Puberty and body anatomy 

In this section, we explain the parts into which our genitals are divided and what they are used for. We will start from defining puberty, as the moment when “your body goes from being a kid to an adult”: such changes happen overtime, in general between ages 8 and 14 (AFAB – assigned female at birth – persons often start puberty before AMAB – assigned male at birth – persons do), and quite slowly, not all at once, and more importantly, in very different ways – bodies are unique, as puberty is! 

What happens to your body during puberty? This video, created by Planned Parenthood, explains everything about those changes:

Puberty affects your body and your emotions, and as all “changes”, may be lived as a stressful, ashaming and confused step: the first advice we would give you is not to worry! Everything is healthy and right. Another tip is to try to find people who you trust and can confide in, whether it’s a close friend, educator or family member, and eventually ask for professional advice – you’ll find some info on this below.

Now let’s see the parts into which our sexual anatomy is divided and their functions:

People with vulva/uterus/ovaries

Remember that each vulva is unique and that virginity is a social construct! Go and read more about it in module 5 

People with penis/scrotum/testicles

Intersexuality and anatomy

Genitals and sexual characteristics can have some variations: we are talking about intersex people. They can have variations of chromosomes, hormone levels, genitalia (ambiguous genitalia).

Some can be:

• Congenital adrenal hyperplasia (CAH): XX individuals with “masculinized” genitalia, “masculine” characteristics at puberty;
• Androgen Insensitivity Syndrome (AIS): XY individuals with “feminised” genitalia, can develop “feminine” body shape;
• Turner Syndrome: only X chromosome (XO)
• Klinefelter Syndrome: extra X chromosome (XXXY)

According to some studies (vd. Anne Fausto Sterling) intersex people are 1,7% of the population – it’s almost the same percentage of people with red hair in the world! Sometimes they don’t have a “diagnosis” until adulthood, sometimes a diagnosis is made because some condition brings infertility. An intersex person may have any gender identity (see module 2).

In most countries intersex people are assigned at birth to one or other sex (M/F).

A very important topic for the LGBTQIA+ community and specifically the intersex community is the topic of genital surgery on intersex people: in many countries, surgical operations are performed on newborns to make the genitals more similar to a vulva or a penis, in order to assign a sex to the person. This is problematic because the person did not have a choice and often this surgery is not performed for health issues.

Intersex conditions are variations of the cultural binary, not a disease, although some conditions could cause syndromes and discomfort, there are a huge number of different sex characteristics.

Anatomy of people with vulva and pleasure

Anatomy of people with vulva and acknowledgment on how their genitalia works have been a mystery for decades and still today there is a gender gap in medical and health research, with consequences on women and people with vulva sexual health and knowledge around female pleasure. 

In 2005 the Australian urologist Helen O’Connell studied and discovered the full anatomy of the clitoris, the organ whose function is entirely meant for giving pleasure. The results of her study “Anatomy of the clitoris” (O’Connell et al., 2005) showed that the typical textbook descriptions of the clitoris didn’t provide detailed information about this organ and also included inconsistencies. Helen O’Connell discovered that the whole clitorial cluster, made of really sensitive erectile tissue, is the key to sexual function and orgasm of people with vulva. Also: there are more similarities between the structure of the clitoris and the structure of the penis than differences; that’s not only interesting, but it also points out how scientific progress could have been done simultaneously in the medical and wellness fields, being neglected and biased by gender discrimination instead.

From this point on, social, political and medical discussion have taken new directions about sexual wellness and pleasure, highlighting the obscurantism based on gender discrimination for women and people with vulva. 

What about self-exploration? Differently from the penis, the vulva is also harder to explore. It is located on the body in a way that requires the use of a mirror and or a speculum. In addition, due to patriarchy, women have been sexually censored by society for ages, in a way that affected their freedom to explore it and get to know it as a source of pleasure, or live their enjoyment without fear, shame or guilt. Still today there is great ignorance around female pleasure and many cisgender women and people with vulva rarely reach the orgasm. Heterosexual cisgender women are the ones that have less orgasms of all: only in 65% of cases. 

Now we’re seeing a wider public discourse that centres pleasure, personal experiences and preferences, adding nuances and in-depth analysis on sexuality that move away from phallocentrism and gender invisibilization. 

Menstruation

A term not well-known is menarche. This is the very first time that people with uterus  will get their period. From that time one, a cis girl or a person with a uterus can get pregnant after sexual intercourse. This time is estimated between 11-16 years old. 

In order to understand how this process starts and continues for people with uterus, we need to examine menstruation. Menstruation, in common terms “period”, happens when blood tissue comes out of the vagina, usually every month. 

Your menstrual cycle is controlled by hormones like estrogen and progesterone. In simple terms: You have 2 ovaries, each with tiny eggs. Hormones make the eggs mature, ready to be fertilised. They also make the uterus lining thick for a possible pregnancy. Midway through your cycle, hormones trigger ovulation, releasing a mature egg. You might feel bloated or in some pain. If the egg isn’t fertilised, the thick uterus lining breaks down, and blood and tissue flow out through your vagina. This is the way for your body to tell you that you are not pregnant.

Be careful though! Having your period does not mean that you cannot get pregnant. Ovulation typically occurs approximately 14 days before the onset of your period, though individual bodies vary. The timing may be earlier or later based on the length of your menstrual cycle. Once released from the ovary, an egg survives for about 1 day, while sperm can persist in the uterus and fallopian tubes for approximately 6 days after intercourse. This means there’s a potential window of around 6 days in each menstrual cycle during which pregnancy can occur. In order to be prepared about your menstrual cycle, you can keep track of your ovulation days on apps or in a calendar. Of course, when the time comes, it is important that you are equipped with period products to absorb the blood flow, like pads, tampons and reusable panties and cups. 

Girls, trans boys, nonbinary people and other people who menstruate don’t receive adequate information prior to their menarche! Also, the message that is transmitted to the girls and other menstruating people is that once the period arrives, they are not girls or kids any more, but grown-ups. This idea totally disorients them as it seems that their personality should change at the drop of a hat, with all of those behaviours that were accepted just before menstruation are no longer correct. Also, while it is a fact that the menarche determines the beginning of fertility, it is very common to hear a discourse exclusively based on the fear of an unplanned pregnancy.

In this sense, CSE along with menstrual education ensure that menstruating young people receive all the information on: 

• the available products to manage their bleeding; 
• the implications that becoming cyclical has for the physical, emotional and sexual well-being; 
• the considerations to take into account regarding cyclicity and fertility so that each one achieves the highest level of body awareness, self-knowledge and empowerment.

What is also important to recognise is that menstruation is nothing to feel embarrassed about but rather something to be prepared for. Periods can be experienced way differently by each person. Symptoms like pain cramps, muscle pain and mood swings are quite common. Feel free to cry, get cozy with warm blankets or exercise during your period cycle. There are times that people with vulva will experience excessive pain or other symptoms that cannot be directly connected to your period. Do not worry, you are not alone! Worldwide, 26% of people with a vulva has chronic intimate pain and suffer from the so-called “silent illnesses” that cause them such pain or other symptoms, such as excessive blood flow, and may makes life very hard interfering with the most simple everyday activities, such as having sex or working at full strength, impacting physical and mental health. One of these silent illnesses is endometriosis: according to statistics, 1 out of 5 people with uterus have it, but it takes up to 8 years for a person with uterus to be diagnosed with endometriosis.  A common symptom is pain in the lower part of the belly (pelvis). Pain may be most noticeable: during a period, during or after sex, when urinating or defecating. In some other cases, there are no clear symptoms and the diagnosis arrives by chance.

Another silent illness is vulvodynia. As the name of the illness reveals, vulvodynia is causing unexplained pain in and around the vulva. Some steps you can follow in order to reduce the symptoms are the following: 

• Opt for cotton underwear and loosely fitting skirts or pants. 
• Steer clear of scented hygiene products, including feminine wipes, bubble bath, and soap;
• Alleviate discomfort by applying chilled gel packs to the vulva. 
• If sexual activities are something you want to do, it may be useful using a water based lube (be careful because a lot of lubes are not good for your genitals, ask an expert!
• Prior to swimming, apply petroleum jelly to shield the vulva from chlorine. 
• Avoid completely or vulva touching, as it may heighten sensitivity. 
• If intercourse is painful, explore more comfortable positions or engage in alternative intimate activities until seeking advice if penetration remains painful. 
• Work on reducing stress, as it can amplify vulvodynia-related pain. 
• To ease sitting discomfort, use a cushion with a doughnut-shaped design.

Abortion

Abortion is the intentional termination of a pregnancy, resulting in the removal or expulsion of the foetus. It can be achieved through medical methods (using medications) or surgical procedures. Contrary to what it could be considered, abortion has not to be a traumatic experience and access to safe and legal abortion services, as well as supportive healthcare and counselling, is crucial for people with uterus’ reproductive rights. Here’s the different methods: 

• Medical: Involves the use of medication to terminate a pregnancy. Typically, a combination of drugs, like mifepristone (a drug that blocks progesterone) and misoprostol (a drug that induces uterine contractions to expel the pregnancy). Usually performed within the first 10 weeks of pregnancy; effectiveness is high.
• Surgical: Involves a procedure to remove the pregnancy from the uterus, for example: suction aspiration (done by a sort of little tube inserted in the uterus to which a valve pumps the air in that creates a suction to remove the tissue), or dilation and curettage (D&C) (the cervix is dilated and the “curette” – a sort of spoon-shaped tool – is inserted in the uterus to remove tissue). Surgical methods could be performed in different stages of pregnancy but it strongly depends on legislative regional laws. 

Following the data given by reproductiverights.com, there are 5 main categories in which laws concerning abortions are developed:

Sexually transmitted infections (STIs)

Sexually transmitted infections (STIs) are primarily transmitted through unprotected sexual intercourse, as well as through contaminated blood or blood products and they can also be spread during pregnancy from the pregnant person to the foetus, childbirth, and breastfeeding. The term STI has been used in the past years more commonly than STD, as “disease” brings a heavy load of stereotypes and negative assumptions (e.g. that it refers to something incurable), and above all may be not correct at all in some cases (e.g. HIV is different from AIDS). 

Common Sexually Transmitted Infections (not exhaustive list)

Talk to professionals, but also to your partners!

about the different barrier methods (see section below), the possibilities of vaccination, and measures such as PREP/PEP

Test yourself!

Although some people might have symptoms of a STI, in many instances STIs have no visible symptoms. The only way one might know that they have STIs is through testing!

Treat, with no fear

If you test positive for an STI, don’t worry: all STIs are treatable. 

Other suggestions:

• Use lubricants (be aware that not all lubes are ok for condoms, water based and silicon based are ok)
• If sex toys are involved and shared with partner, is important to put a condom on or cleaning it: sex toys can be vehicle of STI

Barrier methods and Contraception

While terms “safe sex” and “safer sex” are used interchangeably, it is nowadays more accurate to use the latter. Any sexual intercourse entails a risk and thus, there is no 100% safe sex. Also, the term “safe sex” can lead to a misconception and avoidance of communication between two (or more) sexual partners. There is a difference between barrier methods and contraceptives: the first are all those medical devices that are commonly available (you can find them in shops and supermarkets without a medical prescription) to prevent STIs (sexually transmitted infections); the latter are medical devices to prevent pregnancies, sometimes available without prescriptions, sometimes needed instead. Sometimes the two categories overlap, meaning that what works as a barrier method also protects from pregnancies, doing both preventive and contraceptive methods.

List of the most common barrier methods and contraceptives

Condoms: condoms are membranes of different materials (latex, polyurethane, polyisoprene) that act like a barrier around or inside genitals. They are distinguished in two categories:

• External condoms: commonly known as “male condoms” are those meant to be worn by people with penis; they can be made of different materials (also hypoallergenic), different sizes, different colours, different flavours…
• Internal condoms: commonly known as “female condoms” are those meant to be worn by people with vagina.

While external condoms could be worn in a few moments before the sexual intercourse, internal condoms could be worn even some hours before; as the internal condoms must fit the vaginal canal, you can differentiate them from the external ones because they are stored in a singular bigger pack. 

You can find external condoms mostly everywhere: drugstores, shops, supermarkets and their cost is pretty much affordable. Unfortunately, we can’t say the same for the internal ones: they are difficult to find and their cost is unfairly high; you can find them online and via some drugstore probably with a specific order required.
Every condom, external or internal, must be used once per sexual intercourse: they are disposable and you can’t use it the same, multiple times.
You should be careful about possible allergies due to the material and choose wisely which condom is proper for your health. Condoms are both a barrier method and contraceptive as they are meant to contain semen and other body fluids to avoid sexually transmitted infections and risk of unwanted pregnancy.

• Dental dam/ oral dam: the dental dam, also called “oral dam” is a latex rectangular used for practising oral sex safely: you just have to put on the genital or anal area you’re going to stimulate to use it as a barrier to avoid STIs. Dental dam is just a barrier method. Since it’s not always easy to find, it can be “made” by cutting a condom in half.

Birth control pills: birth control pills are oral contraceptives to take in order to inhibit ovulation and thicken cervical mucus (see menstruation paragraph), typically estrogen or progestin. That means that these pills act like a suspender for the fertility phase of the menstrual cycle. Birth control pills have to be prescribed by a healthcare provider after some texts to understand which kind of pills suit you better according to your health situation and benefits. Birth control pills are contraceptives, not a barrier method: they do not protect from STIs.

In some countries, hormonal contraceptive pills are prescribed to be taken for three weeks consecutively, followed by a one-week pause to coincide with menstruation. The pause week, often referred to as a “withdrawal bleed“, mimics a menstrual period but is not biologically necessary.  Modern research suggests that continuous pill use without a pause may be equally safe and effective, reducing the risk of unwanted pregnancies associated with the pause week. Let’s check the main differences between the two methods: 

Birth control pill with “withdrawal bleed pause”:

• Taken for 21 days consecutively.
• Followed by a 7-day pause for a withdrawal bleed (mimicking a menstrual period).
• The pause is a traditional practice influenced by historical and cultural factors.
• During the pause, hormonal levels drop, leading to a withdrawal bleed.

Birth control pill as a continuous taking:

• Eliminates the withdrawal bleed and continuous hormonal levels are maintained.
• Reduces the risk of missed doses during the pause week, enhancing contraceptive reliability.
• May offer benefits such as reduced menstrual symptoms and pain.
• Equally effective in preventing pregnancy compared to cyclic use.

Some cultural traditions and early contraceptive pill formulations influenced the first pattern, more rooted in historical practices and cultural beliefs (see module 5) rather than medical necessity. Up to now, the second one is largely supported by progressive medical practices and research; nonetheless the choice depends on individual preferences.

Emergency pill (morning-after pill): as you can assume by the name, this pill is the one you take after having unprotected sexual intercourse and you’re at risk of unwanted pregnancy; it could happen you need to take one of them because condoms broke or you or your sexual partner forgot to the daily birth control pill. This pill is most effective when taken as soon as possible after unprotected intercourse: can be taken up to 72 hours (some types up to 120 hours) after unprotected sex. It works the same as the birth pill, so its function is to inhibit the ovulation and delay all the menstrual cycle as it commonly goes. If you’re a person with uterus you may want know this: both birth control pills and emergency pill influence your menstrual cycle in a way that could feel a little discomfort in the beginning: since they both work on delaying ovulation, everything in your menstrual cycle adapt to the changes and reset, that means that your periods could anticipate or come be late according to your original habits. This is nothing to panic about, just consider consulting your trusting health provider to choose what’s best for you. As birth control pills, this pill is contraceptive, not a barrier method: it does not protect from STIs.

Contraceptive patch: it’s literally a patch, waterproof, you can put on your body, typically on the abdomen, it works via hormones absorbed by the skin, it releases estrogen and progesterone. It also acts on the menstrual cycle the same way birth control does. A new patch is applied weekly for three weeks, followed by one week without a patch. You need a prescription to start using it and it does not protect you from STIs.

Contraceptive ring: is a flexible ring meant to be inserted in the vagina and it releases hormones to delay ovulation. You can insert it autonomously and it has to be changed every three weeks plus a suspension week (you don’t have to put it on while having your period, and you can replace a new one when periods end). Also need a prescription and neither does it protect you from STIs.

Intrauterine device (IUD): it’s a small, T-shaped device inserted into the uterus by a healthcare professional to avoid unwanted pregnancies (it does not protect from STIs). There are two types: 

• Copper IUD: it has no hormones, it releases copper that creates an unhospital environment for sperms; it is effective up to 10 years.
• Hormonal IUD: it releases progestin, inhibits ovulation, thickens cervical mucus, and alters the uterine lining. It is effective for up to 3 to 7 years. 

IUD is immediately effective as contraception after insertion; up to now there is no rate of inefficiency. It is suitable for people with uterus that want a long-lasting contraception and it is reversible, meaning that whenever someone decides to interrupt this contraceptive method it is possible to. 

Contraceptive implant: is a flexible plastic rod placed under the skin of the arm. The implant releases hormones, and it lasts at least 3 years. It’s reversible.

Permanent contraceptive Methods: permanent contraceptive methods are those chosen to avoid unwanted pregnancy permanently (they do not protect from STIs). There are mainly two types and both of them are surgical interventions. 

Tubal ligation: for people with uterus. It consists in a surgical sealing of the fallopian tubes. It prevents the fertile egg from travelling through the fallopian tubes to meet the sperm. Once choosing these contraceptive methods, there is no need for other kinds of methods.

Vasectomy: for people with penis. It consists in a surgical blocking of the vas deferens, the tubes that carry sperm.

These are the most common barrier methods and contraceptive methods you will find around. But there are also other elements to consider while thinking about safer sex:

• Ensure that both you and your partner provide consent for sexual activity and have the opportunity to communicate about what brings pleasure.
• Talk and share about your boundaries and what you want to do and what you don’t.
• If you meet someone with HIV, there is no need of panic, do not give up of common stigmatisation: if the person is on HIV treatment, there is the U=U rule:
• U=U stands for undetectable = untransmittable: when a person with HIV has an undetectable viral load thanks to antiviral treatment, it means that they can’t pass the virus. This means that whoever has HIV can still have a regular sexual life if starting as soon as possible with antiviral treatment, for them and their(s) partner(s).
• Taking responsibility for your and your partner’s well-being through safer sex practices allows you to fully savour the pleasures that sexual intimacy can bring.
• Some countries provide some (or all) contraceptive for free at certain ages or to everyone. Talk to the nearer healthcare point!

Sexual Health as a taboo 

There is a reason that is still very alive today turning sexual health into a taboo: lack of education. Unfortunately lack of education can also lead to psychologically harming consequences such as stigmatisation. Stigmatising sexual health can render couples and other partners in different types of relationships (see module 2 of this guide) to find it difficult to discuss their desires, boundaries, and concerns, which can lead to misunderstandings and dissatisfaction.

The ways stigma surrounding sexual health can be detrimental are multiple: 

• On one hand it takes the shape of taboo, excluding every discourse about safety and STIs from the table: absence of CSE about sexually transmitted infections make difficult to people interested in sexual intercourses to have acknowledge and discuss privately about how to have sex, which preventive method and contraceptive to use, what they prefer and what they want to experience;
• On the other hand, focusing just on STIs and prevention could lead to healthism and fear-inducing perspectives about sex. Healthism is a social and cultural belief that implies that your physical, mental and sexual health is your own responsibility, turning the discourse with moral implicit judgments (and prejudices). The reality of matter is more complex than that and leaving the responsibility on a singular individual is just not fair. When you grow up in a society that does not include sex-ed, it’s more than comprehensible that you fall into mistakes and risks while experiencing your sexual relationships! 

What is necessary to do is to admit there are people who still don’t use contraceptives or preventive methods and stay open and positive about it regardless, in order to create a safe and welcoming discourse on sexual health. It’s still possible to comprehend the context in which non-safe sex is made: because of wrong beliefs about pleasure (for example: for people with penises to not use the condom because “they don’t feel anything”) or because they do actually prefer it in that risky way. Leaving people their agency to choose is part of an inclusive CSE.

Concepts about safer sex mostly depend on where you live and how you grew up: information, discussions and beliefs can change whether or not you are in a propositional environment, where opportunities should be meant to be for everyone.       

Finding information and getting support

Sexual health is to be treated as any other health issue. If you feel that there’s a lack of information about sex and health in your school, consider talking to your school administrators, teachers, or even your parents about the importance of comprehensive sex education.

In the absence of CSE in your school, consider seeking reliable online resources and books that provide information about sexual health, consent, and relationships. An online platform that can be of a great assistance, in terms of available resources is thegendertalk.eu/library/sex-ed-resource-database/ 

Going to see doctors is the best practice we can learn to keep ourselves healthy. However, sometimes it may become an uncomfortable or even a traumatic event, as unfortunately some doctors don’t provide us enough information and/or don’t ask us for consent to touch or explore our bodies for medical purposes. Still, we should always claim our right to bodily autonomy, which shall protect us from violent situations and that claims that we have dignity and agency of our own body and we should be able to make decisions over it.

On other occasions, visits to the doctor is the only time when we might receive some information concerning our sexuality. Nevertheless, the fact that we only learn about our sexuality when we go to the doctor (gynaecologist, urologist, sexual specialists, etc.) might make us believe that sexuality is strictly linked to our anatomy and, particularly, to our genitals and reproductive system. This makes us forget that sexuality is a really broad concept that also refers to our gender identity and sexual orientation, to our desire and pleasure, to the relationships we establish, to our self-esteem, and so on.