital herpes in a pregnant woman puts the infant at risk during childbirth.
Gonorrhea Bacteria 147 cases per 100,000 population in Canada (2010). Direct contact with the penis, vagina, mouth, or anus; ejaculation does not have to occur Often no recognized symptoms. Burning sensation when urinating. Abnormal discharge from vagina or penis. Rectal infection symptoms include itching, soreness, or bleeding. If untreated, it may cause serious, permanent health problems, including pelvic inflammatory disease in women with permanent damage to reproductive tissues and possibly sterility in both men and women.
Trichomoniasis Protozoa Millions of Canadians get this infection every year, but most don’t have any symptoms. Genital contact, most often during vaginal sex Most men have no symptoms or may have slight burning after urination or mild discharge. Some women have vaginal discharge with strong odor and irritation or itching of genital area. Trichomoniasis makes an infected woman more susceptible to HIV infection if exposed to the virus. It may cause babies to be born early.  Trichomoniasis is easily treated with medication.
Syphilis Bacteria A sharp increase in syphilis since 2001, up 457% in ten years. 5.2 people per 100,000 in Canada (2010). Direct contact with a syphilis sore, which occurs mainly on the external genitals, vagina, anus, or in the rectum but can also occur on the lips and in the mouth; during vaginal, anal, or oral sex Often no recognized symptoms for years. Primary stage symptom (a small painless sore) appears in 10–90 days but heals without treatment. Secondary stage symptoms (skin rashes, fever, headache, muscle aches) may also resolve without treatment. Late-stage symptoms occur after 10–20 years, including severe internal organ damage and nervous system effects. Because the infected person may feel no symptoms, the risk of transmission is great. Syphilis is easy to treat in the early stages, but treatment in late stages cannot repair damage that has already occurred. Untreated, syphilis is often fatal.

The following are guidelines to protect yourself against STIs if you are sexually active:

  • Know that only abstinence is 100 percent safe. Protective devices can fail even when used correctly, although the risk is small. Understand the risks of not always using protection.
  • Talk with your partner in advance about your sexual histories and health. Agree that regardless of how sure you both are about not having an STI, you will use protection because you cannot be certain even if you have no symptoms.
  • Use a condom. A male condom is about 98 percent effective when used correctly, and a female condom about 95 percent effective when used correctly. With both, incorrect use increases the risk. If you are unsure how to use a condom correctly and safely, do some private online reading. Good information can be found at http://www.emedicinehealth.com/how_to_use_a_condom/article_em.htm. You can watch a video demonstration of how to use condoms correctly at http://www.plannedparenthood.org/teen-talk/watch/how-use-condom-26797.htm.
  • If you are sexually active with multiple partners, see your health-care provider twice a year for an STI screening even if you are not experiencing symptoms.
  • Use the services of the Sexual Health Centre Saskatoon or your USSU Pride Centre.

Preventing Unwanted Pregnancy

Heterosexual couples who engage in vaginal intercourse are also at risk for an unwanted pregnancy. There are lots of myths about how a woman can’t get pregnant at a certain time in her menstrual cycle or under other conditions, but in fact, there’s a risk of pregnancy after vaginal intercourse at any time. All couples should talk about protection before reaching the stage of having intercourse and take appropriate steps.

While a male condom is about 98 percent effective, that 2 percent failure rate is real! When not used correctly, condoms are only 82 percent effective[3]. In addition, a couple that has been healthy and monogamous in their relationship for a long time may be less faithful in their use of condoms if the threat of STIs seems diminished. Other methods of birth control should also be considered. With the exception of the male vasectomy, at present most other methods are used by the woman. They include intrauterine devices (IUDs), implants, injected or oral contraceptives (the “pill”), hormone patches, vaginal rings, diaphragms, cervical caps, and sponges. Each has certain advantages and disadvantages.

Birth control methods vary widely in effectiveness as well as potential side effects. This is therefore a personal decision. In addition, two methods can be used together, such as a condom along with a diaphragm or spermicide, which increases the effectiveness. (Note that a male and female condom should not be used together, however, because of the risk of either or both tearing because of friction between them). Because this is such an important issue, you should talk it over with your health-care provider, or a professional at your student health center or an agency such as the Saskatoon Sexual Health Centre.

In cases of unprotected vaginal intercourse, or if a condom tears, emergency contraception is an option for up to five days after intercourse. Sometimes called the “morning after pill” or “plan B,” emergency contraception is an oral hormone that prevents pregnancy from occurring. It is not an “abortion pill.” Planned Parenthood offices around the country can provide more information and confidential contraceptive services including emergency contraception.

Sexual Assault

Sexual assault is any form of sexual contact without voluntary consent. Examples include unwanted kissing, fondling, touching sexual body parts, and rape (Sexual Assault and Consent, University of Saskatchewan, 2017).

Although rape has no specific provision in Canada’s Criminal Code[4], rape is usually more narrowly defined as “unlawful sexual intercourse or any other sexual penetration of the vagina, anus, or mouth of another person, with or without force, by a sex organ, other body part, or foreign object, without the consent of the victim.” Both are significant problems among university students.

Sexual assault is so common in our society in part because many people believe in myths about certain kinds of male-female interaction.

Rape Culture

You’ve likely heard the term “rape culture” in the last few years, but the term came about in the 1970s in reaction to society’s propensity to victim-blaming and its normalization of sexual violence. There are various behaviours associated with the normalization of rape, including slut-shaming, public apathy, the popularity of violent pornography, suspicion about victims’ honesty, objectification, stigma, rape jokes (including jokes about prison rape), denial of rape statistics, and refusal to understand the consequences and effects of rape. Rape culture is detrimental to both men and women as it stereotypes men as being naturally violent and out-of-control, and women as being “slutty” and dishonest about what they really want.

While many universities are confronting the fact that rape culture has existed on their campuses for decades, many still have not addressed it through their policies and actions. The University of Saskatchewan is undergoing the creation of a sexual assault prevention and response strategy (2016-2017).

Myths

Common myths include “It’s not really rape if the woman was dressed provocatively” and “It’s not rape unless the woman is seriously injured.”  Both statements are not legally correct. Another myth or source of confusion is the idea that “Saying ‘no’ is just playing hard to get, not really ‘no.’” Those who really believe these myths may not think that they are committing assault, especially if their judgment is impaired by drugs or alcohol. Other perpetrators of sexual assault and rape, however, know exactly what they’re doing and in fact may plan to overcome their victim by using alcohol or a predator drug.

Many university administrators and educators have worked very hard to promote better awareness of sexual assault and to help students learn how to protect themselves. Yet universities cannot prevent things that happen at parties and behind closed doors.

Anyone can commit a sexual assault. Perpetrators of sexual assault fall into three categories:

  1. Strangers
  2. Acquaintances
  3. Dating partners

Most sexual assaults are perpetrated by acquaintances or dating partners. The fault for sexual assault will always lie with the perpetrator and never with the person assaulted. To avoid becoming a perpetrator, you must understand the concept of consent.

Consent

It’s important to know that consent for sexual activity is “fundamental to any relationship and can only be given when it is enthusiastic, voluntary, and sober” (University of Saskatchewan “Sexual Assault and Consent,” 2017).  Understand that sexual assault includes any unwanted kissing, fondling, touching, or rape, whether it’s between friends, sexual partners, or strangers; also, remember that alcohol or drugs can affect your judgement when determining whether these things are wanted. If you’ve been told that the plan is to have sex, remember that the person can change their mind at any point. Consent means that someone has said “yes.” Do not push drugs or alcohol on someone, especially without their knowledge.

If You Are a Bystander

Reducing sexual assault is not only on the shoulders of the potential aggressor and the potential victim. Look out for people, especially your friends, and intervene if you can by saying something, doing something, or reporting it.  Here are some ways to be a helpful bystander:

  • Remember that you need to keep yourself safe, too. If you feel that your own safety is going to be compromised by intervening, call the police or campus security.
  • If you see someone targeted, help them out by asking whether they want to go home or go to the restroom. This will give them a reason to leave the area.
  • Get help from someone in a position of authority, such as club security, a coach, or a staff person.
  • If you hear someone tell a sexist joke, a rape joke, or a demeaning comment, speak up.

Protecting Yourself

It’s never your fault if you are assaulted, no matter the circumstances. Here are some tips for reducing your chances of being targeted:

  • Let people (friends or family) know where you’re going and what your plans are.
  • If you are feeling unwell, have someone trustworthy stay with you.
  • Have a party buddy who watches over you, just as you watch over them.
  • Make sure you see your drinks being prepared (by a bartender or host), and keep an eye on them afterwards.
  • Have a transportation plan, and carry money for a cab or bus
  • Don’t be embarrassed about making a scene or making noise
  • If you are walking alone, try to stay on busy streets with good lighting
  • Use the Safewalk service if you’re studying on campus. A male and a female pair of students will walk you to your car or other transportation at night.
  • If you are a woman, consider signing up for a self-defense course like R.A.D.. Bring a friend if you are nervous!

Predator Drugs

In addition to alcohol, sexual predators use certain commonly available drugs to sedate women for sexual assault. They are odorless and tasteless and may be added to a punch bowl or slipped into your drink when you’re not looking. These drugs include the sedatives GHB, sometimes called “liquid ecstasy,” and Rohypnol, also called “roofies.” Both cause sedation in small doses but can have serious medical effects in larger doses. Predator drugs are typically used at parties. Do not force or pressure people into taking drugs, and do not push alcohol on them. To avoid being victimized, the following tips to protect yourself against predator drugs (sometimes called “date rape drugs”):

  • Don’t put your drink down where someone else may get to it. If your drink is out of your sight for even a moment, don’t finish it.
  • Never accept an open drink. Don’t accept a mixed drink that you did not see mixed from pure ingredients.
  • Be wary of drinking from punch bowls.
  • If you experience unexpected physical symptoms that may be the result of something you drank or ate, get to an emergency room and ask to be tested.

If You Are Assaulted

If you are sexually assaulted, always talk to someone. Call the Women Against Violence Against Women (WAVAW) toll-free crisis line at 1-604-255-6344 for a confidential conversation, or contact Student Health Services. Even if you do not report the assault to law enforcement, it’s important to talk through your feelings and seek help if needed to prevent an emotional crisis.

  1. Wikipedia. (2016). Human Sexuality. Retrieved from: https://en.wikipedia.org/wiki/Human_sexuality ↵
  2. Centers for Disease Control and Prevention. (2016). Sexually Transmitted Diseases. Retrieved from: http://www.cdc.gov/std/default.htm ↵
  3. Center for Young Women's Health. (2016). Male Condoms. Retrieved from: http://youngwomenshealth.org/2012/12/11/male-condoms/ ↵
  4. SexAssault.ca. (2016). Sexual Assault Criminal Law, Canada. Retrieved from: http://www.sexassault.ca/criminalprocess.htm ↵

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