Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 1 - Jan/Mar - 2017

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Páginas 112 a 118


Sexual and contraceptive counseling for teens: the importance of gender

Consejo sexual y contraceptivo a los adolescentes: la importancia do género

Aconselhamento sexual e contraceptivo aos adolescentes: a importancia do gênero

Autores: Rita Coutinho1; Pascoal Moleiro2

1. Resident, Pediatrics Unit, Leiria Hospital Center. Leiria, AC, Portugal
2. Pediatrics Assistant, Pediatrics Unit, Leiria Hospital Center. Leiria, AC, Portugal

Rita Coutinho
Centro Hospitalar de Leiria, Hospital de Santo André
Rua das Olhalvas Pousos. Leiria, Portugal. CEP 2410-197
aritacoutinho@gmail.com

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How to cite this article

Keywords: Sexuality, adolescent, sex counseling.
Palabra Clave: Sexualidad, adolescente, consejo sexual.
Descritores: Sexualidade, adolescente, aconselhamento sexual.

Abstract:
OBJECTIVES: With special attention to the importance of gender on the sexual and contraceptive counseling, the present study aims to: 1) describe the differences of sexuality and sexual behaviors of adolescents; 2) identify the beliefs and myths in each gender and their main concerns about sexuality in general and in particular on their one 3) assist healthcare professionals on sexuality counselling according with this approach.
DATA SOURCE: This work is based upon our clinical experience with adolescents and from an analytical review of scientific articles published in electronic databases SciELO and Pubmed. Other sources were data published by official organizations on the internet. We included scientific articles written in English, Portuguese or Spanish, published on the past 20 years, which provided results relating teenage sexuality, counselling and gender. Were used as key words: "adolescence", "sexuality", "gender", "sexual risk behaviors", "beliefs and myths on sexuality".
DATA SYNTHESIS: There are differences of gender in the norms of sexual behavior, myths or beliefs around sexuality. Based on these differences found in the literature the authors innovate proposing a counseling directed to the gender.
CONCLUSION: the professionals who perform counselling for adolescents should be prepared to analyze through gender perspective, the different situations or conflicts they face and be able to anticipate some erroneous beliefs that they have about sexuality.

Resumen:
OBJETIVOS: teniendo en consideración la importancia del género en el consejo sexual y contraceptivo, el presente estudio tiene por objetivo: 1) describir las diferencias de sexualidad y los comportamientos sexuales de los y las adolescentes; 2) identificar las creencias y los mitos en cada género y sus principales preocupaciones sobre la sexualidad en general y suyas en particular, y 3) auxiliar a los profesionales de salud en el consejo sexual según este enfoque.
FUENTE DE DATOS: Este trabajo se basa en la experiencia clínica de los autores con los adolescentes y en la revisión analítica de la literatura de artículos científicos publicados en las bases electrónicas SciELO and Pubmed. Otras fuentes utilizadas fueron datos publicados por órganos oficiales disponibles en internet. Fueron incluidos los artículos científicos redactados en los idiomas inglés, portugués o español, publicados en los últimos 20 años, y que presentaran resultados relacionando sexualidad en la adolescencia, consejo y género. Fueron utilizados como descriptivos: "adolescencia", "consejo sexual", "comportamientos sexuales de riesgo", "creencias y mitos en la sexualidad", "género" y "sexualidad".
SÍNTESIS DE DATOS: Existen diferencias de género en las normas de comportamiento sexual y en los mitos o creencias en torno a la sexualidad. Basado en esas diferencias encontradas en la literatura, los autores innovan proponiendo un consejo dirigido al género.
CONCLUSIÓN: Los profesionales que realizan consejo a adolescentes deben estar listos para analizar, con perspectiva de género, las distintas situaciones o conflictos que éstos enfrentan y antever algunas creencias erróneas que los mismos tienen acerca de la sexualidad.

Resumo:
OBJETIVOS: tendo em consideração a importância do gênero no aconselhamento sexual e contraceptivo, o presente estudo visa: 1) descrever as diferenças da sexualidade e dos comportamentos sexuais dos e das adolescentes; 2) identificar as crenças e os mitos em cada gênero e as suas principais preocupações sobre a sexualidade em geral e a sua em particular e 3) auxiliar os profissionais de saúde no aconselhamento sexual segundo este enfoque.
FONTES DE DADOS: Este trabalho baseia-se na experiência clínica dos autores com os adolescentes e na revisão analítica da literatura de artigos científicos publicados nas bases eletrônicas SciELO and Pubmed. Outras fontes utilizadas foram dados publicados por órgãos oficiais disponíveis na internet. Foram incluídos os artigos científicos redigidos nos idiomas em inglês, português ou espanhol, publicados nos últimos 20 anos, e que apresentassem resultados relacionando sexualidade na adolescência, aconselhamento e gênero. Foram utilizados como descritores: "adolescência", "aconselhamento sexual", "comportamentos sexuais de risco", "crenças e mitos na sexualidade", "gênero" e "sexualidade".
SÍNTESE DE DADOS: Existem diferenças de gênero nas normas de comportamento sexual e nos mitos ou crenças em torno da sexualidade. Baseados nessas diferenças encontradas na literatura, os autores inovam propondo um aconselhamento direcionado ao gênero.
CONCLUSÃO: Os profissionais que realizam aconselhamento a adolescentes devem estar preparados para analisar, com perspectiva de gênero, as distintas situações ou conflitos que estes enfrentam e antever algumas crenças erróneas que os mesmos têm acerca da sexualidade.

INTRODUCTION

Sexuality and romantic and sexual experiences are part of the normal psychological and social development of teenagers, and are essential for establishing their personal identities. Together with the rapid physical and psychological changes of this phase, the typical characteristics of this age bracket (biological immaturity of the pre-frontal cortex and resulting impulsiveness) as well as the sporadic nature of such relationships leave this group more vulnerable to high-risk sexual behaviors, including limited use of contraceptive methods, with higher risks of sexually transmitted infections (STI) and unwanted pregnancies1.

Theoretically, today´s adolescents are freer in sexual terms, with greater gender equality, and easier access to information and contraceptive methods. However, in actual practice, we still see large numbers of unwanted pregnancies and STI in this age bracket1,2. One of the causes underpinning this situation seems to be the influence of myths and fallacies handed down from earlier generations, showing that they still cling to mistaken concepts related to sexuality in general and more specifically intercourse2,3. This prompts the need for greater investments by healthcare practitioners in providing teens with contraceptive and sex counseling.

Gender-related issues are vital for understanding power relationships in society, including those related to health and sexuality4. It is important to view gender as a determining factor for health during adolescence5. There are gender differences in the standards governing sexual behaviors3, with unequal and unfair gender relationships severely undermining the full development of sexuality and triggering specific characteristics and vulnerabilities6. Consequently, the authors believe that healthcare practitioners must acknowledge gender-related inequalities and differences in hands-on experiences of sexuality and sexual behaviors, in order to ensure successful counseling and steer their recommendations.

Bearing in mind the importance of gender for contraceptive and sex counseling, the main objectives of this paper are to: 1) describe differences in sexuality and sexual behaviors among adolescents; 2) identify beliefs and myths for each gender and their main concerns about sexuality in general and their own sexuality in particular; and 3) help healthcare practitioners provide sex counseling based on this approach.

Gender-based differences in sexuality and sexual behaviors among adolescents

It is important to distinguish between sex and gender. Sex refers to biological, anatomical, physiological and chromosomic characteristics that distinguish men from women. Gender is related to a set of ideas, beliefs and attributions that are constructed socially and culturally on the basis of sexual differentiation, encompassing concepts such as femaleness and maleness6. There are gender-related differences in sexual behavioral standards. During adolescence, boys and girls experience different feelings. For the latter, "must be" remains a social standard that links sexual experience to intimacy, love and tenderness, acknowledging that they make love more for love than for pleasure. Among boys, sexuality is centered on the genitals and they engage in intercourse simply for pleasure, with eroticism and emotion edged into the background. In brief, the most probable reasons prompting adolescent girls to become sexually involved are emotional intimacy while pleasing and keeping their partners, in contrast to adolescent boys who engage in intercourse simply for physical pleasure7,8.

Two studies were conducted in Portugal by the Aventura Social staff, in cooperation with the World Health Organization (OMS): the first was under the aegis of the Health Behavior in School-Aged Children (HBSC) project conducted in 2014 with adolescents from the 6th, 8th and 10th grades9; with the second project on Sexual and Reproductive Health Among University Students10, conducted in 2010 with young university students. Both of them showed significant gender-related variations.

Teenage boys and young men mentioned that they had sexual intercourse (SI) more frequently, becoming sexually active at younger ages; they reported casual partners and more frequent intercourse when under the effect of alcohol or drugs. In terms of condom use during the first SI, adolescent girls mentioned this use more frequently than boys, which was not noted among young men. These gender-related variations suggest that teenage boys and young men engage more frequently in high-risk sexual behaviors than teenage girls and /young women11, with these results confirmed by other studies4,7,12,13. Teenage girls and young women also demonstrated significantly greater general knowledge about Human Immunodeficiency Virus (HIV) than their male counterparts11. Several studies found that girls are tested more frequently for STI than boys, with the later avoiding responsibility and delegating the task of taking STI tests to their girlfriends; it was found that far more time had to be spent with the boys in order to encourage them to accept their own sexual responsibilities12,13. Most teen boys and young men disclosed a moderate to very positive attitude when asked whether they purchase or keep them easily available. However, girls encounter greater difficulties here than boys, admitting that they were embarrassed to buy condoms and expecting that their partners would have them to hand when required, not considering this part of the act as their responsibility6,11. This steps up female vulnerability, through losing the possibility of negotiating condom use with their sex partners. It was found that teen boys and girls both use condoms less frequently with steady partners in committed relationships, rather than with casual hook-ups5.

Gender-related differences in beliefs/myths and main concerns about sexuality among teens

One of the reasons identified for the lack of success of sex counseling are mistaken beliefs and / or myths among these youngsters, which are often forgotten or even unknown to healthcare practitioners, and are thus not addressed or demystified during appointments.

There are myths common to both genders, with the most frequent being: "It doesn't count as intercourse without penetration", "You can´t get pregnant with coitus interruptus", "You can´t catch STI through oral or anal sex", "You can´t get pregnant when menstruating", "You can´t get pregnant or catch an STI the first time you have sex", "You can´t get pregnant if you have sex in water"; and "Masturbation is bad for your health"2,3,13,14. There are gender-related differences in beliefs, myths and the main concerns of adolescent boys and girls about sexuality, outlined in Tables 1 and 22,3,13,15,16.






Gender and sex counseling for teens

In this paper, we do not address the contraceptive methods that are available to these youngsters, but rather refer to the guidelines issued by the Portuguese Adolescent Medicine Society, the Portuguese Pediatrics Society, and the Portuguese Contraception Society, published in Ata Pediátrica Portuguesa in 201417. We are talking about sex counseling for adolescents from a gender-based standpoint. Contraceptive and sex counseling may not be limited to specific consultations, in order to be effective. All healthcare practitioners working with adolescents and young people must make good use of all opportunities as they arise, doing so according to the best evidence-based practices, and providing that they have the expertise to address these issues. It is equally important to ensure privacy and confidentiality, creating a safe setting that is free of judgement and prejudice. Easy access and no-charge facilities are extra attractions.

In order to ensure that counseling is successful, it is not enough to explain what contraceptives are available, how to prevent pregnancy or avoid STI. This information is very important, but it has often proven insufficient to change teen behaviors18. Consequently, regardless of gender, other aspects of equal importance must be addressed, particularly: discovering the reasons prompting teens to have sex, allowing them to explain their concerns and doubts. Their intentions in terms of birth control and STI must be assessed, and before offering advice on contraception, it is necessary to discover prior and current barriers to contraception among them, together with concerns over secondary effects, assessing potential difficulties that could hamper compliance18. Talking about the reproductive anatomy of males and females would also be a good practice. Bearing in mind that teens do not usually tell practitioners about their real concerns or doubts, healthcare practitioners must look ahead and address these issues, taking advantage of these occasions to demystify the most frequent gender-based beliefs.

Depending on time availability, in one or more appointments, a meticulous and complete sexual history must always be obtained. It is stressed that the practitioner must record these histories without assuming any sexual orientation for these youngsters, and certainly without assuming heterosexuality: sexual preferences must be assessed in a neutral manner. Table 3 lists the most important items to be addressed while taking these histories, regardless of gender14,17,18,19,20.




As already described, there are gender-related differences in sexual behaviors, which is why the authors propose that counseling should be gender-steered (Table 4). When counseling boys, it must be borne in mind that they become sexually active at earlier ages, associated with lower probabilities of using protection against unwanted pregnancy and higher probabilities of STI, also associated with a larger number of sexual partners during their lives19. Consequently, sex education for boys must begin during their early teens, or at even younger ages: it is known that when sex education is provided before the first sexual experience, this tends to be delayed, with lower probabilities of high-risk sexual behaviors20. Understanding that boys engage more frequently in high-risk behaviors, particularly less frequent condom use during the first SI, with more sex partners of both genders, and frequently have sex when impaired by alcohol and / or other drugs, it is important to underscore the importance of condom use, telling where they can be acquired free of charge. Boys also show less general knowledge about HIV and other STI, meaning that more time must be spent talking to them on these topics, as it is vital to encourage them to feel greater concern with better understanding of heightened risks for STI, in order to avoid adverse effects on their own health or that of other people12.




When counseling girls, they must be asked about the age of menarche, menstrual patterns, previous pregnancies and their consequences. If already sexually active, it is important to know the age at which this occurred: if very young, this is significantly associated with higher risks of pregnancy18. Pain during intercourse and questions about orgasm must be included and demystified. A problem that is relatively common among girls is peer or partner pressure to become sexually active. Consequently, healthcare practitioners must anticipate and address this matter, discussing strategies for dealing with these pressures. In several studies, girls have showed greater difficulties in buying condoms or carrying them around; this is one of the reasons that often hampers negotiation of condom use with their partners, which is why it is important to explain to them that this leaves them more vulnerable and hampers the possibility of negociation6. Finally, practitioners must explain the main myths, beliefs and concerns addressed in Tables 1 and 2, adapting their approach to each gender.


CONCLUSION

Adolescence is a crucial period for the formation of sexual identity and sexual culture of individuals, meaning that it is extremely important to discover perceptions of sexuality among adolescent boys and girls6. It has been noted that although these youngsters have access to information, their behaviors often remain unaltered, particularly inadequate use of contraceptive methods11. This may be explained through mistaken beliefs, meaning it is important for healthcare practitioners to be aware of the most common misconceptions, approaching and clarifying them. It is important to view gender as a determining factor for adolescent healthcare5, including health and sexuality6. Sex-related feelings, concerns and behaviors that appear during this phase are different between boys and girls, underscoring the importance of counseling from a gender-steered standpoint. In conclusion, practitioners counseling teens must always do so from a gender-based standpoint, being well prepared to straighten out mistaken beliefs about sexuality.


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