Complete Sex Education Guide by DR Ankit Chandra PDF

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Dr Ankit Chandra 1st Edition (2019)

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For hard copy of this book

Drop an email at
suniyal3151@gmail.com
Dedicated to God,
Parents & Teachers

ABOUT THE AUTHOR
Dr Ankit Chandra has studied MBBS from Jawaharlal Institute of Postgraduate

Medical Education and Research (JIPMER), Pondicherry. Currently, he is pursuing his
MD from All India Institute of Medical Sciences (AIIMS), New Delhi (India). He
completed his schooling from Sainik School Ghorakhal (SSGK), Nainital.
Author has always been academic and research oriented. He has written and
published research papers in the national and international journals, articles in
renowned newspapers. The author has written question banks for MBBS students and
also provides health talks in schools/media on essential topics like – CPR, First aid,
Sex education, Hygiene.
He also provides health education and study tips on his YouTube channel (Ankit
Suniyal vids) and in Facebook page (ankitsuniyalvids).
For any questions / suggestions or review you can feel free to contact Dr
Ankit Chandra.
Email ID – suniyal3151@gmail.com.
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REVIEW OF THE BOOK BY DOCTORS
“Very good and comprehensive” – Dr Rani Bang (SEARCH, Gadchiroli)
“Very comprehensive” – Dr Sonali Sarkar (JIPMER, Pondicherry)
“All the information provided is elaborate and apt for the current and future
generations. Highly recommended” - Dr Shubham (UCMS, Delhi)
“Detailed. Expert take on a sensitive topic. It’s a must read for all age groups”
– Dr Anvesh
“simple presentation and great by its content delivery” - Dr Sivaraman (JIPMER

Pondicherry)
“Very useful for everyone, particularly for non-medical people” - Dr Farzana (Jamia
Hamdard, Delhi)
“Myths explained very well” – Dr Dhirendra
“Encyclopaedic view of a topic, which is still a taboo in India. A must-read

book” – Dr Harshit
“Interactive, illustrative, straightforward and provides whatever you want to know”
– Dr Anil
“All information at one place, fluid language, will recommend to all” – Dr Monisha

AUTHOR’S NOTE
I believe that sex education (sexual health) should be based on scientific knowledge,
freely and easily accessible to everyone and to be comprehensive. We often
underestimate the benefits of sex education (sexual health). With the advent of mobile,
internet and TV, it is very difficult to keep a child unexposed to the sexual content or
sex education. It’s the utmost need for every child to have a safe childhood.
Unfortunately, even adults of our society lack basic knowledge about sex education.
“Little knowledge or false knowledge is always dangerous”
This book is about providing knowledge from a reliable and scientific source. This book
is made to answer the curious minds, who are searching for answers on internet/digit
media. This book is useful for school and college students, teachers, parents,
guardians, NGOs, health professionals.
The inception of this idea originated while planning a sex education talk for students
with Captain Rohit Dwivedi (Ex-principal of SSGK) in May 2017.I express my gratitude
to the people who gave their precious time and suggestions to improve this book
through their reviews.
- Dr Rani Bang (SEARCH, Gadchiroli)

- Dr Sonali Sarkar (JIPMER, Pondicherry)
- Dr Yogesh Kalkonde (SEARCH, Gadchiroli)
I heartily thank my dear friends for their selfless and prompt help in the completion of
this book; Dr Monisha, Prashant, Rohit, Suhasini, Dr Anil, Dr Anvesh, Dr Harshit, Dr
Ritwik, Dr Rahul, Dr Radhika, Ankit.
I would like to thank the Centre for Community Medicine (CCM), AIIMS, New Delhi
and also to my colleagues/seniors; Dr Aditi, Dr Aninda, Dr Archismita, Dr Surabhi, Dr
Vignesh L, Dr Ravi, Dr Vignesh D, Dr Bhabani.
I would like to thank everyone who gave me suggestions, questions and topics to add
in this book anonymously through the google forms. I am indebted to you for this.
Don’t forget to share this book with others and help them.
#SpreadKnowledge
TABLE OF CONTENTS
About the Author ............................................................................................................................ 3

Review of the Book by doctors ....................................................................................................... 4
Author’s note .................................................................................................................................. 5
Sex education – need and benefits ................................................................................................ 7
Family ........................................................................................................................................... 10
Friendship, Love and Romantic relationship, dating ................................................................. 12
Privacy (Good Touch vs. Bad Touch) ......................................................................................... 18
Female sexual health – anatomy and common doubts .............................................................. 21
Male sexual health – anatomy and common Doubts.................................................................. 31
Puberty and common doubts ....................................................................................................... 41
Menstruation (periods), Hygiene and common problems .......................................................... 49
Masturbation and common doubts .............................................................................................. 60
PORNography .............................................................................................................................. 66
Sexual intercourse and common doubts ..................................................................................... 69
Pregnancy, Abortions – common doubts .................................................................................... 85
Contraception, condoms .............................................................................................................. 98
Sexually transmitted infections/diseases (STI/STDs) ............................................................... 104
Human immunodeficiency virus (HIV) / AIDS ........................................................................ 107
Sexuality, LGBTQ and common doubts.................................................................................... 112
Sexual rights ............................................................................................................................... 117
Cyber bullying & cyberstalking ................................................................................................. 118
Sexual abuse, Harassment, Rape .............................................................................................. 121
Finding Help And support In India .......................................................................................... 126
Laws in India against sexual abuse .......................................................................................... 127
Mental Health ............................................................................................................................ 129
Peer influence, Decision making............................................................................................... 132
Tips and advices For Parents or Guardians ............................................................................. 135
Extra Q & A................................................................................................................................ 143
To Explore More ........................................................................................................................ 146
Reference / Bibliography ........................................................................................................... 147
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SEX EDUCATION – NEED AND BENEFITS
In most of the places sex education is never taught or discussed, most of the parents
don’t want their child to know about it and teachers don’t teach it in school. With the
advent of mobile, internet and TV, it is very difficult to keep a child unexposed to the
sexual content or sex education. When a child feels this subject as forbidden, he/she feels
more curious to know about it and the only source left to him is his/her friends or the
internet. An unreliable source can lead to misguidance and formation of wrong beliefs,
which can be harmful or dangerous.
A study on child abuse in India conducted by the Ministry of

Women and Child Development reported that 53% of boys and
47% of girls faced some form of sexual abuse.
Dr Facto1:
United Nations International Children’s Emergency Fund (UNICEF) household

survey data indicate that in developing countries (excluding China) around 11% of
females and 6 % of males aged 15–19 claim to have had sex before the age of 15. To
stay healthy and safe, adolescents need access to high quality sexual and reproductive
health services and information from an early age.2
Q) What the World Health Organization (WHO) say about it?
A) WHO in 1994 declared sex education a fundamental human health right and an
Important Quality of Life Health Issue. The sex education is also called ‘reproductive
health education’ or ‘sexual health education’ or ‘sexuality education’.
Q) What is ‘sexual health’?
A) World Health Organization(WHO) defines sexual health as “the integration of the

somatic, emotional, intellectual, and social aspects of sexual being, in ways that are
positively enriching and that enhance personality, communication, and love.”3

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Q) What is the purpose of ‘sex education’?
A) The real purpose behind family life and sex education is the transfiguration of a male
child into manhood and of a female child into womanhood. 4 It aims to teach the roles and
responsibilities of males and females toward each other in all relationships in familial and
social contexts, thus endowing the knowledge necessary to maintain sexual health as
they navigate through the vulnerabilities of life.5 During adolescence (10–19 years of
age), sex education is a crucial preventative tool, as it is the opportune time when young
people experience developmental changes in their physiology and behaviour as they
enter adulthood.5
Q) Benefits of sex education
A) World Health Organisation (WHO) has reported the benefits of sex education as 5
- Delays initiation of sexual activity

- Reduction in unplanned and early pregnancies and their associated complications
- Fewer unwanted children
- Reduces risks of sexual abuse/exploitation
- Greater completion of education and later marriages
- Reduces recourse to abortion and the consequences of unsafe abortion
- Curb the spread of sexually transmitted diseases including HIV
- Increases the use of condoms/ contraception
- Reduces risk-taking behavior
- Decreases number of sexual partners
Q) What are the misconceptions about sex education4 ?

A) The wrong beliefs (misconceptions) about sex education are -
- It may lead to promiscuity, experimentation and irresponsible sexual
behaviour
- It may corrupt the youth and offends ‘Cultural/Moral values

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Source – WHO
Q) Who can provide sex education?
A) Ideally, home is the best place for teaching sex education (sexual health) and the
attitude of parents is of vital importance.4 In this book, tips and advice are given for
parents and guardians in a separate chapter. Sex education can be provided by any
qualified person (like biology teacher, doctor, health professional) rather than friends or
by a wrong source (who are a novice in science). In most of the countries, sex education
is an essential component of the school curriculum, where it is taught by a
teacher/qualified person. But still in few places, the word ‘sex’ itself is a taboo and cannot
be discussed openly. People have a narrow sense that sex education is a mere
explanation of the anatomical and biological difference. Many psychologists believe that
sex education begins at an early age and continues throughout the life of an individual.

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FAMILY
Family is usually defined as a group of people living together who are related by blood,
marriage or adoption, living together and shares meals from a common kitchen.6 There
are various definitions available and used. There are different types of family like -
nuclear, extended, single parent, guardian headed, etc.
Growing up means taking

responsibility for oneself and others
Q) What is the Role of Family?
A) Following are the important roles of a family -
1. It provides resources like money, food, clothing, and shelter, for all family
members (a most basic and important role).
2. Nurturing and supporting other family members is primarily an effective role
and includes providing comfort, warmth, and reassurance for family
members.
3. Provides physical, emotional, educational and social development of
children and adults.
4. Marital relationship of a couple has a sexual relationship. This role involves
meeting sexual needs in a manner that is satisfying to both spouses.
5. Building leadership, decision making, handling family finances and
maintaining appropriate roles with respect to extended family, friends and
neighbours.
6. Parents/guardians and other family members help children acquire values
and guide and support their children’s decisions.
7. Siblings, parents/guardians or extended family can provide support to a
young person who discloses or shares information related to sexual
relationships or health.
8. Families can overcome challenges when they support one another with
mutual respect.

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9. Health and illness can affect families in terms of their structure, capacities
and responsibilities.
Love, cooperation, gender equality, mutual

caring and mutual respect are important for
healthy family functioning and relationships
Marriage and Parenting
Marriage is the legally or formally recognized union of two people as partners in a

personal relationship. Marriage is the indispensable event in an individual's life and
carries with it many responsibilities. Marriage and long-term commitments can be
rewarding and challenging. Marriage has been an important social institution. It is the
foundation of the family. The functions of marriage include regulation of sexual behaviour,
reproduction, nurturance, protection of children, socialization, consumption, and passing
on of the race.7
Parents - Some people may want to become parents; some people may not want to; not
everyone is able to become a parent, and some people may have become a parent
without wanting to. There are many factors that influence. People become parents in
various ways (e.g. intended and unintended pregnancy, adoption, fostering, with medical
assistance and surrogacy) and parenthood involve many different responsibilities. Child,
early and forced marriage (CEFM) and unintended parenting can lead to negative social
and health consequences.
Conflict and misunderstandings between parents/guardians and

children are common, especially during adolescence and are
usually resolvable
Miss Smarty

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FRIENDSHIP, LOVE AND ROMANTIC RELATIONSHIP, DATING
Friendships are built on trust, sharing, respect, empathy and solidarity. Friends can
influence one another positively and negatively. Good friends will always care for you and
may show you the correct path in life. There may be those who will become friends with
you for their personal need or with some different intentions. So, you have to be careful
while selecting your friends.
Adolescent friendship8
Healthy friendships matter across the life course. There is some evidence that healthy
adolescent friendship contributes to healthy long-term outcomes, such as physical activity,
better mental health. Furthermore, difficulties forming a healthy friendship in early
adolescence can lead to trouble forming a healthy friendship in late adolescence and
adulthood. There are numerous difficulties adolescents can encounter in the process of
making, keeping and deepening friendships. Struggling to make friends is not unusual, and
parents and other caring adults can help adolescents build the skills needed to make
friends.
Q) Can girls and boys be best friends?
A) Of course, they can. Girls and boys can be very good friends with each other as long
as they respect each other and maintain privacy.
Q) Tips to make friends
A) Some friends are good for having a laugh with, or sharing your favourite hobbies.
And other friends can be there when you want to pour your heart out. The number of
friends you have isn't important. What matters is having friends that you're close to, who
can support you and who won't try to hurt you or bully you. Be careful while choosing

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your friends, because a good friend will always care for you. A good friend will help you
succeed and guide you in the correct direction. While a bad friend may cause trouble for
you. Here are some tips to make friends-
1. Look out for people who have similar interest and hobbies. Most of the friendships
start because people have things in common.
2. Go out and meet them. Sometimes we get busy in our schedule that we don’t get
time to meet and talk with people. So, you can meet people in some groups, get-
together, party, etc.
3. You can always start a conversation by introduction/greetings or by asking - how
are you? Never be shy of talking, be confident and have a smiling face.
4. It is also very important to be a good listener.
5. Give them a compliment. Don’t be a miser in it. You can always compliment your
friend about his/her looks, style, intelligence, clothes, skills, humour, etc.
6. Not everyone can be the same as you. Everyone is different, so accept others as
they are. Don’t try to change them.
7. Always share your food/meals or belongings with your friend. Sharing is caring.
8. A person who helps others has lots of friends, who will help him back later.
9. Be a loyal and trustworthy person.
Relationships involve different kinds of love (e.g. love between friends, love
with parents, love between romantic partners) and love can be expressed in
many different ways. Friendship and love help people to feel positive about
themselves. There are different ways to express affection and love as one
matures. There are healthy and unhealthy relationships.
Q) What are healthy and unhealthy relationships 9 ?
A) The person feels safe, secure and happy in a healthy relationship. In an unhealthy
relationship, the person feels unsafe, stressed or harassed, unhappy. Here are some
signs of healthy and unhealthy relationships -

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Healthy relationship Unhealthy relationship
- Partners treat each - One partner is controlling, makes all the

other with respect and decisions, and tells their partner what they can or
provide space cannot do
- Partners communicate - One partner is hostile, picks fights, or is dishonest
- Partners practice
- One partner is disrespectful, makes fun of their
effective problem-
partner, or crosses boundaries
solving
- One partner is completely dependent on the other
or loses a sense of their individual identity
- One partner intimidates or controls a partner

using fear tactics
- One partner engages in physical or sexual

violence
Romantic relationships can be strongly affected by inequality and differences in power

(e.g. due to gender, age, economic, social or health status). Close romantic relationships
can sometimes become sexual. So, one needs to be careful.
Q) Infatuation vs. Love vs. Lust
A) Love and infatuation are both intense emotions that one feels for another person.
These feelings are most often confused for each other by many people. But the two
feelings differ in their actuality of love, intensity and the final outcome. Lust is defined
as a strong desire of a sex. The definition of these words may differ from person to
person. Love itself is a topic of interest for many writers, philosophers, etc.
Infatuation Love Lust
It is the state of temporary It can be described as a Any intense desire or

attraction toward feeling of intense affection for craving for gratification;
someone, usually occurs another person. Falling in love when contrasted with
is usually a gradual process. It

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at the beginning of the happens over time and love, lust usually means
relationship. deepen with the passage of sexual desire.
time.
Takes off fast and can It is a type of commitment to It can result in sexual
leave feelings of another. In this, a person really frustration and emotional
emptiness. cares about another person's rigidity, when need is
feelings before acting. unsatisfied of one partner
Infatuation is delusional. Love is unconditional and real. It is a temporary

It is all about patience and commitment that lasts
Not real.
waiting. only long enough to fulfil
a desire.
Q) What is a ‘crush’? 😍
A) Informally a ‘crush’ is a sort of an attraction for a person; whether for looks, intelligence,
skills or anything. When you have a crush on someone, it means that you find that person
very attractive; or you have a strong desire for that person. Eventually, it may grow
into love or it may diminish in time. People often perceive crush as an infatuation.
Q) What is dating?
A) With the decline in arrange marriage, a new practice has developed called ‘Dating’. It
is the freedom to choose one’s own mate through meeting and getting to know each other.
It is usually done by mature adults, as dating is to find a partner for marriage or for an
intimate relationship. These days with the advent of technology, people have started
using smartphone applications and websites to find a partner for dating. There are
various applications and websites available depending upon the person’s sexuality and
needs. A person should be very careful with dating through social media or internet, as
there are lots of strangers with fake profile. These people with wrong intentions use this

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platform (social media/dating platforms) for kidnapping, blackmailing, sexual assault,

phishing, data theft, human trafficking, etc.
Q) What is ‘dating violence’ 10
A) Dating violence can be emotional, physical, or sexual. Dating violence also includes
stalking. In any form of dating violence, a person should seek for help from
parents/guardians, friends or authority. If needed, you can always take help of police and
legal system.
1. Emotional violence is when one partner threatens the other or harms his or her
sense of self-worth or self-esteem. Emotional violence includes things like calling
names, behaving in a controlling or jealous way, monitoring the other person
constantly, shaming, or bullying. Emotional violence also happens when someone
keeps the other away from friends and family.
2. Physical violence is when someone pinches, hits, shoves, slaps, punches, or kicks
their partner.
3. Sexual violence is when someone forces a partner to have sex or engage in sexual
activities when he or she does not or cannot consent. Force can be physical or
nonphysical. An example of nonphysical violence is when someone threatens to
spread rumours if a partner refuses to have sex.
4. Stalking is any form of repeated and unwanted contact that makes a person feel
unsafe.
Q) What is a ‘breakup’ and how to cope-up with it?
A) Breakup means termination or end of a relationship. Sometimes it is also called as

‘dumping’ in slang when it is initiated by one partner. There could be various reasons
for a breakup and most of the people experience it at some point in time. Some people
can easily cope up with it as a part of a relationship but some people can experience
devasting effects.

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“sometime good things fall apart, so that better things can fall together” – Marilyn Monroe
Everyone has a different coping mechanism. If a method works for somebody, that
doesn’t mean it may work for you. Here are some ways to deal with it -
1. Try to deal with it maturely. A person is very vulnerable to addiction,

depression, suicide, etc. We have to understand that these things are
temporary. You have to think about your career, parents and friends.
Appreciate the things what you currently have in life. Don’t take any steps
in the heat of the moment.
Remember that time is the best healer, with time everything heals.
Miss Smarty
2. Talk about it with friends or family, A support is needed.

3. Let your emotions - cry, sob, write, shout etc. crying is a normal emotion.
4. Indulge in some activities to divert your attention - Go out for a movie,
party, swimming, sports, dancing, read a book, etc.
5. You can also get involved in spirituality or meditation.
6. Try to look at the positive side of it and every failure is new learning.
7. If needed then, don’t be scared to take professional help.
Love is not about gaining always, it’s also about letting the person go.
Somethings are not in your control.
Miss Smarty

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PRIVACY (GOOD TOUCH VS. BAD TOUCH)
Everyone has the right to decide who can touch their body, where and in what way. During
puberty, private space becomes more important for both boys and girls, particularly while
accessing to toilets for girls. Unwanted sexual attention towards both boys and girls is a
violation of privacy and the right to decide about one’s own body.
Q) Good Touch vs. Bad Touch
A) Here are the differences between a good and bad touch, which should be taught to
every toddler to protect them from any form of assault.
Good Touch Bad Touch
This touch doesn’t scare you or This touch can make you feel scared or
doesn’t makes you uncomfortable uncomfortable
It’s not there on the private parts, it is It can be there on your private parts like – genitals,
mostly on hand or shoulder. hips, lips, chest
It is never told to keep it as a secret It may be told to keep it as a secret
It is never forceful or hurting It may be forceful or hurting
Example – parents hug, grandparents Example – touching or patting on lips, chest, groin,
love, family hug, handshake, high five mouth
You may not report about it. You need to say ‘No’ to it and report this
immediately to the concerned authority or parents
or a trustworthy adult.

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Q) Examples of good and bad touch
Example of Good touch Example of Bad touch
Hugs and kisses from parents and others Hugs and kisses from people we don’t
you know and trust. know or don’t like or makes you feel sad
or unhappy
A doctor or nurse who is trying to make When someone kicks, hits, punches or
you better when you are sick or another slaps.
trusted individual who is helping you in
some way
Q) Who can touch or see your private parts like groin, breast, buttocks, etc.?

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A) Parents or Medical health professionals (like a doctor, nurse, etc.) who is trying to get
you better can touch or see the private parts with your consent. For a child less than 12
years, the consent of a parent or guardian is required for a medical examination in India.
Never agree to keep a touch as a secret. Tell someone you trust.
Whoever gives you a bad touch is the one who is bad, not you.
Your body belongs to you.
Miss Smarty
Q) What is a consent?
A) Consent is a permission or agreement for something to happen. It is always required

before any physical touch or invading into someone’s privacy. A person has full power to
refuse for any touch. It can be in written form or in verbal form.

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FEMALE SEXUAL HEALTH – ANATOMY AND COMMON DOUBTS
Female External Genitalia -
A female’s external genitalia may not be clearly visible, as it lies between thick fold of
skin / vulva.
• Urinary opening (urethra orifice) is just in front of the vaginal opening to pass urine.
• Vagina is an opening for passage of sexual fluids, menstrual fluids, birth of baby
(after pregnancy). It is very elastic, stretchy and muscular.
• The clitoris is a tiny (about the size of a small pea) structure hidden within the folds
of the inner lips where they join. It is extremely sensitive to touch and when
stimulated gently becomes firmer and slightly bigger.
• Anus is an opening between buttocks to defecate/pass stools.
• Just like different people have differently shaped hands and faces. The outer lips,
clitoris and vagina may differ in size, shape and colour from female to female.

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The female reproductive system consists of a pair of ovaries along with a pair of oviducts,
uterus, cervix, vagina and the external genitalia located in the pelvic region.
• Vagina is made up of very stretchable muscle, which has lots of folds in the resting
form and the length is approx. 4cm. To accommodate the penis, the vagina can
stretch up to 10 to 12cm.

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• Vagina doesn’t have any secretory glands but it has secretions from the cervical
gland & Bartholin glands. These secretions help in lubrication during sexual
intercourse.
• There are 2 ovaries on either side of the uterus, with the onset of puberty they
release of an ovum (called ovulation). Ovulation starts on or near 14th days after
the 1st day of menstrual bleed. ovulation occurs every month from the alternate
ovary after reaching menarche age.
• Uterus (womb) is a muscular organ, where a fertilised ovum is lodged and the fetus
develops in case of pregnancy.
• The mouth (opening) of the uterus is called as cervix and the inner layer of uterus
is called as ‘endometrium’.
Q) What is a ‘Hymen’?11
A) Hymen is a very thin elastic membrane, partially covering the vagina opening. It varies
in shape (annular, crescentic, septate, etc.). The hymen is often torn during the first coitus
(intercourse). However, it can also be broken accidently, by vaginal tampon use,
masturbation or due to vigorous exercise. In some women, hymen can persist even after
sexual intercourse. These days hymen can be also reconstructed by surgeries.
The presence or absence of the hymen is not an accurate indicator

of virginity or sexual experience.
Dr Facto11
Q) What is ‘Imperforate Hymen’?
A) Normally the hymen has an opening (orifice) for the passage of menstrual blood.
Rarely, when this opening is not present then it is called as ‘Imperforate Hymen’. In this,
the menstrual blood doesn’t come out of vagina and the female (after reaching the
menarche age) complaints of absence menstruation. This is usually diagnosed by a
Doctor (Gynecologist) and can be easily treated.

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Q) Why to never put water inside the vagina or never wash the vagina from inside?
A) Vagina has self-cleaning mechanisms. Therefore, never wash the vagina from inside
with water or any chemical, as it can wash away the good bacteria (lactobacillus) and
disrupts the healthy vaginal pH.
Q) How to maintain female genital hygiene?
A) If genital hygiene is not followed then there are higher chance of infections and
diseases. These instructions to be followed to maintain genital hygiene -
1. Wash genitals from outside daily with water. Don’t use any soap, antiseptic,
deodorants or any chemical in the genital region.
2. Don’t put water inside the vagina. The vagina doesn’t need any special cleaning.
Vagina cleans by itself. If these good microorganisms (bacteria) are washed away
with water or anything, then there are high chances of growing bad bacteria.
3. While washing anus after defecation (shitting), wash it from front-to-back direction
(in a motion away from the vagina), to prevent infection spreading from anus to
vagina.
4. Change underwear regularly (at least once a day) and avoid synthetic underwear.
5. Wash underwear carefully to make sure you wash off all the soap/detergent from
it.
6. Dry underwear in the sun. As sunlight kills the germs.
7. Do not put any unclean, sharp-edged objects into the vagina. It may cause
bleeding, injury, infection, etc.
8. Do not touch your genitals with dirty hands. Keep your nails short so you don’t hurt
yourself.
9. Don’t put the powder in your underwear but keep the genital area dry to avoid any
fungal infection.
10. During the menses, use a sanitary napkin(pad) and change it every 6-8 hourly.
Q) What is healthy and unhealthy vaginal discharge?

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A) Normally, vagina cleans itself and there are cervical secretions also that could present
as vaginal discharge. So, it is important to know how to differentiate healthy vaginal
discharge with unhealthy discharge. Always consult a doctor in presence of unhealthy
vaginal discharge for treatment.
Healthy vaginal discharge Unhealthy vaginal discharge
- May appear green, grey, yellow or

- Clear or whitish in colour
cheesy white in colour
- A slight odour that is not strong
- May present with itching
smelling
- Can leave whitish/yellowish tint in - May have a strong purulent smell
- May look foamy or frothy
underpants
- Maybe blood stained#
- Changes in consistency
- Maybe associated with fever
throughout menstrual cycle
#mild spotting may be seen before the menstruation(periods) also.
Q) Groin fungal infection / Itchy groin 12?

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A) Normally groin is not itchy. It starts itching mostly due to presence of fungal infection
(Dermatophytes) called ‘Tinea cruris’. It is due to the accumulation of moisture due to wet
undergarment or sweat.
Ways to deal with it
1. Wear loose underwear, if needed then can avoid underwear for few days.
2. Keep the groin dry after the bath, make sure to wear dry underwear only.
3. If needed then remove pubic hair, so the medications can be applied easily and
the groin remains dry for the longer duration
4. Don’t share a towel or undergarment or soap.
5. Use anti-fungal creams like clotrimazole, etc.
6. Feel free to consult a doctor.
Q) What are breasts?
A) Breasts are made up of fat and glandular tissue (secretes milk). They are the most
erotic and fascinating organs for boys and girls. Though males and females both have
mammary glands but only in females breast develop (in size and shape) during puberty.
Breasts have important role in feeding the newborn babies.

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Q) Breast and lactation13
A) Breasts start producing milk (called lactation) after the delivery of the baby. Newborn
babies are fed exclusively only on breast milk for the first 6 months of life. Milk production
is a highly coordinated system between the nervous system and endocrine system of the
body. Amount of milk production also depends on the sucking of breast nipple the baby,
nutritional status of the mother, physical activity and healthy lifestyle. Normally breasts
secrete from 450ml to 800ml of milk after pregnancy. If a woman who never got pregnant
starts women start lactating, then she must consult a doctor for further evaluation of the
cause. It is advised to avoid losing weight rapidly after pregnancy, as it can interfere with
lactation.
Q) Breast size in female14
A) Breasts’ morphology changes with age and reproductive status. Breast size is small
among teenage and old age (sags, less fat). Breast size depends on genes, nutrition, age
and body fat. Female breasts are one of the secondary sexual traits that attract male
attention. People have a different perspective and preference for breast sizes. Few
females may even undergo surgery to increase breast size through breast implants

28
(silicone gel). These implants are also placed after the surgery of breast cancer
(mastectomy).
Q) What are ‘Bras’ or ‘brassieres’?
A) Women wear bras or brassieres to support their breasts. As a girl’s breasts grow she
may need to get a different sized bra every couple of years, till her breasts have stopped
growing. There is nothing unusual about this. Everyone grows at a different pace. A
female needs to wear a bra when her breasts have grown enough to jiggle or bounce
when she runs. A female feels more comfortable wearing a bra especially if she goes for
jogging or any sport. There are various styles and sizes of bra available. The right bra is
one that supports the breasts like a second skin. A female should wear a bra that is neither
too tight nor too loose and preferably a cotton one. A woman should take off the bra at
night to allow for proper blood circulation and so that she can breathe comfortably while
sleeping.
Picture depicting various types of bras

29
Q) Prevention of breast cancer 15
A) Breast cancer is top cancer in women both in the developed and the developing
countries. It is more common during the 30s. Risk factors for breast cancer are – positive
family history (genetics), prolonged exposure to endogenous Estrogen (such as early
menarche, late menopause, late age at first childbirth), Exogenous hormones, radiation,
alcohol use, overweight and obesity, and physical inactivity.
To prevent breast cancer -
- Eat a healthy diet

- Increase physical activity like exercise, yoga, gym, sports, dance
- Control of alcohol intake,
- Control overweight and obesity
- Breastfeeding after pregnancy has a protective effect
- Early diagnosis through breast self-examination and screening
-
Picture – monthly self-examination for early breast cancer detection

30
Q) Prevention of cervical cancer 16,17
A) Cervix is the opening part of the uterus. It’s cancer is one of the most preventable and
curable forms of cancer, as long as it is detected early and managed effectively.
Risk factors for cervical cancer are human papillomavirus (HPV), poor immune status
(HIV), co-infection with other STDs, tobacco smoking, young age at first baby birth,
multiple sexual partners.
Prevention from cervical cancer –
- Primary prevention begins with HPV vaccination of girls aged 9-14 years (before
they become sexually active).
- Avoid smoking or tobacco in any form
- Safe sex practices like use of condoms
- Avoid multiple sexual partners
Every minute, one woman is diagnosed with cervical cancer. It is one of

the greatest threats to women's health.
Dr Facto17
Q) What is ‘prolapse of uterus’?18
A) It is the descent of the uterus into or outside the vagina. It happens due to weak
pelvic muscles and ligaments. It can result in problem during urination and defecation.
Causes and risk factors for the weakening of pelvic muscles and ligaments are – trauma
during childbirth(delivery), multiple pregnancies, smoking, old age, increased abdomen
pressure condition (chronic cough, constipation).
It can be managed conservatively (with pessaries or pelvic floor training) or with

surgeries.

31
MALE SEXUAL HEALTH – ANATOMY AND COMMON DOUBTS
Male sex organs can be divided in to external (visible) and Internal organs.
Male sex organs
External organ Internal organ
1. Testes
1. Penis
2. Prostate
2. Scrotum
3. Seminal vesicle
4. Cooper’s gland
• The penis is the male external genitalia. It is made up of special tissue that helps
in the erection of the penis (as fills with blood). The enlarged end of the penis called
glans penis (most sensitive part) is covered by a loose fold of skin called foreskin

32
(called prepuce). The penis is small in size among children, it grows during the
puberty.
• In males, there is a common opening for the passage of urine and sexual fluid, that
is through the penis.
• Normally, there are two testicles in the scrotum. They are oval in shape, with 4-5
cm in size. The testicles are situated outside the abdominal cavity within a pouch
called scrotum. The scrotum helps in maintaining the low temperature (2 to 2.5
degree centigrade lower than the normal internal body temperature) of the testes
necessary for the sperm formation (spermatogenesis).
• More than two or less than two testicles may be due to some medical problem.
Please consult a doctor.
Q) What is circumcision?19
A) Circumcision is the removal of the foreskin (prepuce) of the penis through a surgical
procedure. It is commonly practiced in certain religions like Muslims and Jew, during early
childhood. It can be also done for some medical conditions like phimosis, hypospadias,
etc. Research studies shows that circumcision in early age is protective against infections,
penile cancer, phimosis and it don’t affect sexual function or pleasure. However, it may
have risks of surgical complications.

33
Q) After what age, the foreskin of a penis (prepuce) can be retracted back in an
uncircumcised penis?20
A) The foreskin of penis is non-retractable before 4-6 years of age, in a certain case may
be up to 8-10year. This is because glans penis and foreskin are attached together by a
layer, which dissolves after a certain age. This is called physiological phimosis. Before
this age, foreskin of penis shouldn’t be retracted as it can cause damage or injure the
penis. There are no objective data to suggest that having physiological phimosis leads to
a pathological phimosis at later stage.
Q) How to clean a penis ? what is smegma 21?
A) In adults with an uncircumcised penis, the penis should be cleaned by retracting the
prepuce (over the glans) with plain simple water. As under the prepuce, a white colour
material called smegma is deposited. Smegma is made up of dead tissues and mucin
content. Smegma protects and lubricates the glans and inner lamella of the prepuce,
facilitating erection, preputial eversion and penetration during sexual intercourse.
Smegma also contains Lytic materials (such as lysozyme), which probably originates from
the prostate and seminal vesicles, destroys bacterial cell walls. It also inhibits and
destroys Candidal species (fungal microbes).
If the smegma is not cleaned then it may harden into ‘smegma stones’ in men, seen with
extremely poor hygienic habits. If smegma is over-cleaned (very frequently cleaned), then
a person can become susceptible to penile candida infection. Therefore, cleaning of
smegma should be adequately done (maybe 2-3 times a week).
Picture: depicting white colour smegma under the prepuce (over glans penis)

34
Q) What is ‘Morning Erection’ or erections during sleep?
A) When a boy is sexually excited, his penis becomes hard and ‘stands up’. This is known
as an erection or a ‘hard-on’ and occurs because of increased blood flow to the penis.
This is a normal phenomenon. Erections sometimes occur on their own, without any
sexual stimulus. During the sleep, there is some change in the nervous system of the
body causing erection of the penis during the morning or in sleep. This is perfectly natural
and normal. It does not mean that they are ‘over-sexed’.
Q) What is semen?22
A) Semen is a white, thick liquid containing sperms mixed with secretions of epididymis
and prostate. The normal quantity of semen per ejaculation is 1.5 to 4 ml, containing
about 20 to 80 million sperms/ml. Emission of the semen during the masturbation or
during erection is completely normal, there shouldn’t be any guilt or bad feeling about it.
Q) What is the normal semen colour?
A) Normal semen colour is white-grey in colour. It can have yellowish tinge sometimes,
when there is prolonged abstinence (from masturbation or sex), it is due to carotene
pigment, and sperm oxidation causes odour.20 If a person ejaculates frequently (e.g. too
many times in a day), then the colour may be watery (mild transparent), which is a
temporary condition and normal.
The colour of semen may change due to fresh blood (red), drugs (pyridium), jaundice
(dark yellow), contamination of semen with urine (e.g. in bladder neck dysfunction). A
person needs to consult a doctor if there is any abnormal semen colour (red, dark yellow,
brown, green, etc).
Q) What is ‘nocturnal emission’ or ‘nightfall’ or ‘wet dreams’?
A) It is the spontaneous ejaculation of semen during the sleep, also called as ‘wet
dreams.’ Many adolescents get scared when it occurs first. It is a normal physiological
process. It occurs after reaching the puberty. It doesn’t lead any weakness or impotence.

35
Q) What is normal penis size in adults?
A) Normal adult penis size should be more than 3 cm in the flaccid state. While in an erect
state it can range from 3 to 6 inches. The erect penis should be long enough to reach the
vagina for sexual intercourse. The size of the penis depends mainly on the race
(genetics), it can’t be changed. Men are generally are obsessed with penis size. Research
has shown that the size and width of the penis have nothing to do with the sexual
performance in males. Sexual performance depends on the mood, correct technique and
the partner.
Remember, size doesn’t matter but your character does.
24?
Q) Can penis size be increased by any medication, oil, exercise or device
A) No, till now there is no adequate scientific data to prove any method or medication can
increase the penis size. These methods may falsely claim to sell their products or
technique. However, some surgeries are possible to increase the length or girth of the
penis but it can be dangerous, as they have certain complications.
Q) Is it common to have a curved penis25?
A) It is common to have a slightly curved penis to right or left in an erect penis. But if it is
significantly bent and causes pain or difficulty in sex, then it could be Peyronie’s disease.
You may have to consult a doctor for further evaluation.
Q) Can a penis be fractured26 ?
A) Penis does not have a bone, it has only muscles (corpus cavernosum and corpus
spongiosum covered by tunica albuginea). Sometimes ‘penile fracture’ term can be used
as in a hospital emergency as tear in the tunica albuginea of the penis often due to forceful
manipulation, vigorous vaginal or anal intercourse or masturbation, gunshot wounds, or
any other mechanical trauma that causes forcible bending of an erect penis. Less
common causes include: turning over in bed, a direct blow, forced bending, or hastily

36
removing or applying clothe when the penis is erect. The most common mechanism of
injury is during sexual intercourse when the penis slips out of the vagina and strikes
against the symphysis pubis or perineum.
Q)Why scrotum is itchy? what is ‘Jock itch’ 12?
A) Normally scrotum is not itchy. It is mostly due to fungal infection (Dermatophytes) in

the groin called ‘Tinea cruris’. It is due to the accumulation of moisture due to wet
undergarment or sweat.
Ways to deal with it
1. Wear loose underwear like boxers, etc.

2. Keep the groin dry after the bath, wear dry underwear.
3. Use anti-fungal creams like clotrimazole, etc.
4. If needed, then remove pubic hairs, so the medications can be applied easily and
the groin remains dry for the longer duration
5. Don’t share a towel or undergarment.
6. Feel free to consult a doctor as soon as possible.
Q) What is ‘hernia’?27
A) It is the bulging out of the abdomen content through a small defect in the
muscle/tissues. It could occur in the abdomen or in the groin (inguinal). A groin hernia is
more common in males. It could be present since birth (congenital) or after any
abdomen surgery (incisional). The risk factors are- old age, obesity, collagen vascular

37
disorder, illness increasing the abdomen pressure (chronic constipation or cough),

weight lifting.
People with hernia complaints of bulging mass in the abdomen or in the groin (e.g
swelling in the scrotum) with dull/dragging type pain. They are reducible in the size (by
manual manipulation or by lying down) in the initial stages. In the later stage
(strangulation of the content) it can become irreducible with severe pain and may need
emergency surgery.
Medicines don’t any role in hernia treatment. Hernia need to be

surgically operated for treatment.
Dr Facto27
Q) What is ‘hydrocele’?28
A) It is swelling of swelling in the scrotum (around testes), due to accumulation of the

fluid. It could be due to infections, congenital defect, associated with groin hernia,
trauma and tumour. Treatment depends on the age and the cause of the hydrocele.

38
Q) What is the prostate problem in old age (Benign Prostatic Hyperplasia)?29
A) The prostate is a gland, which makes fluid for semen. This gland also surrounds the
urethra at the neck of the urinary bladder.
With the increase in age the size of prostate increases due to hormones, genes, etc. It
is called as ‘Benign Prostatic Hyperplasia (BPH)’. Due to the growth of prostate, it
compresses the urethra (blocks) causing symptoms like –
- Increased urinary frequency (urination eight or more times a day)
- urinary urgency (the inability to delay urination)
- trouble starting a urine stream
- a weak or an interrupted urine stream
- dribbling at the end of urination
- nocturia (frequent urination during sleep)
- urinary retention
- urinary incontinence (the accidental loss of urine)
- pain after ejaculation or during urination
- urine that has an unusual color or smell
A person needs medical help. It can be treated or controlled using medicines or/and
surgery.
Q) Myths about masculinity or manlihood
A) Here are a few myths (misconceptions) about masculinity–
Myths Truth
(Misconception)
Men don’t cry Crying is a natural scientific phenomenon. Irrespective of

gender, everyone cries during their lifetime.

39
Men never hold babies Anyone can hold babies. A single parent (father) have to do
everything for the baby
Men never wear a pink Pink is just a colour. It shouldn’t be associated with any
gender.
Men drink alcohol and Even a female can also drink alcohol and can smoke.
smoke It is always advised to avoid alcohol and smoking as they
are injurious to health.
Real man needs to be Not all men are muscular. They are great men who were
muscular and macho lean and thin.
Muscle mass does not matter but intelligence does.
Men never enter into Cooking is one of the essential skills, which every human
the kitchen being should learn for survival.
A Real man never sits Sitting has nothing to with masculinity. A lot of men do not
behind a girl in a ride know how to drive a bike.
(scooty/bike/etc)
A man can’t be home- This was very old and a socio-cultural saying but these days
maker you can see a lot of men are choosing to be a homemaker
and wife are taking up jobs outside the home.
Singing/dancing is This is not true. If you see in the world there are lots of great
never made for men musicians and dancers who were male and have a great fan
following.
A real man has Now, clean shave is also a new fashion trend among men.
moustaches/ beard People working in the food industry should be cleanly
shaved for hygiene purposes
Men like Cricket or This is also not true, a lot of people may not like sports.
Football Every individual is different and has different preferences.

40
Real man is abusive Abuse and aggression are not related to manliness.
and aggressive As a human being everyone should be humble and nice to
people.
The actual truth is that real men always respect women,
Takes a stand for a right cause,
A real man never bullies or rape.

41
PUBERTY AND COMMON DOUBTS
The World Health Organization (WHO) defines puberty as “the period in life when a child
experiences physical, hormonal, sexual, and social changes and becomes capable of
reproduction.”5 It is associated with rapid growth and the appearance of secondary sexual
characteristics. This might be exciting as well as stressful during the adolescence.
However, for boys, the shift of puberty is much more explicitly linked to sexual feelings in
a positive way, whereas for girls this moment often marks the beginning of conflicting
messages about sexuality, virginity, fertility, menstruation and womanhood. Puberty, with
its associated physical and psychological changes, can be a particularly challenging
period for adolescents who are intersex or questioning their gender identity or expression.
Q) Puberty changes (secondary sexual characters) in girls and boys30
Girls Boys
- Testicular enlargement, beginning as

- Appearance of breast buds
early as 9-12 years of age
(between 8 and 12 years of age),
- Appearance of pubic hair (10-15 yrs.)
followed by breast development
- Onset of spermarche, or sperm found
(13-18yr)
in the ejaculate (erection and wet
- Development of pubic hair (11-
dreams)
14yr)
- Scrotal thickness and darkens
- Growth spurt begins (average age-
- Lengthening of genitals (11-14)
10yr), which adds inches to height
- Rapid enlargement of the larynx,
and hip circumference
pharynx and lungs, which can lead to
- Menses begins (average age –
12yr, normal age range between 9 alterations in vocal quality (i.e., voice
cracking)
and 16yrs)
- Changes in physical growth (average
- Enlargement of ovaries, uterus,
age, 14), first seen in the hands and
labia, and clitoris; thickening of the
feet, followed by the arms and legs,
endometrium and vaginal mucosa
and then the trunk and chest
- Appearance of underarm hair (13-
- Weight gain and increases in lean body
16yr)
mass and muscle mass (11-16yr)

42
- Dental changes, which include jaw - Growth of facial and body hair, which
growth and development of molars may not be completed until the mid-20s
- Development of body odor and - Dental changes, which include jaw
acne growth and development of molars
- Development of body odor and acne
Picture: depicting some secondary sexual characteristics in males and females.
Q) Puberty starts at what age?
A) Puberty typically starts for girls between ages 8 and 13, and for boys between ages 9
and 14, and may continue until age 19 or older. Hormones are released by the brain to
start puberty.
Q) What is Precocious puberty?
A) Puberty that begins before age 8 in girls and before age 9 in boys is considered as
precocious puberty (early puberty). It could be due to underlying medical conditions in
the body. So, consult a doctor as soon as possible.

43
Q) Is it ok to feel bad about our bodies and the way we look, as we grow older?
A) The way we feel about our bodies and our looks is called ‘body image’. It's what we
see when we look in the mirror and how we feel inside our own skin. Some people accept
themselves as they are (which is good), while others dislike just about everything to do
with their looks and feel bad about it. What you have to understand is that each person is
unique and special. We have to keep a positive attitude about our self. We also have to
make sure to never body shame any person, this is a wrong thing.
Q) Is there any difference between the rate of physical growth (puberty) of males
and females?
A) Yes, there is a lot of difference in the sequence and the rate of growth. Even among
the same sex, there could be a difference. As growth depends on sex(male/female),
genes, nutrition and other environmental factors. As everybody is unique and different.
James Tanner gave a scale (Tanner scale) describing the various stages of growth during
puberty, if you are interested then you can read it on the internet.

44
Q) Pubic hair removal31
A) Pubic hair removal is a more recent thing but increasingly common grooming practice
and shows a great range of variability between different populations. Although carried out
by both males and females. It is always a personal choice of a person to remove pubic
hair or not.
Numerous reasons exist for removing pubic hair, including hygiene, comfort, aesthetic
reasons, sex appeal, for oral sex, genitals may look bigger and clean, medical reasons
(like a fungal infection, pubic lice infestation, before surgery, etc). A multi-billion-dollar
industry has developed around the numerous methods and products available for hair
removal. Products and techniques are available include shaving (most common method,
performed with a razor/electric razor), trimmer, waxing, threading/plucking, trimming with
scissors, hair removal cream, sugaring (use all-natural paste or gel), dyeing/bleaching,
electrolysis and laser.
Pubic hair removal can result in adverse health events depending on the method used.
These complications can include ingrown hair, cuts, injury, epidermal abrasion, folliculitis,
vulvitis, or contact dermatitis. In more serious cases, genital burns can occur from waxing,
and severe skin irritation from various products can lead to vaginal irritation or post
inflammatory hyperpigmentation.
Q) Axillary hair and hygiene32
A) The axillae are uniquely characterized by the presence of hair follicles and sweat
glands. These glands secrete a clear, odourless substance, consisting primarily of water
and salts. The process of body odour formation in the axillae was found to depend on the
biotransformation of these odourless secretions into volatile odoriferous substances by
commensal bacteria (Corynebacteria or Staphylococci) on the skin and hair surface.
Body odour, in particular axillary odour, is perceived as unpleasant by most cultures

worldwide. Moreover, excessive sweating and the resulting unpleasant odour are
reported to adversely affect self‐confidence and self‐esteem in both men and women.
Reducing or eliminating body odour is an essential goal of many people's daily personal
care routine.

45
Typical axilla hygiene practices include cleansing of the axillae, use of antiperspirants,
application of an anti-perspirant or deodorant product and removal of underarm hair has
become more commonplace in men for hygiene as well as aesthetic reasons.
Shaving of the axilla32 is often accompanied by visible and/or sensory irritation, due to
skin damage. Shaving can lead to dry flaky skin, irritation, physical damage (cuts/ nicks).
Q) What is waxing?33
A) Waxing is a technique of hair removal, which involves applying hot wax to an area of
skin that is covered with cloth/strip (muslin). Then the cloth or strip is quickly removed,
extracting the wax and the hair. It is relatively safe, but it can cause microtrauma to the
skin and its underlying structures with reported complications that include folliculitis,
local spread of infection, burns and syringoma development.
Q) Is it normal if I have hair nearby my anus (peri-anal region)?
A) We all have hairs in our body at various sites (some people can have it in ear also),
they all have some role in the body. Hair growth near the peri-anal region is completely
normal, as it occurs usually during the puberty.
Q) Why do some males don’t grow facial hair (beard) or moustache during the
puberty?
A) Facial hair(beard) growth depends mostly on genes and other factors. Some people
grow a moustache or beard little late, it is completely normal.
Facial hair or a moustache is not a sign of masculinity.
Q) Does shaving causes hair to grow faster, darker or coarser?34

46
A) No, Strong scientific evidence disproves these claims. Shaving don’t have any effect
of hair growth, as it removes only the dead portion of the hairs.
Never use a hair removal cream on face, as face

skin is too soft for those chemicals.
You can use shaving cream and razor or

electronic trimmer.
Q) Can females have facial hair (moustache or beard)?
A) Presence of some amount of facial hair (few and thin) in a female is a common thing.
But the presence of coarse and dense facial hair in females may be due to some hormonal
imbalance conditions like – Polycystic ovary disease (PCOD), ovarian tumour, etc.
Q) Why I have too many hairs on my body compared to other people? Is it normal?
A) Body hair depends on the genetics, environment and other factors. So, don’t worry
about it, it is completely normal.
Q) What causes acne (pimples)35 ?
A) Acne during the puberty is normal. As it typically starts at puberty and resolves slowly
as the person reaches his/her 20s. Acne is a condition of the pilosebaceous unit of skin.

47
Blockage of sebaceous glands and colonisation with bacteria (Proionobacterium

acnes) leads to acne. Acne can have multiple causes like: genetic factors, stress,
androgens, drugs and excess sweating. They can also occur in medical conditions like
polycystic ovary disease (PCOD) in females, etc.
Masturbation doesn’t have any effect on acne
Q) What is a sexual attraction?
A) Sexual attraction is a normal thing, it is an attraction on the basis of sexual desire or

the quality of arousing such interest. It is a subjective measure dependent on another
person's interest, perception, and sexual orientation. For example, a heterosexual person
is sexually attracted to the opposite gender and a gay or lesbian person would typically
find a person of the same sex to be more attractive than one of the other sexes.
Q) Sexual fantasies
A) Sexual fantasies are usually associated with masturbation, but the two can occur
independently. Sexual daydreams and fantasies are common—most people have them,
not just teenagers and not just boys. Fantasies often differ between the males and
females. Sexual aggression and dominance are recurring themes in young male fantasies
and usually contain very specific and graphic sexual behaviours but little emotional
involvement. For adolescent females, sexual fantasies often involve relating to others,
and they are more likely to involve sexual activities with which the girl is already familiar.
A teenage girl’s fantasies are also typically about someone they know - a boyfriend, TV
or music stars, friends, casual acquaintances
The important thing about sexual fantasies is that they are just thoughts. There is
nothing to feel guilty or ashamed. It doesn’t reflect about you being sick, weird, or wrong.

48
Q) When you see a romantic song or movie it feels like something coming out in
the underpants. Why does it happen?
A) When you see something that is romantic or sexy or exciting it is absolutely natural to
feel something happen in your body. Some people feel their heartbeat increasing, or feel
sweaty, their pulse might race, they feel a tingle in some part of the body, girls might feel
slight wetness in the vagina and boys might have an erection accompanied by semen
coming out. During the teen years, the body is just getting used to these new sensations,
sometimes you might find yourself reacting like this quite suddenly. With time, you will be
more in control of these physical feelings.

49
MENSTRUATION (PERIODS), HYGIENE AND COMMON PROBLEMS
Menstruation commonly called ‘periods’ occurs only in females. It’s a regular shedding
of the inner layer (endometrium layer) of the uterus. The menstrual cycle is regulated
by hormones in the body. It is called a menstrual cycle as, after every 28 days, there is
uterine bleeding which comes out through the vagina. The first day of menstrual
bleeding is called ‘Day 1’. There is the release of the egg (ovum) from the ovary on the
14th day of the cycle.
Many girls and boys are shy to acquire knowledge and to ask anybody about it. Lack of
Mensuration
knowledge about menstruation can result in confusion and problems.
Q) At what age menstruation starts?36
A) Menstruation starts usually starts by the age of 10 to 15 years (called as Menarche).
Q) I am a 16 years old female and till now my period (menstruation) have not
started, what should I do? Is it something to worry?
A) If after 16 years also your menstruation doesn’t start then you need to consult a doctor.
There may be underlying causes like – imperforate hymen, absent or anomalous uterus,
hormonal disorder, etc.

50
Q) Why the menstrual cycle (periods) occur?
A) It occurs due to hormonal changes. As soon the bleeding from the uterus stops, the
body starts preparing for the pregnancy with a hope that in the next cycle, pregnancy will
occur (by fertilisation with sperm) and the thickness of the inner layer of uterus increases.
When the ovum doesn’t meet sperm during the fertile period, the inner thickened lining
(endometrium) of the uterus starts shedding and comes out in the form of blood through
the vagina.
Q) What are the symptoms of menstruations?
A) The primary sign of menstruation is bleeding through the vagina (may present as
spotting also). Additional symptoms include: 37
1. Abdominal or pelvic cramping
2. Lower back pain
3. Bloating and sore breasts
4. Food cravings
5. Mood swings and irritability
6. Headache
7. Fatigue
Q) Normal Menstrual cycle
A) Every human being has a unique body response. Here are some normal variations of
the menstrual cycle as -
• Normal cycle days ranges 21 to 35 days
• Bleeding days can be from 3 to 7 days
• Amount of blood loss ranges from 20 to 60ml
• There are no clots in the blood (clot means excessive bleeding)
• It may or may not be associated with pain/cramps

51
Q) Common menstrual disorders
A) If any female has any of the following problems during her menstrual cycle, then she
needs to consult a doctor.
Disorders Definition
Amenorrhea Absence of menstrual bleeding (period).
Girls usually do not get her period till 15-16 year of age.
Menorrhagia Cyclic bleeding which is either prolonged (>8days) or heavy

bleed (>80ml).
Polymenorrhea or Cyclic bleeding where the cycles are less than 21days.
Epimenorrhea
Epimenorrhagia or Frequent cycle with excessive or prolonged bleeding.
Polymenorrhagia
Metrorrhagia Irregular cycle, acyclic bleeding forms the uterus.
Menometrorrhagia Irregular cycle + excessive bleeding
Oligomenorrhea Infrequent cycle >35days.
Hypomenorrhea Menstrual bleeding is scanty(<15ml) and lasts for < 2days.
Dysmenorrhea Severe abdomen pain /cramps during or before the

periods.
Q) Causes of delayed/missed period (secondary amenorrhea)
A) There could be any of the following reasons:
1. Normally periods can be delayed up to 5-6 days. If there are more than 7 days of
delay then you have to consult your doctor regarding this.

52
2. Pregnancy – It could be the most common reason, if the female is sexually active.
3. Stress
4. Thyroid disorder
5. Polycystic ovary disease (PCOS)
6. Drugs/medications
7. Malnutrition
8. Tuberculosis/ infection
9. Endocrine disorder
10. Sudden weight loss
11. Overweight /obesity
12. Extreme over exercising
Q) What is Pre-menstrual syndrome (PMS)?38
A) It is a set of physical and psychological symptoms that start anywhere from a few days
to two weeks before a woman gets her monthly period (menstruation), also called as
“premenstrual syndrome” (PMS). The causes of PMS are not completely clear. But it is
thought that hormonal fluctuations during a woman’s monthly cycle play a role.
Many women experience breast tenderness and abdominal pain, for instance. Other
symptoms include headaches, back pain and joint or muscle ache. Water retention, sleep
problems or digestion problems, skin blemishes and food cravings may occur too.
Women who have PMS often feel exhausted, insecure, down, listless, irritable or angry
in the days leading up to their period. Some have problems concentrating and experience
mood swings. They might feel like they are losing control over their body and emotions.
Severe PMS can really affect everyday life and relationships with friends, family, partners
and colleagues.
How to deal with PMS?
• Get enough exercise and sports

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• Use relaxation techniques and meditating
• Do not smoke
• Drink less alcohol and caffeine
• Eat less salt
• Medications can be also used
• For severe PMS symptoms, feel free to consult a doctor
Q) What is ‘fertile period’ in menstrual cycle (period)?39
A) It is the time period of the menstrual cycle during which if unprotected sexual
intercourse is done, then there is a higher chance of fertilisation of ovum with sperm
leading to pregnancy. Ovulation occurs on the 14th day and lives for 3 days. Sperm has
a life of 72 hours (3days). So, the fertile period ranges from 10th day till 17th day of the
menstrual cycle.
A couple can use this knowledge for conceiving a baby. Use of this knowledge for
contraception is not advisable due to the higher failure rate.
Only in 30% of women the fertile period is between 10 th to 17th day. Most
the women reach their fertile window earlier or later. This fertile period can
be highly unpredictable, even if the menstrual cycle is regular.
Dr Facto39
Q) What are the common myths (misconceptions) regarding menstruation?

40
A) Here are the common myths about menstruation in India, which are not true
1. Women can’t go to work during menstruation. They have to take rest only.
2. Women become impure during menstruation, so women are prohibited from
participating in normal life while menstruating. She must be “purified” before she
is allowed to return to her family and day to day chores of her life.

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3. During menstruation, women are not allowed to go to temple, kitchen or touch holy
books.
4. Menstruating women are unhygienic and unclean, hence the food they prepare or
handle is contaminated.
5. In some cultures, women bury their clothes used during menstruation to prevent
them from being used by evil spirits.
6. Menstrual blood is believed to be dangerous, and a malevolent person can do
harm to a menstruating woman or girl by using black magic
7. Strict dietary restrictions are also followed during menstruation such as sour food
like curd, tamarind and pickles are usually avoided by menstruating girls
8. If a girl or women touches a cow while she is on her period, that the cow will
become infertile
9. She is not allowed to touch water or other people.
Menstrual cycle (period) is a normal biological process, which every

girl faces. A menstruating woman is not impure. There is no need of
any dietary or movement restrictions. She has full freedom to work
and cook, as long she is comfortable and maintains hygiene.
Dr Facto
Q) Menstrual Hygiene practises and other advice
A) Following are the menstrual hygiene practices to be followed -
1. Always use a clean sanitary pad or tampon or menstrual cup to absorb the blood.
If a cloth is used, then it should be neat and clean and prefer cotton cloth. As
synthetic cloth may cause skin reactions.
2. Sanitary pad/cloth needs to be changed frequently (at least every four to six hours)
in order to prevent bad odour or infections.
3. If you are using a cloth which is to be reused, it should be washed thoroughly and
disinfected by drying in the sun. As sunlight kills the germ.
4. Keep yourself and your genitals clean during the periods. Don’t put water /soap/
deodorant inside the vagina.

55
5. Take bath or shower at least once a day. Change the undergarments regularly
6. Wash the genital area from outside with plain water (no soap) after each use of
toilet or urination.
7. Keep the area between legs dry, otherwise chaffing or soaring may develop.
8. Eat a healthy diet, iron-rich diet like green leafy vegetables.
9. Always carry an extra sanitary napkin with you, whenever going out.
10. After using the sanitary napkin(pad), wrap it in paper and dispose of in a closed lid
dustbin. Never dispose of the sanitary pad in an open place or in the toilet.
11. Exercise can help in relieving the symptoms like premenstrual syndrome,
dysmenorrhea and relieve bloating. Exercise also causes the release of serotonin,
making one feel much happier.
12. If feeling tired then rest can be taken. Drink adequate water and be hydrated.
13. A heating pad/hot water fomentation can be applied over the abdomen (tummy) to
relive the pain/cramps. For cramp and back pain, simple painkillers like
paracetamol, mefenamic acid can be also taken.
14. Maintain a calendar/diary, so you are prepared for the next cycle.
Picture: Depicts the things to be followed for a good menstrual hygiene.

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Lack of menstrual and personal hygiene is the most likely

cause of genital and urine infections among girls/women
Dr Facto
Q) How to use a sanitary pad?
A) Here are the steps to use a sanitary pad 41
1. Choose a pad of the appropriate thickness, absorbency, shape and style.
Two types of the pad are: with and without wings. "Wings" are those sticky little pieces
that adhere to your underwear. They keep your pad from lodging to the side and feels
like a diaper. In short, unless they irritate your skin or something, they're your friend.
Avoid scented pads.
2. Get in position
It'll be easiest if you're sitting down and your undies are around your knees.
Standing is fine, too; you just want everything in an arm's reach.
3. Remove any wrappers or boxes from the pad.
4. Fold out the flaps, or wings, and take off the long, center backing that covers the
adhesive on the center. Expose the adhesive on the wings too.
5. Stick the adhesive part to your panties. You want the pad to be directly beneath
your vagina.
6. Wear the panties as usual. Done! If your pad is itchy or irritating your skin at all,
remove it and use a different kind of pad.
7. Make sure to wash your hands before and after changing the pad

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Q) What are the other ways to deal with menstrual bleeding?
A) There are – sanitary pads, tampons, menstrual cups. Commonly sanitary pads are
used.

58
Q) Can menstruation be delayed (postponed)?
A) Yes, with the help of medicine menstrual periods can be delayed up to 1-2 weeks. For
this, you need to consult your doctor. Frequent use of medications or use of medication
for longer duration can result in side effects of medications and can affect the hormone
regulation.
Q) What is ‘Vaginal Douching’?
A) Vaginal douching is the process of intravaginal cleansing with a liquid solution or

water. Some women do it after menstruation or after sex. Douching can change the
necessary balance of vaginal flora (good bacteria live in the vagina) and natural acidic
environment in a healthy vagina. Douching can lead to bacterial vaginosis, Pelvic
Inflammatory Disease (PID), problems during pregnancy (ectopic pregnancy, preterm)
and other problems.
Actually, vagina cleans by itself. Therefore, it is advised not to do douching.
Q) At what age menstruations stop?42
A) They usually stop by 50 years of age (called as Menopause). In some cases, they may
stop quite early or late. The age of menopause may depend on genetics and lifestyle
(smoking, obesity, physical activity and diet).
Q) What is ‘menopausal transition’ or ‘perimenopause’43,44?
A) It is the time period before the menopause (approx. 40 to 50yrs) of age. In this period
there are hormonal and emotional changes. These symptoms vary from person to person,
from mild to severe.
This period is characterized by -
- Menstrual irregularities (periods may come very close together, heavy bleeding,
spotting, irregular periods, episodes of amenorrhea)

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- Vasomotor symptoms like -red blotches, hot flushes (sudden feeling of heat not
only disturb women at work and interrupt daily activities, but also disrupt sleep)
- Vaginal dryness, sexual dysfunction
- Mood changes, some may have depression and irritation
These symptoms can be easily managed by counselling, mental preparation, avoiding

coffee and some mild measures. If a woman feels problematic to handle then please feel
free to consult your doctor for medications.

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MASTURBATION AND COMMON DOUBTS
Q) What is masturbation?
A) Masturbation is sexual self-stimulation, usually achieved by touching, stroking, or

massaging the male or female genitals until this trigger an orgasm. Masturbation is very
ordinary - even young children have been known to engage in this behaviour. As the
bodies of children mature, powerful sexual feelings begin to develop, and masturbation
helps to release sexual tension. For adolescents, masturbation is a common way to
explore their erotic potential, and this behaviour can continue throughout adult life. 30
It usually starts by exposure to pornographic literature/video or self-experimentation or

hearsay from peers. Usually, males stimulate the penis and female stimulate clitoris or
vagina. The desire for masturbation is comparatively higher in men than women.45
Q) Is masturbation a wrong thing or a sinful act?
A) Masturbation is not a wrong thing or a sinful act. Scientifically it is a safe, normal,

healthy and acceptable act. It is a common practice, done by everyone. Often people are
shy or guilty to accept it in public, as it has been condemned in most of the cultures. It’s
about getting comfortable with their own body. Most of the people even believe that it is
the best method of achieving orgasm than sexual intercourse (which may not be safe).
Be safe, don’t harm/injure yourself. Think before trying any new method to avoid trauma
to your body.
Masturbation is a healthy thing, practiced by males & females.
There are no side-effects of masturbation.
Never feel guilty about it. It’s part of life, accept it.
Dr Facto
Q) Why do I feel bad or guilty after masturbation?

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A) This may usually happen if you think masturbation is a sinful act or a wrong thing.
When you explore more about it in a scientific way, then you may start enjoying it and
start feeling relaxed.
Q) When can a person start masturbation?
A) It is can be done after a person attains his/her puberty. It totally varies from person to
person, mostly done when a person is comfortable with his body and feels to be ready for
it. It is never to be pressurized and it should be practiced safely, without causing any
trauma or injury to self. Masturbation is a personal thing done in a private space.
There is no hurry for it. Take your own time and can even
discuss about it with a responsible and a trustworthy adult.
Miss Smarty
Q) What is a ‘refractory period’?
A) Most of the men are incapable of another erection for a period of time after one
ejaculation. This is called ‘refractory period’ which varies between men and at different
time and ages. It may vary from a few minutes to a few hours.
Q) Myths about Masturbation
A) Here are the misconceptions (myths) about masturbation -
Myths (misconception) Truth
It’s a sinful act It’s a normal, scientific and healthy practice.
Masturbation leads to weakness of Masturbation doesn’t lead to any weakness or

body and infertility infertility

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Masturbation causes acne on face Mostly it is due to hormonal changes during the
puberty. Masturbation doesn’t cause acne35
Masturbation affects eye power Masturbation doesn’t have any effect on eyes.
(increases refractive errors)
Masturbation can grow hair on Masturbation doesn’t have any effect on hand
hand
Masturbation leads to curvature of Masturbation don’t affect curvature of penis. It is

penis a myth that an erect penis should be at right
angles. A little or moderate curvature is common
and doesn’t affect the process of sexual
intercourse
A drop of semen is made from 20 Semen is produced by secretion of various

drops of blood. Hence, loss of glands. Semen has no relation to blood and its
semen leads to weakness. loss don’t lead to weakness in the body.
Q) Are there any benefits or use of masturbation?
A) Studies and people claim the following benefits of masturbation -
1. Brings self-satiety of sexual desire, controls the sexual response
2. Relieves anxiety and tension
3. Results in good sleep
4. Maintains better physical & mental health
5. Prevention of the subjects to go to sex workers
6. Prevention of STDs and unwanted pregnancy
Q) How frequently one can masturbate?
A) It totally varies from person to person depending upon his age, time, etc. Mostly
teenagers do it very frequently than elderly. There is no problem with frequent

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masturbation. Only thing is that it shouldn't interfere with daily activities and shouldn’t
become one’s obsession.
Q) When masturbation is a problem?
A) It becomes a problem only when any one of the following is present-
1. When a person becomes obsessed with it (causing addiction)
2. When it inhibits sex with the partner
3. When it is done in public
4. When it interferes with daily life activity or social life
5. When there is a chance of causing harm/injury to the body
6. When there is the presence of irritated genitalia
7. When it causes psychological problems
Q) What to do if you see someone masturbating or two people having sex in their
private zone?
A) You have to provide privacy and space. As it’s their body and choice. They have full
freedom for whatever they want to do in their personal life. So, you just move on. Don’t
scold them, don’t take their picture or video, don’t make fun of them.
Q) How to deal with obsession of masturbation (addiction)?
A) Here are the tips to deal with it –
1. Engage in physical activities like – gym, sports, swimming, yoga, meditation, etc.
2. Take a break from the internet, mobile and computer. Gradually increase the duration
of this break.
4. Religious or spiritual involvement can significantly help. Especially, before going to bed
for sleep, offer a prayer to God.
5. Consider masturbation without the use of pornography. Consider even deleting all the
pornographic material and staying away from the friends who deliver it to you.

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6. Avoid being in alone, try to stay with groups or family as much as you can.
7. Discuss it with your friends or can even take a help from professionals
Q) What is ‘handjob’ and ‘fingering’?
A) Both are the form of masturbation. A handjob is the manual stimulation of the penis by
another person to induce sexual pleasure, sometimes resulting in orgasm. Fingering is
the manual stimulation of the vagina, clitoris or rest of the vulva.
Q) What is G-Spot in females46,47
A) The G-spot is a current and controversial issue, and it now attracts interest in female
sexuality because it involves a market share in genital esthetics with interventions such
as its augmentation. Ernst Grafenberg was the first to describe the G-spot in 1950 as an
extremely sensitive area (erogenous zone) approximately 0.5 cm in size, on the anterior
wall of the vagina. G-spot is self-reported in around or less than 50% of females. During
orgasm, this area is pressed downwards like a small cystocele protruding into the vaginal
canal. Whether it is really anatomically present or a scientific deception still awaits an
answer and publications are contradictory.
Q) What is ‘squirting’? female ejaculation?48,49
A) Squirting is still one of the controversial topics but studies claim that 10-40% of female
experiences ejaculation of a small amount of secretory fluid produced by Skene’s/
Bartholin’s gland (also known as female prostate). Most of the studies claim that squirting
is the involuntary ejaculation of urine, which could be due to a medical condition called
‘urine incontinence’. A person with urine continence should seek for medical help and
treatment. The concept of squirting is usually hyped by pornography.
Q) Premature ejaculation (PE) in males 50
A) It is the ejaculation of semen in males, at the beginning of sex that is within 1 minute
of initiation of the sexual act. Every male can experience this at some point in his life. It
could be due to psychological problems or physical disease.

65
The etiology of PE is still under research but the common speculated causes of
premature ejaculations are –
- Most common is Stress
- Anxiety about sexual performance
- Conditioning and early experience
- Hypersensitive penis
- Lower urinary tract infections
With the help of medications, counselling and therapies it can be managed and treated.

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PORNOGRAPHY
Pornography is a type of sexual amusement based on sexual pictures, videos, audios,

and written materials and can be sourced through an electronic/digital medium like
television, radio, DVDs, print media (magazine), mobile, laptop and the internet.
With the advent of mobile and internet accessibility, it has become impossible for anyone
to completely ignore it. Even in movies and TV sexually explicit content is shown.
Pornography has become an entertainment business. They acquire consumer from every
part of the world and of almost every age group through various modes. To increase the
consumer base, they show unrealistic sexual act and create false expectations/
imagination. The Porn industry is all about making money and unreal acting.
Q) What is the problem (bad things) about porn
A) Here are the bad things about porn -
1. It portrays women as an object rather than a human being

2. It shows unrealistic or abnormal sex organs and behavior
3. It creates a false image of sex and builds unrealistic expectations
4. It contributes to unrealistic expectations about men, women, sexual behavior,
sexual response and body appearance
5. It lacks an emotional connection between two people. Most of the things are fake
in it, as it’s all about acting fake and making money.

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6. It hampers the concentration skill and with the thought process.
Q) Side-effects of watching excessive porn /porn addiction
A) Here are the possible side-effects of porn addiction
- It kills the real love and romance

- It creates a false expectation about sex, which can hamper the marriage
/romantic relationship
- It can mess up with your thought process,
- Hampers concentration leading to poor academic performance
- It causes social isolation and loneliness
- It can result in high-risk behaviour (more partners, paid sex, etc)
Addiction to porn is comparable to an addiction of drugs like cocaine or heroin.
have
Q) How to deal with porn addiction?
A) If you notice porn having a negative impact on your life but find yourself having difficulty
cutting it out, you may need to go to greater lengths to get your problem under control.
By replacing your negative behaviour with positive ones, you can beat this habit.
Here are the tips to deal with it–
1. Engage in physical activities like – gym, sports, swimming, etc.

2. Take a break from the internet, mobile and laptop.
3. Use mobile applications or software to block the pornographic content in mobile
and laptop. Restrict access to it.
4. Discuss it with your friends or can even take a medical consultation
5. Religious or spiritual involvement can significantly help
6. Consider masturbation without the use of pornography.
7. Avoid staying alone, spend most of the time with family and friends.
8. Engage in some activities like singing, dancing, painting or writing.

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9. Think of pornography addiction just like any other kind of addiction (i.e., alcohol,
drugs, food). Strategies to manage other addictive behaviours can be applied
to pornography too.
Each action has an impact;

Choose wisely the impact you want to have
Miss Smarty

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SEXUAL INTERCOURSE AND COMMON DOUBTS
Q) What is sexual intercourse / sexual act?
A) Usually people call it as ‘sex’. The sexual act is usually performed between two
mature adults with consent, who are legally married or in a romantic relationship. It can
be divided into coitus and non-coital sex. Coitus sex is the penile insertion into the
female’s vagina. Non-coital sex is hugging, kissing (cheek, body or on the mouth),
touching, stimulating and masturbation.
Q) Is sexual intercourse natural?
A) Yes, it is a natural biological function like respiration, eating and defecation. Healthy
individuals have sex for reproduction or pleasure or for body need.
Q) Do I have to have sex when I grow up? Isn’t it dirty and wicked?
A) You don’t have to do anything if you don’t want to do. Sex is something that is enjoyed
only if it is done out of free choice. Right now, it might seem quite strange to you but later
you might change your mind. That’s ok. Sex is a way of expressing ourselves and our
feelings. It is not dirty or wicked.
Q) What is ‘consent’ for a sexual act?
A) Sexual consent is an agreement to participate in sexual activity. It could be in verbal

(communicated) or in written form. Consent is never in the form of physical gestures, body
signs, objects, indirect signals, actions, dress, etc. Consent is never implied based on
past behavior/ activity or on the dress. Valid consent is without any pressure or threat,
without any influence of drug or alcohol. Consent is always reversible at any point of time
and it has to be very specific for every step or activity. Consent is required before every
sexual act in life, even if you are a married couple or your partner is a sex worker.
A sexual act without consent is always is wrong and considered as rape, which is a
punishable crime.
Legally in most of the countries (including India), a girl less than 18yr old is not allowed
to give consent for sex.

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Everyone has the right to be in control of what they will and will not do with their body.
Consent is a very important thing for a healthy, pleasurable relationship and consensual
sexual behavior with a partner. Consent should be actively communicated and recognized
by their partners.
A person is free to say ‘NO’ to any sexual advance or act at any

point of time.
Valid consent is without any pressure or threat, without any influence

of drug or alcohol.
Miss Smarty
. Q) How does it feel when you have sex?
A) If you have sex when you are ready for it, with someone you care about and who cares
about you, it feels good in your body and in your mind. But if you are scared or unwilling
or not ready for it, it may be the worst experience. Doing any of the sexual act because
of pressure from someone else can make sex feel quite horrible. People describe sex as
- excited, warm, tingly, thrilled, pleasurable, gentle, loved, wanted, special, happy.
Q) When and with whom a person can have sex?
A) All society accept sex between two lawfully married adults as safe and normal. Sex is
a personal thing, which is always done in private and with the consent of the partner. It
should never be forced. A person can always freely choose the time he/she wants to have
sex. It also depends on the cultural, religious and personal moral values. Most people
wait for the correct time when they are emotionally, mentally and physically mature
enough. Some people may choose to never ever have sex in their whole life like nuns,
bharamacharits, etc. While some people might be sexually active at a quite early age.

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Q) How to know whether if you are ready for sex?51
A) No matter what you've heard, read, or seen, not everyone your age is having sex
in any form. Most of the teens choose to wait until they're older to have sex. If you have
already had sex but are unsure if you should have it again, then wait before having sex
again.
Being physically attracted to another person and trying to figure out how to deal with these
feelings is perfectly normal. Kissing and hugging are often accompanied by really intense
sexual feelings. These feelings may tempt you to "go all the way."
Before things go too far, try asking yourself the following questions:
• Do I really want to have sex?
• Is this person pressuring me to have sex?
• Am I ready to have sex?
• What will happen after I have sex with this person?
Miss Smarty
Remember, you can show how you feel about someone without having sex (being
abstinent) with him or her. You can be sexual without having sex by spending romantic
time together, holding hands, kissing, or cuddling.
Ask yourself the following questions:
1) How do you feel when you are with this person?
2) Is this person kind and caring?
3) Does this person respect you and your opinions?
4) Have you talked together about whether to have sex?
5) Have you talked together about using some form of protection like condoms to
prevent infections, and using condoms or other forms of protection to
prevent pregnancy?
6) Will you stay together even if one of you does not want to have sex?

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7) Do you know if your partner has ever had sex with other people?
8) Do you feel pressured to have sex just to please your partner?
If you and your partner find it hard to talk about sex, it might be a sign that you are not
ready to have sex. Open and honest communication is important in any relationship,
especially one that involves sex. It's normal for teens to be curious about sex, but deciding
to have sex is a big step.
Some things to think about before you have sex are -
• What would your parents say if you had sex?
• Are you ready to be a parent?
• Could you handle being told that you have an STI?
• Do you know where to go for birth control methods?
• How would you feel if your partner tells you it's over after
you have sex?
• How would you feel if your partner tells people at school the
two of you had sex?
• How would you handle feeling guilty, scared, or sad

Miss Smarty because you had sex?
If you don't want to have sex, set limits before things get too serious. Never let anyone
talk you into doing something you don't want to do. Boys and girls need to understand
that forcing someone to have sex is wrong.
If you don't know what to say, here are some suggestions.
• "I like you a lot, but I'm just not ready to have sex."
• "You're really fun to be with, and I wouldn't want to ruin our relationship with sex."
• "You're a great person, but sex isn't how I prove I like someone."
• "I'd like to wait until I'm older before I make the decision to have sex."

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Remember "no" means "no" no matter how far you go.

If you feel things are going too far sexually, tell your partner to stop.
Miss Smarty
If you choose to wait, then follow these things -
• Avoid being alone with the same person too often. Spending time with your other
friends is important too.
• Avoid giving someone the wrong idea. Stick to your limits. It's also not a good idea
for you to kiss a lot or go too far sexually if you don't really want to have sex.
• Avoid using alcohol or drugs. Both of these affect your judgment, which may make
it hard to stick to your decision not to have sex.
• Avoid giving in to the pressure. It may be tempting to keep up with the crowd, but
keep in mind that they may not be telling the truth.
People who wait until they are older to have sex usually find out that it is -
• More special
• More satisfying
• Less risky to their health
• Easier to act responsibly and take precautions to avoid infections and pregnancy
• More accepted by others
Be patient. At some point, you will be ready for sex. Move at your own pace, not
someone else's.
have

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Q) Why waiting for the correct age and time for sex make sense?
A) Here are the 3 reasons -
1. Sex can lead to pregnancy. So, ask these questions before any sexual act - Are
you ready to be pregnant or become a teenage parent? It's a huge responsibility.
Are you able to provide food, clothing, and a safe home for your baby?
2. Sex has health risks. A lot of infections can be spread during sex. Sexually
transmitted infections include chlamydia, gonorrhoea, hepatitis B, herpes, HIV (the
virus that causes AIDS), human papillomavirus (HPV), or syphilis.
3. Sex can lead to emotional pain and distractions. You may feel sad or angry if
you let someone pressure you into having sex when you're not really ready. You
also may feel sad or angry if you choose to have sex but your partner leaves you.
Your partner may even tell other people that you had sex with him/her.
Better be safe than sorry
Miss Smarty
Q) How frequently people have sex?
A) Generally, when people are new to sex (like newly married couple), they may have
sex very frequently from many times a day to every day. With the advance in age, the
frequency of sex decreases continuously.
Q) Do people have sex on the marriage night called ‘suhaag raat’?
A) Sometimes they do, and sometimes they wait till they get to know each other a little
better.
Q) What is pre-marital sex?
A) It means sex before marriage. Socially it may be considered as wrong, as depends

on the culture and individual’s belief.

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Q) Why don’t people have a baby every time they have sex?
A) People don’t have babies every time they have sex because the egg (ovum) and the
sperm do not always meet and mix. As most of the couple use something called a
‘contraception’, to prevent having a baby. You will read about contraception in details
in the upcoming chapter.
Q) Who is a virgin?
A) A virgin is anyone (male or female) who did not have intercourse.
Q) Is it wrong to be a virgin?
A) No, it is not wrong. Being a virgin is totally normal as a person is free to decide about
his life and body. Most of the people wait for the right person and the right time to start
their sexual life. Choosing right person and time is always a crucial part of making the
right decision in life. As early exposure to sex may sometime lead to mental and physical
trauma and complications.
Q) What is the first-time sex is like?
A) Usually, people don’t have a good experience with first-time sex, as they are
inexperienced, shy, uncomfortable and lack knowledge. Being comfortable with the
partner and environment can lead to good sex. Sex with a stranger or under the
pressure/influence may be traumatic. Most of the time people aren’t aware of how to
provide or receive a sexual stimulation for sexual satisfaction.
Q) Why the first the time sex may be painful for a woman?
A) There may be various reasons. Here are the few –
- During the first-time sexual intercourse, a hymen may get ruptured which may
cause minute bleeding (mild painful). Remember, most of the times hymen may
not be present or don’t bleed. Presence of hymen is not a sign of virginity.

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- Most of the females may not know about how to relax their vaginal and pelvic
muscles.
- Due to anxiety and fear of penetration
- Due to vaginismus.
Q) What is ‘vaginismus’ in female 52,53?
A) It is a penetration disorder in which any form of vaginal penetration such as tampons,

digit, vaginal dilators, gynaecologic (GYN) examinations, and intercourse is often painful
or impossible. It is due to recurrent or persistent involuntary spasm of the musculature of
the vagina, which can interfere with coitus and causes distress, depression. It can be also
there due to fear and anxiety to penetration.
Vaginismus treatment include -
- Counselling to relieve the anxiety and fear

- Use of local anaesthetic cream (like lignocaine)
- use of vaginal dilators, Kegel’s exercise
- use of medications and some procedures
Q) What is a kiss?
A) A kiss is an expression of love, warmth and affection toward loved ones. A kiss is a
quick touching of lips to another’s body part like on cheek, lips, forehead, hands, etc.
Depending upon the location of kiss, there are different connotations are implied. Kiss on
cheek or forehead or on lips with closed mouth is considered as friendly and is universally
accepted among loved ones like parents, family members, lovers, etc.
Kissing on cheek/forehead and hugging a family member or

friend is not a part of sex.
Q) what is ‘smooch’ and ‘French kiss’?

77
A) Smooch is lip to lip kiss with open mouthed but without tongue. French kiss is a deep
kiss where a person explores another partner’s mouth with tongue. Smooch and French
kiss induce sexual arousal and are shared with someone you love and sexually drawn
too. These are done with clean mouth and fresh breath.
Q) Is there any harm in deep kissing like smooch or French kiss?
A) There is no harm in deep kissing as long as both partners are clean, do not have any
infection, especially in the mouth and done with consent. Exchange of saliva during deep
kiss can transmit the infections, if the partner is suffering from any open wound or infection
in the oral cavity.
Q) How a person responds to a sexual act / sexual response cycle?54
A) Sexual response cycle refers to the sequence of physical and emotional changes that
occur as a person becomes sexually aroused and participates in sexually stimulating
activities, including intercourse and masturbation. Sexual responses in males and female
are divided into 4 identifiable phases. Both men and women experience these phases,
although the timing usually is different. For example, it is unlikely that both partners will
reach orgasm at the same time. In addition, the intensity of the response and the time
spent in each phase varies from person to person. Understanding these differences may
help partners better understand one another's bodies and responses, and enhance the
sexual experience.
Phases Details
Excitement It is accompanied by visual, audio or physical arousal.

phase
Plateau There is a change in the size and shape of sex organs. Breathing rate
phase and heart rate also increases
Orgasmic At the sexual climax, there is an intensely satisfying sensation/feeling

phase called an orgasm

78
Resolution Sex organs return to their normal sizes and shape and also the feeling
phase subsides, heart rate and breathing rates comes to normal
Q) What is an orgasm?
A) It is an explosive feeling of sudden and intense pleasure, a physiological result of

heightened sexual excitement followed by relaxation of sexual tension and body muscles.
It can be achieved by Masturbation or sexual Intercourse. Its duration can be of 4 to 6

secs. Generally, males reach orgasm within 4 to 8 minutes. Females take a little longer
time to reach orgasm (takes 10 to 20 mins) and can have multiple orgasms
simultaneously.
Orgasm can be marked by –
Females Males
• A feeling of intense pleasure • Feeling of intense pleasure
• Flushing of skin • Ejaculation
• Vagina is profusely lubricated • Flushing of skin

(increased secretions) • Spasm of pelvic muscles
• Engorged breasts & vulva • Involuntary vocalization
• Erected nipples
• Spasm of pelvic muscles
• Rhythmic vaginal contractions
• Involuntary vocalization
Q) What is a fake orgasm?
A) A fake orgasm occurs when a person pretends to have an orgasm without actually
experiencing one. It can be faked for various personal reasons. Mostly it is difficult for a
male to fake an orgasm as an ejaculation of semen is strong evidence for orgasm. For
females, it is easy to fake an orgasm.

79
Q) What is foreplay?
A) It is part of a sexual act, where before the sexual intercourse hugging, kissing, petting
cuddling, touching, etc. is being done as a part of sexual stimulation. Generally, for
females, it is the most important part of sexual arousal and helps in reaching orgasm
early.
Q) What is ‘oral sex’ 55?
A) Oral sex refers to sexual activities involving the stimulation of the genitalia by the use
of the mouth, tongue, teeth, mouth or throat. Oral sex is now very common in both
heterosexual and homosexual couples. People may involve in oral sex as part of foreplay
before sexual intercourse, or during or following intercourse. Oral sex may be practiced
by people of all sexual orientations.
The various types of oral sex performed are:
1. Cunnilingus (Oral-Vaginal Contact): Oral stimulation of a woman's vagina and/or

vulva, especially her clitoris, by her partner's lips and tongue.
2. Fellatio (Oral-Penile Contact): Stimulation of a man's penis by his partner's mouth-

usually by licking or sucking. This is called also called as ‘blowjob’ in slang terms.
3. Analingus (Oral-Anal Contact): Stimulation of the partner's anus with tongue or

lips. In slang terms, it is called as ‘rimming.’
Oral sex is an efficient mode of transmission for infections like syphilis,

gonorrhoea and herpes, HIV, Chlamydia, and HPV, can also be
transmitted through oral sex.
Dr Facto55

80
Methods of preventing infection during oral sex –
1. Use physical barriers like condoms (for fellatio), plastic wrap (for analingus), dental
dams/ latex square (for cunnilingus)
2. Avoid any form of sex if your partner has any sign of Sexually Transmitted
Diseases (STDs)
3. Avoid oral sex if the woman is menstruating
4. Make sure that the genitalia and surrounding areas are thoroughly washed and
cleaned
5. Limit the number of sexual partners
6. Avoid sex with an unknown or unfamiliar partner
7. Avoid oral sex after recent dental treatment or periodontal therapy
8. Rinse your mouth with antibacterial mouth wash
9. Maintain good oral hygiene by frequent brushing and flossing.
10. Regular health check-up and screening
Q) What is ‘sodomy’ or ‘anal sex’?
A) It is a sexual act in which a male thrust his penis into the anus of another male or
female. It may be considered a sexual offence under certain circumstances. Many people
claim that they get erotic reaction to anal stimulation. Anal sex is painful to the receptor
and can lead to tears of delicate anal mucosa. It is a contributory factor for fecal
incontinence.56 Anal intercourse is a highly efficient mode of HIV transmission than
vaginal intercourse and it can also transmit other sexually transmitted diseases (STDs)
like Gonorrhoea, syphilis, etc.57,58
Q) Can oral sex or anal sex can lead to pregnancy?
A) Oral sex or swallowing of semen (containing sperm) doesn’t lead to pregnancy. Anal
sex also doesn’t lead to pregnancy. For pregnancy, semen needs to be ejaculated inside
the vagina only.
Q) Is sex with animal carried out?

81
A) It is unethical and illegal to have sex with an animal. It could be very dangerous and
harmful also. It is called as ‘bestiality’ and it is a punishable crime under the law.
Q) What are safe sex practices?
A) ‘Safe sex’ refers to those practices that enable people to reduce their sexual health
risks and lower the likelihood of infection with HIV and other sexually transmitted diseases
(STDs). Safe sex practices include:
1. Staying in a mutually faithfully relationship where both the partners are not
infected.
2. Using a condom/contraception for sexual intercourse
3. Avoid sex when either partner has open sore or any STD
4. Abstinence can be one of the best protection against sexual transmission of HIV
infection
Q) What are safe and unsafe lubricants for sex?
A) Generally, during sexual intercourse, natural lubricants are released from the vagina
and penis. But still, lubricants may be used to decrease in friction in case of dryness, anal
sex, etc. Safe lubricants are water-based lubricants which can be easily washed off and
works well with a condom also. Oil-based lubricants can result in failure of condoms.
Unsafe lubricants are products containing harmful chemicals for an internal organ like
mustard oil, shampoo, soap, skin lotion, etc. Saliva is also a poor option as it spread
certain serious infections /STDs.
Q) Is it safe to have sexual intercourse(sex) when a woman is menstruating (having

periods)?
A) It actually varies from person to person depending on the choice and experience.
Some people find sex as helpful during menses and while some faces increased
menstrual blood flow. As sex during menstruation can be messy with blood and may
smell, this could be a turnoff.

82
If unprotected sex is done during the menstruations then there are

still there are chances of pregnancy, which can’t be ignored.
Dr Facto59
Q) What is a ‘hickey’ or love bite?
A) Love bite or hickey is a small bruise caused by repeated kissing, sucking or biting of
skin. These bruises appear easily on sensitive areas like neck, cheek, breast, etc. it is
due to burst of small superficial blood vessels of the skin. A person has to ask the
permission before giving hickey about the site as it can embarrass the receiver. Some
people like getting a hickey as they like to flaunt about their passionate session of
lovemaking. They like to conceal the hickey by applying ice or makeup over it. While
some people don’t like hickey, as it can be dangerous and can cause a little pain. If hickey
is directly given over a blood vessels (major artery), then it can form a clot (embolism)
causing stroke60. Hickey can also transmit certain infections.
Q) What is a sex toy61?
A) These are adult toys used for sexual satisfaction during masturbation or sexual
intercourse. There are various sex toys in the market depending upon the gender and
choice. Most common sex toy for females are vibrators or dildos (in shape of the penis).
One has to be very careful while using sex toys they as can be dangerous if not used
properly, as they can get stuck or can cause injury to the genitals. Hygiene has to be also
maintained to avoid any infection.
Q) What are ‘sex positions’?

A) Sex positions are the positions of the body that people use for sexual intercourse or
other sexual activity. There are numerous and endless positions based on the type of
sexual intercourse or activity like - man on top (missionary), woman on top (cowgirl),
men from back (doggy), sixty-nine, etc. The choice of the sex position depends on the

83
comfort and personal interest of the people performing the act. There need to be a
proper communication, consent and understanding between the partners before trying
any sex position. As sometime it may cause trauma or injury to the body or genitals.
Q) What is Kamasutra62?
A) It is a book written by Indian philosopher Vatsyanyana during 1st to 4th century A.D. It
is the world’s most famous book on sexuality. This is a guide to ‘art of living’ and it
encompasses philosophy of love, various sex positions, sensuality, seduction, courtship,
marriage, wifely duties & conjugal happiness. This work left impressions in art and found
in Konark, Khajuraho, Belur, Halebidu, etc.
Q) What happens to sex life in old age63 64?

A) Human beings are actually never too old to enjoy a happy and healthy sex life. Usually,
sexual activity decreases with age but there are people who remains sexually active in
the old age, which is a normal thing. For the elders, the ability to remain sexually active
is a major concern in their lives. Fear about the loss of sexual prowess in older males is
common. Older women also express sexual desire but may fear their interest is
undignified and disgraceful.
Elders may experience sexual dysfunction due to boredom, fear, fatigue, grief, or other
factors (e.g., intrinsically low sexual desire, physical disability). Normal ageing brings
physical changes in both men and women. These changes sometimes affect the ability
to have and enjoy sex.
A woman may notice changes in her vagina like shortening & narrowing of the vagina,
hot flashes, vaginal dryness (causing pain during penetration). As men get older,
impotence (also called erectile dysfunction) becomes more common. Some illnesses (like
arthritis, diabetes, stroke, depression, incontinence, heart disease, dementia), disabilities,
medicines, alcohol and surgeries (hysterectomy, Prostatectomy) can affect the ability to
have and enjoy sex.
Q) What is the ‘Erectile dysfunction’ in men?65
A) It is defined as the inability to achieve and maintain an erection sufficient to permit

satisfactory sexual intercourse. It may result from psychological, neurologic, hormonal,

84
arterial, or cavernosal impairment or from a combination of these factors. There are

various medications, procedure and treatment available depending upon the cause.
Q) What is ‘Viagra’ and its side-effects66?
A) Viagra is the brand name of a drug called ‘Sildenafil’. It is used in the treatment of
erectile dysfunction, as it increases blood to the penis resulting in increased duration of
penile erection in men. It can cause – headache, flushing, syncope(fainting), blue vision,
cardiac problems, indigestion, etc. Therefore, it is strictly advised to consult your doctor
before taking such medications. It is not effective in patients with endocrinal impotence,
loss of libido, premature ejaculation or infertility.

85
PREGNANCY, ABORTIONS – COMMON DOUBTS
Q) How babies are born?
A) Married couple perform sexual intercourse (people usually call it ‘sex’). During this, a
male inserts his penis into the vagina and the penis ejaculate semen (contains sperms)
into the female’s vagina. This results in fertilization (meeting) of the female’s ovum by
male’s sperm. This fertilization leads to conception of the product in the uterus. After 9
months (40 wks) of this fertilization, a baby is born either through normal vaginal delivery
or through the abdomen by an obstetrician (called ‘caesarean section’).
People do not want to keep having babies every time they have sex. So, they use certain
things to prevent the sperm and the egg from meeting. These things are called
contraceptives (explained in details in a later chapter).
Q) How to calculate the expected date of delivery of the baby?67
A) There are various methods, but the common one is by using the patient's last
menstrual cycle. The patient must be sure of the first day of their last menstrual period to
use this method in establishing the due date. Adding seven days and then nine months
to the patient’s last menstrual period (or 280 days) will give an estimated delivery date.
This technique assumes that the patient has a normal 28-day menstrual cycle and

86
ovulates on day 14 of that cycle. Currently, there are various smartphone applications
and online software available to calculate it for you.
Only 4% of the woman deliver exactly on the date of expected

delivery (280 days).
Dr Facto68
Q) What is ‘test tube baby’?
A) If for some reason the sperm and the egg cannot meet inside the woman’s body after
repeated attempts but the couple wants to have a baby, they can have a test-tube baby.
Test tube babies are made by taking the woman’s egg and the man’s sperm and making
them meet outside the body, in a laboratory (but not in a test tube, as the name suggests).
Then the fertilized egg is put inside the woman’s uterus where it grows like any other baby
and is born after nine months.
Q) Who will decide that a baby born will be a boy or a girl?
A) Chromosomes decide whether the baby will be a girl or a boy. Women have only one
type of chromosome – ‘X chromosome’ in the ovum. Men have two types of chromosomes
– ‘X’ and ‘Y ‘chromosomes.
So, if a sperm with an X chromosome fertilizes the egg (which has X chromosomes), the
baby will be a girl. If a sperm with the Y chromosome fertilizes the egg, the baby will be a
‘boy’.
No one can control or decide which sperm will meet the X

chromosome of the female’s ovum.
Dr Facto

87
Q) How twin babies are formed?
A) Twins means two babies born in a single pregnancy. They could be identical (look-
alikes) or non-identical twins. The identical twins are formed through division of one
fertilized ovum/egg (zygote) into two, that’s why scientifically also called as monozygotic
twins. The non-identical twins are formed due to fertilization of 2 separate ovum/eggs with
2 sperms, they are also called as zygotic twins (fraternal twins).

88
Q) Can a 13-year-old girl become pregnant?
A) A girl who has started having her periods can become pregnant if semen enters her
vagina. Also, if a girl, who has not yet begun to get her periods but will start having her
periods from that month onwards, she can become pregnant if semen enters her vagina.
Q) Can kissing lead to babies?
A) No
Q) Will a girl become pregnant if semen is ejaculated outside the vagina (nearby
vulva or groin)?
A) No, she can’t become pregnant unless semen (contains sperm) is ejaculated inside
the vagina. However, pre-ejaculatory secretions from the penis, which are released during
the sexual intercourse for lubrication may contain some sperms which can lead to
pregnancy. Therefore, it is always advised to use some form of contraception.
Q) Can a female become pregnant, if there is no vaginal penetration?
A) No, a woman cannot become pregnant if there is no vaginal penetration by a penis.
Q) How does a woman know that she is pregnant?
A) A woman who has been having regular periods stops having her periods when she is
pregnant. So, if a woman who has sex does not get her period on time might be a sign
that she is pregnant. To be sure that she is pregnant she needs to have a pregnancy test,
as periods can also stop because of illness or tension also.
Here then are some signs and Laboratory test for pregnancy -
Early signs of pregnancy Late signs of pregnancy

89
Delayed menstrual periods (1-2 wks beyond Breast becomes enlarged

the expected date) Nipple becomes darker
Nausea (vomiting sensation) Increased vaginal discharge
Tired, mood swings Feeling the movement of a baby
Pica (preference for pickle, sour food, earth (usually starts around 5th month)
pellets)
Enlarged abdomen
Increased frequency in urination
• Uterus is a pelvic organ till 12th week, it reaches till umbilicus at 24th weeks of
gestation and reaches till xiphoid at 36th week. After 36th week, uterus starts
coming down toward umbilicus with flanks start becoming full.
• Most conclusive clinical sign of pregnancy is fetal heart sound (FHS), which
become evident clinically by 18-20th week of pregnancy.
Q) Laboratory tests for pregnancy -
A) Laboratory tests can detect the pregnancy early and can confirm it –
1. Urine pregnancy test (UPT)

2. Ultrasound (USG) – confirmatory test
• Detection of hCG in maternal serum or urine can be done as early as 8-11 days
of conception.
Q) How long does it take for a woman to know she is pregnant?

A) For most women, that's as early as five or six weeks into pregnancy and only 1 or 2
weeks after a missed period.
Q) How to use a urine pregnancy kit/test?
A) Urine pregnancy kits are available at the pharmacy and general store. Anyone can
avail it. Here are the steps to use UPT kit-
1. The Urine Pregnancy Test (UPT) can be performed at any time of the day;
however, testing first-morning urine is preferable.

90
2. Urinate into a clean, dry cup or a container.
3. Remove the testing device from the foil pouch by tearing at the notch. Take out
the device /card (see image below) and place it on a flat surface.
4. Draw out a little urine with a dropper (provided with the kit) and put just two drops
in the circular test well that is usually marked 'S' (sample). Do not spill urine on the
reading strip.
5. Wait for three to five minutes (depending on the manufacturer's instructions) and
then read the test results. Trying to read the results before the stipulated time or
waiting too long, can both lead to inaccurate readings.

91
Q) How to interpret a urine pregnancy test (UPT)?
1. Look at the regions marked 'C' and 'T' on the test card. 'C' indicates a control. This
band must always appear because this is the comparison band. 'T' indicates the test
sample.
2. If only one pink/purple band appear in the region marked 'C', it means that the test is
negative for pregnancy.
3. If two pink/purple bands appear, one in the region marked 'C' and the other in the region
marked 'T', it means that the test is positive for pregnancy
4. In case no bands appear, then the test is invalid. Repeat the test with a new pack of
urine pregnancy test after 72 hours.
5. If the line formed in region 'T' is faint, this could be due to low levels of hCG hormone.
It is said that it is weakly positive but better to repeat the test with a new pack card after
72 hours.
Q) Is sexual intercourse safe during pregnancy?69
A) Sex during pregnancy is normal and safe. A woman can have a normal sex life.
Abstinence from sex is recommended only for women who are at a higher chance (risk)
for preterm labour, miscarriage/ abortions, antepartum haemorrhage. Some research
shows that sex can be avoided in the last 3 months (3rd trimester) of the pregnancy, as it
can result in pre-term labour (early delivery). It is always advised to consult your doctor,
when in doubt.
Q) After how many days a woman can have sexual intercourse after pregnancy
(after delivery of the baby)?69
A) Generally, it is often advised that a women should avoid sexual intercourse until 4 to
6 weeks after vaginal or caesarean delivery. Following childbirth, a woman's body enters
a healing phase when bleeding/lochia stops, episiotomy tears heal and the cervix closes.
She can have intercourse when she feels comfortable and healthy for it. A woman may
experience little pain or discomfort during sexual intercourse but it subsides with time and
proper lubrication.

92
Q) Can be women become pregnant if she is having unprotected sexual intercourse

after delivery of the baby(during post-partum period)?
A) Yes, it is possible to become pregnant very soon after having a baby. Using a birth
control method in the weeks after having a baby (during the postpartum period) helps to
avoid an unintended pregnancy.
Q) Weight gain in pregnancy

A) average weight gain in pregnancy is around 11kg. 1kg in 1 st trimester, 5 kg in 2nd
trimester, 5kg in 3rd trimester.
Ideally Total Weight gain should be according to BMI (weight measured before
pregnancy) 70-
BMI Total Weight gain in pregnancy
<18.5 (underweight) 12.5-18 Kg
18.5 – 24.9 (normal) 11.5 – 16 Kg
25-29 Overweight) 7- 11.5 Kg
≥30 (Obese) 5-9 Kg
• Abnormal weight gain is >500gm in a week or more than 2.2 kg in a month.
Consult a doctor if suspected.
There is increased demand for calorie, protein and iron during the
pregnancy for a healthy baby
Dr Facto
Q) Advice to be followed during pregnancy

1. The diet should be light, nutritious, easily digestible, rich in protein, minerals &
vitamins.
2. Folic supplements (0.4mg/day) need to be started as soon as possible (can be
started before pregnancy also) till the 12th week of pregnancy. It is given to
prevent Neural Tube Defects (NTDs).

93
3. Iron tablets need to be started on 4th month onwards up to 6 months of post-

delivery. It can be taken with lemon juice, as vitamin C increases absorption of
Iron.
4. Try to eat a diet rich in iron like – green leafy vegetable, egg, meat, beans.
5. A pregnant woman needs to take 8 hours of sleep in night & 2 hours of sleep in
the day (post lunch, in left lateral position).
6. A pregnant woman can travel, but prolonged sitting is avoided. Advised to take a
break after every 2 hours (walk and move in between a prolonged journey). In
cars, the seat belt should be under the abdomen. Generally, the rail route is
preferred.
7. Aircraft travel is safe up to 36 weeks only. In multiple pregnancy, it is safe up to
34 weeks.
8. Avoid smoking & alcohol. Reduce the intake of tea and coffee also.
9. Maintain good hygiene (oral, dental, hand, genitalia).
10. For back pain, diclofenac gel or paracetamol tablet and hot water fomentation
can be done.
11. Constipation is common, so it is advised to have lot of fluids & fibres in the diet.
E.g.- salads, vegetables, fruits.
12. Vigorous exercise, sitting on ground & weight loss need to be avoided. However,
evening walks or mild upper limb exercises can be done.
13. Don’t miss any meal, always carry some food while travelling or meeting.
14. Take small meals but frequently
15. Consult your doctor before taking any medications and keep all the health
records safe.
Q) Important key danger signs during pregnancy

A) Following are the key dangers signs during pregnancy,71 if any sign present then
consult a doctor.
Key Danger signs during - Severe vaginal bleeding,
pregnancy - Swollen hands/face,
- Blurred vison,
- Signs of gestation hypertension

94

labour & childbirth - Prolonged labour,
- Convulsions,
- Retained placenta,
post-partum period - Foul smelling vaginal discharge,
- High fever
Key Danger signs in the - Convulsions /spasms/ rigidity,
new born - Difficult/ fast breathing,
- Very small baby,
- Lethargy / unconsciousness.
Q) What is the depression after delivery (postpartum depression)?72
A) Postpartum depression is a mood disorder that can affect women after childbirth.
Mothers with postpartum depression experience feelings of extreme sadness, anxiety,
and exhaustion that may make it difficult for them to complete daily care activities for
themselves or for others. Postpartum depression does not have a single cause, but likely
results from a combination of physical and emotional factors. Only a health care provider
can diagnose a woman with postpartum depression as symptoms of this condition are
broad and may vary between women. The condition, which occurs in nearly 15 percent
of births, may begin shortly before or any time after childbirth, but commonly begins
between a week and a month after delivery. Because of the severity of the symptoms,
postpartum depression usually requires treatment. It can be treated with counselling and
medications.
Q) What are ‘baby blues’?72

95
A) The “baby blues” is a term used to describe the feelings of worry, unhappiness, and
fatigue that many women experience after having a baby. Babies require a lot of care, so
it’s normal for mothers to be worried about, or tired from, providing that care. Baby blues,
affects up to 80% of mothers, includes feelings that are somewhat mild, last a week or
two, and go away on their own.
Q) Abortion
A) Abortion is the medical termination of pregnancy (MTP) before 20 weeks of gestation.
The 4 common Indications for abortions (MTP) are
1) Therapeutic (for cure)

2) Eugenic (child with defects)
3) Failure of contraception
4) Danger to mother health
Female above the age of 18 years can give consent for abortion, without the consent of
her husband or caregiver.
In India, abortions are not allowed after 20 weeks (5th month) of the pregnancy.
Q) Is abortion a bad thing?
A) Abortion is not a bad thing but it should be always carried out safely and legally.
Q) What is safe and unsafe (criminal) abortion
A) Abortion can be done safely by a trained certified doctor or unsafely by a quack.
Safe abortion Unsafe/criminal abortion
It is an abortion that is done with It refers to abortion provided by

appropriate and safe methods during untrained unauthorized individuals
the appropriate duration of pregnancy or/and by using dangerous methods
or/and after the legal duration of

96
and is done by a trained health-care pregnancy. There are punishments

provider (who is legally authorized). under the law for criminal abortions.
There are medical (tablets) and surgical

methods (vacuum aspiration, dilatation
and evacuation) available.
Q) What are the health consequences (complications) of unsafe abortions?
A) Following are the consequence:
Immediate medical Late medical Psychological and other

complications complications consequences
- Subsequent - Depression
- Excessive vaginal
spontaneous - Social withdrawal
bleeding
abortions - Sexual dysfunction
- Infection
- Secondary infertility - Financial burden
- Injury to organs
- Pre-term labour - Lost working
- Shock causing
- Chronic pelvic capacity
Death of the patient
infections (PID)
- Increased risk of
tubal pregnancy
Q) What is infertility? Why some married couple are unable to conceive a baby?
A) Infertility is a condition when a married couple is unable to conceive a baby through

unprotected vaginal sex for 1 year. In an infertile couple it is recommended that first a
husband should undergo the tests (investigations), as investigations for men (like semen
analysis, scrotal ultrasounds) are cheaper and non-invasive than investigations for
females.
Infertility has multiple causes, out of which 40% are due to male
factors and 40% are due to female factor and 15-20% are due to
unknown causes.

97
Dr facto73
Q) Lifestyle changes that may boost fertility
A) Here are the following tips74 –
1. Quit smoking
2. Reduce alcohol consumption
3. Maintain a healthy weight according to your height
4. Don’t consume drugs and marijuana
5. Have a healthy diet rich in fruits and vegetables
6. Caffeine has a negative impact on woman’s fertility, so reduce its amount
7. Avoid exposure to overheat and radiation
8. Do a regular physical activity
9. Try to avoid stress and learn to manage it

98
CONTRACEPTION, CONDOMS
Contraception is the intentional prevention of pregnancy by artificial or natural means.

Contraception allows people to attain their desired number of children and to determine
the spacing of pregnancies by delaying or preventing childbearing. Numerous
contraceptive options, designated by duration and context of use (long-acting,
permanent, short-term, emergency) and by the method of operation (hormonal, non-
hormonal, barrier, fertility awareness-based). 75
WHO and other international organization recommend waiting of 2 to 3 years

between two pregnancy to reduce deaths of babies and to benefit mother’s
health. Research shows that spacing of 3 to 5 years is more advantageous.
Dr Facto76
Q) Why adolescents should know about contraception? Problems with

adolescent pregnancy?
A) Some adolescents may choose not to be sexually active, some may choose to be
sexually active. Here are the problems75 -
1) Pregnancy at an early age can result in complications (like eclampsia, puerperal

endometritis and systemic infections, low birth weight, preterm delivery), which can also
cause the death of the mother or child or both.
2) Unsafe abortions among young girls can cause death complications and death.
3) Unmarried pregnant adolescents may face stigma, rejection or violence by partners,

parents and peers
4) Girls who become pregnant before the age of 18 years are more likely to experience
violence within a marriage or partnership
5) Adolescent pregnancy may also jeopardize girls’ future education and employment
opportunities
Q) Methods of contraception

99
A) The methods could be broadly divided into natural, temporary and permanent
methods -
Natural methods Temporary methods Permanent methods
1. Barrier methods 1. Vasectomy (Vas

1. Abstinence from sex
like condoms Deferens is cut in
especially during the
(male condom), males). It is simpler
fertile period (10th to
femidom (female and easier than
17th days of the
condom), tubectomy.
menstrual cycle)
2. Withdrawal or coitus Diaphragms, 2. Tubectomy
cervical caps and (Fallopian tubes is
interruptus (the male
vaults cut in females)
partner withdraws his
2. Intra Uterine
penis from the vagina
Devices (IUDs) like
just before ejaculation)
copper-T
3. Lactational
3. Injectables
amenorrhea is a
Implants,
method based on the
4. Injections (DMPA)
fact that ovulation is
5. Oral Contraceptive
absent post the
pills (OCP) it also
delivery of baby
has many benefits
(maximum till first 6
in the treatment of
months), if the baby is
menstrual
regularly breastfed.
abnormalities.
Natural methods have higher chances of failure compared to the

temporary and permanent methods.
Dr Facto77
Q) Emergency contraception

100
A) Emergency contraception is NOT a regular method of birth control. Emergency

contraception can be used after unprotected sexual intercourse, or if the birth control
method failed (such as if a condom broke).
1. Copper IUD—Women can have the copper-T IUD inserted within five days of
unprotected sex.
2. Emergency contraceptive pills—Women can take emergency contraceptive pills up to

3 to 5 days after unprotected sex. The sooner the pills are taken, the better they will work.
They can be availed in the pharmacy or general stores in the name of Ezy pill, i-pill,
unwanted 72, plan-B, morning after, etc. Frequent use of emergency pills to be avoided
as they can hamper the menstrual cycles and can cause hormonal imbalance.
If there is a frequent need for emergency pills, then one needs to shift to other
contraceptive methods like oral contraceptive pills (OCP), intrauterine devices (IUCD) like
copper T or injectable contraceptive.
Q) What will happen if a male takes an oral contraceptive pill or emergency pill?
A) Mostly, nothing much will happen to a male but it is advised for not to do so.
Q) How effective are various contraceptive methods?77
A) The least effective are natural methods. Therefore, it is always advised to avoid using
natural methods, as there is a high chance of failure.

101
Q) How effective are condoms?
A) Condoms provide protection against sexually transmitted disease (STDs), approx.

80% protection. Condoms have a high failure rate as 12%, if it is used properly then the
failure rate can be reduced to 3%. They can fail due to slippage, breakage, etc.
Q) What to do if a condom breaks or slips?
A) Don’t panic. You can use emergency contraception or else you can wait for the next
menstrual cycle. If there is a delay of menstrual cycle beyond 1 week, then contact a
doctor for further evaluation and management.
Q) DO’s and Don’ts’ for condom use 77
Do’s for condom use Don’ts for condom use
• DO use a condom every time you • DON’T store condoms in your wallet as
have sex. heat and friction can damage them.
• DO put on a condom before having • DON’T use nonoxynol-9 (a
sex. spermicide), as this can cause
• DO read the package and check the irritation.
expiration date. • DON’T use oil-based products like
• DO make sure there are no tears or baby oil, lotion, petroleum jelly, or
defects. DO store condoms in a cooking oil because they will cause the
cool, dry place. condom to break.
• DO use latex or polyurethane • DON’T use more than one condom at a
condoms. time. It may cause friction and can lead
• DO use water-based or silicone- to breakage of condom
based lubricant to prevent • DON’T reuse a condom.
breakage. • DON’T wash a condom
• DON’t use latex condom, if you are
allergic to latex

102
Q) How to wear a condom? steps
A) Condoms are stored in dry and cool places. Steps to wear and use the condom is also
given in the instruction manual available with the condom packet.
Step1. check the expiry date of the condom, as an expired condom can break easily.
Open the condom carefully, don’t use your nails or sharp items which can damage it.
Step2. Place condom on the head of the erect and hard penis. If uncircumcised penis,
pull back the foreskin first.
Step 3. Pinch air out of the tip of the condom. If air is present then, there is a high chance
of breakage.
Step 4. Unroll condom all the way down the penis. After this, penis can be inserted into
the vagina. Don’t use any lubrication, as condoms are pre-lubricated and vaginal
secretions also act as lubricants.
Step 5. After sex before pulling out the penis, hold the condom at the base. Then pull out,
while holding the condom in place. Withdrawal the penis, while the penis is still erect.
Take off the condom without spilling semen on the vagina.
Step 6. Carefully remove the condom, tie a knot at the open end of the condom, cover it
in a wrapper or paper and throw it in the dustbin. Never reuse them.

103
The Original condoms were made from intestines of animals. The

First rubber condom was produced in 1855 after rubber vulcanization
process was invented by Charles Goodyear.
Dr Facto78
Q) What are flavoured condoms? what’s their use?
A) They are sugar-coated condoms usually used for oral sex (where a penis is involved).
They shouldn’t be used for vaginal-penile sex, as sugar can lead to secondary infections
in the vagina. Also, vagina and anus don’t have any taste buds.
Q) Can I use a plastic sheet or anything else, If I don’t have a condom?
A) No, never use any plastic sheet or anything except condom, as they may break or slip
easily causing Pregnancy. Also, introducing any unsterile thing into the vagina can cause
infections and the irregular surfaces can cause trauma or injury.
Condoms are easily available across most of the pharmacy and

general shops. They are also freely distributed by the government
through various modes.
Miss Smarty

104
SEXUALLY TRANSMITTED INFECTIONS/DISEASES (STI/STDS)

79
Sexually transmitted infections (STIs or STDs) are infections caused by bacteria,
viruses and parasites transmitted through sexual contact, including vaginal, anal and oral
sex. Some STIs may also be spread by skin-to-skin sexual contact or through non-sexual
means, such as from mother to child during pregnancy and childbirth.
There are more than 30 known bacteria, viruses and parasites that cause STIs. 8 of these
pathogens are linked to the greatest incidence of sexually transmitted disease.
Q) What are the common STDs?
A) There are common 8 infections
- Out of which 4 are currently curable: syphilis, gonorrhoea, chlamydia and

trichomoniasis.
- The other 4 are viral infections and are incurable: hepatitis B, Herpes Simplex
Virus (HSV), Human Immunodeficiency virus (HIV), and human papillomavirus
(HPV).
Safe and highly effective vaccines are available for 2 STIs: hepatitis B and HPV. HPV
causes cervical cancer in females and penile cancer in males.

105
Q) What are the symptoms of STDs?
A) Symptoms may vary according to the gender, severity and type of STDs
STD in Males STD in Females
Pus/discharge from the penis Pus/white, smelly discharge from the

vagina
Ulcer on penis or scrotum
Itching or ulcers around the vagina
Pain or burning sensation on urination
Pain or burning sensation on urination
Swollen or painful testis
Q) Who are at the risk for STD?
A) any person who indulges in sexual activity is at risk. One person can get multiple STDs
at the same time also. People at higher risk are –
1. Who has multiple sexual partners
2. Who has sex with commercial sex workers (prostitutes/sex workers)
3. Homosexual males (as anal sex has a higher risk of HIV transmission compared to
vaginal sex).
4. Those who don’t follow ‘safe sex practices.
Q) Who are commercial sex workers/prostitutes?
A) They are the people who offer sex in exchange for money or other benefits. They sell
sex for their livelihood. They could be male (gigolo), female or transgender. Most of them
are forced to do so. They are more prone to drug abuse, physical abuse and STDs.
Q) How to avoid (prevent) STDs -
A) The only guaranteed way is to abstain from sexual activities. The other ways as
follows-
(i) Avoid sex with unknown partners/multiple partners.

106
(ii) Always use condoms during coitus.
(iii) In case of doubt, go to a qualified doctor for early detection and treatment
(iv) Get vaccinated against hepatitis B and HPV.
Q) By immediately cleaning genitals with soap/antiseptic lotion after having sex,

can I avoid STDs?
A) The risk may be little reduced but can’t be eliminated. This is not applicable to
HIV/AIDS.

107
HUMAN IMMUNODEFICIENCY VIRUS (HIV) / AIDS

80
Human immunodeficiency virus (HIV) is a virus that targets the immune system and
weakens the body’s defense systems against infections and some types of cancer. The
most advanced stage of HIV infection is Acquired Immunodeficiency Syndrome (AIDS),
which can take from 2 to 15 years to develop depending on the individual. AIDS is defined
by the development of certain cancers, infections, or other severe clinical manifestations.
There is currently no cure or vaccine for HIV or AIDS. However, effective antiretroviral
(ARV) drugs can control the virus and help prevent transmission so that people with HIV,
and those at substantial risk, can enjoy healthy, long and productive lives.
There are approx. 21.4 lakh people living with HIV in India (2017)
Dr. Facto81
Risk factors for HIV
Behaviours and conditions that put individuals at greater risk of contracting HIV include:
1. Having unprotected anal or vaginal sex;
2. Multiple sexual partners or sex with sex workers
3. Sharing contaminated needles, syringes and other injecting equipment and drug
solutions when injecting drugs;
4. Receiving unsafe injections, blood transfusions, tissue transplantation, medical

procedures that involve unsterile cutting or piercing; and
5. Experiencing accidental needle stick injuries, including among health workers.
Signs and symptoms of HIV
The symptoms of HIV vary depending on the stage of infection. Though people living
with HIV tend to be most infectious in the first few months, many are unaware of their
status until later stages.

108
The symptoms may be
- fever for more than 3 weeks,

- cough or diarrhoea of more than 3weeks which don’t get treated with routine a
treatment
- weightless despite a good diet
- extreme weakness
- small multiples swellings in neck, armpits or groin
- Reddish rash on skin or white patches on mouth
Without treatment, they could also develop severe illnesses such as tuberculosis,
cryptococcal meningitis, severe bacterial infections and cancers such as lymphomas and
Kaposi's sarcoma.
Transmission/spread of HIV
HIV can be transmitted via the exchange of a variety of body fluids from infected
individuals, such as blood, breast milk, semen and vaginal secretions.
Individuals cannot become infected through ordinary day-to-day contacts

such as kissing, hugging, shaking hands, or sharing personal objects,
food or water.
Dr Facto57
5 Major routes of HIV transmissions are –
1. Unprotected sexual intercourse with HIV infected person

2. Getting transfusion of HIV infected blood
3. Contaminated syringes and needles
4. Piercing of ears, nose or tattooing with contaminated instruments
5. May spread from HIV positive mother to her baby

109
Q) How HIV doesn’t spread?
A) HIV doesn’t spread via the following modes/methods –
1. Don’t spread by hugging
2. Don’t spread by Shaking hands
3. Don’t spread by kissing on cheek /forehead
4. Don’t spread by coughing or sneezing
5. Don’t spread by insect bites /mosquitoes
6. Don’t spread by sharing a towel, mobile, transport vehicle, toilets, swimming pool
7. Don’t spread by sharing food or crockery

110
Prevention of HIV
1. Correct and consistent use of male condoms during vaginal or anal penetration can
protect against the spread of sexually transmitted infections, including HIV.
2. Mutually faithful sexual relationship with only one partner
3. Never reuse any needle or syringes
4. Be careful with any transfusions, piercing or cut.
Evidence shows that male condoms have an 85% or greater protective

effect against HIV and other sexually transmitted infections (STIs).
Dr Facto82
Testing of HIV80
HIV infection is often diagnosed through rapid diagnostic tests (RDTs), which detect the
presence or absence of HIV antibodies. Most often these tests provide same-day test
results, which are essential for early treatment and care.
Most individuals develop antibodies to HIV within 28 days of infection and therefore
antibodies may not be detectable early, during the so-called window period. This early
period of infection represents the time of greatest infectivity; however, HIV transmission
can occur during all stages of the infection.
Scientists identified a type of chimpanzee in Central Africa as the source

of HIV infection in humans
Dr Facto57
Q) Can HIV be cured?
A) No, till now there is no cure for HIV.

111
Q) 3 Important Rights in HIV83
A3) Three of the most important rights in the HIV scenario include:
Right to Testing for HIV requires specific and informed consent of the
Informed person being tested and for any research and information
Consent sharing.
Right to A person has the right to keep information on HIV status
Confidentiality confidential. However, they can take the help of Suppression of
Identity under a pseudonym.
Right against A person has the right to be treated equally as per the
Discrimination fundamental rights covered under law and constitution.
Please don’t look at any HIV patient with contempt or any judgement.
Treat them normally and affectionately. They deserve to be respected.
Miss Smarty

SEXUALITY, LGBTQ AND COMMON DOUBTS
Sexuality is not just based on the body or the body parts alone. Sexuality is
experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values,
behaviours, practices, roles and relationships.
Q) Biological sex and sexuality?3
Biological Sex Sexuality (Gender)
It refers to the biological characteristics It is a central aspect of being human

that define humans as female or male. throughout life and encompasses sex,
gender identities and roles, sexual
For example, based on the genitalia a
orientation, eroticism, pleasure, intimacy
boy (male) have a penis and a girl
and reproduction. It can be other than
(female) have a vagina.
male and female also.
It is influenced by biological factors It can be influenced by the interaction of

(genes, hormones) only. biological and external factors
(psychological, social, economic, political,
cultural, ethical, legal, historical, religious
and spiritual factors).
Sexuality (gender identity) is person’s internal, deeply felt sense of being male,
female, other, or in between. Everyone has a gender identity.
Q) What is sexual orientation and sexual behaviour?
Sexual Orientation84 Sexual Behaviour85
It refers to whether a person is sexually It is the is the manner in which humans

attracted (aroused) to a person of the experience and express their sexuality.
same sex or different sex or gender.
One does not have to be sexually active
to have a sexual orientation.
113
Established preference Sexual action
Sexual orientation develops as you grow and experience new things. It

may take time to figure it all out. So, don't worry if you're not sure. If over
time your attraction to members of the same sex continues to grow, it's not
a bad thing, it's just who you are.
Miss Smarty
Q) What is homosexual (homo) and heterosexual (straight)?
Homosexual (homo) Heterosexual (straight)
People who have sexual or romantic People who have sexual or romantic
feelings for people of the same sex. feelings for people of the opposite
Example - Men are attracted to men gender. Example - Men are attracted to
and women are attracted to women. women and women are attracted to
men.
Sometime people use the term ‘gay’ for
homosexual.
Some estimates say that about 10% of the population is homosexual. There are
homosexual people of every race, age, family background, and body type. You can't
tell just by looking at someone that he or she is homosexual.
Just because a boy has some feminine qualities or a girl acts a little
masculine does not mean that he or she is homosexual.
Dr Facto
Q) What is LGBTQ and intersex?

114
A) LGBT stands for Lesbian, Gay, Bisexual, Transgender and Queer. Here are the
meanings of these words -
Lesbian Woman attracted to another woman. (Homosexual woman)
Gay Commonly term ‘gay’ is used to describe homosexual man.
Bisexual People who have sexual or romantic feelings for both men and
women.
Transgender Transgender an umbrella term which includes all those that sit
outside the realm of ‘traditional’ ideas of gender, which includes
trans men, trans women, people who go through gender
reassignment, people who choose not to, people who do not wish
to identify as male or female and people who wish to identify as
both.
Queer Queer is an umbrella term for people who are not heterosexual
and/or do not conform to gender norms. For example, transgender
people, bisexual people and homosexual people.
Intersex Intersex is a term that is used for people whose biological sex
cannot be clearly categorised as either male or female, they have
ambiguous genitalia. Intersex individuals should have full control
over any medical procedures they may wish to undergo and should
not be subjected to medically unnecessary gender normalising
procedures. It is important that intersex individuals get to determine
their own sex and gender, just like everyone else
The two most-recognized international LGBT

symbols are pink triangle & rainbow flag.
Gender reassignment is a process(surgery) in which some people

go through to change their bodies in line with their gender identity.

115
Q) Is homosexuality a disease or disorder?
A) Homosexuality is not a disease or a disorder. All of the major medical organizations,

including The American Psychiatric Association, The American Psychological
Association, and the American Academy of Paediatrics agree that homosexuality is
not an illness or disorder, but a form of sexual expression.
No one knows what causes a person to be gay, bisexual, or straight. There probably
are a number of factors. Some may be biological. Others may be psychological. The
reasons can vary from one person to another.
The fact is that you do not choose to be gay, bisexual, or straight.
Dr Facto
Q) Problems faced by LGBTQ youth
A) Many lesbians, gay, bisexual, transgender and Queer (LGBTQ) adolescents are
happy and thrive during their teenage years. However, as a group they are more likely
than their heterosexual peers to experience difficulties: LGBT adolescents are at
increased risk for suicide attempts, homelessness, alcohol use, and risky sex.
The way parents respond to their LGBT adolescents can have a tremendous impact
on their children's current and future mental and physical health. Supportive reactions
can help adolescents cope and thrive. 86
Don’t Judge people, It’s their choice and Life

116
On 6th September 2018, the Supreme Court of India ruled unanimously

that section 377 of the Indian penal code was unconstitutional.
The historic judgement, which decriminalised sexual acts between

consenting adults of the same sex, was hailed as a landmark decision
for LGBTQ rights in India.
Dr Facto87
Q) What is ‘hypersexuality’ or ‘hypersexual disorder’88?
A) Hypersexual disorder refers to exhibiting unusual or excessive concern with or

indulgence in sexual activity. It is called ‘satyriasis’ among males and ‘nymphomania’
in females.
Q) What is ‘asexuality’?
A) Asexuality89 is usually defined as having no sexual attraction to a partner of either

sex. It is mostly self-identified based on lack of sexual attraction or lack of sexual
behaviour. Sometime it may overlap with hypoactive sexual desire disorder (HSDD),
which is defined as persistently or recurrently deficient (or absent) sexual fantasies
and desire for sexual activity. Asexuality and HSDD is one of the grey area, which is
difficult to define.

117
SEXUAL RIGHTS
Sexual rights embrace certain human rights that are already recognized in
international and regional human rights documents and other consensus documents
and in national laws.5
Rights of sexual health include:
1. The rights to Life, Liberty, Autonomy and Security of the person

2. The rights to equality and non-discrimination
3. The right to be free from torture or cruel, inhuman or degrading treatment or
punishment
4. The right to privacy
5. The rights to the highest attainable standard of health (including sexual health)
and social security
6. The right to marry and to found a family and enter into marriage with the free
and full consent of the intending spouses, and to equality in and at the
dissolution of marriage
7. The right to decide the number and spacing of one’s children
8. The rights to information, as well as education
9. The rights to freedom of opinion and expression, and
10. The right to an effective remedy for violations of fundamental rights.

118
CYBER BULLYING & CYBERSTALKING

Cyberbullying90
Cyberbullying involves posting or sending electronic messages (sometimes
anonymously), including text, pictures or videos, aimed at harassing, threatening or
spreading rumors, sexual remarks on another person via a variety of digital platforms
such as online social networks, chat rooms, blogs, instant messaging and text
messaging.
Cyberbullying has increased with the increased use of the social media sites, the
Internet, e-mail, and mobile devices. Unlike more traditional bullying, cyberbullying
can be more anonymous and can occur nearly constantly. A person can be
cyberbullied day or night, such as when they are checking their e mail, using Facebook
or another social network site, or even when they are using a mobile phone.
Cyber-victimization has been associated with depression, anxiety,

stress, low self-esteem and behavioral problems.
Dr Facto
Q) Cyberstalking 10
A) Technology gives youth new chances to be stalked by a current or former dating

partner. Cyberstalking includes:
1. Unwanted, frightening, or offensive emails, text messages, or instant

messages (IMs)
2. Harassment or threats on social media
3. Tracking computer and internet use
4. Using technology such as GPS to track a person

119
Q) Signs that a child is a victim of cyber-bullying
1) Drastic change in their use of devices (sudden increase or decrease)

2) Begins to avoid several social situations
3) Displays extreme sadness, loss of interest and isolation of people and
activities.
4) Starts to become secretive by hiding their screens when others are near.
5) Sudden shut down of social media accounts or the creation of new ones.
Q) Ways to avoid cyberstalking and predators
A) Here are the following methods to be safe from cyberbullying -
1. Never put up your personal details on the internet /social media like full name,
address, cell phone number, specific places they hang out, financial
information, ethnic background, school, or anything else that would help
someone locate you.
2. In cyberspace, there’s no such thing as an “erase” button—messages, photos,
rants, and musings can and do hang around forever. Information that may seem
harmless now but it can be used against you at any time—may be in the future
when you are applying to college or looking for a job. Photos posted on the
sites should not reveal too much personal information.
3. Shut down a personal website or blog if there is even a small threat to bullying
or flaming. If necessary, get a new email address and instantmessaging (IM)
identity.

120
4. Never become friends with any strangers online, as they may some other
intentions like kidnapping, human trafficking, assault, etc.
5. Never save the password in any of the websites.
6. Be careful with the location services of the mobile or laptop.
7. You can always choose to discuss social media post/profile with your friends
and parents, to be safe.
8. Never trust anyone whom you met online. There are a lot of fake profiles. Never
try to go and meet them. Always inform your parents.
9. Keep your webcam on laptop or computer always disconnected. As these can
be easily hacked and can record your personal details. Be safe with mobile as
well.
10. Keep the laptop/computer at the common place (avoid keeping in bedroom or
at personal space)
Always feel free to compliant about cyberbullying or cyberstalking to

police and parents/care-taker.
Miss Smarty

121
SEXUAL ABUSE, HARASSMENT, RAPE
A sexual assault 91 is any sexual act that a person did not consent to, or is forced into
against their will. It is a form of sexual violence and includes rape, or other sexual
offences, such as groping, forced kissing, child sexual abuse or the torture of a person
in a sexual manner.
Sexual violence or assault can happen to anyone of any age: men, women and
children. Most young people who have been abused have been abused by someone
they know e.g. a neighbor, a driver, a relative, a family member, or a domestic helper.
If it has happened to you, remember that it is not your fault; it is the

abuser who did wrong, not you; it does not have to spoil your life.
Look for help if you are feeling confused or bad. If you are in a
situation that you feel might be abused, speak to someone you trust;
try getting out of the situation if you can; try not to be alone with the
abuser, and seek help soon.
Miss Smarty
Your body is your own. It is your 'private property'. If someone touches you or
clicks picture or records video in a way that you do not want or do not like, it is wrong.
You have to report this to your parents or responsible adults.
Sexual abuse takes many forms and does not always involve direct physical contact.
If a person is forced to have sex when they do not want to, it is called Rape (an assault
involving penetration of the vagina, anus or mouth). When someone is sexually
abused by a relative, it is called incest.
Abuse involves trust being broken and can make a person feel horrible or angry or
scared or all of these feelings and more.
Q) Why adults may molest or assault young children?

122
A) Adults may sexually molest young children as they may think –
- It is easier to approach
- Rejection is less damaging
- A sexual encounter is less threatening
- Wrong beliefs
When you are young, no matter how much or how little you
know about sex, it is not right for an adult to be sexual with
you –it is called sexual abuse. It must be reported to Parents
or Police.
Miss Smarty
Q) Child sexual abuse
A) It may include touching and non-touching activity –
Touching activity Non-touching activities
- Deliberately exposing an adult’s

- Touching a child’s genitalia (private
genitals to a child
part) for sexual pleasure.
- Inappropriately watching undress or
- Making a child touch someone’s
while using the bathroom
genitals or to play a sexual game or
to have sex. - Showing pornography to a child
- Putting any object or any body part - Photographing a child in sexual poses
- Encouraging a child to watch or sexual
(finger, tongue, etc.) inside vagina
acts
or mouth or anus for sexual
- Showing/ flashing genitals to a child
pleasure.

123
Q) What to do if someone on road or on the bus is showing you his penis?
A) Don’t stare at him but just look away, keep walking, do not show him that you are
shocked or angry although you may feel it; tell someone responsible elder or
authority person (police or bus in-charge) about this, so they can do something to
stop him from doing this to other children or another person; avoid taking that road
/bus alone for a few days at least; if you are with friends make sure that none of you
giggles or shows any interest in what he is doing because that will encourage him to
do this again. Showing private parts in public is a punishable crime, you can report
this to the police.
Q) Rape definition under Indian law
A) It is defined under section 375, It defines rape to include any or all of the following
acts, by man against a woman
(a) penetrates his penis, to any extent, into the vagina, mouth, urethra or anus of a
woman or makes her do so with him or any other person;
b) inserts, to any extent, any object or a part of the body, not being the penis, into the
vagina, the urethra or anus of a woman or makes her do so with him or any other
person;
c) manipulates any part of the body of a woman so as to cause penetration into the
vagina, urethra, anus or any part of the body of such woman or makes her do so with
him or any other person;
d) applies his mouth to the vagina, anus, urethra of a woman or makes her do so with
him or any other person,

124
under the circumstances falling under any of the following seven descriptions:
1. Against her will.
2. Without her consent.
3. With her consent, when her consent has been obtained by putting her or any person
in whom she is interested, in fear of death or of hurt.
4. With her consent, when the man knows that he is not her husband and that her
consent is given because she believes that he is another man to whom she is or
believes herself to be lawfully married.
5. With her consent when, at the time of giving such consent, by reason of
unsoundness of mind or intoxication or the administration by him personally or through
another of any stupefying or unwholesome substance, she is unable to understand
the nature and consequences of that to which she gives consent.
6. With or without her consent, when she is under eighteen years of age.
7. When she is unable to communicate consent.
Q) What is ‘Marital Rape’?
A) It is an act of sexual intercourse with one’s spouse without the consent. Some
countries have criminalised the marital rape, while some countries have not.
Q) Things a rape victim can do 91
1. Don’t be scared, directly file a police complaint or tell it to your parent or someone
responsible adult whom you trust.
2. Before the collection of medical evidence by a forensic team (police) - don’t take
bath, don’t change clothes, don’t wash the vagina or anus or mouth, don’t cut nails.
As they contain certain forensic evidence which may get destroyed.
3. Don’t be scared of any call threat or blackmail. Because once you get scared, then
it will boost the confidence of the perpetrator and he may repeat the assault again.
4. If you don’t feel like going to the police station on the same day. Take your time and
then file a written or online complaint.

125
5. Your identity will be not be revealed in public or media in any form. As revealing the
identity of the rape victim is a punishable crime under the Law.
6. If needed then avail the government facilities for counselling, contraception, legal
and social matters.
Q) What to be done if you meet a rape victim91
1. Someone who has been abused needs your support. They also need you to
respect their wishes.
2. Never reveal to anyone about what has happened to them.
3. If you know someone who abuses others, do not protect them; abusers are a
danger to other people.
4. Don't judge them, don't blame them. A sexual assault is never the fault of the
person who is abused.
5. Listen to the person, but don't ask for details of the assault. Don't ask them -
why they didn't stop it. This can make them feel as though you blame them.
6. Offer practical support, such as going with them to appointments. Respect
their decisions.
7. Bear in mind they might not want to be touched. Even a hug might upset
them, so ask first. If you're in a sexual relationship with them, be aware that
sex might be frightening, and don't put pressure on them to have sex.
8. Don't tell them to forget about the assault. It will take time for them to deal
with their feelings and emotions. You can help by listening.

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FINDING HELP AND SUPPORT IN INDIA
Friends, family, teachers, religious leaders and community members can help each
other. It’s important to assess sources of help and support, including services and
media sources, in order to access quality information and services. People also need
support for counselling, testing and treatment for STIs/HIV. Everyone has the right to
affordable, factual and respectful assistance that maintains confidentiality and protects
privacy.
Here is the list of some agencies/source from where you can access any help and
support in India. You can find more in your nearby area through the internet or friends.
1. National Commission for Women (India) –
Telephone - 011 - 26944880, 26944883
Email - complaintcell-ncw[at]nic[dot]in
Online link for complaint - http://ncw.nic.in/onlinecomplaintsv2/frmHome.aspx
2. Child Helpline number (India) – 1098

3. Police helpline number (India) – 100
4. Online crime reporting (Digital police) -
https://digitalpolice.gov.in/ncr/login.aspx
5. Child Line, New Delhi (For people under 18 years) Phone: 011-24324503
6. TARSHI, New Delhi (For sexuality issues) Phone: 011-24372229
7. Depression helpline – AASRA 91-22-27546669
8. Saathiya helpline – 1800-233-1250

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LAWS IN INDIA AGAINST SEXUAL ABUSE
Q) Protection Of Children from Sexual Offences (POCSO) Act
A) Introduced in 2012, POCSO was enacted with the aim of protecting children,
below the age of 18. It provides a robust legal framework for the protection of
children from offences of sexual assault, sexual harassment and pornography, it also
criminalizes acts of immodesty against children too. It criminalizes even watching or
collection of pornographic content involving children. The framing of the Act seeks to
put children first by making it easy to use by including mechanisms for child-friendly
reporting, recording of evidence, investigation and speedy trial of offences through
designated Special Courts.
The Act also criminalises consensual sexual intercourse between two people below
the age of 18. Age for consent for sexual intercourse in 18 years of Age
Under this Act, if any girl under 18 is seeking abortion the service provider is
compelled to register a complaint of sexual assault with the police.
Punishment under POCSO ranges from 3 years imprisonment to life imprisonment

with or without fine.
Q) Why a girl should marry after 18 years only?
A) Before the age of 18year, girls are immature physically, mentally and emotionally.
Any form of marriage (social /informal) among before the age of 18years in female and
21yr of age in males is called child marriage, which is an illegal and punishable crime
under the law of India.

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Q) Important Indian Penal code (IPC) for sexual assault and punishment under
India law.
IPC Offence Punishment
294 Singing lewd songs directed at women in public spaces Imprisonment up to 3 months
or fined or both
354 A Demanding sexual favors despite the indication of Imprisonment ranging from 1
disinterest is a crime (unwelcome physical contact or – 3 year or fined or both
colored remark)
354 B Disrobing a woman Imprisonment ranging from a

3-5 year or fined or both
354 C Voyeurism (man who watches, or captures the image of a Imprisonment ranging from a
woman engaging in a private act in circumstances) 1 -3 year with or without fine
354 D Stalking a woman (physical or digital) Imprisonment ranging from 3-

5 years
503 threatens another with any injury to his person, reputation Imprisonment up to 2 years
or property, or to the person or reputation of anyone in or fine or both
whom that person is interested, with intent to cause alarm
to that person, or to cause that person to do any act which
he is not legally bound to do, or to omit to do any act which
that person is legally entitled to do, as the means of
avoiding the execution of such threat, commits criminal
intimidation
499 Defamation (includes morphing of pictures) Imprisonment up to 2 years

or fine or both
67 A Punishment for publishing or transmitting of material Imprisonment up to 2 years

containing sexually explicit act, etc., in electronic form. with or without fine
509 Insult to outrage the modesty of a woman (by words or Imprisonment up to 3 years
gesture). Eve teasing. with or without fine

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MENTAL HEALTH
Q) Depression 92
A) Depression is due to multiple factors resulting from complex mechanisms; there

can be no single identifiable cause. However, there is conclusive evidence to reveal
that several biological (genetical), social, economic, cultural and environmental factors
operate in leading to depression. Common causes are – endogenous (biological),
stress, disease, old age, love failure, post-delivery, poverty, social conflicts, etc.
The overall prevalence rates of childhood depression in India vary

anywhere between 0.3% to about 1.2%. The NMHS (2015-16) reported a
prevalence rate of 0.8% for depression among 13–17 year-old children.
Dr Facto92
Depression can range from mild to severe based on the symptoms. Following are the
signs and symptoms of depression -
1. Frequent sadness, tearfulness, crying

2. Decreased interest in activities or inability to enjoy formerly favorite activities
3. Hopelessness
4. Persistent boredom, low energy
5. Social isolation, poor communication
6. Extreme sensitivity to rejection or failure
7. Increased irritability, anger, or hostility
8. Difficulty with relationships
9. Frequent complaints of physical illness such as headaches or stomachaches
10. Frequent absences from school or poor performance in school
11. Poor concentration
12. Feeling overwhelmed easily or often
13. A major change in eating and/or sleeping patterns
14. Talk of or efforts to run away from home
15. Thoughts or expressions of suicide or self-destructive behavior

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Treatment –There are various forms of treatment available from counselling to

medications. Depression is largely preventable and treatable.
Depression is not a sign of weakness. Please feel free to seek

medical and to talk about it to your friends.
Dr Facto
Q) Stress management skills for young people and adults
A) Here are the tips for stress management -
1. Talk about problems with other trusted peoples like friends, parents, teachers,
etc.
2. Take deep breaths, accompanied by thinking or saying aloud, “I can handle
this”.
3. Perform progressive muscle relaxation, which involves repeatedly tensing and
relaxing large muscles of the body. You can count from 10 to 1 (reverse
counting).
4. Set small goals and break tasks into smaller, manageable chunks.

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5. Exercise and eat regular meals. Involve in outdoor sports and be physically
active.
6. Get proper sleep, at least 6-7 hours per day.
7. Break the habit of relying on caffeine or energy drinks to get through the day.
8. Focus on what you can control (your reactions, your actions) and let go of what
you cannot (other people’s opinions and expectations).
9. Work through worst-case scenarios until they seem amusing or absurd
10. Lower unrealistic expectations.
11. Schedule breaks and enjoyable activities.
12. Accept yourself as you are; identify your unique strengths and build on them.
13. Give up on the idea of perfection, both in yourself and in others.

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PEER INFLUENCE, DECISION MAKING
Peer pressure 8
Friends can influence an adolescent’s attitudes and behaviours in ways that matter
across multiple domains of health and well-being, well into adulthood. We often hear
about this in the form of peer pressure, which refers more explicitly to the pressure
adolescents feel from their friends or peer group to behave in certain ways, good or
bad. It can take the form of encouragement, requests, challenges, threats, or insults.
Sometimes, peer pressure is unspoken an adolescent may feel pressured to do
something simply because their friends are doing it.
Research shows that friends and peer groups are linked to adolescents’ positive and
negative:
1. Health behaviours, including their diet and level of physical activity
2. Risk behaviours, including tobacco use, marijuana use, alcohol use, and use
of other drugs;
3. School engagement, including their GPA and attitudes towards school;
4. Tastes in clothing and entertainment;
5. Dating behaviours and the formation of sexual identities and romantic

partnerships.
Generally, young adolescents are the most susceptible to peer pressure, and recent
research indicates that popular adolescents may be under higher pressure than other
youth to conform to peer behaviours. While popular adolescents often possess a wider
range of social skills and better knowledge about themselves than other
youth, popularity can be associated with higher rates of alcohol and substance use,
vandalism, and shoplifting.
Everyone deserves to make their own decisions and all

decisions have consequences.
Miss Smarty

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Q) How should one deal with the peer-pressure?
A) There are lots of techniques to deal with a peer-pressure.
1. First of all, one has to know what is good and bad for him, if unaware then must
talk to parents or to a responsible adult about it.
2. You have to understand that peer-pressure is long term or lifelong thing. You
have to take a stand, deal and speak about it. Be assertive by speaking out
when someone is being bullied or pressured into making a sexual decision that
they don’t want to take.
3. Be smart and patient, never act in the heat of the moments. Plan for it and try
to find ways to deal with it in a subtle and smart way.
4. Best is to discuss with the people you trust like your parents, teachers or any
responsible adults. They may be able to give you better ways/tricks to get away
with it.
Q) How to resist sexual pressure?
A) The process of making decisions about sexual behaviour includes consideration of

all positive and negative potential consequences. Decisions about sexual behaviour
can affect people’s health, future and life plan. There are factors that can make it
difficult to make rational decisions about sexual behavior like - range of emotions,
alcohol and drugs, poverty, gender inequality and violence.
Decision-making is a skill that can be learned and practiced

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Here are the words for fending off unwanted sexual advances -
Hook (provoke) Sinker (way to refuse)
“Aw c’mon, everybody “I don’t care, I’m not everybody. And besides, not everybody
does it! ‘does it,’ including some of the kids who say they do.”
“If you loved me, you’d “If you loved me, you wouldn’t pressure me into doing
go to bed with me.” something that I’m not ready to do.”
“If you don’t have sex “If being your girlfriend means that I have to sleep with you,
with me, I’ll break up then I guess I don’t want to be your girlfriend.”
with you.”
“Why won’t you have “Because I don’t want to.” No further explanation needed.”
sex with me?”
“We had sex before; why “I’m entitled to change my mind. It’s my body and my life,
are you turning me and I want to wait until I’m older before I have sex again.”
down now?”
“Yo, let’s do it. You know “No. No. No! What part of ‘no’ don’t you understand?”
you want to!”
“Your parents are out all “Go back to my house?

night; let’s go back to We can’t. My parents won’t let me have boys over
your house.” when they’re not home.”

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TIPS AND ADVICES FOR PARENTS OR GUARDIANS
Q) Things a parent or guardian should do
A) Here are things a good parent/guardian should follow–
1. Never deny or ignore the questions of kids, answer them always with truth
and logic. Kids are smart and intelligent. Don’t underestimate them.
2. Never lie to a kid, as it leads to loss of trust and faith
3. Get their trust. So, in case of trouble or problem, they should come first to you
with ease.
4. Never simply say ‘Don’t do’ or ‘that is bad’. Instead, always explain the real
scientific reason for not doing so.
5. Always be careful with the words you use in fronts of kids. They listen,
observe and remember everything. They may learn bad things or bad words
from you.
6. Never cross dress them when they are young. Example - never dress a boy
as a girl, this may later impact him psychologically.
7. Never undress them in front of outsiders or unknown people. Give them full
privacy and respect.
8. Teach them about good and bad touch.
9. Never force a kid if he/she is uncomfortable in hugging, kissing or in sitting in
the lap of someone.
Q) Successful teen-parent conversation about sex
A) Here are the advices -
1. Engage children in open, honest discussions regarding appropriate dating

behavior, emotional and sexual intimacy, sexual identity, and emotional
commitment.
2. Discuss responsibilities regarding commitment and intimacy in romantic
relationships.
3. Discuss responsibilities regarding avoiding pregnancy, STIs, and HIV.
4. Teach teens not to exploit other people socially, emotionally, or sexually.
5. This is impossible to teach if it is not also modelled. Similarly, teach teens how
to recognize abusive and exploitive relationships.

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6. Set appropriate limits regarding dating, such as the age at which dating will be
allowed, curfews, and the age of person your child may date.
7. Since teens may be embarrassed to talk with their parents about sex and
relationships, try to provide access to other trusted adults (church members,
counsellors, relatives, teachers, etc.).
8. Be open to questions and values expressed by the teen.
Q) How to support healthy identity formation in children
1. Accept the adolescent for who she or he is.

2. Respect the differences between the two of you.
3. Negotiate with teenagers, especially when establishing limits, and explain
your reasoning.
4. Practice consistency in enforcing rules.
5. Encourage a young person’s self-expression.
6. Take the teen’s point of view into account when reasoning with him or her.
Q) Dealing with powerful media images of youth
1. Explain that media images do not reflect the average person here is wide
diversity in physical appearance and rate of development.
2. Point out how body sizes, shapes, and faces are altered in magazines and
photographs using software programs like Photoshop. Waists and thighs are
whittled, cheekbones sharpened and lips plumped for women. Muscles are
pumped up and defined, and complexions smoothed for men.
3. Encourage critical thinking about the media and the nature of our consumer
culture. Now is the perfect time to help teens develop their critical thinking skills
- help them question what is “normal.”
4. Turn to resources that reflect realistic, diverse appearances of actual people.
5. Encourage activities that focus on attributes other than physical appearances,
such as academics, sports, music, the arts, writing, or crafts.
6. Reinforce these messages regularly.

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Q) Teaching decision-making strategies to children
A) Adolescents need opportunities to practice and discuss realistic decision-making.

Here are some ways adults can facilitate the process:
1. Get youth actively practicing decision making through role-playing and group
problem-solving exercises.
2. Take a look at how you make decisions and then lead by example.
3. Demonstrate to teens how to choose between competing pressures and
demands.
4. Many adolescents live in the now. Show them the benefits of future thinking
by anticipating difficult situations and planning in advance how to handle
them.
5. Encourage adolescents to spend time with friends who share their values.
Q) Warning signs of bullying
1. Damaged or missing clothing and belongings

2. Unexplained cuts, bruises, or torn clothes
3. Lack of friends
4. Frequent claims of having lost pocket money, possessions, packed lunches,
or snacks
5. Fear of school or of leaving the house
6. Avoidance of places, friends, family members, or activities teens once
enjoyed
7. Unusual routes to and from school or the bus stop
8. Poor appetite, headaches, stomachaches
9. Mood swings
10. Trouble sleeping
11. Lack of interest in schoolwork
12. Talk about suicide
13. Uncharacteristic aggression toward younger siblings or family members
Q) Signs of child abuse

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A) signs depend on the type of abuse like physical abuse and sexual abuse
I) Signs for physical abuse
What to look for on the body What behavior/s to look for
- Extremes in moods, overly happy

- Bruises
or sad
- Welts
- Frightened of you, or other family
- Burns
or friends
- Fractures
- Doesn’t want to be touched
- Lacerations/cuts
- Gets upset when another child
cries
- Tells you someone hit him/her
II) Sexual abuse signs
What to look for physically What behavior/s to look for
- Withdraws or engages in infantile

- Torn, stained, bloody
behavior
undergarments

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- Pain or genital itching - Poor peer relationships

- Bruises, bleeding or swelling of - Does not want to do any physical
genitals activity
- Has acquired a sexually - Hides in his/her room or does not
transmitted school want to go to
- Disease - Trying to tell you something but
- Has semen on mouth or genitals does not
- Is pregnant
Q) Factors associated with the occurrence of adolescent (teenage) pregnancy
A) Following factors may be responsible for teenage pregnancy –
1. Early marriage
2. Physical and psychosocial changes leading to early sexual activity
3. Social media, TV, print media giving a conflicting message and idolize certain
sexual behavior
4. Experimentation with sex
5. Lack of information on contraception
6. Social barriers to access family planning services
7. Lack of negotiating skills on the part of adolescents
Q) What to do if a child uses bad words or abusive words in his language?
A) Here are a few advice, you can use any of the tips –
1. Be careful about the language you use in front of your child.
2. Be firm and tell him that such language is not acceptable.
3. Most of the times kids use bad words by overhearing someone and starts using
them without knowing the meaning. So first find out what all words do he uses
and ask him the meaning. If he doesn’t know the meaning but can understand
some, then explain him the meaning. He starts thinking twice before using such
words.
4. Find out his source of learning and cut that source out.

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5. Don't laugh and discourage your friends and family from laughing when he says
a bad word. He will interpret laughter as encouragement. Try not to react at all.
Maintain a poker face. If he can't get a rise out of you, he will soon tire of these
antics.
6. Use the reward and punishment method
7. You can provide them with different words for replacements
Q) Things that can cause stress among teenagers/adolescents
A) Here are the following causes
1. School pressure and career decisions

2. After-school or summer jobs
3. Dating and friendships
4. Pressure to wear certain types of clothing, jewellery, or hairstyles
5. Pressure to experiment with drugs, alcohol, or sex
6. Pressure to be a particular size or body shape. With girls, the focus is often
weight. With boys, it is usually a certain muscular or athletic physique.
7. Dealing with the physical and cognitive changes of puberty
8. Family and peer conflicts
9. Being bullied or exposed to violence or sexual harassment
10. Crammed schedules, juggling school, sports, after-school activities, social life,
and family obligations
Q) Signs an adolescent is overloaded
A) Here are the signs -
1. Increased complaints of headache, stomachache, muscle pain, tiredness

2. Shutting down and withdrawing from people and activities
3. Increased anger or irritability; i.e., lashing out at people and situations
4. Crying more often and appearing teary-eyed
5. Feelings of hopelessness
6. Chronic anxiety and nervousness
7. Changes in sleeping and eating habits, i.e., insomnia or being “too busy” to eat
8. Difficulty concentrating

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Q) Potential unhealthy responses to physical changes30
A) It is normal for young people to feel self-conscious and fret about their appearance.
Once in a while, more serious difficulties arise as teens deal with physical changes.
These include:
1. Fear, confusion, or withdrawal, especially during early adolescence, ages 10-

14yr
2. Obsessive concern about appearance
3. Excessive dieting or exercise
4. Early-maturing teens being exposed to social situations they may not be ready
to handle (e.g., being invited to parties with older teens)
5. Experiencing depression and eating disorders
6. Being bullied, teased, or excluded
Q) Life skills for adolescents -
Thinking skill Social skill Negotiating skill
- Positive - Coping effectively

- Self-awareness
relationships with stress
- Raising self
- Value others way - Learning to say
esteem
of thinking ‘No’ to oneself
- Self confidence
- Good listener - Say ‘No’ to peer
- Empathy
- Good pressure
- Goal setting
- Problem solving communication - Be assertive and
skill not aggressive or
- Decision making
- Able to Judge passive
correctly - Making mutual
compromises
Life skills and examples of life skill activity -

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Skill Examples of life skill activity
Decision making and For example, A group of young boys try to threaten 2-
problem solving 3 young girls in the evening time. The girls have to
work out whose help to seek if this happens again
Critical thinking and A young girl is able to assess the risks involved in
creative thinking accepting a car lift/bike lift at late evening from a male
stranger
Communication and A child is able to resist peer pressure when his friends
interpersonal ridicule his refusal to drink alcohol or smoke cigarette
relationships
Coping with stress and A youngster learns how to cope with the conflicting
emotion pressure of marks in school
Self-awareness and A young boy develops an awareness of his sexual

empathy feelings can “take over” sensible decisions. This
awareness helps him avoid situations where he might
risk unsafe sex either with his girl friend

143
EXTRA Q & A
Q) Why the pH of vagina is acidic?93 How sperm is able to survive in the acidic
medium of vagina?
A) The normal vaginal pH is 3.8 to 4.5 (acidic), it is due to the presence of lactobacillus
bacteria (produces lactic acid). The acidic medium of vagina kills sperms and microbes
(protects against infections). The optimum pH of sperm viability is 7 to 8.5. During the
sexual intercourse, vagina pH is neutralised by the secretions of cervical mucus and
seminal fluid for the passage of sperms into uterus without any damage.
Q) Which testicle is lower in men?
A) In most of the men, the right testicle is a little bigger than the left. The left testicle
hangs lower compared to the right. These could be subjective finding or may be vice-
versa is some people, which is may be normal.
Q) What physiological changes causes morning erection?
A) Nervous system changes which occur during the sleep are –
1. Overcome of Parasympathetic system in REM sleep over the sympathetic one.

Stimulation of the parasympathetic system can cause a penile erection.
2. A full bladder can also stimulate the sacral nerve (parasympathetic system).
Q) Nutritional requirement in pregnancy

A) These values are in reference to Indian 55kg moderate female worker.
*reference – National Institute of Nutrition, Hyderabad (India).
In non- During 0-6th month 6-12th month
pregnant pregnancy of lactation of lactation
women
Calorie 2230Kcal /day 2580 Kcal/day 2830 2750
required Kcal/day Kcal/day
Protein 55 gm 78 gm 74 gm 68 gm
required

144
• Calcium requirement in pregnancy is 1200mg/day.

• Total iron requirement in pregnancy is 1000mg (300mg for fetus & placenta,
500mg for mother,200mg shed out).
Q) Rate of HIV transmission through various modes

145
Q) Causes of erectile dysfunction 65

146
TO EXPLORE MORE
Books and study material
1. For more details you can go through the bibliography/references

2. ‘Red Book’ and ‘Blue book’ by TARSHI http://www.tarshi.net/index.asp?pid=9
3. Books on sexual health are available in Hindi by TARSHI -
http://www.tarshi.net/index.asp?pid=239
4. Saathiya (android application in Hindi by Govt. of India)
5. Discovery series: Human sexuality by Janell L. Carroll
6. ‘A handy guide for good sex and family life’ – a book by Dr. Bir Singh and Dr.
V.P. Reddaiah
7. ‘Know about HIV and AIDS’ by Dr Bir Singh
8. Adolescent Health – Module for Basic Health Functionaries, IEC division,
Ministry of Health and Family Welfare (2004)
9. Sexuality education for children and adolescents with developmental
disabilities (Florida Developmental Disabilities Council, Inc)
Videos /TV series/ Movies
1. ‘Sex chat with Pappu and Papa’ by YFilms, available in various languages
(Hindi, Tamil, Telugu, Bengali, Kannada, Malayalam) in Youtube
https://www.youtube.com/playlist?list=PLEDnP0ud0ZBjwM_Nim8jLqlcTjQHn2Xm
Y
2. Sex sense ‘Sex Education for Grown-ups’ by Discovery channel
3. ‘In the womb’ by National Geographic (2005)
https://topdocumentaryfilms.com/national-geographic-in-the-womb/
4. Sex-rated: The VICE guide to Sex in India
https://video.vice.com/en_in/show/sex-rated-the-vice-guide-to-sex-in-india
5. ‘Sex ed for adults’ by TED.
https://www.ted.com/playlists/293/sex_ed_for_adults
6. “Period – End of Sentence” Oscar winning documentary on menstruation in
India (2019)
7. ‘The Education of Shelby Knox’ (2005)
8. Sex(Ed) the movie (2014)
9. ‘Sex Education’ TV drama series by Netflix (2019)

147
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Other references -
- ‘A handy guide for good sex and family life’ – a book by Dr. Bir Singh and Dr.
V.P. Reddaiah
- ‘Know about HIV and AIDS’ by Dr Bir Singh
- ‘The Red Book’ by TARSHI
- NCERT textbook
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Ministry of Health and Family Welfare (2004)
- Sexuality education for children and adolescents with developmental
disabilities (Florida Developmental Disabilities Council, Inc)

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1

Dr Ankit Chandra 1st Edition (2019)

For hard copy of this book

Dr Ankit Chandra 1st Edition (2019)

Dr Ankit Chandra has studied MBBS from Jawaharlal Institute of Postgraduate

Suniyal vids) and in Facebook page (ankitsuniyalvids).

REVIEW OF THE BOOK BY DOCTORS

“Very good and comprehensive” – Dr Rani Bang (SEARCH, Gadchiroli)

“Very comprehensive” – Dr Sonali Sarkar (JIPMER, Pondicherry)

“simple presentation and great by its content delivery” - Dr Sivaraman (JIPMER

“Myths explained very well” – Dr Dhirendra

“Encyclopaedic view of a topic, which is still a taboo in India. A must-read

“Interactive, illustrative, straightforward and provides whatever you want to know”

Dr Ankit Chandra 1st Edition (2019)

“Little knowledge or false knowledge is always dangerous”

- Dr Rani Bang (SEARCH, Gadchiroli)

About the Author ............................................................................................................................ 3

SEX EDUCATION – NEED AND BENEFITS

A study on child abuse in India conducted by the Ministry of

United Nations International Children’s Emergency Fund (UNICEF) household

Q) What the World Health Organization (WHO) say about it?

Q) What is ‘sexual health’?

A) World Health Organization(WHO) defines sexual health as “the integration of the

Dr Ankit Chandra 1st Edition (2019)

Q) What is the purpose of ‘sex education’?

Q) Benefits of sex education

- Delays initiation of sexual activity

Q) What are the misconceptions about sex education4 ?

Dr Ankit Chandra 1st Edition (2019)

Q) Who can provide sex education?

Dr Ankit Chandra 1st Edition (2019)

Growing up means taking

Q) What is the Role of Family?

A) Following are the important roles of a family -

Dr Ankit Chandra 1st Edition (2019)

Love, cooperation, gender equality, mutual

Marriage and Parenting

Marriage is the legally or formally recognized union of two people as partners in a

Conflict and misunderstandings between parents/guardians and

Dr Ankit Chandra 1st Edition (2019)

FRIENDSHIP, LOVE AND ROMANTIC RELATIONSHIP, DATING

Q) Can girls and boys be best friends?

Q) Tips to make friends

Dr Ankit Chandra 1st Edition (2019)

Q) What are healthy and unhealthy relationships 9 ?

Dr Ankit Chandra 1st Edition (2019)

Healthy relationship Unhealthy relationship

- Partners treat each - One partner is controlling, makes all the

- One partner intimidates or controls a partner

- One partner engages in physical or sexual

Romantic relationships can be strongly affected by inequality and differences in power

Q) Infatuation vs. Love vs. Lust

Infatuation Love Lust

It is the state of temporary It can be described as a Any intense desire or

Dr Ankit Chandra 1st Edition (2019)

Infatuation is delusional. Love is unconditional and real. It is a temporary

Dr Ankit Chandra 1st Edition (2019)

platform (social media/dating platforms) for kidnapping, blackmailing, sexual assault,

Q) What is ‘dating violence’ 10