Revista Adolescência e Saúde

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

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 3 - Jul/Sep - 2019

Original Article Imprimir 

Páginas 17 a 22


Educational activity on sexual and reproductive health for at-risk girls

Actividad educativa sobre salud sexual y reproductiva para niñas en riesgo

Atividade educativa em saúde sexual e reprodutiva para meninas em situação social de risco

Autores: Karine Corcione Turke1; Paulo Afonso Ribeiro2; Camila Sando3; Graziella Luciano Antonio4; Victoria Cassioti Teodoro5; Lígia de Fátima Nóbrega Reato6

1-5. Medical student at the ABC School of Medicine (FMABC). Santo André, SP, Brazil
6. Doctorate in Medicine from the Faculty of Medicine at the University of São Paulo (USP). Teacher of the Pediatrics Department at the Medical School of ABC (FMABC). Santo André, SP, Brazil

Karine Corcione Turke
(karineturke@hotmail.com)
Faculdade de Medicina do ABC - FMABC
Av. Lauro Gomes, 2000 - Vila Sacadura Cabral
Santo André - SP, Brasil. CEP: 09060-870

Submitted on 11/30/2018
Approved on 3/18/2019

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How to cite this article

Keywords: Adolescent; Sexuality; Sex Education.
Palabra Clave: Adolescente Sexualidad; Educación sexual
Descritores: Adolescente; Sexualidade; Educação Sexual.

Abstract:
OBJECTIVE: Describe an educational action about the sexuality theme for girls supported by a charitable institution in the periphery of the metropolitan region of São Paulo.
METHODS: The participants in risky situation were divided into 3 groups: group 1 (8-9 years) and group 2 (10-13 years), and the teens were stimulated to draw a doll, attributing to it characteristics under guiding instructions. After the dynamic, a Tanner Staging poster was presented and the group talked for questions and possible doubts.
RESULTS: While group 2 was at first shy, group 1 was curious and receptive. In the course of the dynamics, group 2, when feeling secure, started sharing more intimate facts such as interpersonal relations. Group 1, on the other hand, had doubts about the body development and physiological processes such as menstruation.
CONCLUSION: There was favorable participation of both groups besides good receptivity. The action became effective as doubts were answered. Thus, actions like this are necessary to promote the health and physical and psychological well-being of young people in situations of greater social vulnerability.

Resumen:
OBJETIVO: Describir una actividad educativa sobre el tema sexualidad para adolescentes pre-púberes y mujeres tratadas en una organización benéfica ubicada en las afueras de la región metropolitana de São Paulo.
MÉTODOS: los participantes en riesgo se dividieron en dos grupos: grupo 1 (8-9 años) y grupo 2 (10-13 años) y se les animó a diseñar una muñeca siguiendo las instrucciones de orientación. Después de la dinámica, hubo una presentación de la estadificación de Tanner, y también hubo una rueda de conversación para aclarar dudas.
RESULTADOS: Mientras que el grupo 2 era inicialmente tímido, el grupo 1 era curioso y receptivo. En el curso de la dinámica, el grupo 2, sintiéndose más seguro, comenzó a informar hechos más íntimos, como las relaciones interpersonales. El grupo 1 había dudas sobre el desarrollo corporal y los procesos fisiológicos como la menstruación.
CONCLUSIÓN: hubo participación favorable de ambos grupos y buena receptividad. La acción se hizo efectiva en la medida en que se respondieron las preguntas. Por lo tanto, tales acciones son necesarias para promover la salud y el bienestar físico y psicológico de las mujeres jóvenes en situaciones de mayor vulnerabilidad social.

Resumo:
OBJETIVO: Descrever uma ação educativa realizada sobre o tema sexualidade para pré-púberes e adolescentes do sexo feminino atendidos em instituição beneficente localizada na periferia da região metropolitana de São Paulo.
MÉTODOS: As participantes em situação de risco foram divididas em dois grupos: grupo 1 (8-9 anos) e grupo 2 (10-13 anos) e foram estimuladas a desenhar um boneco, sob instruções norteadoras. Após a realização da dinâmica, houve uma apresentação do Estadiamento de Tanner, havendo também uma roda de conversas para esclarecimento de dúvidas.
RESULTADOS: Enquanto o grupo 2 se mostrou, a princípio, tímido, o grupo 1 se mostrou curioso e receptivo. No decorrer da dinâmica, o grupo 2, ao sentir maior segurança, começou a relatar fatos mais íntimos, como relações interpessoais. Já o grupo 1 apresentou dúvidas em relação ao desenvolvimento corporal e processos fisiológicos tal qual a menstruação.
CONCLUSÃO: Houve participação favorável de ambos os grupos além de boa receptividade. A ação se tornou efetiva na medida em que dúvidas foram respondidas. Assim, ações como essa se fazem necessárias para promover a saúde e o bem-estar físico e psicológico das jovens em situação de maior vulnerabilidade social.

INTRODUCTION

Adolescence, which according to the World Health Organization corresponds to the age group between 10 and 19 years old, is marked by changes that cover several fields: physical, emotional, mental, sexual and social1. In this period, social and gender inequalities are important causes in the spread of risky sexual behavior and lead to a higher chance of acquiring sexually transmitted infections (STIs) or unwanted pregnancies2. It is well known that adolescents who do not receive information about STIs and/or information about pregnancy prevention are at higher risk of having unprotected sex3.

The precariousness of access to information by young people in vulnerable situations justifies actions aimed at clarifying them about sexuality and alerting them to the risks of unsafe sex4.

Thus, educational actions aim to convey information about puberty and its transformations, as well as guide them to the use of condoms and clarify them about questions related to sexuality.


METHODS

This is a cross-sectional and descriptive study about extension action carried out with a group of socially at risk youth in which the themes puberty and sex education were addressed. This study design was developed from a humanization project of the Department of Pediatrics of the ABC School of Medicine (FMABC), and was supported by social care and psychology professionals from the Institute of Hebiatry for planning and execution. Under technical supervision, second-year medical students undertook dynamics with pre-pubertal and adolescent children treated at the Sister Marli Beneficent Institution, located on the outskirts of Santo André, São Paulo.

Ethical issues

Contact was made with the coordinators, as well as a previous visit to the institution prior to project implementation. Written consent was also requested and the Consent and Informed Consent sent to the legal guardians, as well as the Consent Form to the participants. The study was approved by the FMABC Research Ethics Committee under CAAE nº. 90038018.3.0000.0082. The study included girls who were present on the day of the action and who agreed to participate in the dynamic. Participants were divided into age groups of 8 and 9 years (Group 1) and 10 to 13 years (Group 2), all being female, attended by the Institution.

Procedures

The dynamic was selected from the book "Group Dynamics on Sexuality"5 and consisted of the collective making of a human figure containing physical, social and psychological characteristics designed for pre-pubertal and female adolescents of different age groups. During the action, guiding questions were answered about the demographic characteristics of the doll produced, as well as about its imagined relationship about body changes, desires and doubts.

Participants older than 10 years answered questions about sexual initiation, dating, risks and doubts regarding the exercise of sexuality. After group discussion and clarification of doubts, the Tanner Staging was explained to them and, for those who chose, a tutorial on barrier contraceptive methods was presented, with emphasis on the male condom.

Statistical analysis

The data obtained were collected and analyzed considering the following variables: age, perception and understanding of body transformations, the result of the design and the way it was done, as well as information about the reproductive and prevention aspects.

Categorical data were described by frequency and percentage. The age of the groups and the sample were described by means and standard deviation, median and percentiles, depending on the parametric or non-parametric distribution of the data, as determined by the Shapiro-Wilk Normality Test. For this, the statistical program R version 3.2.1 was used.


RESULTS

Eighteen girls were included (Table 1), eight from group 1 (44%) and 10 from group 2 (55%). In group 1, the most prevalent age was nine years, corresponding to 33% of the sample, and in group 2 was 10 years (27% of the sample). The average age was 9.83 years in the total sample, 8.75 years in group 1 and 10.7 years in group 2.




Regarding the dynamics, in Group 1 there was a large participation of girls during the activity. For information about the doll, such as name, age, place of residence, participants reached an easy consensus among themselves by voting on items in which more than one opinion was expressed. When asked about the body and the future changes that the doll would go through, the girls were eager to talk about it, especially about the first menstruation and the wearing of bra, and at that moment projected questions related to such events where participants questioned the researchers about their personal experiences.

None of the girls in group 1 had menstruated, nor had any of them had contact with tampons, and all expressed that they were not available for such conversations at home. Some types of tampons were presented and they received guidance on their use and hygiene during the menstrual period.

Most were curious about hair growth, distribution and quantity. At the end of the dynamic, one of the girls asked what "vagina" meant, a term often used by educators.

In Group 2, there was a favorable participation of the group as a whole and throughout the dynamics; the adolescents were able to transpose characteristics of the doll to themselves, bringing their own doubts and impressions heterogeneously to the discussion, guiding the aspects of the conversation. The answers about the doll (Table 2) were elaborated in consensus with the whole group, in those topics in which there was initial disagreement, the participants themselves suggested voting.




No major doubts were reported about physiological events such as menstruation in this group, since only one adolescent had not yet menstruated. However, one of the girls asked if boys would also have their periods.

The guiding questions that most aroused the interest of adolescents were about relationships. Despite initial shame, the participants talked about their own feelings, always comparing themselves with their colleagues. One of the girls wondered why her mother forbade her to kiss the boys. Despite this, more than 50% of them had already given the first kiss.

One of the teenagers reported being in a serious relationship for more than 6 months with sexual intercourse. It was also discussed about family structure, and, similarly to Group 1, the girls reported not having this type of conversation at home.

At the end of the dynamic the two groups were brought together and the two types of condoms (female and male) were presented, as well as the Tanner Staging. The girls were able to clear all doubts about how to put on the condom, as well as the right time for it.


DISCUSSION

During the dynamics, the heterogeneity was noticed between the groups. In group 2, we noticed a large projection of the girls in the doll, as they reported characteristics present in their reality. On the other hand, in group 1 there were possible dreams and fantasies of girls, and a lower identification.

In group 1, there was greater interest in female physiological issues such as wearing a tampon and bra. Thus compatible with the onset of the pre-pubertal phase, group 1 presented characteristics of the early stage of adolescence, which is marked by this great interest in the body itself6-8. Regarding relationships, little interest was observed, since the doll of this group was described as having no love interest9-11.

In group 2, there was greater interest in interpersonal relationships, especially love. Thus, the sexuality of the adolescents was broader, comprising the desire for contact, warmth, affection or love12. The adolescent who reported being in a serious relationship and with sexual activity, as well as the others, was told about the importance of condom use.

It is well known that the misinformation of young people about sexuality education issues is related to the increase of teenage pregnancy and STIs13. It was clearly perceived through the applied dynamics that dialogue should be stimulated, since the lack of inadequate information or information can compromise the natural process of growth beyond physical and emotional development, and may have consequences, as already mentioned. In this way, sex education can take place in many ways, from the simplest ones through frank and facilitative dialogue and without further complications.

Although the educational activity has presented satisfactory results, limitations are recognized by the small number of participants and limited time of action14. Thus, it is noteworthy that future actions are necessary to continue the educational work, deepening the theme according to the understanding of the target audience. It is noteworthy that almost all professionals involved in this study were female, which may have facilitated the opening of participants to perform the dynamics. In addition, it is considered essential that activities be carried out to stimulate a cozy, taboo-free environment and to foster conversations on the subject in the family environment.


CONCLUSION

There was favorable participation from both groups and good receptivity. The action became effective as questions were answered regarding pubertal development, condom use and interpersonal relationships. Thus, actions such as these are necessary to promote the health and physical and psychological well-being of young women, especially those in situations of greater social vulnerability.


REFERENCES

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13. Ferreira EA. A expressão de adolescentes sobre sexualidade, saúde reprodutiva e métodos contraceptivos no município de Macapá [dissertação]. Niterói (RJ): Universidade Federal Fluminense; 2017

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