8. SEXUAL MATURATION

8.1. INTRODUCTION

Sexual development is a complex process which includes emotional, social, cultural, and physical aspects, and it starts much earlier than puberty, yet through puberty it is more intense and visible. It is never too early to speak about and answer children’s questions about sexual and reproductive health – while using age-appropriate language. It is a great opportunity to offer quality information and to set open and a safe atmosphere were talking about sexual health is not taboo.

Rapid changes of body during puberty can be confusing and demanding for young people and their body image due to beauty standards.

It is essential that adults know how the human body works. Teachers and parents should also be educated about intimate relationships and sex. This is made more difficult by making these topics taboo over time because of their relationship to sexuality and frequent myths.

8.2. DEVELOPMENT OF THE TOPIC

8.2.1. Stages of sexual development

The way adults think about sexuality is rather different from how children perceive it, yet it does not mean that they do not perceive it at all. In infancy and early childhood (0-5 years of age) it is normal to be curious about their own body and to touch it for a soothing feeling, having no inhibitions about nudity. Around age three the curiosity can lead to “playing doctor” games or asking about where babies come from. Already in this age children understand well gender roles in the society they live in as well as they start perceiving their own gender. They are also more aware of the societal norms related to the sexual behaviour and their own sexual expression starts to be more covert in contrast with the very open one they had in lower ages. In middle childhood (5-8) it is common to perceive the gender roles even more strongly, it is also usual that children try to masturbate for pleasant feelings, and they can be curious about sex activities or exploring with their peers.

In late childhood and puberty physical changes become more pronounced with secondary sex characteristics coming in play as a result of hormonal changes. That includes growing taller, changes in fat distribution, voice changes, hair growth, breast growth, widening of shoulders or hips, etc. For people with a vulva there comes the start of monthly menstruation and for people with penis there starts to be nocturnal emissions and erections. The age of puberty varies significantly among people, as it can start as early as seven years old, or much later as in 12 years of age (National Child Traumatic Stress Network, 2009).

It is estimated that the age when children start feeling sexual attraction may occur strongly and surely around the age of 10, for children regardless their gender or their sexuality (Pattatucci, & Hamer, 1995). Already the age of six it is considered as the age of rising of sexual subjectivity of children due to onset of adrenarche (Herdt & McClintock, 2000). Adrenarche is a process of increased production of adrenal androgens which influences emotional and psychological development of children. However, the age of realizing sexual attraction may vary greatly due to various factors (individual personality, family environment, etc.).

8.2.2. Anatomy: links with transition, hormones, etc.

Biological sex is constituted of many aspects of the human body. The first characteristic, which can be identified already in a human foetus, are chromosomes. The most known sex chromosomes are XY (male) and XX (female), and there are other variations like for example X0 or XXY. All of these can be identified by genetic testing.

At the beginning of the pregnancy the foetus has undifferentiated gonads. In the first trimester it goes through a process called sexual differentiation which is influenced by androgens. Androgens are key hormones defining how the genitalia of a foetus will develop (if there are high levels of androgens, the foetus will have testicles), and they also influence brain development (Smith et al., 2003). When genitalia develop, they start to produce sex hormones which further influence the development of the body. The main sex hormones are oestrogens, progesterone, and testosterone. Although oestrogen and progesterone are considered to be more “female” hormones and testosterone to be “male” hormone, their combination can be found in all bodies, but in different levels.

Another period of significant body changes due to hormonal secretion is puberty. For people on the female side of the spectrum it means growth of breasts, rise of fat percentage in the body, especially around hips and thighs, growth of vulva and eventually menarche (the first menstruation). For people on the male part of the spectrum, it means growth of testicles and penis, lean body mass increase and visible change of larynx and voice tone. Other changes such as more visible body hair, pubic hair, skeletal growth, or occurrence of acne are found across all parts of the sex spectrum (Wheeler, 1991).

People who are transgender or nonbinary might want to go through transition, which is a process of changing their presentation and body according to their gender identity. Transition has several levels, and not all people want and need to go through all of them. These levels are (Doležalová et al., 2021):

• Social transition (living in a role which aligns with their gender identity)
• Medical transition (hormonal therapy and possibly surgeries)
• Legal transition (change of name, official documents)

Masculinizing hormonal therapy usually includes testosterone treatment and leads to growth of more face/body hair, deepening of voice, enlargement of clitoris and increased muscle mass. Feminizing hormonal therapy usually includes oestrogens, progesterone and also testosterone blockers. This treatment leads to enlargement of breasts, skin softening, redistribution of body fat and pelvis change.

Hormone therapy can be different for children and young people, since they still haven’t gone through the process of puberty. For them an option could be either the hormonal therapy as mentioned above or puberty blockers (usually gonadotropin-releasing hormone analogue), which give the young person more time to think about their identity to decide (Rew et al., 2021).

Due to research on biological sex over past decade we can conclude it is more accurate to describe biological sex in humans as bimodal, but not strictly binary. Bimodal means that there are essentially two dimensions (two maxima) to the continuum of biological sex, where most people can fit, but each in different part of the spectrum with their unique hormone levels and combination of sex characteristics. In order for sex to be binary there would need to be two separated, non-overlapping and unambiguous ends to that continuum, but there clearly are not. There is overlap in the middle – hence bimodal, but not binary (Blackless et al., 2000) (See Figure 6).

Figure 6. The sex spectrum
Source: https://cadehildreth.com/gender-spectrum/?fbclid=IwAR2O5F_RyhSeMt24t9GGSkP40pUirYfGpRtIPB4XF-VvxhAfV65ZFifFsCM

8.2.3. Body hair

Body hair refers to visible hair growing on various parts of the body such as face, chest, legs, arms, armpits or pubic area and it develops mainly during puberty. Another type of body hair is vellus hair, which are short and almost not visible and are present on most of the body since early childhood. People vary in the amount, strength, and visibility of their body hair, which is absolutely normal, as it is influenced by many factors, including the levels of androgens.

Body hair is an absolutely natural part of the human body and has a protective function. There is nothing unhygienic about it (when adhering to basic hygienic practices as washing regularly) as it can be sometimes falsely claimed. Body hair removal is primarily motivated by social norms of attractiveness and gender stereotypes of what femininity or masculinity should look like. Feelings of shame or disgust with body hair are generated by societal norms which create feelings for example for women that a woman’s body is unacceptable if unaltered (Williamson, 2015). On the other hand, a man’s body is considered to be unusual or labelled as “gay” if they choose to remove their body hair. Body hair should be discussed openly and accepted as a normal part of our bodies because it is a personal choice that can change over time but that should remain a personal choice. No person should be pushed or convinced to remove their body hair in order to fit in.

8.2.4. Body image

Body image is a set of thoughts and feelings of a person towards their own body and how they perceive its attractiveness and abilities as well as how they relate to it. It can influence how people see their body (which sometimes does not correspond to how it actually looks like) and how they feel about their body – which can vary from dissatisfaction to happiness.

Body dissatisfaction can lead to risk behaviours, excessive dieting and avoiding physical activity (Kopcakova et al., 2014), spending a lot of time on appearance and self-objectification.

Body image is influenced by societal norms, media, unrealistic cultural beauty standards and behaviour of important family figures. Young women usually feel pressure to be skinny and yet to have curves, while young men adhere to the ideal men who is muscular and tall. Queer people and BIPOC people (abbreviation for Black, Indigenous, and People of Colour) may also have unique and complicated experiences with body image, as everyone. Body image can be also negatively influenced by unrealistic beauty standards on social media with the usage of filters changing proportion of face and/or body and pictures being in general heavily edited (Dakanalis et al., 2015). A child’s perception on their body image can be improved with programs focused on body appreciation and embodiment (Guest et al., 2022).

8.2.5. Hymen myths

The hymen is a thin mucous membrane, partially closing the vaginal orifice. It consists of collagenous elastic tissue, and it is elasticity grows during puberty. The hymen is not a unified full-covering membrane separating the vagina from the world, in fact it covers only part of the vaginal orifice, and the shape and size of it varies greatly among people. In many cultures the myth prevails that virginity is associated with an intact hymen, and that it represents a female chastity and pride (Hegazy & Al-Rukban, 2012). It is assumed that the hymen “breaks” when a person has penetrative sex for the first time and that this leads to bleeding. Not only is this a social construction to impose the idea of purity in young girls and women but it is also untrue, because the hymen can either stretch (especially if the vagina is lubricated) or it can be ruptured due to other reasons, like sport, the use of tampons etc. The hymen is not an indicator of virginity, and it has no biological purpose (Cook & Dickens, 2009). It is not anyhow defining the worth of a person or being an indicator of their sexual behaviour.

Hymen myths are based on misconceptions, misinformation about virginity and can be extremely harmful for the mental and physical health of young girls and women. Because of the shame and stigma connected to hymen not being intact, people might seek hymen reconstruction surgeries, which are very controversial procedure. It involves stitching parts of hymen together to ensure the person bleeds next time they have intercourse. We might reflect on if this is ever beneficial and that it’s not the best way to tackle the source of the problem (Saharso, 2022).

The imposed cultural norms can lead people to seek hymen reconstruction.

8.2.6. The clitoris (function, history)

The clitoris is an important and the most sensitive erogenous part of the vulva (see Figure 7 to identify different types of vulva) partially visible with its glans above the vaginal canal at the junction of inner labia and hidden by its bigger part. It consists of highly nerved tissue similar to the one constituting the penis. It is associated with sexual pleasure and most people with a vulva can reach an orgasm through clitoral stimulation.

Figure 7. Types of vulva
Source: attachment of the lesson “Sexuality Myths and Sex Lessons for Education on Respectful Relationships” (originally in Czech: “Mýty o pohlavních orgánech a sexu Lekce sexuální nauky pro vzdělávání o respektujících vztazích”. Dagmar Krišová, Johana Nejedlová, Konsent, z.s., 2021)

Many scientists, textbooks, teachers, and parents in the past and still today stay silent about the anatomy of the clitoris and its function (Ogletree & Ginsburg, 2000). The clitoris was studied fully only in 1998 (O’Connell et al., 1998) before scientists associated it with shame or had no interest in it since they thought it had no reproductive function. In fact, clitoris arousal causes the lubrication of the vagina and also induces contractions in the uterus which can help the sperm to move forward, increasing the chance of getting pregnant. You can see the anatomy described in the Figure 8.

• The clitoral glans is the most innervated part of the clitoris, full of free nerve endings. It is the only party of clitoris which is visible to the eye and can be easily and directly stimulated for pleasure, it is only ⅕^th of the overall size of clitoris.
• Corpus cavernosum are made of erectile tissue and follow the pubic rami on each side of vulva, it is covered by a muscle so it is hidden, it can reach seven cm or more in length.
• Crus of clitoris: the crura are two legs that extend from the clitoral body. They are the longest part of the clitoris.
• Urinary meatus is the ending of urinal tube.
• Vaginal opening: vagina extends from cervix, a neck-like piece of tissue that connects the vagina to uterus. Vagina ends as a hole outside of the body, called vaginal opening. Vagina opening can be found between the urinary tube ending and the rectum.
• Bulb of vestibule: there are two bulbs of erectile tissue that starts close to the inferior side of the body of the clitoris. The vestibular bulbs then extend towards the urethra and vagina on the medal edge of the crus of the clitoris

Figure 8. Structural diagram of the clitoris
Source: Wikipedia (https://commons.wikimedia.org/wiki/File:Sch%C3%A9ma_strucurel_l%C3%A9gend%C3%A9_du_clitoris.svg

8.2.7. Penis (function)

The penis is an external organ with complex anatomy with combined function (see Figure 9 to identify different types of penis). It is used to urinate, for sex and for reproductive behaviours. The anatomy of the penis includes the head (glans), shaft, and foreskin. The shaft is made of erectile tissue as well as the urethra, which carries urine out of the body. Every penis looks a little different, especially when erected as a result of arousal – for example, some may be curved like a banana while others may straighter, facing downward or upward.

Figure 9. Types of penis
Source: attachment of the lesson “Sexuality Myths and Sex Lessons for Education on Respectful Relationships” (originally in Czech: “Mýty o pohlavních orgánech a sexu Lekce sexuální nauky pro vzdělávání o respektujících vztazích”. Dagmar Krišová, Johana Nejedlová, Konsent, z.s., 2021)

• Glans

Glans is also called the head or tip of a penis. It contains the opening of the urethra – it’s where bodies with penises pee out of, and it is also the place where other fluids like pre-ejaculate and semen come out of it. For many people, it’s the most sensitive part of the penis.

• Shaft

The shaft of the penis extends from the tip to where it connects it with ones lower belly. It looks like a tube, and it contains the urethra inside.

• Foreskin

The foreskin is a patch of skin that covers and protects the glans. When a penis gets erected or hard because of arousal, the foreskin usually pulls back, and the tip is exposed. Sometimes foreskin is circumcised (when a doctor surgically removes the foreskin) soon after birth, so not everyone has it. Circumcision is sometimes based on cultural and religious traditions but sometimes it may be necessary to enable functioning of the penis during erection. Sometimes when people mature, their foreskin may remain too tight for glans to be normally uncovered, this may cause problems with hygiene (cleaning the glans) or disable normal function when the penis is hard during sex – circumcision or partial circumcision are easy surgical remedies of these problems.

• Frenulum

The frenulum is where the foreskin is connected with the underside of penis. It is typically V-shaped and starts just below the head. Usually, part of it remains after circumcision and for many people, it’s very sensitive.

8.2.8. Masturbation

Masturbation is the “manipulation of one’s own genital organs, typically the penis or clitoris, for purposes of sexual gratification. The act is usually accompanied by sexual fantasies or erotic literature, pictures, or videos. Masturbation may also include the use of mechanical devices (e.g., a vibrator) or self-stimulation of other organs, such as the anus or the nipples” (APA, n.d.).

Until this day, there are many myths about masturbation which have no scientific basis such as masturbation being harmful, decreasing sensitivity in genitals, or causing infertility. Contrary to that, Rullo et al. (2018) showed that vibratory stimulation has evidence-based support for the treatment of erectile dysfunction, ejaculatory dysfunction, and anorgasmia.

In general, masturbation, when it is not done in public or in excessive amounts, is an absolutely normal and healthy activity bringing pleasurable sensations, both to teenagers and adults (Leung & Robson, 1993). Masturbation should not be perceived as a compensation for a missing sex partner but rather as an independent way to gain sexual pleasure as it can also improve orgasm achieving (Kontula & Haavio-Mannila,2003). The more you know about your own body, what you like and what you do not, the better you can construct your partnered sexual relationship in a way that would bring you more pleasure. It’s important to speak about masturbation and debunk myths around it, which can lead to more positive attitudes towards masturbation (Lo Presto et al.,1985). There are multiple ways in which masturbation may be conducted (Pla, 2020), involving objects, sex toys, single or partnered sex, etc.

8.2.9. Menstruation cycle

The menstruation cycle is a hormone-controlled cycle which can take between 21 and 35 days, depending on the body, and it is connected with the uterus and ovaries functions.

First comes the follicular phase – it is controlled by gonadotropin-releasing hormones and during this phase the follicles in the ovary become mature.

The second phase is ovulation – there is a rise in oestrogen hormone, which causes the ovary to release an egg. Lining of the womb starts to thicken at this point.

The third comes the luteal phase, where hormones of progesterone and oestrogen are high, during this time, while the lining of the uterus normally gets thicker to prepare for a possible pregnancy. If pregnancy doesn’t occur, the egg is reabsorbed into the body. Levels of oestrogen and progesterone fall, and the womb lining comes away and leaves the body as a period = menstruation flow. The duration of a menstruation flow is different for everyone, but usually lasts somewhere between two to seven days.

One or two weeks before the menstruation flow, PMS = Premenstrual syndrome might occur. Every person experiences it differently, but common symptoms are: mood changes, bloating, acne, tiredness. During the menstruation flow, many people experience painful muscle cramps in the tummy. If the pain is too much and is seriously affecting your ability to function, always consult it with your doctor.

Despite of the fact that menstruation is a natural body function, and it always has been, it is usually stigmatized and not talked about, which is leading to the spread of myths and misinformation. People of all genders should have basic knowledge related to menstruation (see Figure 10). Providing information without shaming is of utmost importance as young people should learn how to take care of their bodies before, during and after their menstruation flow. 

Figure 10. Menstrual circle

8.2.10. Unintended Pregnancy: abortion, the contraceptive pill

Every time the penis penetrates the vagina, there is a possibility of conception. There are various options for contraception – the most common one being the condom or the hormonal pills (see various types of contraception below). However, if an unwanted pregnancy occurs, there are still more options to deal with such a situation. One of them is the emergency contraceptives also known as “morning-after pills”. It was created for people with a uterus and should be taken after unprotected sexual intercourse. Depending on the pill, it can be taken up to five days after the unprotected sexual intercourse and can cause different physical reactions in your body. It works primarily by preventing ovulation or fertilization. However, it cannot be used regularly as a type of contraception. Because of its compounds and the strength, it has on the body, it is advisable to have a window of at least six months between taking another morning after pill. This also depends on the pill and on the body, which is why it is best to talk to a pharmacist or a doctor and explain the whole situation. Leaving out details out of shame can cause wrongful treatment or negative effects on your body.

If found out later, unintended pregnancy can be terminated through interruption, which has different requirements (circumstances of the conception, age of pregnant person, week of pregnancy, cost of the procedure, form of the procedure.) in every country. Depending on the phase of the pregnancy the interruption can be made through medication or through surgical intervention. Usually, it can be done until the third month of the pregnancy. However, some countries do not offer any guidance or support related to emergency contraception or pregnancy interruptions out of social, cultural, or religious reasons. Other countries offer some of the options but regulate them strictly (e.g., you need a doctor’s prescription to go to the pharmacy and buy the morning after pill) or prohibit it completely and do not perform any kind of intervention related to it. You can find more information on the emergency contraception and on abortion laws and policies in the European Laws chapter, sexual health, and reproductive rights sections.

Finding out about possible pregnancies can be done through taking a pregnancy test – most of them are reliable two weeks after the sexual intercourse but it is always needed to read the instructions on the package of the test. However, sometimes tests can be false negative or false positive, so it is important to always consult with a doctor.

A method which is not reliable to prevent unintended pregnancy is the “pulling-out” method when the penis is taken out of the vagina right before ejaculation. This technique does not work because even before ejaculation there is pre-ejaculation liquid coming out of the penis which can contain sperm and might cause pregnancy.

8.2.11. Types of reliable contraceptive methods (NHS, 2021):

• Hormonal pills: they are pills containing hormones, most of them contain a combination of oestrogen and progesterone and can be used by people with a uterus as it prevents the release of the egg. The prescription is usually to take one pill a day (around the same hour every day) for 21 days a month. In the next seven days when no pill is taken the bleeding should occur. After those seven days starts another 21 days of taking pills every day. The pill can have a lot of side effects and also can interact with other medication, so it should be consulted properly with a gynaecologist and GP. Side effects can vary but the most common are increased risk of having vein thrombosis, acne, headaches, bloating, and fatigue, and mood swings (Teal & Edelman, 2021). Lot of people report also changes in the way they experience stuff, like different energy levels, loss of sexual libido and changes regarding the period. Taking pills should be always thought through while weighting the pros and cons carefully. If used correctly, the pill can have 99% of efficiency in preventing a pregnancy. Other types of hormonal pills are pills with progestogen, which are taken every day without a break. The other rules of usage (taking the pill around the same time a day) are the same and the efficiency is similar. The efficiency of hormonal pills might be affected when having stomach problems, vomiting or diarrhoea. Pills can be prescribed by a gynecologist after check up and interview, price depends of different types of pills and companies
• Condoms: there are two types of condoms, which are a) external condoms to be put on the erected penis and b) condoms to be inserted inside vagina. Both types of condoms, if used properly, prevent unwanted pregnancy as well as transmission of STI. Condoms are the only method apart from abstinence to make you safe from transmission of STI through penetrative sex.
  • External condoms are usually made out of latex but can be also found from different materials in case of allergy to latex. Lubricants can be used with condoms but should be water-based so they do not affect the function of the condom. Condoms can be used only once, when you have sex again it is needed to use new one. Condoms should be ideally stored in not too hot and sunny places, avoiding sharp objects, and used before expiration date. When unpacking a condom, it is good to be careful when opening it so it does not get pierced or damaged in other ways. Then put it on top of erected penis and roll down to its base, make sure it holds good. You can check once in a while if the condom holds on good, and when putting the penis out of the vagina, hold the condom so it does not slip. Condoms are 98% effective. External condoms are easy to access and can be bought in drugstores, most supermarkets and sex shops. Price depends on types and brands.
  • Vaginal condoms work on the same principle as external condoms by creating a barrier so semen cannot reach the egg and cause a pregnancy. Condom should be put into vagina before sex, making sure penis does not touch it before. When opening, be careful to not use teeth or sharp object to tear it. Putt the smaller ring inside the vagina and the bigger ring of a condom at the opening of the vagina. The risk when using female condom is if penis slides in between the condom and the side of the vagina, or if the condom gets pushed too deep into vagina. Else they are 95% effective. Vaginal condoms (sometimes labelled as female condoms) are not so accessible, they can be found mostly in sex shops or other online stores.

• An IUD is a small object put into the uterus which can be either hormonal or non-hormonal. It has to be fitted in only by a gynaecologist. Each type of IUD has different specifics, but it can have its protective function for up to five years. This can be a convenient form of contraception for some since it requires low effort and is highly effective in preventing pregnancy (99%), yet some people might experience increased pain and heavy bleeding during periods when having intrauterine device. IUD can be prescribed and also inserted only by gynecologist – the one time cost can be quite high.
• Contraceptive patch: it is a sticky patch, looking similar to a plaster, which is releasing hormones to one’s body through skin. It contains the same hormones as the pills (progesterone and oestrogen) and is made to be used by people with uterus. Use the patch as instructed on the package, one patch should be worn for approximately one week and then switched for a new one. Patches are also used in the cycle of 4 weeks, 3 weeks with patch (each week new one) and one week patch free. It should be resistant to water and sweat so no restrictions in regime are needed. The possible side effect is heightened pressure. Contraceptive patch has to be prescribed by gynecologist.
• Contraceptive diaphragm or cap is a silicone cap which is inserted into the vagina before sex. The principle is that the cap covers the cervix and creates a barrier so sperm cannot enter the uterus and fertilize the egg. The cap has to stay inserted at least 6 hours after sex to be efficient, and it is recommended to use it together with spermicide gel which together makes circa 94% of efficiency in preventing the pregnancy. The caps are of various sizes so it can take some time to find the right size and to learn how to use it properly. One cap can be used repeatedly for proximately 1-2 years. Cap can be bought in sex shops or pharmacies.
• Vasectomy is a surgical procedure for people with testicles to cut or seal the tube with sperm and therefore prevent pregnancy. Vasectomies can be reversed again with surgical reconnection of the tubes, yet the procedure of the reverse surgery is not guaranteed to work, especially the longer it took since the vasectomy was done. First few weeks (8-12) after the procedure other contraceptive methods should be used because there might still be sperm in the tubes. After vasectomy, there will be ejaculation, but the semen won’t carry sperm. Some people can have problems with painful testicles after this procedure
• Female sterilization – for people with uterus it means blocking or sealing the fallopian tubes to prevent the eggs reaching the sperm and becoming fertilized. Most tubal ligation procedures cannot be reversed. If reversal is attempted, it requires major surgery and isn’t always effective.
• Vaginal ring is a soft plastic ring which is put into vagina, and which releases oestrogen and progesterone to prevent pregnancy. Ring works for one month, when put inside vagina correctly – if the ring comes out, it can be washed with warm water and put inside again. It is more than 99% effective. Vaginal ring can be bought in specialised drugstores or pharmacies.

– 8.3. SITUATIONS OF DISCRIMINATION RELATED TO THE TOPIC –

• Genital mutilation.
• Shame for being/not being a virgin.
• Harassment and push for removal of body hair due to societal norms – saying to a girl who has non-shaved legs/armpits “you look like a tomboy”, “why don’t you take care of yourself?” , “you think someone will like you like this?”, “it’s unhygienic.”
• Harassment of boys who don’t have ”enough” facial hair, insensitive commenting and saying they’re “immature” if they don’t have any.
• Shaming girls for being sexual – pushing girls to become someone who has to prioritise their physical appearance above all in order to “be wanted”, but also teaching them to be “modest” and passive, and to avoid expressing their sexuality openly. Calling girls “sluts” if they show skin, or dress in a revealing way. Calling girls “sluts” if they have more sexual experiences.
• Shaming girls (people in general) for masturbating, spreading false claims about masturbations, such as that the fact that it would make their genitals “too used”, that it’s “against the nature” and “unholy” -> creating an atmosphere where people feel shame when masturbating
• Shaming boys for not being sexual or “manly” enough – There’s a narrative that they have to be sexual, and to want sex all the time, or else they would be perceived as being weird. They can be called “faggots” if they are not interested in girls and not dating “enough”.
• Push for an early start of sexual life (first sexual experience) and shaming those who wait longer for any reason “you’re 15 and you still haven’t done it? what is wrong with you?”
• Body shaming – harassment and bullying of people for some aspects of their appearance. It can be their weight, their face, their thighs, anything. Making disrespectful comments about the appearance of others and inventing harmful insults based on that.
• Speaking about contraception and reproduction only to girls and therefore making them responsible, while leaving the boys out of it.
• Not informing all the people in the class about all the topics (example – separating class in girls and boys and informing girls about period and boys about erection) – everyone should know all of these!
• Assuming everyone who has a penis is a boy, and everyone who has a vulva is a girl – not using inclusive language and not including queer perspective which makes LGBTQ+ students feel left out and more confused.
• Porn showing mostly long penetrative sex, violent sex and giving unrealistic and unhealthy perception of sex.
• Stigmatizing having a period.

8.4. BEST PRACTICES

Canadian material teaching sexual health offers following tips (Alberta, n.d.):

• Develop open and positive communication about sex and sexual development. Answer questions that children have in an age-appropriate way – avoid telling them they’re too young for something. If they ask about something, this is the time they’re interested in it, and you have a chance to give them information without creating a taboo around this subject. Let them know they can always come to ask you questions about sexuality and you will do your best to answer. Be aware that if you do not give them information, they will find a different way to get it and it will most probably be of a worse quality (information from porn, from peers, from the web), misinformation, spreading of myths, perpetuating taboos, etc.
• Inform children about puberty and sexual development changes when they’re young before they experience them. In this way they will feel more prepared and will know partially what to expect which could decrease stress and help them cope with these changes, encouraging them to make safer decisions.
• Avoid unnecessary and harmful comments on children’s bodies appearance and weight because that can worsen their feeling of self-worth and easily lead to developing a negative body image. When speaking about bodies, show pictures of people of various shapes and origins which represent real people and are more relatable.
• Support children in having a positive relationship with their body. You can do that by tackling and challenging shameful comments, not applying stereotypical beauty standards, by appreciating children’s abilities and strengths and with activities encouraging children to find positive aspects of their bodies, aspects they like and enjoy. You can also promote body positivity by being an example and showing mindfulness of your own attitudes towards food, weight and attractivity. Avoid commenting on other people’s physical appearance and promoting of extremely restrictive diets and excessive exercising.
• When speaking about body parts, do not avoid naming the genitals with their proper anatomical names. Children will benefit from being able to name parts such as penis, testicles, vulva, clitoris, etc. without shame and it will help them to relate to their body better and to communicate about body parts in general. Do not leave out the clitoris out of the talk as it can be the main source of pleasure for people with a vulva. Apart from possibly developing a healthier relationship with their bodies, knowing the anatomical names for body parts contributes to their mental and physical health as it encourages information and decreases the chances of being sexually harassed, assaulted, or exploited. Using metaphors for body parts only contributes to children being more confused about their body and its functions, which could place them in a vulnerable position making boundaries and limits blurry for them and exposing them to manipulation.
• Debunk myths about physical appearance, including body hair, shame connected to menstruation, false believe that the vulva has to be small and pink, that the penis has to stay erect for a long time, etc. Address the fact that porn, social media, and other representations are not accurate, and stress out the beauty and normality of variations of body appearance and shapes.
• Instead of promoting the abstinence, inform children about various forms of sex and types of contraception with focus on practical use and pros and cons. Inspiration of how to do an activity about contraception can be found here.
• Do not leave out information about masturbating as safe, healthy, and independent sexual activity.
• When speaking about sex development and bodies, take the diversity of bodies into account, including queerness, ability, age and other aspects that go beyond binary categories.

8.5. REFERENCES

Alberta (n.d.). Curriculum overview. Available from https://teachingsexualhealth.ca/teachers/sexual-health-education/understanding-your-role/get-prepared/curriculum-overview/

Blackless, M., Charuvastra, A., Derryck, A., Fausto‐Sterling, A., Lauzanne, K., & Lee, E. (2000). How sexually dimorphic are we? Review and synthesis. American Journal of Human Biology: The Official Journal of the Human Biology Association, 12(2), 151-166

Cook, R. J., & Dickens, B. M. (2009). Hymen reconstruction: ethical and legal issues. International Journal of Gynecology & Obstetrics, 107(3), 266-269. doi: 10.1016/j.ijgo.2009.07.032

Dakanalis, A., Carrà, G., Calogero, R., Fida, R., Clerici, M., Zanetti, M. A., & Riva, G. (2015). The developmental effects of media-ideal internalization and self-objectification processes on adolescents’ negative body-feelings, dietary restraint, and binge eating. European child & adolescent psychiatry, 24(8), 997-1010.

Doležalová, P., Heumann, V., Orlíková, B., Hull-Rochelle, G., Pavlica, K., et al. (2021). Rozvoj duševní pohody u transgender klientů. Poznatky a holisticky orientovaný terapeutický přístup. Národní ústav duševního zdraví, Klecany. Available from: https://www.nudz.cz/files/pdf/rozvoj-dusevni-pohody-u-transgender-klientu.pdf

Guest, E., Zucchelli, F., Costa, B., Bhatia, R., Halliwell, E., & Harcourt, D. (2022). A systematic review of interventions aiming to promote positive body image in children and adolescents. Body Image, 42, 58-74. https://doi.org/10.1016/j.bodyim.2022.04.009

Hegazy, A. A., & Al-Rukban, M. O. (2012). Hymen: facts and conceptions. The Health, 3(4), 109-115.

Herdt, G., & McClintock, M. (2000). The magical age of 10. Archives of Sexual Behaviour, 29(6), 587-606. https://doi.org/10.1023/A:1002006521067

Kontula, O., & Haavio-Mannila, E. (2003). Masturbation in a generational perspective. Journal of Psychology & Human Sexuality, 14(2-3), 49-83.

Kopcakova, J., Dankulincova Veselska, Z., Madarasova Geckova, A., Van Dijk, J. P., & Reijneveld, S. A. (2014). Is being a boy and feeling fat a barrier for physical activity? The association between body image, gender and physical activity among adolescents. International journal of environmental research and public health, 11(11), 11167-11176.https://doi.org/10.3390/ijerph111111167

Leung, A. K. C., & Robson, L. M. (1993). Childhood Masturbation. Clinical Pediatrics, 32(4), 238–241. https://doi.org/10.1177/000992289303200410

Lo Presto, C. T., Sherman, M. F., & Sherman, N. C. (1985). The effects of a masturbation seminar on high school males’ attitudes, false beliefs, guilt, and behaviour. The Journal of Sex Research, 21(2), 142–156. doi:10.1080/00224498509551255

National Child Traumatic Stress Network.(2009). Sexual development and behaviour in children: Information for parents and caregivers.Retrieved from the Alaska Department of Health and Social Services, Office of Children’s Services:http://hss.state.ak.us/ocs/Publications/pdf/sexualdevelop-children.pdf

NHS (2021). Your contraception guides. Available from https://www.nhs.uk/conditions/contraception/

O’Connell, H. E., Hutson, J. M., Anderson, C. R., & Plenter, R. J. (1998). Anatomical relationship between urethra and clitoris. The Journal of urology, 159(6), 1892-1897.

Ogletree, S. M., & Ginsburg, H. J. (2000). Kept under the hood: Neglect of the clitoris in common vernacular. Sex Roles, 43(11), 917-926. https://doi.org/10.1023/A:1011093123517.

Pattatucci, A. M., & Hamer, D. H. (1995). Development and familiality of sexual orientation in females. Behaviour Genetics, 25(5), 407-419. https://doi.org/10.1007/BF02253370

Pla, J. (2020). Bliss Club: Sex tips for creative lovers. Hardie Grant.

Rew, L., Young, C. C., Monge, M., & Bogucka, R. (2021). Puberty blockers for transgender and gender diverse youth—a critical review of the literature. Child and Adolescent Mental Health, 26(1), 3-14. https://doi.org/10.1111/camh.12437

Saharso, S. (2022). Hymen ‘repair’: Views from feminists, medical professionals and the women involved in the middle east, North Africa and Europe. Ethnicities, 22(2), 196–214. https://doi.org/10.1177/14687968211061582

Smith, E. E., Atkinson, R. L., Fredrickson, B., Hilgard, E. R., Nolen-Hoeksema, S., & Loftus, G. (2003). Atkinson & Hilgard’s introduction to psychology. Wadsworth Publishing Company.

Wheeler, M. D. (1991). Physical Changes of Puberty. Endocrinology and Metabolism Clinics of North America, 20(1), 1–14. doi:10.1016/s0889-8529(18)30279-2

Williamson, H. (2015). Social pressures and health consequences associated with body hair removal. Journal of Aesthetic Nursing, 4(3), 131–133. doi:10.12968/joan.2015.4.3.131