INTRODUCTION

Adolescence, which according to the World Health Organization corresponds to the age group between 10 and 19 years, is marked by changes that encompass several areas: physical, emotional, mental, sexual and social ¹ . During this period, social and gender inequalities are important causes of the spread of risky sexual behavior and lead to a greater chance of acquiring sexually transmitted infections (STIs) or unwanted pregnancy ² . It is known that adolescents who do not receive information about STIs and/or information on preventing pregnancy are at greater risk of having unprotected sex ³ .

The precarious access to information by young people in vulnerable situations justifies actions that aim to enlighten them about sexuality and alert them to the risks of practicing unsafe sex ⁴ .

Thus, educational actions aim to transmit information about puberty and its changes, as well as guide them on the use of condoms and clarify doubts related to sexuality.

METHODS

This is a cross-sectional and descriptive study about an outreach action carried out with a group of young people in a situation of social risk in which the topics of puberty and sexual education were addressed. This study design was developed based on a humanization project of the Department of Pediatrics of the ABC School of Medicine (FMABC), and had the support of social work and psychology professionals from the Institute of Hebiatrics for planning and execution. Under technical supervision, second-year medical students carried out dynamics with prepubescent children and adolescents treated at the Irmã Marli Charitable Institution, located on the outskirts of the city of Santo André, São Paulo.

Ethical issues

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

Procedures

The dynamic was selected from the book “Group Dynamics on Sexuality” ⁵and consisted of the collective creation of a human figure with physical, social and psychological characteristics designed for prepubescent and adolescent females 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 with body changes, desires and doubts.

Participants over 10 years of age 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 to use it, a tutorial on barrier contraceptive methods was presented, with an emphasis on the male condom.

Statistical analysis

The data obtained were gathered and analyzed considering the following variables: age, perception and understanding of body transformations, result of the drawing and the way it was made, in addition to information about reproductive and prevention aspects.

Categorical data were described by frequency and percentage. The age of the groups and the sample were described by means of mean and standard deviation, median and percentiles, depending on the parametric or non-parametric distribution of the data, determined by the Shapiro-Wilk Normality Test. For this purpose, 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 it was 10 years (27% of the sample). The mean 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 great deal of participation from the girls during the activity. Regarding information about the doll, such as name, age, and place of residence, the participants easily reached a consensus among themselves, by voting on items in which more than one opinion was expressed. When asked about their bodies and future changes that the doll would undergo, the girls were eager to talk about the subject, especially about their first menstruation and the use of a bra, and at that moment they projected questions related to such events in which the participants asked the researchers about their personal experiences.

None of the girls in Group 1 had menstruated, just as none of them had had contact with sanitary pads, and all of them expressed that they did not have the time for this type of conversation at home. Some types of sanitary pads were presented and they received instructions on how to use them and on hygiene during the menstrual period.

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

In Group 2, there was favorable participation from the group as a whole and during the dynamics, the adolescents were able to transfer characteristics of the doll to themselves, bringing their own doubts and impressions in a heterogeneous way 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 where there was initial disagreement, the participants themselves suggested voting.

There were no major doubts 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 menstruate.

The guiding questions that most aroused the adolescents’ interest were about relationships. Despite initial embarrassment, the participants talked about their own feelings, always comparing themselves to their peers. One of the girls asked why her mother forbade her from kissing boys. Despite this, more than 50% of them had already had their first kiss.

One of the adolescents reported being in a serious relationship for more than 6 months, with sexual intercourse. Family structure was also discussed, and, similarly to Group 1, the girls stated that they did not have 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 clarify any doubts they had about how to put on a condom, as well as the appropriate time to do so.

DISCUSSION

During the dynamics, heterogeneity was observed between the groups. In group 2, a great projection of the young women onto the doll was noted, since they reported characteristics present in their reality. On the other hand, in group 1, possible dreams and fantasies of the girls were noted, and a lesser identification.

In group 1, there was greater interest in female physiological issues such as the use of sanitary pads and bras. Thus, compatible with the onset of the pre-pubertal phase, group 1 presented characteristics of the initial stage of adolescence, which is marked by this great interest in one’s own body ^6-8 . Regarding relationships, little interest was observed, since the doll in this group was described as having no romantic interest ^9-11 .

In group 2, there was greater interest in interpersonal relationships, especially romantic ones. Thus, the sexuality of the adolescents was shown to be broader, including the desire for contact, warmth, affection or love ¹² . The teenager who reported being in a serious relationship and sexually active, like the others, was advised about the importance of using condoms.

It is known that young people’s lack of information about sexual education issues is related to the increase in teenage pregnancy and STIs. ¹³. It was clear from the dynamics applied that dialogue should be encouraged, since the lack of information or inadequate information can compromise the natural growth process, as well as physical and emotional development, and may lead to consequences such as those already mentioned. Thus, sexual education can be provided in several ways, from the simplest to frank and facilitative dialogue, without further complications.

Although the educational activity presented satisfactory results, limitations are recognized due to the small number of participants and the limited time of the action ¹⁴ . Thus, it is worth emphasizing that future actions are necessary to continue the educational work, deepening the topic according to the understanding of the target audience. It is worth emphasizing that almost all of the professionals involved in this study were female, which may have facilitated the participants’ openness to carrying out the dynamics. In addition, it is considered essential that activities be developed with the purpose of stimulating a welcoming environment free of taboos and that encourages conversations about the topic in the family environment.

CONCLUSION

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