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Chapter
5
Sexuality: Healthy Expression
Throughout Life
My own view, for what it’s worth, is
that sexuality is lovely, there cannot be
too much of it, it is self-limiting if it is
satisfactory, and satisfaction diminishes
tension and clears the mind for
attention and learning.
PAUL GOODMAN 1964
Table of Contents
Chapter 5
Reproductive Health Awareness:
A Wellness, Self-Care Approach
Sexuality: Healthy Expression Throughout Life
Chapter 5
Sexuality: Healthy Expression Throughout Life
Introducing Chapter Five..........................................................................................................5-3
Training Schedule for the Sample RHA Training..............................................................5-10
Objectives...........................................................................................................................5-11
Sample Lesson Plan for Session 5......................................................................................5-12
Important Terms.....................................................................................................................5-14
Activities and Handouts for the Sample Lesson Plan ............................................................5-16
Red Light, Green Light––Identification of Risk.................................................................5-17
The Three Circles: Personal Sexuality Standards ..............................................................5-20
Human Sexual Response Cycle..........................................................................................5-24
Homework—How Do Our Family and Friends Assess Risk? ...........................................5-30
Alternate Activities and Handouts .........................................................................................5-34
Reproductive Organ Talk ...................................................................................................5-35
Female Genital Cutting (FGC): Starting the Conversation for Change .............................5-38
Conflict in the Bedroom: Problems and Possible Causes ..................................................5-42
Sexual Truths, Myths, and Fears About Men and Male Sexual Performance....................5-51
Farm Animal Game ............................................................................................................5-57
Resources ...............................................................................................................................5-65
Related Activities in Other Chapters
Reproductive System Puzzle Pieces...................................................................................3-19
Menstrual Cycle Flash Cards..............................................................................................3-42
STI and HIV/AIDS Risk Scenarios ....................................................................................4-74
Partner Negotiation Role-Play............................................................................................6-27
Body Image, Sexuality, and the Media...............................................................................8-56
Dual Protection and Sexual Expression ...........................................................................10-20
5-2
Reproductive Health Awareness
Sexuality: Healthy Expression
Throughout Life
Key Questions
• What is normal sexual behavior?
• How can health providers support and enhance
the individual’s healthy expression of his/her
own sexuality?
• What are the different sexual boundaries seen in
providers, clients, and societies?
I
ntroducing Chapter Five
An obstetrician in a public family planning clinic in Washington, D.C. wears a surgical mask the
entire time he is in the examination room with clients because “you never know when one of
them might have something.”
All providers carry their own values with them and convey them subtly, and in the case of this
obstetrician, not so subtly to clients. Historically providers have not done a very good job with
dealing with clients’ needs for sexuality information or problem solving.
Providers can let clients know that they are open to their questions and concerns by integrating
questions regarding sexual health into the routine examination and by offering to discuss sexual
issues should the client have any questions or problems. Having a basic understanding of one’s
own sexuality is fundamental to providing sensitive and good care.
Human beings are sexual beings from the moment of birth until death. We express this in
everything we do—how we dress, how we act with other men and women, what words we
choose in speaking to others, and what jobs, toys, and roles we consider to be appropriate for
boys, girls, men, and women.
Sexuality: Healthy Expression Throughout Life
5-3
Humans are sexual beings from birth until death
Sexual Development through the Life Cycle
Many people cannot imagine that all people, including babies, children, teenagers, adults, and old
people are sexual beings. Some believe that sexual activity is reserved for those just in early and
middle adulthood, and teenagers often feel that adults are too old for intercourse or “having sex.”
However, sexuality is much more than just sexual intercourse.
Sexuality includes an individual’s attitudes, fantasies, dreams, thoughts, beliefs, perceptions,
experiences, and behaviors that could result in any type of erotic stimulation. It is part of who a
person is and involves his or her thoughts, feelings, forms of sexual expression and relationships,
as well as the biology of the sexual response system (EngenderHealth, 2002). We are sexual
beings throughout our lifetime.
Sexuality in Infants and Toddlers
Children are sexual even before birth. Males can have erections while still in the uterus, newborn
boys can have frequent erections, and infants often touch and rub their genitals because it
provides pleasure. Boys and girls can experience orgasms from masturbation, but boys do not
ejaculate until puberty. By about age 2, children know their sex. They are aware of differences
between genitals and in how boys and girls urinate.
Sexuality in Children Ages 3 to 7
Preschoolers are interested in everything about their world, including sexuality. They may
practice urinating in different positions. They are very affectionate and enjoy hugging other
children and adults. They begin to be more social and may imitate adult social and sexual
behaviors, like holding hands or kissing. Many young children “play doctor” during this stage,
looking at other children’s genitals and showing off their own. This is normal curiosity. By age 5
or 6, however, most children become more modest and private about dressing and bathing.
5-4
Reproductive Health Awareness
Children of this age are aware of marriage or “living together,” based on their family experience.
They may role-play being married or having a partner while they “play house.” They model
behavior they see in the home and “try on” various roles. Most young children talk about
marrying or living with a person they love when they get older. School-age children may play
sexual games with friends or siblings of their same sex, touching each other’s genitals or
masturbating together. Most sex play at this age occurs because of curiosity.
Young children are often affectionate and enjoy
hugging other children and adults
Sexuality in Preadolescent Children (ages 9 to 12)
Puberty, the time when the body matures, begins between the ages of 9 and 12 for most children,
though later maturation may be perfectly normal. Girls begin to grow breast buds and pubic hair
as early as age 9 or 10. Boys’ development of the penis and testicles usually begins between the
ages of 10 and 11. After puberty, pregnancy can occur. Children become more self-conscious
about their bodies at this age and often feel uncomfortable undressing in front of others, even a
parent of the same sex.
Masturbation continues and increases during these years. Preadolescent boys and girls do not
usually have much sexual experience, but they often have many questions. They have usually
heard about intercourse, petting, oral and anal sex, homosexuality, and rape and incest, and they
want to know more about these things. The idea of actually having intercourse, however, is
unpleasant or strange for most preadolescent girls and boys.
Homosexual experiences are common at this age. Boys and girls tend to play with friends of the
same sex and often explore sexually with them. Masturbating together and looking at or
caressing each other’s genitals is common among boys and girls. Such same-sex behavior is
usually unrelated to a child’s sexual orientation.
Sexuality: Healthy Expression Throughout Life
5-5
Some group dating may occur. Pre-adolescents may attend girl/boy parties, dance, and play
kissing games. By age 12 or 13, some young adolescents will pair off and begin dating or
“making out.” In some urban areas, boys experience vaginal intercourse at this age. Girls are
usually older when they begin having vaginal intercourse. However, it is not uncommon for
young teens to practice sexual behaviors other than vaginal intercourse, like petting to orgasm
and oral intercourse. The age for many of these norms is affected by the society in which they
live.
Sexuality in Adolescents (ages 13 to 19)
Once children reach puberty, their interest in genital sex increases and continues through
adolescence. There is no way to predict how a particular teenager will act sexually. As a group,
most adolescents explore relationships with one another, fall in and out of “love,” and participate
in sexual behaviors before the age of 20. In many cultures, girls are expected to marry during this
age range to prevent sexual experimentation outside of marriage. In other cultures, girls are
expected not to marry and not to have sexual relations during this age.
Adult Sexuality
Adult sexual behaviors are extremely varied. In most cases, they remain a part of an adult’s life
until death. Early adulthood is a time for both men and women to find a partner, establish their
career, and start a family if they so choose. It is a time when they must balance the needs for their
own sexual gratification with a partner’s sexual needs, along with family and work needs.
At around age 50, women experience menopause, which affects their sexuality. Their ovaries no
longer release eggs and produce estrogen. They may experience several physical changes––
vaginal walls become thinner and intercourse may be painful, there is less vaginal lubrication,
and the entrance to the vagina becomes smaller. Regular sexual activity tends to slow the rate of
these changes. On the other hand, freedom from risk of pregnancy can be very liberating and
stimulate a rise in sexual desire and pleasure.
5-6
Reproductive Health Awareness
As people age and grow older, the desire for touch and
intimacy continues
Adult men also experience some changes in their sexuality, but not at such a predictable time as
menopause. Men’s testicles slow down their testosterone production between ages 20 and 25.
Erections occur more slowly. Men also become less able to have another erection after an
orgasm. It may take up to 24 hours to sustain another erection. The amount of semen released
during ejaculation also decreases, but men are capable of producing a baby even when they are
very old––some men have become fathers in their 90s! Many older men have an enlarged
prostate gland in their later years, which may interfere with their ability to urinate.
Although adult men and women do go through some sexual changes as they age, they do not lose
their desire or their ability for sexual expression. Even among the very old (those age 80 and
older), the need for touch and intimacy remains, although the desire and ability to have sexual
intercourse may wane.
We truly are sexual beings from birth to death.
Source: The description of sexual development throughout the life cycle was adapted from Advocates for Youth,
1995, pp. 127-128
Sexuality: Healthy Expression Throughout Life
5-7
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Sexuality is clearly an integral part of
reproductive health at every age. When
sexuality is expressed in a positive and healthy
way, people can better enjoy the pleasures of
sexuality, respect the reproductive rights of
others, and communicate their thoughts and
feelings with partners to practice mutually
consensual sexual activity that fosters good
health and wellbeing for all involved. Healthy
expression of sexuality encompasses
protection from unintended pregnancy and
sexually transmitted infections, as well as
protection from unwanted sexual advances or
practices that cause pain and suffering like
female genital cutting. The healthy expression
of sexuality can also enhance an individual’s
self-esteem and personal identity.
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Sexuality and the RHA Approach
AWARENESS
AWARENESS
Body
Awareness
and Self-Care
Gender
Sexuality
Interpersonal
Communication
A person’s attitudes and beliefs about sexuality are shaped by his or her culture and personal
experiences. Providers can play an important role in helping clients and community members
receive accurate information about healthy sexual development and learn skills that protect their
sexual and reproductive health at every age.
The third pillar of the RHA approach addresses issues of sexuality and challenges providers to
become more aware of—
• Their own sexuality and the range of sexual expression experienced by clients they
serve and the broader community
• How sexual expression may affect a person’s health and well being
• Ways to talk with clients about developing positive and healthy sexuality
• Ways to help clients address sexual problems and concerns such as poor
communication with partners about sexual issues, sexual dysfunction, sexual abuse,
and other issues
As providers learn more about sexuality they can become more comfortable, respectful, and
skilled when engaging clients in important discussions about their sexual and reproductive
health.
In This Chapter
The goal of this chapter is to broaden awareness of the importance of addressing issues of
sexuality when providing reproductive health education, counseling, and services.
5-8
Reproductive Health Awareness
The sample lesson plan on sexuality includes activities on the following topics—
• The range of normal sexual expression within a community
• Personal sexuality standards
• Sexual behaviors resulting in risks to reproductive health
• Human sexual response cycle
The additional activities included at the end of this chapter explore both common and technical
terms used to talk about sexuality and address attitudes regarding the way people talk (or do not
talk) about sexuality. There are also activities that focus on sexuality issues of special interest to
men, as well as efforts to end harmful practices such as female genital cutting and sexual abuse
of women and children.
Since human sexuality is such a very broad topic, it is important to review the resource list and
seek additional references for more detailed information relevant to the educational needs of your
group.
Sexuality: Healthy Expression Throughout Life
5-9
Reproductive Health Awareness:
A Wellness, Self-Care Approach
Training Schedule for the Sample RHA Training
Schedule
Day One
Day Two
Day Three
Day Four
Review Any Homework Assignments
(Chapter 1)
Introduction
Pretest
Reproductive
Health Awareness:
An Overview
Session
1*
(Chapter 13)
Implementing the
RHA Approach
(Chapter 9)
RHA Through the
Life Cycle: Fertile
and Aging Adults
(Chapter 5)
Sexuality: Healthy
Expression
Throughout Life
5
9
13
BREAK
(Chapter 2)
Gender:
Implications for
Health
Session
(Chapter 6)
Interpersonal
Communication:
Talking with My
Partner
2
(Chapter 10)
Family Planning
and the RHA
Approach
6
(Chapter 13)
Implementing the
RHA Approach,
continued
10
14
LUNCH
(Chapter 3)
Body Awareness
and Self-Care:
Focus on Fertility
Session
(Chapter 7)
Interpersonal
Communication:
Skills for Providers
3
(Chapter 11)
Creating Change:
Achieving Healthy
Behaviors
7
(Chapter 13)
Implementing the
RHA Approach,
continued
11
15
BREAK
(Chapter 4)
Body Awareness
and Self-Care
Practices
Session
(Chapter 8)
RHA through the
Life Cycle: Birth
through
Adolescence
4
(Chapter 12)
RHA and the
Community: A
Focus on Safe
Motherhood
8
(Chapter 14)
Evaluation
Posttest
Presentation of
Certificates
12
16
Assign Any Homework
* Bold numbers refer to the number of each 90-minute session for this sample training.
5-10
Reproductive Health Awareness
Sexuality: Healthy Expression
Throughout Life
O
bjectives
By the end of this session, the participants will be able to––
• Define sexuality education
• Describe the range of normal sexual behaviors in their culture and what behaviors
bring risks of sexually transmitted infections or unplanned pregnancy
• Describe manifestations of sexuality for all age groups from newborn to elderly
• Describe the difference between what they consider as normal or proper sexual
expression for themselves and what is acceptable within society
• Describe the normal sexual response cycle
Sexuality: Healthy Expression Throughout Life
5-11
Sample
Lesson
Plan
Sexuality: Healthy Expression
Throughout Life
Sample Lesson Plan for Session 5
Time
Content
Methodology
Materials
40
minutes
Red Light, Green
Light––Identification
of Risk
Trainer gives each
participant a slip of
paper with a different
sexual behavior
written on it.
Participants group
these behaviors based
on their perception of
health risks associated
with each behavior.
They discuss how
actual risk may
depend upon the
person and the
circumstance.
Large pieces of paper,
felt pens, masking
tape
Participants work
individually to group
words that describe
sexual behaviors in
concentric circles.
The inner circle is for
personal standards,
the middle circle is
for societal standards,
and the outer circle is
for dangerous or
unsafe standards.
- Paper and pens
Identification of risk of
sexually transmitted
infections and
unintended pregnancy
20
minutes
The Three Circles:
Personal Sexuality
Standard Circles
Personal and societal
standards of sexual
expression.
5-12
Reproductive Health Awareness
Small slips of paper
with one sexual
behavior written on
each slip
Evaluation
Participants
accurately—
- Describe the
range of normal
sexual expression
in their
community
- Identify sex
behaviors that
may bring health
risks
- Handout “Personal
Sexuality
Standards”
Participants are
able to determine
and record their
own standards and
compare these with
what they consider
to be acceptable
and unacceptable in
the broader society.
Time
30
minutes
Content
Human Sexual
Response Cycle
Excitement phase
Plateau phase
Orgasm
Resolution phase
10
minutes
Homework—How Do
Our Family and
Friends Assess Risk?
Factors that may
influence perceptions
of risk
Comparing
perceptions of
community members
with perceptions held
by providers
Methodology
Materials
Handout “Sexual
Trainer reviews the
Response Cycle”
normal sexual
response cycle and
invites participants to
discuss key issues in a
question and answer
format.
Participants interview
a community member
about his or her
perception of risk of
unintended pregnancy
and sexually
transmitted infections.
Handout “Assessing
Perceptions of Risk:
What Do My Family
and Friends Really
Know?”
Evaluation
Participants
recognize the
relationship of the
normal sexual
response cycle to
the use of family
planning methods
and recall two or
three screening
questions to use to
determine if clients
are having any
sexual difficulties
Participants are
able to conduct
interviews, obtain
the point of view of
the person
interviewed, say
how it differs from
his or her own
point of view, and
how this
information could
be used to improve
reproductive health
services.
Sexuality: Healthy Expression Throughout Life
5-13
Important Terms
Abstinence
“Some people define abstinence as refraining from vaginal or anal intercourse.
Others have a more broad definition that may range from not having any
genital contact with another person to avoiding all sexual behavior all together,
including masturbation. Primary abstinence refers to someone who has not had
a sexual experience with another person. Secondary abstinence refers to a
person who is sexually experienced but chooses not to engage in sexual
activities during some time of their lives.” (Hatcher, et al. 1998, p. 297)
Female Genital
Cutting (FGC)
Also known as “female genital mutilation (FGM)” and “female circumcision.”
Foreplay
The kissing, touching, or oral-genital contact preceding intercourse.
Gender Identity
How one psychologically perceives oneself as either male or female.
Genitals
The sexual organs of males and females.
Heterosexual
A person whose primary sexual attraction is towards members of the opposite
sex.
Homosexual
A person whose primary sexual attraction is towards members of the same sex.
Incest
Sexual interaction between close relatives other than husband and wife.
Masturbation
Stimulation of one's own genitals to create sexual pleasure.
Orgasm
A series of muscular contractions of the pelvic floor muscles occurring at the
peak of sexual arousal that are usually perceived as highly pleasurable.
Petting
Physical contact including kissing, touching, and manual or oral genital
stimulation but excluding intercourse.
Puberty
The stage of life between childhood and adulthood during which the
reproductive organs mature.
Rape
Sexual intercourse (oral, vaginal, or anal) that occurs without consent, under
actual or threatened force.
Sexual Abuse
When a sexual activity is used to harm another person physically or
psychologically. Sexual abuse occurs when one person does not consent to
sexual activity. Any sexual relationship with a child (consenting or not) is
sexual abuse.
Sexuality
An individual's attitudes, fantasies, dreams, thoughts, beliefs, perceptions,
experiences, and behaviors resulting in any type of erotic stimulation.
5-14
All procedures involving partial or total removal of the external female
genitalia or other injury to the female genital organs whether for cultural or
other non-therapeutic reasons (World Health Organization, 1997).
Reproductive Health Awareness
Sexuality Education
Sexuality education is a lifelong process of acquiring information and forming
attitudes, beliefs, and values. It encompasses sexual development, reproductive
health, interpersonal relationships, affection, intimacy, body image, and gender
roles.
Sexuality education addresses the biological, sociocultural, psychological, and
spiritual dimensions of sexuality from the cognitive domain (information); the
affective domain (feelings, values, and attitudes); and the behavioral domain.
(Sexual Information and Education Council of the United States, 2001)
Transsexual
A person who appears to be of one sex who has the strong conviction that he
or she is actually a member of the opposite sex. This conviction is often
accompanied by a profound sense of loathing of one’s own primary and
secondary sexual characteristics.
Virgin
A person who has not experienced sexual intercourse.
Sexuality: Healthy Expression Throughout Life
5-15
Sexuality: Healthy Expression
Throughout Life
Activities and Handouts
for the
Sample Lesson Plan
• Red Light, Green Light––Identification of Risk
• The Three Circles: Personal Sexuality Standards
• Human Sexual Response Cycle
• Homework—How Do Our Families and Friends
Assess Risk?
5-16
Reproductive Health Awareness
A
ctivity Red Light, Green Light––Identification of
Risk
Objective
By the end of the activity, participants will be able to—
• Discuss what is considered to be the range of normal sexual behaviors
in their culture
• List behaviors that bring risk of sexually transmitted infections and
unintended pregnancy, as well as behaviors that may harm self-esteem
and self-image
Time
40 minutes
Preparation
Cut slips of paper, each with the name of a sexual behavior. See tools for
trainers “Sample List of Sexual Behaviors” for ideas or create your own list.
You will need at least one slip of paper for each participant.
Make three separate signs on three large pieces of paper. The first sign has a
large green circle on the upper half to represent little or no risk. The second
sign has a large yellow circle to represent a medium level of risk. The third
sign has a large red circle to represent very risky or harmful behaviors. Leave
enough space under the circles to write or paste the slips of paper with names
of sexual behaviors on them.
Directions
1. Hang the three papers with large circles side by side on the wall.
2. Hand out the slips of paper to the participants so that each person has one.
3. Invite participants to come forward one by one, read the sexual behavior
on their paper, and place their slip of paper on the poster they feel is most
appropriate. Tell them to place the slip of paper according to how risky
their behavior is. Give no clues regarding “risky for what.” Only tell them
that green means “little or no risk,” yellow means “somewhat at risk,” and
red means “high risk.”
4. Invite participants to comment on any sexual behaviors they feel have
been placed in the wrong category. Encourage the person who originally
placed the behavior in this category to explain or defend his or her choice.
Attempt to get group consensus and clarify risk factors.
5. As the group discusses the behaviors, help them realize that what is risky
behavior for exposure to pregnancy may be very different from risky
Sexuality: Healthy Expression Throughout Life
5-17
behavior for sexually transmitted infections. Both may be different from
risks that may damage self-esteem, self-image, or relationships.
6. Lead a discussion about how the level of “risk” depends on the individual
and the specific circumstances. Remind participants that sex acts between
two uninfected people will not spread sexually transmitted infections.
However, if one of the partners has a sexually transmitted infection (even
if there are no symptoms) the infection can spread to others. Many sexual
behaviors are not easily classified. For example, sucking the partner's
breast is unlikely to spread disease. However, a participant might suggest
that this behavior is so stimulating that intercourse is very likely.
Therefore, it might be categorized as “high risk.”
Wrap-up
Summarize what puts a person at risk for sexually transmitted infection,
pregnancy, and damage to self-esteem and self-image. Close with the
following points.
• As providers we must be aware of the broad range of sexual behaviors
available to us and the clients or community members we serve.
Healthy sexual behavior is part of our daily lives.
• Though we often view sexual behaviors in terms of risk (pregnancy,
loss of innocence, infection, responsibility before able to cope, etc.), it
is important to see how they enrich our lives on a daily basis and can
be enjoyed.
Evaluation
Through class discussion, participants can accurately describe the range of
normal sexual expression in their community and identify sexual behaviors
that may bring health risks.
Note to Trainers
Participants can become quite passionate and involved in
this activity. Some may find some of the sexual behaviors
quite distasteful and speak out using religious or moral
arguments as to why one should not engage in these. It is
important that you keep the group focused on being aware of
a broad range of practices, the diversity of individuals’ point
of view, their need as providers to be able to separate out
what is personally OK with what another may find to be OK.
The next activity will help them to make those distinctions.
5-18
Reproductive Health Awareness
Sample List of Sexual Behaviors
Tools
for
Trainers
Note: You may use these examples of sexual behaviors for the activity “Red Light, Green Light–
–Identification of Risk” or create your own list. Cut the slips of paper before the activity so you
can give each participant one slip with one behavior written on it.
Kissing
Petting
Dancing slow
Dancing fast
French kissing
Back massage
Self-masturbation
Mutual masturbation
Sitting on partner's lap
Foot massage
Breast massage
Holding hands
Wrestling
Swallowing semen
Sucking partner's breasts
Whistling
Blowing in partner's ears
Sucking or licking partner's genitals
Vaginal intercourse
Intercourse with withdrawal
Drinking from the same glass
Brushing your teeth with the same toothbrush
Anal intercourse
Wearing partner's clothing
Note: Although there is individual opinion as to what is very stimulating and leads to high-risk
behavior, behaviors like vaginal intercourse, intercourse with withdrawal, anal intercourse, and
sucking or licking partner’s genitals are clearly at high risk for sexually transmitted infection.
Vaginal intercourse also includes the risk of pregnancy.
Sexuality: Healthy Expression Throughout Life
5-19
A
ctivity The Three Circles: Personal Sexuality
Standards
Objective
By the end of the activity, participants will be able to—
• Describe the difference between what they consider as normal or
proper sexual expression for themselves and what is acceptable within
society
Time
20 minutes
Preparation
Make a copy of the handout “Personal Sexuality Standards” for each
participant.
Directions
1. Using the handout “Personal Sexuality Standards” point out the three areas
labeled Personal Standards, Societal Standards, and Dangerous or
Unsafe Standards.
2. Let participants know that this activity is for their personal learning and
will not be collected. Nor do they need to share what they have on their
papers if they choose not to.
3. Tell participants they are to use the list of sexual behaviors discussed in
the activity, “Red Light, Green Light––Identification of Risk” and also
include new behaviors.
Samples of some new behaviors to add are—
5-20
-
Rape
-
Strangling for sexual enhancement
-
Sex with children
-
Sexual abuse of another adult
-
Use of street drugs
-
Use of alcohol
-
Use of restraints
-
Use of inhalants or other aphrodisiacs
Reproductive Health Awareness
-
Selling of sex
4. Ask each participant to write each of the behaviors in one of the three
circles. If it is a behavior the person would practice, write it under
Personal Standard. If it is a behavior that the person does not or would
not practice, but is acceptable in society, write it in the middle circle
labeled Societal Standard. If the behavior is not acceptable to the person
or society, write the sexual behavior in the outermost circle labeled
Dangerous or Unsafe Standards.
5. Without pressuring participants, ask if anyone would like to share where
they placed various behaviors on their circles. Ask others to offer specific
behaviors. Lead a discussion as to how they placed certain behaviors. For
example, anything that deprives the rights of the partner belongs in the
outer circle (e.g., date rape, beating, strangulation, etc.). How behaviors
are divided between the innermost and middle circle depends on personal
preference (e.g., homosexual or heterosexual expression, type of foreplay,
expressions of love, etc.).
Reflecting on sexuality—A provider’s
perspective on acceptable sexual
standards may be different from a
client’s perspective
Sexuality: Healthy Expression Throughout Life
5-21
Wrap-up
Summarize the main points and close with the following.
• How providers and clients express their sexuality may vary quite a lot.
As long as behaviors are not harmful, providers should support
individual choices without prejudice.
• It is important that providers explore what they find to be acceptable
for society and for themselves in an effort to increase their sensitivity
to the informational and health care needs of their clients.
Evaluation
By completing the handout “Personal Sexuality Standards,” participants
determine and record their own personal standards regarding sexual
expression and compare these with what they consider to be acceptable and
unacceptable in the broader society.
Note to Trainers
This activity can trigger strong emotional reactions with
participants who are quite conservative and feel all should
share their views regarding what are acceptable forms of
sexual expression. It is important to be prepared to help
health providers understand that their role is to help
individuals think though issues of reproductive rights,
avoidance of risk, freedom of expression, etc., and not
convert the individual to the provider’s personal point of
view.
5-22
Reproductive Health Awareness
Personal Sexuality Standards
Handout
Dangerous or Unsafe
Standards
Societal Standards
Personal Standards
Sexuality: Healthy Expression Throughout Life
5-23
A
ctivity Human Sexual Response Cycle
Objective
By the end of this session, participants will be able to—
• Describe the normal sexual response cycle
• Relate the sexual response cycle to utilization of family planning
methods
• Recall two or three screening questions to use to determine if clients
are having any sexual difficulties
Time
30 minutes
Preparation
Tape large pieces of white paper onto a wall or flipchart with the human
sexual response cycle drawn on it. You may make your own posters from the
diagrams in the handout “The Human Sexual Response Cycle.” You will also
need colored markers for this activity.
Directions
1. Present basic information about the human response cycle as described in
the handout. If the group is familiar with this theoretical information, it
can be elicited from the group for review.
2. Lead a group discussion to make certain that participants understand the
content and appreciate why sharing this information is important for
providers and clients.
Some questions you may wish to raise are—
5-24
-
Why should young teens understand the sexual response cycle?
-
What are the implications for use of family planning methods if we
understand our sexual response cycle?
-
What should the elderly know about the cycle?
-
What do you think we should be telling clients about the possible
effects of smoking, drinking, hypertension, diabetes, etc., upon
their sexual response cycle?
-
Is it OK for a couple to have sexual intercourse on days when the
woman menstruates?
-
If you could tell a man just one thing about women and their sexual
response cycle, what would you tell him?
Reproductive Health Awareness
-
If you could tell a woman just one thing about men and their sexual
response cycle, what would you tell her?
-
What two or three screening questions could you integrate into
your routine histories to determine if your client is having sexual
problems?
3. You may wish to give participants the information on the sexual response
cycle as a handout for future reference. If the information on the handout is
too detailed, you may create a simpler handout from the one that is
provided with this activity.
Wrap-up
Summarize the main points about the sexual response cycle and close with the
following.
• Health providers have a tremendous opportunity to eliminate myths,
provide preventive health care advice, and enrich the sexual lives of
clients by enabling them to understand the human sexual response
cycle, and recognize common difficulties and giving anticipatory
advice.
Evaluation
Based on question and answer responses, participants recognize the
relationship of the normal sexual response cycle to the use of family planning
methods and recall two or three screening questions to use to determine if
clients are having any sexual difficulties.
Note to Trainers
The content of this activity on sexuality is vast. It is very
helpful to read up on areas where you need more
information. The reading list at the end of the chapter is an
excellent place to start. Websites from SIECUS, Planned
Parenthood, and other organizations have very helpful
information.
Sexuality: Healthy Expression Throughout Life
5-25
The Human Sexual Response Cycle
Handout
The sexual response pattern for males (figure 1) and the three patterns for females (figure 2)
include the same four phases: excitement, plateau, orgasm, and resolution.
1. Excitement phase—This is a time of sexual arousal when blood rushes to the genitals
and causes engorgement. The amount of time for this phase varies widely.
2. Plateau phase—After the rapid increase in sexual excitement during the excitement
phase, the physical changes in the body continue and level off. Some people try to
prolong this phase to make sex last longer. However, this phase is relatively short.
3. Orgasm phase—This is the climax of the sexual response cycle. It is a time of rapid
pleasurable release. Men typically experience ejaculation and women feel the muscle
contractions of orgasm. It typically lasts for a minute or less.
4. Resolution phase—This is when the body gradually returns to its normal relaxed state.
This may take from a few minutes to up to 24 hours or more.
The plateau phase is actually an advanced stage of excitement in which high tensions are
maintained for a brief time before climax. Even though this stage cannot be easily separated in an
individual’s experience, it is considered a separate phase based on seminal research by Masters
and Johnson (1966).
Orgasm
Male Sexual Response
Plateau
Excitement
Resolution
Figure 1: Male Sexual Response Cycle
5-26
Reproductive Health Awareness
The Human Sexual Response Cycle, continued
Orgasm
Female Sexual Response
Plateau
Excitement
Resolution
Figure 2: Female Sexual Response Cycle
These response patterns are true no matter which type of stimulation or sexual activity that
produces them. The basic physiology of orgasm is the same, regardless of whether it is bought
about through masturbation, coitus, or some other activity. Differences resulting from the type of
stimulation do not affect the changes noted in the body, but do affect the intensity of responses to
some extent.
In general, there is great similarity of sexual responses in the two sexes. There are, however, a
number of important differences between male and female responses that must be noted. Some
result from anatomical differences; others cannot be explained structurally and possibly reflect
variations in nervous system organization.
The first major difference is the range of variability. Note on the two figures that a single
sequence characterizes the basic male pattern; three alternatives are possible for females. (Even
this diagram does not fully convey the much richer variety of female responses.)
The second difference between the sexes involves the presence of a refractory period in the male
cycle. (A cell, tissue, or organ may not respond to a second stimulation until a certain period of
time has elapsed after the preceding stimulation. This period is known as “refractory.”) The
refractory period immediately follows orgasm and extends into the resolution phase. During this
period, regardless of the nature and intensity of sexual stimulation, the male will not respond. He
cannot achieve fuller erection or another orgasm. Only after the refractory period can he do so. In
principle, a man can then go on to have another orgasm. In practice, his ability to do so is quite
limited.
Females do not have such refractory periods. Even in a woman’s pattern closest to that of the
male, as soon as her first orgasm is over, her level of excitement can lead her immediately to
another climax. Women can have multiple orgasms in rapid succession. If they do not, the cause
lies in the specific circumstances of the occasion including the males’ inability or unwillingness
to provide the necessary sustained stimulation, lack of self-stimulation, fatigue, or other
individual factors.
Sexuality: Healthy Expression Throughout Life
5-27
The Human Sexual Response Cycle, continued
Apart from these differences, the basic response patterns in the two sexes are the same. In males
and females, excitement mounts with effective and sustained stimulation, which may be
psychogenic (erotic thoughts and feelings) or somatogenic (physical stimulation), but usually
involves both.
Orgasm
Human Sexual
Cycle Response
Plateau
Excitement
Resolution
Male
Female
Figure 3: Female and Male Sexual Response Cycle
Excitement may mount rapidly or more slowly, depending on various factors. If erotic
stimulation is sustained, the level of excitement becomes stabilized at a high point or the plateau
phase. Sometimes during this phase, a climax is reached and orgasm follows. The abrupt release
at orgasm is succeeded by a gradual dispersion of pent-up excitement during the resolution
phase.
During all phases of the sexual response cycle, there are many physiological changes that take
place––
• Penis—The penis becomes engorged and erect with various degrees of rigidity,
purplish coloration. At orgasm, semen (sperm and fluid) is ejaculated in rhythmic
spurts.
• Prostate, seminal vesicles, and vas deferens—These vessels pour their fluid into the
urethral bulb. Males are aware at this point that ejaculation is inevitable.
• Scrotal sac—The sac contracts and thickens, losing its baggy appearance.
• Testes—These pull up next to body by shortening of the spermatic cords and increase
in size up to 50 percent from vasocongestion (the process of blood filling the organ).
These return to normal size and position during the resolution phase.
• Vagina—During the excitement phase, the vagina changes in lubrication, expands the
inner end, and changes color. Moistening of the vaginal walls is the first sign of
sexual response in a woman and usually occurs within 10 to 30 seconds after erotic
stimulation. Lubrication oozes from the vaginal walls and is sometimes referred to as
5-28
Reproductive Health Awareness
a sweating mechanism. During plateau phase, the outer third of the vagina, which
dilated during the excitement phase, now becomes vasocongested and decreases in
opening size by at least a third. On the inner third of the vagina, a tenting or rising up
is noted. During orgasm, the area contracts rhythmically several times at about 0.8second intervals. During the resolution phase, the congestion leaves and color returns
to normal. With sufficient stimulation, another orgasm can follow rapidly.
• Clitoris—The clitoris becomes congested, erect, very sensitive, and often does not
permit direct stimulation without pain. It retracts behind the clitoral hood and
reappears 5 to 10 seconds after orgasm.
• Major lips (Labia majora)—The major lips become somewhat congested during
excitement and take a long period (several hours) post-coitus to return to a nonstimulated state.
• Minor lips (Labia minora)—The minor lips become markedly engorged, swelling to
two to three times the normal size. Color becomes intense red or wine colored.
• Uterus—This becomes elevated in position during stimulation phase, remains
elevated during plateau, and returns to normal position 5 to 10 minutes after orgasm.
• Breasts—Male and female breasts respond, though female breasts are more
responsive. Nipples become erect with stimulation. The breast and areola increase up
to 25 percent in size.
• Skin—The skin flushes (more common in women) over the chest, starting on the
lower chest and spreading over the whole chest wall and neck.
• Heart—The pulse of the heart rises, as well as the blood pressure.
Source: Adapted from Katchadourian, 1972
Sexuality: Healthy Expression Throughout Life
5-29
A
ctivity Homework—How Do Our Family and
Friends Assess Risk?
Objectives
By completing this homework assignment, participants will be able to—
• Assess how family and friends are able to realistically and completely
assess their own risk for unintended pregnancy and sexually
transmitted infections
Time
You will need about 10 minutes to describe the assignment. Remember to
schedule an additional 30 minutes on the day the assignment is due to discuss
the homework experience and share lessons learned.
Preparation
Make copies of the handout “Assessing Perceptions of Risk: What Do My
Family and Friends Really Know?”
Directions
1. Ask participants to reflect on the day’s activities when the risk of
unintended pregnancy and the risk of sexually transmitted infections have
been discussed at length. Note that the discussions have been from the
point of view of adult health providers. Stress that their perception of risk
is affected by their knowledge of the consequences of these problems
(infertility, abortion, chronic pelvic inflammatory disease, death, societal
disgrace, economic hardship, etc.).
2. Ask participants to select one community member (adult, adolescent, or
child) and determine his or her point of view regarding risk as it relates to
unintended pregnancy and sexually transmitted infections. Give them a
copy of the handout “Assessing Perceptions of Risk: What Do My Family
and Friends Really Know?” Ask them to use it as a guide and also add
their own questions to determine how others perceive risk. Tell
participants when they will need to report back on their findings and
lessons learned.
3. The next day, or at a later time, ask participants to report on what they
learned. During these presentations group, and record the lessons learned
on a grid like the following.
5-30
Reproductive Health Awareness
Perceptions of Risk: Lessons Learned
Adult
Adolescent
Child
Female
Male
4. Be sure to note whether the respondent was an urban or rural dweller. As
participants are reporting on the lessons they learned from community
members, encourage them to address the following points—
Wrap-up
-
How age affects our willingness to participate in risky behaviors
-
The effect of fear of responsibility
-
The dislike of abortion, rushed marriage, and family pressure
-
The power of peer pressure and attitudes
-
The importance of the kind of relationship people have with their
partners on the perception of risk
-
Differences in rural and urban environments
-
Whether health, societal approval, or economic consequences seem
most important in forming a person’s perception of risk
-
How a provider’s counseling and education of clients can improve
based on what he or she is learning about misperceptions, gaps in
knowledge, etc
Close by summarizing the differences in perception of risk noted by
community members in contrast to the perceptions of health providers. Note
that the better providers understand the perceptions of their clients, the more
focused, effective, and sensitive they can be when providing reproductive
health services.
Sexuality: Healthy Expression Throughout Life
5-31
Evaluation
Participants are able to conduct the interviews, obtain the point of view of the
person interviewed, say how it differs from his or her own point of view, and
how this information could be used to improve reproductive health services.
Note to Trainers
If you are focusing on a particular age group in your
training, you may choose, for example, to interview only
adolescents or only rural dwellers.
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Reproductive Health Awareness
Assessing Perceptions of Risk:
What Do My Family and Friends Really Know?
Handout
Directions: Approach a friend, family member, or stranger. Tell them you are participating in a
training regarding reproductive health. As part of that training, you are trying to learn the
opinions of various community members regarding risks to their health. You would like
permission to ask them questions for about 10 minutes. If permission is granted, ask the
following questions. Feel free to add some of your own questions.
Questions:
Community member profile
Age
Sex
Circle one in each category:
Marital status
Single
Married
Home
Urban
Rural
Divorced
Polygamous relationship
Cohabiting
Widow/er
1. What do you think is a bigger problem in this community, unintended pregnancy, or
sexually transmitted infections?
Why?
2. Is (insert answer from above) more of a problem in a particular age group (children,
young adults, elderly)?
Why is that?
3. Personally, are you more concerned about unintended pregnancy or sexually
transmitted infections?
Why is that?
4. What have you seen or experienced yourself that has made you feel the way you do?
Thank the person interviewed for sharing his or her feelings and knowledge with you. Assure the
person that all names will be kept confidential.
Sexuality: Healthy Expression Throughout Life
5-33
Sexuality: Healthy Expression
Throughout Life
Alternate Activities
and Handouts
• Reproductive Organs Talk
• Female Genital Cutting: Starting the Conversation
for Change
• Conflict in the Bedroom: Problems and Possible
Causes
• Sexual Truths, Myths, and Fears Held by Men
• Farm Animal Game
5-34
Reproductive Health Awareness
A
ctivity Reproductive Organ Talk
Objective
By the end of this activity, participants will be able to—
• List different names of sexual organs, including slang terms
• Begin using language that describes different aspects of sexuality with
more ease and graciousness when working with clients or community
members
Time
30 minutes
Preparation
Large pieces of white paper taped onto a wall or flipchart. Colored markers.
Directions
1. Remind participants that most people know sexual organs by slang names
even when they don't know the technical names. These slang terms may
vary with age and sex of the participants.
Ask the group to share slang terms they know for male and female external
genitals, vulva, vagina, penis, and testicles. List these names on the large
pieces of paper as the group offers them. Possible words may include—
Female External Genitalia
Male External Genitalia
Cunt
Snatch
Pussy
Equipment
Pencil and tassels
Balls and bat
Vulva
Muff
Bearded clam
Beaver
Hair-pie
Happy valley
Penis
Cock
Dick
Wang
Prick
Reamer
Vagina
Hole
Quem
Cockpit
Testicles
Balls
Jewels
Dead meat
Source: This list was adapted from Crooks, 1980, p. 38
Sexuality: Healthy Expression Throughout Life
5-35
2. Ask participants to classify the names as positive, negative, and neutral.
Ask why they have classified the terms this way. For example, the penis
may be called “prick.” Is this a demeaning term, fanciful or fun loving,
animalistic, etc?
3. Lead a short discussion with the group regarding why it is important to be
aware of our own perceptions of the many words used to describe aspects
of sexuality. Discuss why providers should know the slang terms for body
parts and how to be more comfortable when talking with clients and
community members who may only know these words. Some questions
you may wish to include are—
-
Why do you think there are so many slang terms for body parts?
-
If a client does not know the regular name for a body part, would
you use the slang equivalent?
-
If a client uses such terms to express symptoms or problems, how
should you respond?
-
If a client uses terms that are degrading, how can you indicate it is
not a proper term without damaging your relationship?
4. You may wish to play the role of a client struggling to express his or her
concern about a sexual problem while using street language and anxious
pauses. Then, invite participants to demonstrate how they would respond
to you (as a client) in a way that is respectful, nonjudgmental, and helpful.
Wrap-up
Close the activity by summarizing the main points and conclude with the
following.
• Some of the terms commonly used may be offensive or strange to
providers. It is important to learn current slang names in order to
understand the questions and concerns of clients. It is important to
invite their concerns even though clients may not have a formal or
medical vocabulary for expressing their concerns.
5-36
Reproductive Health Awareness
Evaluation
Based on the class discussion, the trainer will determine whether participants
are able to list different names of sexual organs, including slang terms, and
assess their apparent readiness to use language that describes aspects of
sexuality with more ease and graciousness when working with clients or
community members.
Note to Trainers
This activity can be used to help desensitize providers who
may be new to the profession or quite conservative in their
approach. It is particularly helpful in dealing with
professionals who are new to dealing with youth or who
never integrate sexual concerns into their provision of
reproductive health care.
If time is available, you may ask participants to form two
groups with one for male terms and one for female terms.
The two groups compete with one another to come up with
the greatest number of slang terms. The trainer then hangs
up both lists and discusses with the entire group which terms
are respectful, degrading, etc.
Sexuality: Healthy Expression Throughout Life
5-37
A
ctivity Female Genital Cutting (FGC): Starting the
Conversation for Change
Objective
By the end of this activity, participants will be able to—
• Identify and describe ways to help clients and communities break the
cycle of female genital cutting (FGC) by helping to create behavior
change
Time
45-60 minutes
Preparation
To conduct this activity you will need large pieces of white paper taped onto a
wall or flipchart and colored marking pens. Review the tool for trainers
“Female Genital Cutting: A Summary” for background information on FGC,
and the tool for trainers “Sample Responses from Small Groups: Knowledge,
Attitudes, and Actions for Ending Female Genital Cutting.” for possible small
group responses.
Directions
1. Review basic information on female genital cutting and briefly discuss the
following questions—
-
How would you describe female genital cutting?
-
Why are these practices carried out?
-
How does this practice affect a girl or woman’s health?
-
How else is it harmful?
-
Are there benefits from this practice? For men? For women?
-
What efforts have been made to end this practice?
2. Review behavior change theories with the group. See chapter 11,
especially the handout “Five Stages of Change” on page 11-21 and the
handout “Behavior Change” on page 11-25. Describe how we may be able
to assist moving individuals, families, and communities along the path to
behavior change through many interventions.
3. Invite participants to form small groups of no more than five or six people.
Give each group large pieces of white paper and colored marking pens.
Ask each group to make columns labeled Knowledge, Attitudes, and
Actions as in the following example.
5-38
Reproductive Health Awareness
Knowledge
Attitudes
Actions
4. Ask the small groups to brainstorm the knowledge, attitudes, and actions
needed to institutionalize stopping this harmful cultural practice. Possible
answers are listed on the tool for trainers, “Sample Responses from Small
Groups: Knowledge, Attitudes, and Actions for Ending Female Genital
Cutting.”
5. Invite a representative from each small group to summarize their
discussion and present their lists. After all groups have presented,
highlight the main points.
Wrap-up
Emphasize and review the following points.
• Changing such a complex cultural practice as female genital cutting
may take quite a bit of time and patience.
• Changing this behavior has profound benefits for the woman and her
family and therefore is worth intense and repeated effort on the behalf
of health providers.
Evaluation
By assessing the small group presentations and reviewing each group’s list of
knowledge, attitudes, and actions for change, trainers will assess whether
participants can identify and describe ways to help clients and communities
break the cycle of female genital cutting.
Note to Trainers
This activity is designed for participants who are aware of
the dangers of female genital cutting and interested in
working to stop these practices. If participants are unaware
of these practices or are in favor of continuing these
practices, design another activity that focuses more on
raising awareness and examining attitudes about FGC.
Sexuality: Healthy Expression Throughout Life
5-39
Female Genital Cutting: A Summary
Female genital cutting (FGC) may also be called “female
circumcision” or “female genital mutilation.” Basically, there
are three major types of female genital cutting.
The first type is called “Sunna” and involves the removal of
the prepuce with or without the excision of part or the entire
clitoris.
The second type is called “clitoridectomy.” This involves the
partial or entire removal of the clitoris, as well as the
scraping off of the labia majora and labia minora.
The third and most extreme form is called “infibulation.”
This consists of the removal of the clitoris, the adjacent labia
(majora and minora), and the joining of the scraped sides of
the vulva across the vagina, where they are secured with
thorns or sewn with catgut or thread. A small opening is kept
to allow passage of urine and menstrual blood. An
infibulated woman must be cut open to allow birth of her
baby and is often re-sewn after delivery.
Complications suffered by girls and women having these
surgeries include: hemorrhage, infection, death, urinary
stones, frequent urinary tract infections, infertility, painful
intercourse, lack of sexual gratification, large painful scars,
emotional trauma, difficulty giving birth, and others.
In some areas, these practices are done under very unsanitary
conditions that can result in infection and transmission of
HIV/AIDS. Even when these practices are done in hospitals
or by trained personnel, the immediate and long-term effects
on women and girls are devastating.
Source: Adapted from World Health Organization, 1997
5-40
Reproductive Health Awareness
Tools
for
Trainers
Sample Responses from Small Groups
Tools
for
Trainers
Knowledge, Attitudes, and Actions for
Ending Female Genital Cutting
Knowledge
• Knows and teaches
messages on normal body
physiology
• Knows and teaches
messages on reproductive
health
• Knows and teaches
messages on human rights
• Understands the
consequences of harmful
practices and the
importance of good
reproductive health
practices
• Is aware of discriminatory
practices against women
and children in the
community
Attitudes
• Recognizes the value of
Actions
• Discusses reproductive
utilizing reproductive
health services
• Communicates with
spouse, family, and friends
about desired family size
and reproductive health
• Accepts women heading or
leading mixed community
groups
• Desires to propose
strategies for reducing
discriminatory practices
against women
• Desires to propose
strategies for reducing
gender-based violence
health and human rights
with own family and in
public
• Makes testimonials in
public of own experiences
regarding female genital
cutting (FGC)
• Advocates anti-FGC ideas
to other individuals
• Joins or creates a
movement against
violence
• Makes a public declaration
against FGC
• Does not permit own
• Recognizes and accepts
daughter or other family
members to have FGC
basic human rights and
reproductive health rights
Source: Adapted from the Frontiers Project, Population Council, 2002, April, p. 16
Sexuality: Healthy Expression Throughout Life
5-41
A
ctivity Conflict in the Bedroom: Problems and
Possible Causes
Objective
By the end of this activity, participants will be able to—
• Describe some common sexual problems men and women may
experience
• Dispel myths regarding male sexual functioning related to age
Time
45-60 minutes
Preparation
For this activity you will need large pieces of white paper taped onto a wall or
flipchart and colored markers. You will also need copies of case studies for
participants to discuss. You may use the “Sample Case Studies on Sexual
Concerns" described in tools for trainers or create your own. Review the
handouts “Common Sexual Concerns” and “Suspecting Sexual Abuse” and
make copies for participants, if appropriate.
Directions
1. Invite participants to form four small groups. Give each small group a
different case study and a different set of questions to discuss.
2. After about 15 minutes, ask a representative from reach group to share a
summary of their group’s discussion.
3. Provide additional information about normal sexual development, aging,
and common sexual concerns if needed. See the handouts “Common
Sexual Concerns” and “Suspecting Sexual Abuse” and select additional
material on these topics from the resource list.
Wrap-up
Summarize the lessons learned and close with the following.
• It is common for people to have sexual concerns at some point during
their lives. Sometimes these problems can be addressed by encouraging
clients and community members to talk about their sexual concerns
(giving permission to talk about a topic that is often taboo in many
cultures) and by providing them with limited information to address their
specific concern. For example, a premenopausal woman may experience
little vaginal lubrication during the excitement phase, which may result
in painful intercourse. If this woman knows she can use a water-based
lubricant such as KY jelly, sex may be much more pleasurable for her.
• For more difficult sexual problems, clients may need specific
suggestions or intensive therapy from providers who have been
5-42
Reproductive Health Awareness
specially trained as a sex therapist. For example, a man with no
apparent medical problem who has never been able to get or keep an
erection would benefit from the help of a provider with special training
in sexual therapy.
By discussing sexuality with clients, providers can
tailor information and services more appropriately,
advocate respect for the rights and desires of both
partners, and help clients learn to communicate better
about sexual issues and concerns
Evaluation
Through large group discussion, participants will demonstrate their ability to
describe common sexual problems and dispel myths regarding male sexual
functioning related to age.
Note to Trainers
If you do not have time for small group discussion of the
cases, you may choose to discuss each of the cases in the
large group and then review the handouts and other support
material.
Sexuality: Healthy Expression Throughout Life
5-43
Sample Case Studies on Sexual Concerns
Tools
for
Trainers
Case Study #1
Josh is a 29-year-old male who works as a long distance truck driver. He is away from home
about 2 weeks out of every month. He has been an insulin dependent diabetic for 10 years and
takes insulin three times a day. Josh drinks two to three beers per day and smokes an occasional
cigar on the weekends relaxing with friends. His wife Angelina is very frustrated. In addition to
being away long periods of time, their sex life is not satisfying. Josh has trouble obtaining and
maintaining an erection. He gets angry when this happens and is increasingly unwilling to try.
Angelina thinks he has a lover on his truck route in another city. Their marriage is in crisis.
What are the causes of stress on their marriage?
What are the possible contributors to Josh’s sexual difficulty?
What are potential solutions to his problem?
Case Study #2
Gustavo is a 76-year-old man who has been retired for 8 years. He used to be a math teacher and
track coach. He now tutors primary school students in math and plays golf at least twice a week.
His first wife died. His second wife Ana Maria is 41 years old. She sells property. They are
worried that she has missed her last period and is experiencing occasional nausea.
What are the possible causes of her missed period and nausea?
Is it necessary to use birth control with a husband this old?
What are possible sexual difficulties this couple might be expected to have?
5-44
Reproductive Health Awareness
Sample Case Studies on Sexual Concerns, continued
Case Study #3
Krishna and his wife, Gita, have been married for 3 years and live with his parents and his three
younger siblings in a three-room house. Gita has not been able to get pregnant yet and is getting a
lot of pressure from her mother-in-law to produce a son. Krishna “comes” too early to penetrate
his wife. Once he has ejaculated prematurely, he is not able to get hard again. He is very
frustrated by his inability to perform, sometimes takes it out with abuse of his wife, and
sometimes tries herbs, aphrodisiacs, and other traditional methods from healers. Nothing has
helped. Gita has difficulty feeling desire for her husband, as she fears his temper and physical
abuse when he is unable to perform.
What are the possible causes of his sexual difficulty?
Is there any hope for this problem?
What advice would you give this couple?
What would you do during a counseling session if you suspected that a client suffered
from physical or sexual abuse?
Case Study # 4
Sheeday is a 16-year-old girl who lives with her parents, brothers, sisters, and grandmother. Her
parents want her to marry soon. She is not interested in boys. If fact she finds herself more
attracted to young women. She is not at all interested in marrying a man. She wonders if she
might be homosexual but feels she could never talk with anyone about this. In her community, all
girls are expected to marry and obey their husbands.
What is homosexuality?
What options does Sheeday have for a healthy and fulfilled sexual life?
How are gay men and lesbian women treated in your community?
How would you counsel someone who came to you with concerns about his or her sexual
orientation?
Sexuality: Healthy Expression Throughout Life
5-45
Common Sexual Concerns
Handout
Although people are born sexual beings, they learn how to relate to others in a sexual way.
Knowledge, culture, personal experiences, age, the nature of a relationship, medication, some
illnesses or diseases, relationship problems, sexual abuse, and other factors can influence sexual
desire or performance. Providers can play an important role by asking questions and providing
appropriate information and quality services, advocating respect for the rights and desires of both
partners, and helping clients learn to communicate better about sexual issues and concerns.
Sexuality and Aging
As people age, sexuality continues to be a natural, healthy part of living. Knowing about the
normal changes associated with aging may help a person accept and work with these changes in
order to maintain a satisfying sexual relationship.
For example, an aging man may need more stimulation to get and maintain an erection. After
orgasm, he may be less able to have another erection very soon. It may take many more hours to
be able to have another erection after orgasm, when compared to when he was younger. The
amount of semen released during ejaculation also decreases with aging. However, a man is still
able to get a woman pregnant even when he is very old. Men in their 90s have been known to
father children!
As women age and go through menopause, they may experience several physical changes that
may affect their sexuality––vaginal walls become thinner; there is less vaginal lubrication, and
the opening to the vagina becomes smaller. These changes can result in painful intercourse.
Regular sexual activity often helps. The use of lubricants and other remedies can also help a
woman continue to have very pleasurable sex.
Sexual Orientation
This is the erotic or romantic attraction for sharing sexual expression with members of the
opposite sex (heterosexuality), one’s own sex (homosexuality), or both sexes (bisexuality). Many
people believe that sexual orientation is determined before birth, although it is also influenced by
many social factors. During adolescence, a person’s sexual orientation usually becomes more
apparent. However, a person may engage in sexual behaviors with another person for reasons
other than sexual orientation. The need for money, the pressure of societal norms, curiosity,
power, and other reasons may cause a person to engage in sexual practices that are not consistent
with the person’s sexual orientation.
5-46
Reproductive Health Awareness
Common Sexual Concerns, continued
Possible Sexual Problems
Many women and men notice occasional changes or problems in their sexual response. Often
these problems can be remedied with limited information or specific suggestions. However, if the
person becomes very anxious about their problem, the problem occurs over and over again, or
has gone on for a long time, the individual may need more skilled intervention or sexual therapy.
Some of the possible sexual problems are briefly described below.
• Inhibited sexual desire—This is the loss of sexual desire that disrupts sexual
relationships. Both women and men can experience this condition. Factors that
contribute to it include hormone deficiencies, depression, alcoholism, liver or kidney
disease, chronic illness, side effects of drugs, psychological trauma, etc.
• Conditions in women— Some women experience recurring genital pain during sexual
activity (dyspareunia). This condition may have many causes including episiotomy,
radiation, sexually transmitted infections, other health problems, and psychological
issues. Another condition (vaginismus) results in involuntary contractions of the
muscles around the vagina. This condition is often associated with women who have
suffered from physical or sexual abuse. Difficulty achieving orgasm is another
possible problem. Although a woman may not experience orgasm through penilevaginal stimulation, she may achieve orgasm through erotic stimulation of other areas
like the clitoris. However, when a woman cannot experience orgasm at all
(anorgamia) there may be anger or hostility between partners, ineffectual sexual
technique, religious teachings that discourage sexual pleasuring, poor communication
between partners, or other causes.
• Conditions in men— Premature ejaculation is when a man consistently ejaculates with
minimal sexual simulation, before he wishes. This is more common with younger
men and men with little sexual experience. The condition is often associated with
anxiety about sexual performance although there can also be physical causes. Another
condition is when men are unable to have an orgasm (male orgasmic disorder). This is
usually associated with traumatic sexual experience, strict religious upbringing,
hostility, over control, or lack of trust. Impotence (also called “erectile dysfunction”)
is another condition. A man with this condition is unable to attain an erection or
maintain the erection long enough to complete the sexual activity. There are many
causes for impotence. Drugs, alcohol, HIV, diabetes, multiple sclerosis, Parkinson’s
disease and other diseases can contribute to this problem as well as injuries to the
spinal cord. There are often psychological causes, or both physical and psychological
factors may contribute to the problem.
Many factors may affect sexual performance and cause sexual dysfunction. As just described,
these may include psychological problems, certain drugs including alcohol and cigarettes, health
problems associated with aging and other health problems (e.g., diabetes or Parkinson’s disease).
A client experiencing sexual problems or concerns may need more information, specialized
services, referral, and ongoing support from providers.
Source: This handout is adapted from EngenderHealth, 2003
Sexuality: Healthy Expression Throughout Life
5-47
Suspecting Abuse
Handout
Abuse and maltreatment can happen to people of any age—young children, adolescents, the
aging, those with mental disabilities, women, young boys, and men. When a client or community
member is the victim of verbal, physical, or sexual abuse, providers may not know this is
happening. Or, providers may suspect abuse but feel uncomfortable and ill prepared to talk with,
support, and offer resources to a client who has been abused.
Throughout life, people should be able to enjoy and express their sexuality while respecting the
rights of others. If a sexual activity is used to harm another person physically or psychologically,
this is sexual abuse. It occurs when one person does not consent to sexual activity and is coerced
or forced to participate. Any sexual activity with a child (consenting or not) is sexual abuse.
Abuse of Children and Young Adults
Sexual abuse of children occurs when an older, stronger, or more powerful person looks at or
touches a child’s genitals for no legitimate reason. This can happen to boys or girls. Most adults
and adolescents would never abuse children. However, when abuse occurs, the abuser is often
someone the child knows.
From an early age, children should learn that if they experience unwanted or uncomfortable
touching they should tell a trusted adult right away, even if the abuser warns them not to tell
anyone. Health providers, teachers, ministers, and other caring adults can help.
Gender-based Violence
This is any activity that results in or is likely to result in physical, sexual, or psychological harm
or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty,
whether occurring in public or private life (United Nations General Assembly, 1993).
Although abuse can happen to anyone, in any situation, researchers have found it useful to look
at an “ecological framework” for understanding partner violence against women. This framework
addresses the combined interplay between personal, situational, and socio-cultural factors that
seem to increase the likelihood of abuse.
5-48
Reproductive Health Awareness
Suspecting Abuse, continued
To help understand why some individuals and societies are more violent toward women, the four
levels of the “ecological framework” are listed as follows. Following each level, the factors
associated with an increased risk that a man will abuse his partner are shown.
1. Individual level—
• Being abused as a child or witnessing marital violence in the home
• Having an absent or rejecting father, and frequent use of alcohol
2. Family and relationship level—
• Male control of wealth and decision-making in the family
• Marital conflict
3. Community level—
• Women’s isolation and lack of support
• Male peer groups that condone and legitimize men’s violence
4. Societal level—
• Gender roles rigidly defined and enforced
• Concepts of masculinity linked to toughness, male honor, or dominance
• Tolerance of physical punishment of women and children; acceptance of
violence as a means to settle disputes, the perception that men have
“ownership” of women
Keep in mind that other types of abuse occur also. This includes abuse of men by women, abuse
of the elderly and the disabled by women and men, etc.
What Providers Can Do
If providers suspect violence or sexual abuse, they should show that they care in a
nonjudgmental, empathetic way and ask questions. Some programs ask all clients about domestic
violence. Others only screen if there are signs of abuse such as apparent unexplained injuries or
chronic vague complaints that have no obvious physical cause. The following are a few possible
questions a provider might ask to assess abuse—
• I do not know if this is a problem for you, but since violence is common in women’s
lives, we have begun asking all clients about abuse. Has this ever been a problem for
you?
• Sometimes when I see an injury like yours, it is because somebody hit them.
Did anyone hit you?
• Did you ever have an unwanted sexual experience as a child?
Sexuality: Healthy Expression Throughout Life
5-49
Suspecting Abuse, continued
An abused person may not share this information with a provider right away. However, a caring
provider may do a lot in terms of increasing awareness about the opportunity to change. It is
always best for providers to have a coordinated community response or plan for referral and
support for those who suffer from abuse. When sexual abuse or other forms of abuse are revealed
a provider should consider the following—
Respect confidentiality—Discuss the problem in a private area without other family members
present. Let the person know their rights and your responsibilities. When there is suspected abuse
of children, the provider may need to report this to an agency that investigates suspected abuse of
children.
Believe and validate the person’s experiences—Listen actively in a nonjudgmental and
empathetic way. Acknowledge the person’s feelings and let the person know he or she is not
alone.
Acknowledge the injustice—Abuse is not the victim’s fault. No one should be abused.
Respect autonomy of adults and take care of children—Respect that adults can make their
own decisions, about their own lives, when they are ready. Offer support, information,
encouragement, resources, and other forms of help. With children, however, adults need to
protect them and take a more active role. Many programs have a policy for reporting suspected
abuse of children.
Help plan for future safety—Assess for immediate danger. The most dangerous time for a
woman with an abusive partner is often immediately after she leaves or decides to leave the
relationship. Although a woman may not be willing or able to leave an abusive situation at a
given point in time, providers may explore ways she can protect herself and her children. This
may include keeping a bag packed with important documents, keys, change of clothes, and
seeking support of neighbors and friends. Children in an abusive situation may need to be
removed from the home by an agency that protects and cares for abused and neglected children.
Promote access to community resources— Know the resources in your community, develop
linkages, and help people in need access and use the resources that are available. When resources
are lacking or inadequate, help establish and develop needed resources.
Source: This handout is adapted from Heise et al., 1999
5-50
Reproductive Health Awareness
A
ctivity Sexual Truths, Myths, and Fears About Men
and Male Sexual Performance
Objective
By the end of this activity, participants will be able to—
• Identify and dispel myths regarding male sexual functioning
Time
45-60 minutes
Preparation
Make a copy of the tools for trainers “Sexual Myths, Truths, and Fears.” Cut
the slips along the dotted lines. Select enough slips for each participant to have
one. Choose items that you know to be particular problems in your culture or
items that will stimulate good group sharing. Instead of using the tool for
trainers, you may prefer to write myths, truths, and fears that are common in
your area on the slips of paper. You will also need large pieces of white paper
taped onto a wall or flipchart and colored markers.
Directions
1. Distribute the slips of paper so that each participant has one.
2. One by one ask participants to read the statement on their slip of paper.
After each participant reads a statement, discuss the following questions
with the group—
-
Is this belief true in your culture?
-
Is it a harmful belief for men? Women? Both?
-
Is this belief outdated?
-
Is this belief dangerous or limiting? If yes, how so?
-
How would you talk with a client or community member who held
this belief?
Sexuality: Healthy Expression Throughout Life
5-51
Exploring different perceptions about men and
male sexual performance
3. Discuss how providers can help dispel myths and provide accurate
information in a sensitive, nonjudgmental way. For example, foreplay can
help a woman become more lubricated or “wet” in the vaginal area. This
helps her feel more receptive and have more pleasurable sex. Dry sex can
cause pain. It is good for women to feel sexual pleasure, just as it is good
for man to feel this type of pleasure.
Wrap up
Conclude the activity with the following.
• Culture, religion, the media, family, peers, personal experiences,
sexual orientation, and other factors help shape our beliefs about sex
and sexual functioning.
• It is important for providers to talk with clients and community
members about normal healthy sexual functioning as well as identify
possible health problems and seek workable solutions.
• Accurate information, respect for the rights and desires of a partner,
and interpersonal communication can go a long way in fostering
mutually pleasurable sexual experiences between both partners.
Evaluation
5-52
By observing class discussion, the trainer will assess whether participants are
able to identify and dispel select myths about sex and sexual functioning.
Reproductive Health Awareness
Sexual Myths, Truths, and Fears
Tools
for
Trainers
It is better to be a man than a woman.
Men need sex more than women.
Family planning is not man’s responsibility.
Real sex is flesh to flesh (no condom).
We don’t have homosexuals here.
The bigger the penis the better.
Big hands, big shoes, big penis.
A man’s sexual partner should always be younger.
If you are having sexual problems, having a few drinks will relax you and improve your
performance.
You can’t get a girl pregnant if you “do it” standing up.
Vasectomy will make you loose your ability to get erections.
If you have a problem getting an erection, it is the fault of the woman.
Getting a vasectomy will reduce sex drive and performance.
It is OK for men to have multiple sex partners but not women.
Condoms are for preventing sexually transmitted infections not for family planning.
Educated women don’t make good sexual partners. You can’t control them.
STDs affect women but not men in terms of symptoms.
Once boys are circumcised, they are allowed to engage in sex.
Your sexual partner should not be too tiny a woman. She may not be able to survive childbirth.
Masturbation is OK for guys but not for girls.
Men are sexually able to perform until they die.
Sexuality: Healthy Expression Throughout Life
5-53
Sexual Myths, Truths, and Fears, continued
A low sperm count is the fault of the woman.
Women are “used clothes” by the time their children are getting married and should not have sex
any more. You should not compete with your daughter, i.e., have kids while she is.
If you have had a heart attack, your sex life is over.
If a woman’s vagina is dry, sex is more pleasurable.
A woman after menopause is no longer sexually attractive.
An inguinal hernia will decrease your fertility.
Casual sex is not infidelity if the man has a wife or a long-term partner.
A sexually attractive woman has big hips, chubby, and non-sagging breasts.
A sexually attractive woman has big breasts and is small everywhere else.
I have money. I’m cool. STIs can’t happen to me.
A sexual partner should be 17 to 25 years old.
A wife must be a virgin. She should bleed on the wedding night. Her husband needs to check the
bed sheets to confirm it.
Women are not capable of desire.
Men prefer light-skinned women. (In some areas there is the perception that being light skinned
means that she has not labored in the sun and comes from an upper-class family.)
Your casual sexual partner can wear short pants, tank top, make-up, and be bubbly. A wife must
be passive, demure, and reserved.
Sex is quick. It is not making love. Lift her clothes and do it quickly. No foreplay.
Men make the advance. Women receive it.
It is usual to have homosexual relations until your virgin wife is old enough to marry.
The woman should become pregnant soon after marriage.
The woman should become pregnant before marriage to prove her fertility.
5-54
Reproductive Health Awareness
Sexual Myths, Truths, and Fears, continued
Women should marry before going for advanced education. If she has too much education, she is
un-marriageable.
A woman’s genitals should never be touched. It is unclean. She should not get pleasure from her
genitals. She shouldn’t want sex. She might become promiscuous, premarital sex, etc
A man’s genitals are clean.
Divorce carries a stigma. It is shameful. It shows you couldn’t keep your family together.
Polygamy is natural.
If a woman cannot have children, she is less than a woman. Better to get rid of her than to help
her out.
A woman previously married or known to have sexual experience is often regarded as a
prostitute or more experienced than the man, and therefore not a good choice.
STIs are the fault of the woman.
Menses is dirty. Your wife must sleep on the floor away from you or in a separate sleep space
during menses.
Bigger is better.
You don’t use condoms with your wife.
To adopt a child does not carry stigma.
Homosexuality is unacceptable. You can be jailed for it just by having someone claim you are.
Homosexuality is silly and unfortunate but OK.
No intercourse until you are married.
Your sexual partner should always be younger.
It is OK for men to have multiple sex partners but not women.
It is important to please the woman sexually. Sensitive foreplay is necessary.
If you are having sex with a very young girl, you need to provide family planning. If she is older
it is her responsibility.
Sexuality: Healthy Expression Throughout Life
5-55
Sexual Myths, Truths, and Fears, continued
Family planning is a shared responsibility and an economic necessity.
A man should be able to control impotence and premature ejaculation.
Sex with animals is OK in early puberty until a regular sex partner is available.
If you are infertile, you are less of a man.
Masturbation is natural.
Romantic gestures may or may not be needed to relate to a partner.
A man is attractive if he is tall and large, dresses and carries himself with confidence, is a bit
rough and tumble, and is surrounded by many women.
Women need to marry and bear children early. They need to learn home skills early. It is a
burden to the family to hold on to girl who can’t find a partner.
A woman who sleeps around is a whore. A man who sleeps around is a stud.
A woman who moves her hips when she walks is sexually experienced.
A woman who is not a virgin has a flattening of her mons pubis. (The mons pubis is a padded
area with pubic hair, located below a woman’s abdomen.)
If you masturbate a lot, it affects your health and makes you weak.
I do not talk about sex with my friends. I do not feel like I have much information.
You cannot discuss sex with parents, spouse, or relatives. You can only talk to doctors and very
close friends.
Homosexuality is disgusting. It is somewhat more OK for lesbians than for gay men.
If you have strong muscles and are in shape, you won’t have problems with impotence.
5-56
Reproductive Health Awareness
A
ctivity Farm Animal Game
Objective
By the end of this activity, participants will be able to—
• Help agricultural workers use their knowledge of farm animals to build
upon their understanding of human reproduction
Time
2 to 4 hours
Preparation
Make enough copies of the handouts “Reproduction Worksheet: Males” and
“Reproduction Worksheet: Females” so each participant has a copy of each
handout. To conduct this activity you need a facilitator who is knowledgeable
regarding farm animals and a facilitator who knows human reproduction.
Directions
1. Ask participants to form teams of three or four members each. Each group
is playing to have their team win. This is a good activity for the evening if
the training is residential and all are together.
2. After teams have been chosen, give half of the teams copies of the handout
“Reproduction Worksheet: Males” and the rest of the teams copies of the
handout “Reproduction Worksheet: Females.”
3. Instruct each team to fill out the worksheet as completely as possible in the
limit of time you give them (it might be one evening or two evenings).
Each team is free to use any available books, interview local farmers, or
call resource persons. They are competing to get the most answers correct
in the time allotted.
4. Ask the animal and human reproductive health facilitators to grade the
handouts from each team. Give the winning team a nice prize of your
choice.
5. Invite the two facilitators to lead a discussion about what participants have
learned about farm animals as it relates to their knowledge of humans.
You may lead a discussion by asking the following questions (answers are
in italics)—
-
In what way are male animals similar to human men? (Fertile all
month, fertile all adult life, produce huge numbers of sperm,
sexually responsive throughout the cycle, etc.)
-
In what way are male animals different from human men?
(Initiation of sexual activity affected by culture in humans, sexual
maturity delayed for years, etc.)
Sexuality: Healthy Expression Throughout Life
5-57
-
In what way are female animals similar to human females? (Fertility
is cyclical, are sexually responsive throughout the month whether
fertile or not, vulnerable to sexually transmitted infections, etc.)
-
In what way are female animals different from human females?
(Initiation of sexual activity affected by culture in humans, sexual
maturity delayed for years, long gestation and small “litter size”
in humans makes births especially precious, etc.)
-
What vulnerabilities do humans and other animals share? (Can get
sexually transmitted infections, can get pregnant when the
environment does not support a new mouth to feed, etc.)
-
Would you use an activity like this with agricultural workers in
your community? Explain. (Answers depend on the group.)
Wrap-up
Share with the group the handout labeled KEY for both male and female
worksheets. Summarize the discussion reinforcing similarities and differences
between animals and humans, pointing out how our knowledge of animals can
assist our understanding of ourselves. Stress that it is essential that we
understand how our bodies work and what we can do to protect our
reproductive health.
Evaluation
Trainers or evaluators may observe participants as they use or adapt this
activity when working with agricultural workers in the community.
Note to Trainers
To be effective, the participants and facilitators must have a
good understanding of farm animals and be comfortable with
comparing animals to humans. Though any audience could
learn from the game, true competition and excited discussion
requires some background with the material. If participants
find references to pigs offensive, delete that column of the
chart before playing the game.
Source: Great technical assistance and advice for the creation of this activity came from the Christian Veterinary
Mission with special thanks to Drs. Leroy Dorminy, Kit Flowers, John Fletemine, and Keith Flanagan for their
information, patience, and avid interest. Christian Veterinary Mission, 19303 Fremont Avenue North, Seattle,
Washington, 98133, USA.
5-58
Reproductive Health Awareness
Tools
for
Trainers
Reproduction Worksheet
Males
KEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEY
MALE
Humans
Cattle
Pigs
Chickens
Age when
sexually mature?
11-13 years of age
16-18 months
5-6 months of
age
6 months
Have a hormonal
cycle?
No
Yes, very slight
No
Yes, affected by
light
Length of
fertility?
Puberty until death
Puberty until
death
Puberty until
death
Puberty until
death
Becomes sexually
active when?
Culturally
influenced, 14-20
years.
16-18 months
5-6 months
6 months
Is sexually
responsive when
in cycle?
Throughout the
month
All the time
All the time
All the time,
unless
overcrowded
Number of
sperm
produced?
250-350 million per
ejaculate
7.5 billion per
ejaculate
30-100 billion
per ejaculate
5-10 billion per
ejaculate
Volume of
ejaculate?
3-5 cc (5 cc =
one teaspoon)
5-6 cc
150-500 cc
(16 oz.)
2 cc
Gets sexually
transmitted
diseases? If so,
which ones?
Yes—herpes, HIV,
trichomonas,
chlamydia, syphilis,
gonorrhea, etc.
Yes—
trichomonas,
vibriosis,
brucellosis
Yes—
brucellosis.
leptospirosis,
parvovirus
No
Sexuality: Healthy Expression Throughout Life
5-59
Tools
for
Trainers
Reproduction Worksheet
Females
KEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEY
FEMALE
Humans
Cattle
Pigs
Chickens
Age when
sexually
mature?
11-13 years of age
8-18 months
6-12 months
of age. Varies
with breed.
4-6 months
Number of
days in
hormonal
cycle?
25-32 days
21 days
19-21 days
4-6 months
Length of
fertility?
About 6 days per cycle
18 hours estrus,
ovulates 11 hours
after estrus
begins
1-2 days per
cycle
Puberty until death
Starts sexual
activity when?
Culturally influenced,
14-20 years
10 to 13 months
depending on
breed and
nutrition
8 months or
more if poorly
nourished
4-6 months
Is sexually
responsive
when in cycle?
Throughout the month
All the time
All the time
All the time, unless
overcrowded
Contact
ovulators?
No
No
No
No
Number of
eggs produced?
100,000 to 200.000 at
birth
??
??
30 dozen (360) per
lifetime
5-60
Reproductive Health Awareness
Reproduction Worksheet: Females, continued
FEMALE
Humans
Cattle
Pigs
Chickens
Gets sexually
transmitted
diseases? If so,
which ones?
Yes––herpes, HIV,
trichomonas,
chlamydia, syphilis,
bacterial vaginosis
gonorrhea, etc.
Yes––
trichomonas,
vibriosis,
brucellosis
Yes––
brucellosis.
leptospirosis,
parvovirus
No––diseases can
be passed through
the eggs
(salmonella,
Marek’s disease,
herpes)
Average time
of
breastfeeding?
Culturally determined
(several weeks to 2
years)
7-8 months
8-10 weeks
None
Number of
teats?
2
4
10-12
None
Average litter
size?
1
1
11
1
Average length
of gestation?
267 days
280 days
114 days
Incubation 20-22
days
Slippery
discharge when
fertile?
Yes
Yes
Yes
No
KEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEYKEY
Sexuality: Healthy Expression Throughout Life
5-61
Reproduction Worksheet
Handout
Males
NAME____________________________
MALE
Humans
Age when
sexually mature?
Have a hormonal
cycle?
Length of
fertility?
Becomes sexually
active when?
Is sexually
responsive when
in cycle?
Number of
sperm
produced?
Volume of
ejaculate?
Gets sexually
transmitted
diseases? If so,
which ones?
5-62
Reproductive Health Awareness
Cattle
Pigs
Chickens
Reproduction Worksheet
Handout
Females
NAME____________________________
FEMALE
Humans
Cattle
Pigs
Chickens
Age when
sexually
mature?
Number of
days in
hormonal
cycle?
Length of
fertility?
Starts sexual
activity when?
Is sexually
responsive
when in cycle?
Contact
ovulators?
Number of
eggs produced?
Sexuality: Healthy Expression Throughout Life
5-63
Reproduction Worksheet: Females, continued.
FEMALE
Humans
Gets sexually
transmitted
diseases? If so,
which ones?
Average time
breastfeeding?
Number of
teats?
Average litter
size?
Average length
of gestation?
Slippery
discharge when
fertile?
5-64
Reproductive Health Awareness
Cattle
Pigs
Chickens
Resources
Reference List
Advocates for Youth. (1995). Life planning education. Washington, DC: Author.
Crooks, R., & Baur, K. (2001). Our sexuality. Belmont, CA: Brooks/Cole.
EngenderHealth. (2003). Sexuality and sexual health: Online minicourse. Retrieved March 12,
2003, from http://www.engenderhealth.org/res/onc/sexuality/index.html
Frontiers Project, Population Council. (2002, April). Using operations research to strengthen
programmes for encouraging abandonment of female genital cutting: Report of a
consultative meeting on methodological issues for FGC research April 9-11, 2002, Nairobi,
Kenya. Washington, DC: Frontiers Project, Population Council.
Hatcher, R., Trussell, J., Stewart, F., Cates, W., Stewart, G., Guest, F., et al. (1998).
Contraceptive technology (17th rev. ed.). New York: Ardent Media.
Heise, L., Ellsberg, M., & Gottemoeller, M. (1999, December). Ending violence against women,
Population Reports, Series L, No. 11. Baltimore, Maryland: Johns Hopkins University
School of Public Health, Population Information Program.
Katchadourian, H.A., & Lunde, D.T. (1972). Fundamentals of human sexuality (2nd ed.). New
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5-66
Reproductive Health Awareness
Organizations
Christian Veterinary Mission, 19303 Fremont Avenue North, Seattle, Washington, 98133, USA,
Phone (206) 546-7569
FGM Awareness and Education Project, PO Box 6597 Albany, California 94706, USA
RAINBO, 915 Broadway, Suite 1109, New York, NY 10010-7108, USA, Phone (212) 477-3318
SIECUS (Sexuality Information and Education Council of the United States), 130 West 42nd St.,
Suite 350, New York, NY 10036, USA, Phone (212) 819-9770
Sexuality: Healthy Expression Throughout Life
5-67
MAIN OFFICE
1400 16th Street, NW, Suite 100
Washington, DC 20036, USA
Tel: 202-667-1142
Fax: 202-332-4496
E-mail: cmail@cedpa.org
EGYPT
53 Manial St., Suite 500
Manial El Rodah
Cairo 11451, Egypt
Tel: 2-02-365-4567
or 2-02-531-8149/8150
Fax: 2-02-365-4568
E-mail: cedpa@intouch.com
GHANA
P.O. Box CT 4977
Cantonments
Accra, Ghana
Tel: 233-21-234-175
Fax: 233-21-251-063
E-mail: cedpaghana@cedpa.org.gh
GUATEMALA
2a Avenida 9-42 #4, Zona 9
Guatemala City 01009
Guatemala
Tel: 502-360-7252
or 502-334-6047
Fax: 502-331-3482
E-mail: cedpa@terra.com.gt
INDIA
50-M Shantipath
Gate No.3, Niti Marg
Chanakyapuri,
New Delhi, India 110021
Tel: 91-11-26886172
Fax: 91-11-26885850
E-mail: marta@vsnl.com
MALI
BP 1524
Rue 939
Quizambougou, Zone Industrielle
Bamako
Mali
Tel: 223-21-5429
Fax: 223-21-0246
E-mail: cedpa@cedpamali.org
denotes countries with ENABLE projects
NEPAL
Gairidhara
G.P.O. 8975, EPC 5316
Kathmandu, Nepal
Tel: 977-1-427-739
or 977-1-417-071
Fax: 977-1-421-696
E-mail: cedpa@wlink.com.np
NIGERIA
18A &B Temple Road
Off Kingsway Road
Ikoyi, Lagos, Nigeria
Tel: 234-1-260-0020
Fax: 234-1-260-0022
E-mail: cedpa_nigeria@usips.org
RUSSIA
The Latin American Institute of the
Russian Academy of Sciences
21/16. Bolshaya Ordinka St.
Moscow, Russia
Tel: 7-095-951-0087
Fax: 7-095-951-1059
E-mail: policy@online.ru
SENEGAL
BP 259 Dakar Liberté
1917 Sicap Liberté 3
Dakar, Senegal
Tel: 221-864-3705
Fax: 221-824-2071
E-mail: enablesenegal@sentoo.sn
SOUTH AFRICA
Kutlwanong Democracy Centre
357 Visagie Street 0002
P.O. Box 11624, The Tramshed
Pretoria 0126, South Africa
Tel: 27-0-12-320-2067
Fax: 27-0-12-320-5943
E-mail: info@cedpa.org.za
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Headquartered in Washington, DC, CEDPA
is an international nonprofit organization
that seeks to empower women at all levels
of society to be full partners in development.
Founded in 1975, CEDPA supports programs
and training in leadership, capacity building,
advocacy, governance and civil society,
youth participation and reproductive health.
The Enabling Change for Women's
Reproductive Health (ENABLE) project
works to strengthen women's capabilities
for informed and autonomous decision
making to prevent unintended pregnancy
and improve reproductive health. Initiated
in 1998, ENABLE seeks to increase the
capacity of non-governmental organization
(NGO) networks to expand reproductive
health services and to promote a supportive
environment for women's decision making.
ENABLE is funded by the Office of
Population and Reproductive Health,
Bureau for Global Health, U.S. Agency for
International Development, under the
terms of Cooperative Agreement No.
HRN-A-00-98-00009-00.
www.cedpa.org
ISBN 0-9742200-5-1