Any sexual activity with a child (by an adult or another child) is sexual abuse. It causes physical and emotional pain. It has long-term effects on the child. And it is a crime. Recognizing childhood sexual abuse isn’t easy. Children are often afraid and embarrassed to tell someone. Many times, the abuser is someone the child knows and trusts. This could be a family member or someone living in the child’s home. It also can be a stranger.

Path to improved health

You do not need to be overly suspicious of sexual abuse. The risk of childhood sexual abuse is low. A stable family home lowers a child’s risk of sexual abuse. However, parents should always keep a watchful eye on any form of childhood abuse. These physical and behavioral signs should raise concern:

• Your child tells you they have been touched inappropriately or sexually.
• Your child is behaving sexually inappropriately around others (this includes touching others inappropriately).
• Your child uses sexually inappropriate language.
• Your child’s knowledge of sex seems to be more than it should be at their age.
• Your child seems withdrawn and doesn’t want to be hugged by some or all of their family members, family friends, teacher, or a particular person.
• Your child is suffering from depression or anxiety.
• Your child has harmed themself.
• Your child is making comments about their low self-worth.
• Your (young) child has blood in their underwear.
• Your (young) child is complaining of pain in their genital area.
• Your child has injuries in their genital area, such as bruising, bleeding, or swelling. The injuries might cause your child pain when walking or sitting.
• Your child shows signs of infection in their urinary or genital area. This would include frequent burning, itching, or discharge.
• Your child becomes pregnant.
• Your child has new academic changes (falling grades, missing assignments, repeated absences).
• Your young child is regressing, such as wetting the bed or thumb sucking.
• Your child is acting overly concerned for a sibling.
• Your child has changes in hygiene, such as refusing to take a bath (in younger children). Older children may shower more (to cleanse themselves of what they perceive as shame and embarrassment).
• Your child is suddenly receiving gifts or money from a person in authority (a teacher, coach, etc.).

If you know your child has been sexually abused, report it to the police. Take your child to the doctor for an exam. Ask your child’s doctor for the name of a counselor or psychologist. Talk to your local police about tracking sex offenders in your neighborhood or city.

Things to consider

Certain situations put children at a higher risk of sexual abuse. Your child may also be at higher risk if they:

• Live in a home where the parents are divorced and/or living with stepparents
• Live in a home without either parent (in foster care)
• Live in a rural or low-income area
• Have been a victim of another type of abuse, such as physical or emotional
• Spend long periods of time alone with people in authority (teachers, clergymen, coaches, babysitters, etc.)

Girls and children with intellectual disabilities face a higher risk. Remember, childhood sexual abuse can occur between a male and female, as well as in same-sex situations.

Questions to ask your doctor

• What other things could explain injuries to my child’s genitals?
• How young can a girl become pregnant?
• What are the signs of sexually transmitted diseases or infections in boys and girls?
• What is the treatment for sexually transmitted disease?
• Can my child eventually overcome the emotional pain of childhood sexual abuse?
• What physical or behavioral signs should I look for if I suspect my child is the one sexually abusing a child?
• How do I raise a concern with my child about possible sexual abuse?

Resources

National Institutes of Health, MedlinePlus: Sexual Abuse in Children – What to Know

Rape, Abuse & Incest National Network: Child Sexual Abuse

The U.S. Department of Justice National Sex Offender Public Website: How to Identify

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Sexual health is a big part of life. It can affect and is affected by other aspects of health. This includes physical, mental, emotional, and social health. Being in good sexual health means you are well informed, careful, and respectful to yourself and others. It also means enjoying yourself sexually in a way you are comfortable with.

Path to improved health

Most people learn about sexuality and sex early on. You may have discussions with parents, siblings, teachers, or mentors. Or you may discover it on your own. You learn about gender and genitalia. You learn about what sex is and the risks it carries. Risks include pregnancy, sexually transmitted infections (STIs), and sexual abuse. It is important to learn as much as you can about sex. The more informed you are, the more prepared you are to make good choices.

Safety is a key aspect of sexual health. There are many ways to protect your sexual health and care for yourself. Abstinence is the only way to 100% prevent pregnancy and STIs. This means not having vaginal, anal, or oral sex.

If you decide to be sexually active, you may want to consider a form of birth control. Different types include a condom, pill, patch, shot, implant, diaphragm, or intrauterine device (IUD). These can help prevent unwanted pregnancy. Condoms are the only method to help prevent STIs.

Talk to your doctor before you start having sex. They will talk to you more about safety, risks, and prevention. They can answer any questions you have about sexual health. They also can prescribe a form of birth control.

Some people have sexual problems or restrictions. Certain medicines and conditions can limit desire or function. Talk to your doctor before you take over-the-counter (OTC) drugs, or if you have side effects, such as pain, from sex.

Another part of sexual health is communication. Talk about sex to a doctor, parent, or adult you trust. It is best to be honest with questions and concerns.

You also need to be direct and clear with the partner you are sexually interested in. Talk about your expectations and set boundaries. Do not let them, or other peers, pressure you into anything. And do not pressure them to do anything they do not want to do. You each should only do things that you agree, or consent, to do. Do not do something that you don’t want to do or that makes you uncomfortable. If you find yourself in a situation like this, tell the person no. Then leave the situation and tell someone you trust about it. They can protect you and get you help, if needed.

If you have been diagnosed with an STI, you should tell your sexual partner(s). They may be affected as well. The more partners you have, the higher your risk of getting an STI. Treatment can help cure or relieve symptoms of some STIs. There can be long-term negative effects of untreated STIs.

Things to consider

It is normal for your sexual health to evolve as you age. To stay healthy, it is best to regularly reflect on your thoughts, feelings, and emotions. Doing this in advance will prepare you for sexual encounters.

Sexual health is not something you should manage on your own. It is something you should talk about with people you trust or love. You can talk about what is considered safe and what the risks are of certain actions. You should understand what consent is and that it’s okay to say no.

If you think you are pregnant, have an STI, or have been abused, seek help right away. For pregnancy and STIs, a doctor can do a test to confirm. They can provide you with more information and discuss your options. For abuse, a doctor can perform tests and provide treatment. A police officer or lawyer can provide legal assistance. You also may want to see a counselor, who can offer emotional support.

Questions to ask your doctor

• How will I know if I’m ready to have sex?
• What are the risks of having sex?
• If I decide to have sex, do I need to be on birth control?
• How can I practice safe sex?
• Are there any vaccines I should get before I have sex?
• I had sex, but now I wish I hadn’t. What can I do?
• How do I know if I am in poor sexual health?
• What should I do if I’m concerned about my sexual health?

Resources

American Academy of Family Physicians: Birth Control Options

Centers for Disease Control and Prevention: Sexual Health

Planned Parenthood: Get the Facts on Sexual Health

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Girls are not the only ones who can benefit from the human papillomavirus (HPV) vaccine. Boys also can reduce their chances of developing some cancers if they get the vaccine.

The HPV vaccine was first developed to help prevent cervical cancer in women. Researchers now know the vaccine can help prevent HPV-related cancers in men, too.

Cancers of the mouth and throat are on the rise, according to the Centers for Disease Control and Prevention (CDC). So are cases of anal cancer. People typically aren’t screened for these cancers. This makes them harder to spot. Treating these cancers can be harder because they aren’t found early. But the HPV vaccine can help prevent them.

What is HPV?

Human papillomavirus is a common sexually transmitted virus. It’s the most common sexually transmitted infection (STI) in the United States. There are more than 100 types of HPV. HPV can cause genital warts and cancers of the cervix, vagina, vulva, anus, penis, and throat.

HPV is passed from one person to another through skin-to-skin contact. Some people never realize they have it because they have no symptoms. They can still spread the infection to others.

Path to improved health

Doctors recommend vaccinating boys and girls for HPV at ages 11-12. Preteens who are vaccinated at this age will need only two rounds of the vaccine. These rounds will be spaced 6-12 months apart. If your child is already 15 years old, he will need three rounds of the vaccine. The 3 rounds will take place within a 6-month period.

It’s never too late to get the vaccine. Setting the age for the vaccine at 11-12 is intended to protect boys and girls before they’re exposed to HPV. It’s possible to get the vaccine as early as 9 years of age.

Vaccines to prevent HPV

There are currently 3 vaccines used to prevent the spread of HPV, according to vaccines.gov. All 3 vaccines are approved by the FDA to prevent HPV infections:

• Gardasil is an HPV vaccine for males and females.
• Gardasil 9 is an HPV vaccine for males and females.
• Cervarix is an HPV vaccine for females only.

All 3 vaccines prevent infection from the most common types of HPV: types 16 and 18. Gardasil also protects against HPV types 6 and 11. Gardasil 9 guards you from infection against an additional 5 HPV types: 31, 33, 45, 52, and 58.

Know these vaccines don’t provide protection from other sexually transmitted infections. Also, they don’t protect you from all HPV types. They do protect you from those types most likely to cause cancer.

The American Academy of Family Physicians (AAFP) recommends that boys and girls ages 11-12 receive HPV vaccines as part of their vaccination schedule.

When should I not give my child this vaccination?

Your child shouldn’t be vaccinated for HPV if he or she is severely allergic to any of the components of the vaccine. Your child shouldn’t get the vaccine if he or she has a severe allergy to yeast. Tell your doctor about all your child’s allergies.

Women who are pregnant should wait to get the HPV vaccine. It’s safe for women who are breastfeeding.

If your child is sick, you should wait to vaccinate him or her. Ask your doctor if you aren’t sure.

Things to consider

Side effects from the HPV vaccine are usually mild. They will likely go away on their own. Examples of mild side effects include:

• A sore arm from the injection.
• Redness or swelling where the shot was given.
• A low-grade fever.
• Headache.

Also, sometimes people faint following an injection. Your doctor will have you stay seated or lying down for up to 15 minutes following the shot.

As with any medication, it’s possible to suffer more serious side effects with the HPV vaccine. There’s a very small chance that taking any vaccine can cause serious injury or death. Also, severe allergic reactions are rare but do sometimes occur.

According to the U.S. Department of Health and Human Services (HHS), the benefits of the vaccine far outweigh any risk. “Studies show that HPV vaccines are very safe and have been used in the United States and around the world for many years,” reports HHS.

Questions for your doctor

• Should my child get the HPV vaccine?
• Which HPV vaccine (Gardasil, Gardasil 9, or Cervarix) is best for my child?
• How many rounds of this vaccine will my child need?
• How long will the vaccine last before he or she needs a booster shot?
• What side effects should we expect?
• My child had the Gardasil vaccine. Should he or she now have the Gardasil 9?
• If my child is already sexually active, is it too late for the vaccine?

Resources

National Institutes of Health, MedlinePlus: Human Papillomavirus (HPV) Vaccine

U.S. Department of Health & Human Services, vaccines.gov: HPV (Human Papillomavirus)

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Sexually transmitted infections (STIs) are infections spread by sexual contact. These infections are usually passed from person to person through vaginal intercourse. However, they also can be passed through anal sex, oral sex, or skin-to-skin contact. STIs can be caused by viruses, bacteria, or parasites. Many people get STIs but don’t know it because they don’t have symptoms. Other people have symptoms that can be mild or more bothersome.

Path to improved health

There are many different kinds of STIs. Here is information on some of the most common ones, their symptoms, and their treatments.

Chlamydia

What it is: Chlamydia is a bacterial infection that is easily cured. Left untreated it can cause infertility in women.

Symptoms: Women may have pain when urinating, itching around the vagina, yellow fluid (discharge) from the vagina, bleeding between periods, or pain in the lower abdomen. Men may have a burning sensation when urinating and a milky colored discharge from the penis. It can also cause painful swelling of the scrotum in men.

Treatment: Antibiotics. Both partners should be treated.

Gonorrhea

What it is: Gonorrhea is a bacterial infection. Left untreated, it can cause serious health problems. But it’s easily cured.

Symptoms: Women may have white, green, yellow, or bloody discharge from the vagina, pain when urinating, bleeding between periods, heavy bleeding during a period, or a fever. Both women and men can get sore throats if they’ve had oral contact with an infected person. Men may have thick, yellow discharge from the penis and pain when urinating. The opening of the penis may be sore. Gonorrhea can cause serious complications if it’s not treated.

Treatment: Antibiotics. Both partners should be treated.

Herpes

What it is: Herpes is a viral infection that causes painful sores in the genital area. It’s spread through skin-to-skin contact. Once you’re infected, you have the virus for the rest of your life.

Symptoms: Women and men may have tingling, pain, or itching around the vagina or penis. They also may develop oral lesions (blisters) through sexual contact. These may look like fever blisters because they are caused by a similar virus. Small blisters can form on the penis, vaginal area, around the anus, or on the mouth depending on the exposure. When the blisters break open, they can be very infectious. This means you could easily transmit herpes to another person. When the blisters break, they also can cause a burning feeling. It may hurt to urinate. Some people have swollen glands, fever, and body aches. The sores and other symptoms go away, but this doesn’t mean the virus is gone. The sores and blisters can come back periodically. This is called an “outbreak.”

Treatment: Medicine can treat symptoms but can’t cure herpes. If one partner is infected, the other should by checked by a doctor.

HIV/AIDS

What it is: HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV attacks the body’s immune system, making you more likely to get sick from other viruses or bacteria.

Symptoms: HIV makes the body’s immune system weak so it can’t fight disease. Symptoms may take years to develop. When symptoms do appear, they can include swollen lymph nodes, diarrhea, fever, cough, shortness of breath, or unexplained weight loss. Symptoms are often similar to those of other illnesses, such as the flu.

Treatment: Medicines can treat symptoms but can’t cure HIV or AIDS. If one partner is infected, the other should be checked by a doctor.

HPV/Genital Warts

What it is: HPV (human papillomavirus) is a family of more than 100 types of viruses. Some don’t cause any symptoms. Some types cause genital warts. More aggressive types can cause cancer.

Symptoms: HPV can cause warts in or around the vagina, penis, or rectum. In women, the warts can be on the cervix or in the vagina where you can’t see them. Or they may be on the outside of the body, but may be too small to see. The warts can be small or large, flat or raised. They can appear alone or in groups. They usually don’t hurt. Most types of HPV, including those that cause cancer, don’t have symptoms.

Treatment: No medicine cures HPV. A doctor can remove external warts. Warts on the cervix or in the vagina can cause changes that may lead to cervical cancer. Doctors will watch for these changes. If one partner is infected with HPV, the other should be checked by a doctor.

Some types of HPV can be prevented, including those that cause cancer. There is a vaccine that can prevent some types of HPV in young men and women. The Centers for Disease Control and Prevention (CDC) recommends that girls and boys between the ages of 11 and 12 receive the vaccine, before they become sexually active. The vaccine is approved for men and women between the ages of 9 years and 45 years.

Pubic lice (crabs)

What it is: Pubic lice (also called crabs) are tiny insects that live in pubic hair and lay eggs. They spread through direct contact but don’t cause many problems.

Symptoms: Women and men may have redness and itching around the genitals. You may be able to see the lice or their eggs on the shaft of the pubic hair.

Treatment: Medicine, such as over-the-counter lotions or shampoos (some brand names: Nix, Rid), can kill the lice. Prescription shampoos, lotions, or pills are also available if over-the-counter medicine doesn’t work. Clothes, sheets, and towels must be washed in hot water to kill remaining bugs, or your lice can come back. Usually both partners need to be treated. Removal of the nits (lice eggs) is important to reduce the chance of another outbreak after treatment.

Syphilis

What it is: Syphilis is a serious bacterial infection that causes sores in the genital area. It’s passed by touching the blood or sores of an infected person.

Symptoms: An early symptom is a red, painless sore, called a chancre. The sore can be on the penis, vagina, rectum, tongue, or throat. The glands near the sore may be swollen. Without treatment, the infection can spread into your blood. Then you may experience a fever, sore throat, headache, or pain in your joints. Another symptom is a scaly rash on the palms of the hands or the bottom of the feet. The sores and other symptoms go away, but this doesn’t mean the infection is gone. It could come back many years later and cause problems in the brain and spinal cord, heart, or other organs.

Treatment: Syphilis can cause serious health problems if it’s not treated. Antibiotics should be taken as early as possible after infection. If one partner is infected, the other should be tested.

Trichomoniasis

What it is: Trichomoniasis is an infection caused by a parasite. The parasite spreads through skin-to-skin contact.

Symptoms: Women can have a heavy, greenish-yellow frothy discharge and pain when urinating or while having sex. It also can cause redness, itching, and a burning feeling in the genital area. Men may have burning with urination or ejaculation, itching, or irritation inside the penis, or discharge from the penis. Left untreated, the infection can last for months or years.

Treatment: Antibiotics. Usually both partners need to be treated.

Things to consider

It’s common to feel guilty or ashamed when you are diagnosed with an STI. You may feel that someone you thought you could trust has hurt you. You may feel sad or upset. Talk to your doctor about how you’re feeling.

Remember you can take steps to prevent getting an STI. The only sure way to prevent them is by not having sex. But if you do have sex, you can lower your risk if you do the following things.

• Limit your number of sex partners.
• Avoid sex with people who have had many sex partners.
• Use condoms consistently and correctly.
• Ask your partner if he or she has, or has had, an STI. Tell your partner if you have had one. Talk about whether you’ve both been tested for STIs and whether you should be tested.
• Look for signs of an STI in your sex partner. But remember that STIs don’t always cause symptoms. Don’t have sex if you or your partner are being treated for an STI.
• Wash your genitals with soap and water and urinate soon after you have sex. This may help clean away some germs before they have a chance to infect you.

Questions to ask your doctor

• Do I have an STI? Can it be cured?
• What kind of treatment will I need?
• Can I have sex with my partner without passing on my STI?
• Can I spread an STI if I don’t have symptoms and don’t even know I have it?
• How do I prevent getting an STI?
• What long-term problems might I have if I have an STI?
• If I’m pregnant, can I pass my STI onto my baby?
• Are there any STI support groups in my area?

Resources

Centers for Disease Control and Prevention: Sexually Transmitted Diseases

National Institutes of Health, MedlinePlus: Sexually Transmitted Diseases

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