Safer Sex

Talking about Birth Control and Sexually Transmitted Infections (STIs)

It can be hard for parents to accept that their child may be involved in a sexual relationship. If parents cannot acknowledge that their child is in a sexual relationship, they likely will not talk about sexuality with them.

Talking to youth about sexuality is important because it can increase their ability to make healthy decisions, including whether or not to have sex.

SARAH & JOSH’S STORY…

Sarah and Josh met two years ago volunteering at Stampede. What started as friends turned into a dating relationship that they both had fun with. Recently Sarah’s group home coordinator Vic had a call from Josh’s parents asking if he could talk to the couple about safer sex. Josh told his parents that he loves Sarah and is ready to take the relationship to the next level. His parents are really happy that he had shared this with them and although they are worried, they know that at age 23 Josh wants to make his own choices. Vic feels comfortable talking about the topic with the couple, but where can he get the most up to date information and advice about birth control and STIs?

When a relationship becomes intimate, it’s important that youth have the skills and knowledge needed to make healthy choices.

Youth need to know:  
  • the consequences of sexual activity, including pregnancy and sexually transmitted and blood-borne infections (STIs and BBIs)
  • how to give and get consent to take part in sexual activity
  • how to talk about safer sex with a partner, including negotiating use of condoms
  • where to go for information about birth control and STIs

The goals of comprehensive sexual health education are:

  • To help all Canadians obtain positive outcomes, like rewarding relationships, good self-esteem, informed reproductive choices and non-exploitive sexual relations
  • To help all Canadians avoid negative outcomes, like unintended pregnancy, STIs and sexual coercion

Abstaining from sexual activity is the only method that offers 100% protection from pregnancy and STIs.

This means not taking part in any sexual activity that involves exchanging body fluids, genital to genital contact or skin to genital contact. If abstinence is not possible, then birth control and condoms should be used consistently and correctly.

Good to Know

Research looking at sexual activity rates, birth control use and pregnancy rates found little difference between youth with physical disabilities and those without a disability. Parents and providers can help youth build skills to make healthy choices about sex and provide information about how to get birth control and STI testing.

Tip

Even if the youth you care for can consent to getting their own care, they may want your support. Ask them if they would like you to come to the clinic with them. They may want your support to get to the clinic or they may want you to sit in the waiting room while they see the healthcare professional alone.

Consent from Parents and Guardians

Visiting a clinic or doctor’s office to talk about birth control and sexual health is an important skill for healthy living. Youth may need support to connect with services that can help them. Healthcare professionals will assess whether or not the youth can understand the nature of their visit and make decisions about any drugs or treatment. Some youth with disabilities may need the consent of a parent or guardian to receive healthcare to help them with decision-making.

Preventing Pregnancy

 Learning about pregnancy and pregnancy prevention helps youth make informed choices about their sexual health. This information is important for all youth, including those living with disabilities.

What is birth control?

Birth control is also known as contraception and refers to methods used to prevent a pregnancy. Contraception works by either preventing the fertilization of egg by the sperm, or preventing the fertilized egg (embryo) from implanting in the uterus. No method of birth control is 100% effective and most do not give protection from STIs. There may be side effects with some methods. The best birth control method is the one that will be used consistently and correctly.

Methods of birth control are sometimes divided into categories:

Natural family planning – includes abstinence, fertility awareness and withdrawal (“pulling out”). These methods require planning and are not considered very effective since many people have a hard time using these methods correctly.

Hormonal – includes the pill, patch, vaginal ring, “the shot” (Depo-Provera injections) and hormonal IUD. These methods are very effective, but a visit to a health care provider is needed. The emergency contraception pill is a hormonal method that can be purchased at many pharmacies without a prescription, but this method is not designed to be used as someone’s regular birth control.

Barrier – includes diaphragms and condoms. A prescription is needed for the diaphragm and it needs to be fitted by a healthcare provider. Condoms can be purchased at pharmacies or supermarkets. Some youth clinics have them available for free. If used consistently and correctly, condoms can be effective at preventing both pregnancy and STIs.

Spermicidal – includes foams, jellies, film and sponge. These methods are less effective and usually need to be used with another method of birth control.

Other – includes copper IUD and surgical methods (e.g., tubal ligation and vasectomy). Surgery is considered permanent and the IUD can be removed at any time. All are very effective but require a visit to a health care provider.

Good to Know

If there has been unprotected sex or the birth control method fails (like the condom breaks) in the last 5 to 7 days, using emergency contraception can help prevent pregnancy. Emergency contraception does not prevent against STIs, so that person may need to see a healthcare provider to access STI testing.

Two forms of emergency contraception are the copper IUD and the emergency contraception pill. Emergency contraception pills work best when they’re taken within the first 24 hours after unprotected sex, but can be used up to 5 days after. Some emergency contraception pills can be purchased at a pharmacy without a prescription, while other emergency contraception pills require a prescription from a healthcare provider.

The copper IUD can be used as emergency contraception up to 7 days after unprotected sex and serve as a long-term reversible birth control method as well. Visiting a healthcare provider as soon as possible after unprotected sex can be helpful to assist in deciding which type of emergency contraception is the best for the person. A healthcare provider will also be able to assist in creating a more reliable birth control plan and provide any STI testing and treatment.

How to Access Birth Control

Some birth control methods can be purchased over-the-counter, like condoms or emergency contraception pills. Other methods require a prescription, like the birth control pill, patch, ring and IUD. Some methods require insertion by a healthcare provider.

Access for youth to no-cost birth control and prescriptions can be found at Alberta Health Services Sexual and Reproductive Health Clinics.

Planning to Use Birth Control

Deciding to use birth control is the first step. If youth are sharing that they plan to have sex or have been sexually active already, they are ready to talk about protection.

Good to Know

Hormonal contraception can be used to control menstruation by stopping periods or making them lighter and shorter. This is very helpful for those who have hygiene issues and heavy bleeding caused by the use of certain medications or for someone who finds it hard to cope with periods because of a disability.

Good to Know

Not everyone can use all birth control methods due to individual health conditions or disability. For example:

  • Latex allergies and sensitivities are particularly common in people diagnosed with spina bifida. Even though condoms are commonly made from latex, there are non-latex condoms widely available
  • Using condoms can be difficult for anyone with reduced dexterity
  • Hormonal methods, such as the pill which needs to be taken at the same time every day, may not be the best option for youth with learning disabilities who may have a hard time remembering to take it regularly
  • Some seizure medications reduce the effectiveness of the birth control pill

The good news is that there are lots of different methods to choose from and there is something that will work for everyone, no matter their disability.

Some Questions to Ask Youth Include:

  •  Are you truly ready to be sexually active? Do you trust the other person? Do you both give each other consent to have sex each time?
  • Do you need a birth control method that gives protection from STIs? It is recommended that people use a condom (external or internal) every time they have vaginal, anal and genital to genital contact in order to prevent STI transmission. Other birth control methods do not protect against STI transmission. To use a method of birth control AND condoms is called dual protection. Dual protection greatly lowers the risk of unintended pregnancy and STI.
  • Do we need to visit the doctor to talk about which method is best? What are the side effects? Where can we go to get birth control? This may take planning as some types of birth control will not work right away.
  • What will you do if you do not like the type of birth control you choose? If someone has unpleasant side-effects or does not like using the chosen method, it is important to talk with a health care provider. Quitting a method suddenly can lead to unintended pregnancy.

Sexually Transmitted Infections and Blood Borne Infections (STBBIs)

There are many myths about STIs and BBIs.

MYTH: Only people who have lots of different partners are at risk.

FACT: Anyone who is sexually active can come into contact with STIs and it is possible to contract an STI during the first sexual experience. Do not assume that youth who are dating for the first time are not at risk.

MYTH: It is easy to tell if someone has an STI just by looking at them.

FACT: Having an STI is not like having the chicken pox. Many people show no symptoms and if there are any, they may not be visible. Testing is the only way to know for sure if someone has an STI and partners can only really know if they ask each other. Anyone can get tested at a sexual and reproductive health clinic, STI clinic, or doctors’ office. Testing and treatment is free.

MYTH: STIs are only spread through sexual intercourse.

FACT: STIs can be passed on through skin-to-skin contact, with no body fluids involved. Oral sex is a high-risk activity for STIs along with vaginal and anal sex without protection.

What are STIs and BBIs?

Sexually transmitted infections (STIs) and blood borne infections (BBIs) are also risks of sexual activity. STIs are types of infections that are spread through sexual contact. STIs are sometimes called sexually transmitted diseases or STDs. There are many types of STIs. Some are easily cured with prescribed medication; others have no cure. BBIs are infections that are spread by the blood and other high risk body fluids such as semen, vaginal or rectal fluid.

Good to Know

Sexual contact means any intimate skin-to-skin contact with the genital area. This includes touching, oral sex, vaginal sex or anal sex with a partner. Youth may need information that both giving and receiving oral sex carries risk for STIs.

Types of STIs:

Viral

Examples of viral STIs include:

  • HPV
  • Genital herpes

Bacterial

Examples of bacterial STIs include:

  • Chlamydia
  • Gonorrhea
  • Syphilis

Parasite

Examples of parasite STIs include:

  • Pubic lice
  • Scabies
If detected early, bacterial and parasite STIs are generally easy to treat. Viral STIs can be treated, but are more difficult to cure. Some viral STIs are not curable at this time. Untreated STIs can damage the reproductive system, which may cause problems with fertility later in life.

Some types of blood borne infections (BBIs) are Human Immunodeficiency Virus (HIV) and Hepatitis B. HIV is a virus that attacks the immune system and makes it hard for the body to fight diseases and infections. Currently, there is no cure for HIV. However, with early diagnosis and treatment, people can live long and healthy lives. Untreated HIV can lead to a condition called AIDS.

Hepatitis B is a liver infection caused by the Hepatitis B virus. It is more infectious than HIV.

Good to Know

The most common symptom of STIs and BBIs is having no symptoms. If a person experiences any problems like unusual bleeding or discharge, pain, lumps, bumps, sores or rashes, they should see a healthcare provider ASAP.

Prevention

For those who choose to have sexual activity, condoms reduce the risk of STIs and BBIs. It is recommended that people use a condom every time they have vaginal and anal sex, and any time there is genital to genital contact.

Condoms or dental dams should be used during oral sex as well.

Vaccination is another way to prevent STIs and BBIs.

HPV Gardasil vaccinations are routinely offered to grade 6 students in Alberta. Students who miss it can get it later through public health.

Hepatitis B vaccinations are routinely given to grade 6 students in Alberta. The vaccine may be given during the first year of life if the parents were born in an endemic area or if they are carriers of Hepatitis B.

Talking with Youth about Condoms

Safer sex means using protection against unexpected pregnancy and STIs. This includes using condoms.

Protection from pregnancy and STIs includes using birth control, getting tested for STBBIs and using condoms. Talking about condoms and safer sex with youth can be difficult for parents and service providers, but when condoms are used correctly they are very effective.

Condoms can prevent pregnancy and STIs and the best time to talk about using them is before a youth starts to have sex. It is important to help them get familiar with what condoms look like and how to use them correctly but it is equally important to help them talk about and negotiate condom use with a partner.

Tips for talking about condoms:

  • Choose a time without distractions and prepare for some embarrassment and maybe giggles.
  • Not everyone can use latex condoms due to allergies. Latex free condoms are available along with female condoms that do not contain any latex.
  • Be sure to show condoms inside packages and talk about where condoms can be bought and also picked up for free, like at sexual health clinics
  • Explain that condoms, like medicines, have an expiry date and that it is best not to use the condom if that date has passed.
  • People with hand mobility challenges may find it difficult to use condoms as they require some fine motor skills. A partner can be encouraged to help and this makes condom use something that couples can talk about together.
  • Discuss setting limits about sex and condoms – no condom means no sex! Talk about what might happen if a couple wants to have sex but they don’t have a condom. What if one person does not like using condoms?

Click here for more tips about talking to a partner about condoms

Where to Get Help

Birth control information, prescriptions and safer sex supplies in Calgary:    
Alberta Health Services Sexual and Reproductive Health Clinic. 

Birth control information, prescriptions and safer sex supplies in Alberta:    
AlbertaHealthServices.ca/srh

STI testing, treatment, information and support in Calgary:  
Alberta Health Services Sexual and Reproductive Health Clinic or STI Clinic.

STI testing, treatment, information and support in Alberta:  
AlbertaHealthServices.ca/srh

Sexual health services outside of Alberta: https://www.actioncanadashr.org/resources/services

Good to Know

Youth can get help at:

  • walk-in clinics
  • their family doctor
  • urgent care facilities

For Sexual Health Services in Alberta, click here

1SIECCAN. (2019). Canadian guidelines for sexual health education. Toronto, ON: Sex Information & Education Council of Canada (SIECCAN). 
2Public Health Agency of Canada (PHAC). (2013). Questions & Answers: Sexual health education for youth with physical disabilities. Retrieved from http://librarypdf.catie.ca/pdf/ATI-20000s/26289_B_ENG.pdf
3Public Health Agency of Canada (PHAC). (2019). Canadian guidelines on sexually transmitted infections. Retrieved from http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/index-eng.php