Lower Secondary Health

51 5. Aerobic exercise It is an exercise which requires prolonged duration such as jogging, quick walking, and swimming. It is popular among exercise lovers, sports scientists and people in the medical field. It can effectively enhance the physical fitness of each person. 3.1 Exercise steps The selection of an exercise type depends on the desire or satisfaction of the person doing the exercise. Exercise leads in all cases, to a stronger body, better health and immunity without having to rely on expensive vitamins or supplementary foods, particularly if we are on a budget. Sports or exercise can play an important role in enhancing our movement. Therefore, sports are very popular to living of today. Steps for guiding people to exercise and do sports 1. Provide information for the person doing exercise so that they can understand the principles, rationales, limitations and cautions concerning exercises/sports. 2. Promote a good attitude towards exercise. 3. Keep practicing until skill mastery. After that, you will want to do exercise/sports. 4. Regularly participate in the activity. 5. Make sure the activity improves physical fitness such as increased strength, endurance, flexibility, speed and decision making. To exercise for health, we need to keep the heart rate at approximately 120-130 beats/minute for healthy adults. Or we need to burn 285 calories/day or 2,000 kilocalories/week. Good exercise programs should result in the following benefits: 1. Encourage the person to think clearly and be smarter. 2. Help the person in getting to know more people and have better relationships. 3. Create positive emotional effects, such as fun and pleasure. 4. Create positive physical effects, such as strength and power. 5. Help build concentration and peace of mind, and release stress. Those interested in exercise and sports, but do not know what to do may use the

52 following checklist: 1. Good exercise should facilitate a steady rate of respiration. 2. There should be little or no bumping, using of too much force or holding breath. 3. The person should understand the advantages of exercise. 4. The person should have fun and willingly participate in exercise. 5. The person should learn to help themselves. 6. After playing a strenuous sport, the person should be tired but feel healthy. 3.2 Principle and types of exercise for health The principle of exercise for health is to enhance the functions of the lungs, heart, circulatory system, and muscle and joint strength which brings about good physical and mental health. Types of exercise can be categorized as follows: 1. Exercise through playing. 2. Exercise through working. 3. Exercise through physical exercise. 1. Exercise through playing includes playing a favorite sport, or walking, running and swimming. 2. Exercise through working includes doing housework, planting flowers or growing fruit trees. Apart from getting work done, this kind of exercise also helps strengthen muscles through movement. 3. Exercise through physical exercise includes exercising in general, yoga or aerobic dancing. This can help exercise certain parts of the body and builds firm muscles. The principles of exercising for health is doing a kind of exercise that strengthens the lungs, heart, circulatory system, muscles, and joints. All these will finally lead to good physical and mental health as well as a good personality.

53 Aerobic exercise is a worldwide popular exercise for health. It can be practiced as follows: 1. Intensity The intensity of exercise should reach 70% of the highest heart rate for the particular age group. It can be calculated by using the standard number 170 subtracted by the age. The outcome is the appropriate heart rate during exercise. 2. Duration The exercise should be carried out at least 20 minutes or longer each time. 3. Cool down This period lasts five minutes to stretch muscles and make joints flexible. Therefore, the total exercise period is 20-30 minutes per day. People who do a lot of exercise or are athletes use more energy than people in general. Moreover, they lose a lot of water and minerals, so consuming sufficient amount of water to replace the loss is very important. They should consume more rice, carbohydrates, fruit or fruit juice to boost their energy and drink enough water. However, it is not necessary to take supplementary food, mineral water or energy drinks.

54 Lesson 2: Learning Activities Activity 1 1. Describe the following topic based on your own understanding: “A sound mind is in a sound body”. 2. Write your plan for a 7-day healthcare. Activity 2 1. How can you categorize advantages of exercise to human health? Activity 3 1. How can exercise affect human development? 2. What should be the guidance for doing exercise?

55 Lesson 3 Sexual Health Main content Early sexual relationships are currently one of the major problems faced by Thai youth. Therefore, it is necessary to learn about behaviors which encourage sexual relationships, and about sexual harassment and unwanted pregnancy in order to help protect oneself. In addition, taking care of one’s body, especially one’s reproductive system is important as it will ultimately lead to good health. If everyone takes proper care of their reproductive system, they should not have any sexual health problems. Expected learning outcome 1. Be able to explain how to refrain from behaviors which encourages sexual relationships, sexual harassment and unwanted pregnancies. 2. Be able to explain how to take proper care of one’s sexual health and avoid sexual problems. Content scope Topic 1: Anatomy related to reproduction Topic 2: Changes when reaching puberty Topic 3: Behaviors which encourage sexual relationships Topic 4: Sexual health

56 Topic 1: Anatomy related to reproduction Human growth and development refers to the process of growing and developing both physically and mentally through various stages from children to adolescents to adults. Generally, growing and developing physically ends at the age of approximately 25 years. From this age onwards, body organs start to deteriorate and people will then reach old age and eventually die. Growing and developing mentally is an endless process. People’s mind will grow and develop until they reach old age. 1. Practices related to the health of reproductive organs Human reproduction is a natural process. Its purpose is basically for the preservation of the human race. Reproduction involves two key elements, the human male and the human female. Both the human male and the human female have their own specific body structures which involves a sexual organ for reproduction. 1.1 The male reproductive system Most of the male reproductive organs are outside of the human body. Protecting them from contracting contagious or infectious diseases is quite simple. The male reproductive organs are related to the urinary system as the sperm is released from the body through the urethra. The male reproductive system consists of the following key organs: (1) Testis: Is shaped like a small egg, about 4 cm long, 4 cm wide and 2-3 cm thick. It weighs around 15-30 grams. The left testicle is slightly larger than the right one. Normally, there are two testicles.

57 The inner part of the testicles has many small tubes called seminiferous tubules which are shaped like coils. Male hormones and sperm cells are produced inside the seminiferous tubules. At the back of the testicle, there are numerous small tubes called the epididymis which is where the sperm cells are kept temporarily until they finish maturing. (2) Prostate Gland: It surrounds the inner part of the urethra just below the urinary bladder. Its main function is to secrete a slightly alkaline fluid for keeping in the epididymis. Once combined with seminal vesicle fluid, the alkalinity of this fluid helps neutralize the acidity of the vaginal tract, prolonging the lifespan of the sperm, and increasing the probability of conception. (3) Penis: The penis is a part of the male reproductive organ which is specific to the male gender. It stands out from the human body, with its tip having a shape similar to a soldier’s helmet and slightly bigger than its body. The tip of the penis also contains numerous nerves, causing it to be highly sensitive. During sexual arousal, the penis will stiffen as a result of more blood entering the penis, and the penis can grow 1-2 times bigger than its normal size. When the penis stiffens, the small glands inside the urinal duct produce a milky fluid which acts as a lubricant and helps sperm cells to exit the body smoothly. (4) Epididymis: The epididymis is crescent-shaped and is attached to the testis. The top part of the epididymis, which is called the head, is quite large. Next to the top are the body part and the tail. The epididymis consists of several small tubes shaped like coils. The sperm generated will be sent to the epididymis before passing through the urinal duct. (5) Van Deferens: This is a small tube attached to the testicles. The sperm cells and the semen travel along this tube until they reach the epididymis.

58 (6) Scrotum: The scrotum is a bag holding the testicles. While males are still a fetus, the testis grows in the abdominal cavity. As men mature, the testis gradually descends from the abdominal cavity into the scrotum around the groin. The scrotum surface is covered with thin, dark, and creased skin. There is a middle line from the anus to the penis. There is also a muscle like a thin wall dividing the scrotum into two smaller sacks. The scrotum is attached to a type of muscle which will contract or relax upon temperature changes so as to maintain the right temperature for the formation of sperm and to prevent against external impact. 1.1.1 Creation of male reproductive cells and nocturnal emissions (wet dream) The male reproductive cells or sperm is created in the seminiferous tubules. The sperm is very tiny and looks like a tadpole. It contains a big head and a long, thin tail. The tail part is used for swimming. The length of the body is around 0.05 mm. It is tens of thousands of times smaller than the female egg. After the sperm is created in the seminiferous tubules, it will stay in the epididymis until maturity. Then, the sperm will move to the seminal vesicle. At this stage, the prostate gland and other glands will produce a liquid to feed the sperm. If the semen is not released through sexual intercourse, it will be ejaculated from the body through the urinal duct during sleep. This body mechanism naturally helps reduce the number of sperm cells and sexual emotional stress, and is known as a wet dream which is a phenomenon indicating that a male adolescent has reached sexual maturity and that his body is ready to initiate conception.

59 1.1.2 Health practices for the male sexual organs (genitals) 1. Take a bath twice a day. Clean the body and the genitals with soap. Then rinse with water and towel dry. 2. Wear clean clothes. The underwear should neither be too tight nor too loose. 3. Practice good hygiene when using the toilet. 4. Do not have a sex with multiple partners or commercial sex workers. 5. If you suspect that you have a sexually transmitted disease (STD), go see a doctor. 6. Do not use medical or chemical substances to arouse sexual desire. 7. Do not indulge in or be obsessed with sex. Recreational or sports activities are a better choice. 8. Prevent genitals from impact. 1.2 The female reproductive system The female reproductive system consists of several parts. Only the key parts will be mentioned here. (1) Ovary: The ovary is a female reproductive gland. Its main function is to produce reproductive cells called ovum. It is often found in pairs, one on the right and one on the left. It lies within the pelvic cavity. It

60 has a quite rounded shape and weighs around 2-3 grams. It secretes female hormones which ripen the eggs and prepare them for release. (2) Fallopian Tubes: After the eggs leave their encapsulating sac, they will pass through the fallopian tubes. These tubes are approximately 6- 5 cm long. One end of the tube (called infundibulum) has a shape like a cone while the other end is thin and narrow and attached to the uterus. Inside the fallopian tube, there is a special muscle which is covered with cilia and contracts regularly. With the aid of the cilia and muscle contractions, a mature egg travels to the fallopian tube where they meet the sperm before moving into the uterus. (3) Uterus: The uterus is located in the pelvic cavity between the urinary bladder and the anus. Its normal size is around 7-8 cm. long, 4 cm. wide and2 cm. thick. It consists of a muscle with a cavity and is lined with a thick inner layer. An egg will travel down the fallopian tube into the uterine cavity. If the egg is fertilized by a sperm, the lining of the uterus thickens and becomes rich with blood. The fertilized egg would then attach itself to this lining which provides a nurturing environment for the developing embryo and fetus. The uterus shrinks in size and becomes small around menopause.

61 Fallopian tube or uterine tube Cell division into The first stage of multiple cells cell division Cell division into 4 Fallopian tube cells Zygote Uterine lining Embryo attaches to uterine lining The egg is fertilized Ovulation period by a sperm. Endometrium Ovary Uterus Follicle Cervix Vagina Illustration of fertilization The female reproductive system (4) Vagina: The vagina has a cavity inside and its normal length is approximately 8-10 cm. The vagina consists of a layer of smooth muscle and extends from the vulva to the cervix. The internal lining of the vagina consists of a thin creased tissue which may contract and stretch considerably during birth. The vagina is endowed with a rich set of nerve endings, especially those at the vaginal opening. The vagina serves as a passage for menstruation to flow out of the body and provides a passage for the sperm to fertilize an egg in the fallopian tube. (5) Clitoris: The clitoris is a small, button-like tissue near the front junction of the labia minora. It can stretch and contract. It is full of blood veins and nerves and is highly sensitive like the penis. (6) Bartholin Glands: They are two glands located to the left and right of the opening of the vagina. They secrete mucus to lubricate the vagina during sexual intercourse. (7) Perineum: The perineum is the region of the body inferior to the pelvic diaphragm which is located between the vagina and the anus. It may stretch and contract. It consists of three key muscles which help

62 strengthen the vagina muscle and prevent against a vaginal prolapse. If perineal tears occur and no suture is made, a uterine prolapse may occur as women get older. (8) Breast: There are two breasts, each of about the same size. At the center of each breast is a nipple. Each breast consists of several lobes. Each lobe is composed of many lobules. When reaching adolescence, women’s breasts gets larger due to the development of tissue and fat. During pregnancy, the breast is enlarged due to the development of milk glands and lobules. The breast is highly sensitive due to a large number of blood veins and nerves. 1.2.1 Knowledge about the effects of female sexual maturity When reaching adolescence, females will experience not only physical changes such as growing breasts and other changes, but also sexual maturity. Female sexual maturity occurs upon their first menstrual period. The menstrual period repeats itself every month and the monthly menstrual cycle can vary around an average of 28 -30 days per cycle. Each monthly menstrual cycle can be divided into the following phases: 1. Destructive phase: This is when menstrual bleeding occurs due to the rupturing of the inner tissues of the uterine lining. This phase lasts about 3-7 days. In other words, menstrual bleeding occurs for approximately 3-7 days. The average blood loss during menstruation is 125 cc. Apart from blood, other matters such as ruptured uterine lining tissues also come out. Before menstruation begins, women may experience both physical and psychological symptoms such as frequent

63 urination, facial pimples, breast enlargement and tenderness, headaches, tiredness and feelings of being upset or emotional. 2. Follicular phase: The anterior pituitary gland produces a type of hormone which enters the blood flow. This hormone is then brought to the ovary, making the eggs within the ovary grow and ripen. This phase lasts for about 9 days. The combined period of the destructive phase and the follicular phase is approximately 14 days. 3. Luteal phase: This is when the eggs fully ripen and are released from the ovary. The ovary then produces a type of hormone which induces the thickening of the uterine lining and increases blood flow to the uterus, making the uterus receptive to the fertilization of an egg. If the egg is not fertilized, this hormone will be reduced and the beginning of the destructive phase or menstruation will be triggered. 1.2.2 Health practice regarding female reproductive organs 1. Always take a bath to keep the body clean. When taking a bath, taking special care of the genitals is required such as rinsing and towel drying. During menstruation, it is recommended to use warm water to rinse off the blood. 2. Wash and dry the genitals after defecation and urination. 3. Wear clean clothes, especially underwear which should neither be too tight nor too loose and should be changed daily. 4. Preserve your virginity. Premarital sex is not advised. 5. Do not use medical or chemical substances that promote sexual arousal. 6. In using toilets, hygienic practices should be adopted.

64 7. Have hobbies or do exercise to help reduce sexual interest. 8. During menstruation, keep an adequate supply of pads and change pads frequently. 9. During menstruation, do not do hard or serious exercise. Mild exercise and enough rest are recommended. 10. Keep record of menstruation periods. Slightly early or delayed menstruation is considered normal. Should a menstruation period begin sooner or later by 7-8 days or longer, it is recommended to see a doctor. 11. During menstruation, if one feels pain in the abdomen, it is recommended to place a hot water bag on the lower abdomen to produce warmth and take medicine to relieve pain. 12. If experiencing physical irregularities during menstruation such as severe pain in one’s abdomen or bleeding, it is recommended to see a doctor immediately. 13. Prevent genitals from impact. 14. In case of irregular changes to the genitals, it is recommended to see a doctor. Topic 2: Changes when reaching puberty 1. Sexual development and adaptation during puberty Both male and female adolescents will experience rapid physical changes and sexual development at the same time. However, there are differences between males and females.

65 1.1 Female physical changes Girls reach puberty faster than boys. On average, girls begin puberty at the age of 11-13. The pituitary gland will produce a hormone which accelerates growth and stimulates the function of the ovary in creating reproductive cells and in producing female reproductive hormones. During this period, female adolescents grow rapidly with significant increases in height and weight. The genitals grow larger. The pubis and arm pits become covered with hair. A smaller waist, thicker thighs and larger breasts begin to develop. Facial pimples may occur. The uterus, the ovary and other related organs develop further. Girls at this age start to have menstruation periods. A female adolescent, having menstruation, has reached sexual maturity and is able to get pregnant. Menstruation is a natural phenomenon which occurs when females reach adolescence. The ovary produces hormones and eggs. Normally, the left and the right ovaries will take turns in releasing grown and mature eggs at the rate of one egg per month. A ripened egg leaves the ovary and travels to the fallopian tube or the uterine tube to be fertilized by sperm. At the same time, the female reproductive hormone produced from the ovary and disseminated throughout the body, causes changes to the lining of the uterus. During the first week of a monthly menstrual cycle, the lining of the uterus thickens and becomes rich in blood. The uterus is then ready for the implant of the fertilized egg. If the egg is not fertilized by sperm, the lining of the uterus including numerous blood veins around the uterine lining will gradually rupture and shed, causing blood to come out through the cervix and out of the vagina. This process is called menstruation or menstrual bleeding or menses or a period. Some people may experience symptoms prior to or during menstruation such as headaches, feeling bloated, discomfort in the abdomen, muscle pain, backache, pain in the thighs, breast tenderness, feeling upset or emotional, mood swings, loss of appetite, nausea, etc.

66 Health practices during menstruation: Properly use menstrual pads and always wash your hands after changing pads. During menstruation, some people may have the symptoms mentioned above while some people may also experience painful cramping in the lower abdomen. These symptoms will disappear when menstruation ends. For those having serious symptoms such as severe pain in the abdomen during menstruation or having menstruation for more than 7 days or very unusual menstruation cycles, it is recommended to see an obstetrician. It is recommended to change menstrual pads frequently, i.e. at least 2-3 times a day and every time after taking a bath or defecating. Always keep the body and clothing clean. Do not share clothes with others. Do less exercise than normal. Have enough rest. Remain cheerful and happy. If painful cramps are felt in the lower abdomen, lie face down on a bed or floor with a supporting pillow beneath the lower abdomen for about 15-20 minutes. This will help improve menstrual bleeding and relieve pain. No pain reliever is required. Pain relievers should be taken only if serious pain is felt. In case of unusual pain or excessive bleeding, it is recommended to see a doctor immediately. During menstruation, taking a bath by soaking in a river or canal, a bathtub at home or a swimming pool is not advised as germs may enter the uterus due to the slight opening of the cervix. Taking a bath using a bath bowl or taking a shower is recommended. 1.2 Male physical changes Boys reach puberty at the age of 13-15 years. The pituitary gland will produce a hormone to stimulate body growth and the testes to produce reproductive cells and hormones. Male adolescents experience physical changes including increases in height and weight. Legs and arms grow longer and shoulders broaden. Bones and muscles get stronger and more powerful. Voices may also crack or become deeper. Breasts may temporarily grow, accompanied by feelings of tenderness or pain.

67 Hair may grow around the face, forelegs, armpits and genitals. Pimples may appear on the face, chest or back. The penis grows bigger and may harden due to sexual desire or arousal. While sleeping, boys having ‚wet dreams‛ can get erections and ejaculate semen from the penis. This is an indicator of sexual maturity in boys, meaning that they can get females pregnant. Wet dreams are a natural phenomenon occurring in males. That is, the testicles produce male reproductive hormones and sperm which will be stored in the epididymis. The male reproductive hormones will have an impact on a teenagers’ mentality and emotions as they will start to have sexual desires or express an interest in members of the opposite sex. When the body stores an increased amount of semen and psychological and emotional changes occur, the nerves will get stressed and thus, during sleep, sexual thoughts or fantasies may occur. This causes the epididymis to contract and eject sperm and semen into the urethra and out of the body.. This symptom is called a ‚wet dream‛ and is a natural and normal process. It helps to reduce mental stress and sexual desire. 1.3 Ductless glands that influence sexual development Key ductless glands that have an influence on growth and development of teenagers are the pituitary gland, the thyroid gland, and the adrenal or suprarenal glands. Each ductless gland has an impact on growth and development of teenagers. 1.4 Sexual feelings or sexual desire It refers to a subjective feeling that can be triggered by both internal and external stimuli. Sexual desire varies significantly from one person to another depending on the ability to control emotions and the stage of maturity of each individual.

68 According to the above meaning, intrinsic and extrinsic stimuli are key factors that trigger emotion and sexual desire. Key points related to sexual desire in teenagers can be summarized as follows: 1) Sexual desire is an instinct to preserve the human race which occurs naturally. It is an indication that teenagers have fully developed bodies, minds and emotions and have become ready to reproduce. 2) At present, there are numerous media forms in society that encourage the sex drive in teenagers. Sexual pictures or statements are presented through various media channels and constitute a factor that stimulates sexual desire in teenagers and encourages them to have sexual relationships more easily and earlier. These media forms include certain types of books and movies as well as information obtained from searches through the Internet. Sexual desire can have negative effects especially if teenagers lack the correct knowledge and understanding of proper practices for controlling their sexual desires. Eventually, they may engage in risky behaviors such as unintentional sexual activity. This leads to social problems related to inappropriate sexual behaviors in teenagers. 3) Without proper control, the sexual desire of teenagers may lead to increasingly inappropriate sexual behaviors. Although teenagers tend to have a greater sex drive than persons of other age groups and are physically ready to have sex or to produce offspring, in the Thai culture such inappropriate sexual behavior is viewed as unacceptable. Entering into a sexual relationship after marriage or at an appropriate age is more appropriate. Sexual desire in the teenage years is an indicator of a person having reached full physical development and a person who is physically ready to reproduce and to preserve the human race. Sexual desire is triggered by intrinsic and extrinsic stimuli.

69 1) Characteristics of intrinsic stimulus Intrinsic stimulus is a result of changes in the body and is influenced by hormones produced by ductless glands. Such hormones stimulate a systematic and continuous physical development. Reproductive hormones are an important intrinsic stimulus which triggers the development of sexual feelings in teenagers and leads to sexual desire at different ages. The male reproductive hormone is called testosterone and the two primary female reproductive hormones are called oestrogen and progesterone. 2) Characteristics of extrinsic stimulus Extrinsic stimulus refers to the external environment which may trigger or provoke sexual feelings in recipients. Examples of extrinsic stimulus are various forms of media which trigger or provoke sexual feelings in teenagers. At present, there are a wide variety of media, especially sexual media which present sexual pictures and/or statements. This media triggers or provokes media recipients, especially teenagers. Such a variety of sexual media is called ‚commercial sexual products‛. Nowadays, the number of such products produced and disseminated has grown considerably. Social and cultural conditions have changed. At present, people widely recognize that social and cultural settings are different from those in the past. With the adoption of western culture into Thai society, there have been changes in various aspects. In Thailand, there have been changes relating to the practice of having opposite sex friends. It appears that they currently have more freedom in such matters. In addition, the Thai family lifestyle has changed. Parents spend less time taking care of their children due to economic conditions. People also have more freedom to view materials related to sexuality via different forms of media. This is

70 considered an important extrinsic stimulus which can arouse and stimulate sexual desire in teenagers, especially if proper care and control is not exercised. Social and cultural changes relating to sexuality have led to various inappropriate values and behaviors embraced by teenagers. For example, teenagers tend to wear fashionable clothing which may be immodest without considering the consequences, such as clothing which is too tight or which reveals female body parts. Such displays can arouse and provoke sexual desire in male teenagers. It is also found that many teenagers value the free expression of their desires through different means such as going out to enjoy the nightlife, touching the body of a person of the opposite sex, holding hands or arms in public, staying alone with a companion of the opposite sex, or ignoring the importance of virginity, etc. These things are considered an extrinsic stimulus which can arouse or provoke sexual desire in teenagers. Changes in teenagers in terms of sexuality, sexual feeling or sexual desire, whether triggered by intrinsic or extrinsic stimulus, can be divided into two categories: psychological and physical changes. 1) Psychological changes It is found that normally people, when having a sexual feeling, will develop a certain level of sexual imagination which can vary depending on the ability to control emotions and feelings of each individual. Also, generally females usually develop sexual feelings slower than males. However, both males and females, if failing to adequately control or manage their feelings may suffer from a psychological problem. This is caused by mental stress which may lead to the development of concerns over sexuality and lack of self-confidence.

71 2) Physical changes Apart from psychological and behavioral changes in response to sexual desire, physical changes are also witnessed. For example, the reproductive organ grows bigger due to more blood supply. Male: The penis increases in size and hardens; the scrotum thickens; and the testicle moves up. Female: Apart from the enlarged reproductive organ, the vagina may produce a lubricating liquid and the muscle around this area may contract periodically. In addition to changes in the reproductive organs, sexual feelings can also lead to increased blood flow, which causes a redder skin color of visible areas such as the face, the chest and the stomach. Nipples and breasts may also expand. Sexual feelings in teenagers can have negative effects which may eventually lead to social problems. One prominent social problem is the adoption of inappropriate behaviors by teenagers, leading to unwanted pregnancies, sexually-transmitted diseases, and HIV/AIDs in teenagers. These problems are consequences of improper control and management of sexual feelings of teenagers. The guidelines for managing sexual feelings in teenagers can be divided into two main categories: guideline for suppression of sexual feelings and guideline for relieving sexual desire. 1) Guideline for suppression of sexual feelings The guideline for suppression of sexual feelings refers to efforts to avoid extrinsic stimuli which provoke sexual feelings. Details of the guideline are as follows:

72 - Avoid watching or reading various media materials that present provocative pictures or statements such as books or movies or the Internet that show pictures or statements related to sex, thereby encouraging sexual arousal. - Avoid being idle. Do not lie still and awake, daydreaming or exercising your sexual imagination. Avoid staying in a place that has bright lights and sound which provokes sexual desire. Although there are consistent viewpoints from psychological and medical authorities that masturbation does not cause any physical or psychological problems, it is recommended to refrain from such a practice on a frequent basis to avoid becoming obsessed about sex. Otherwise, such a practice could become a habit and have a negative impact on the person’s personality as well as undermine his/her emotional control. If such a practice is necessary and unavoidable, the following three rules must be taken into consideration: 1) Always observe hygienic practices 2) Use a private and discreet location and 3) Do not use violent methods which may cause wounds or infections. 1.5 Sexual adjustment when reaching teenage years When reaching teenage years, teenagers should adopt the following practice in order to adjust themselves properly and in accordance with their gender: 1) Study and gain an understanding of the physical and psychological changes related to sexuality. When reaching their teenage years, teenagers will experience several changes. Sometimes, these changes may make them feel uncomfortable. For example, certain male teenagers may not want to speak with their friends as they feel embarrassed about their breaking voice. Female teenagers may be concerned about their first menstrual period and

73 associated symptoms. Nevertheless, studying and understanding the conditions of such changes thoroughly will enable them to conduct themselves suitably. 2) Properly adjust oneself to opposite sex friends: Teenagers must undergo many sexual changes. Males and females have more social interactions with each other. As a result, they express a greater interest in opposite sex friends. Having opposite sex friends is not a bad thing. However, teenagers must behave themselves within appropriate limits and know how to treat each other in a proper manner. Males: Males should treat females with respect and courtesy, and should not make inappropriate sexual advances or take liberties with them. Males should also offer help to females such as holding their belongings, giving up seats for them, etc. Males should not act or speak in an inappropriate way such as using profane words or exercising physical force against others. Females: Females should behave properly and preserve their virginity. Females should not stay alone with a male companion and should not travel to a secluded place. Females should dress appropriately and should not act or speak in an inappropriate way such as making loud noises or using profane words. Females should show generosity and respect for males. 3) Consult adults whenever experiencing any problem or obstacle related to sexuality: Most teenagers have concerns about their physical and psychological changes. When facing any problem, they should seek advice from their parents, teachers, relatives or adults whom they respect or trust as such adults have more experience and are in a position to provide advice on proper practices for teenagers.

74 4) Adhere to decent traditions such as to respect and obey adults, to actively engage in learning and studying, to avoid sexual behaviors before reaching the appropriate age, to uphold decent traditions and values which will help create an awareness of the proper ways to behave. 2. Teenagers and friends Teenagers place high importance on friends and would like to be popular within their group of friends. A good friend would be helpful in many ways such as sharing happiness and grief, listening to problems, suggesting proper solutions to problems, etc. A bad friend would lead others to do things inappropriately. Therefore, teenagers should know how to choose a good friend and develop a good relationship with him/her. This will help teenagers better adapt themselves to society. 2.1 Rules for having friends Rules for having friends: It is necessary to consider the behaviors of our friends. If any of our friends misbehave, we should give them advice and persuade them to behave in an appropriate way. It is also important to learn how to say the word NO. We should not accept invitations from friends who misbehave or follow them to do inappropriate activities such as truancy, going out at night, gambling, drug use, etc. We should use a firm tone of voice while saying the word NO. Speaking your feelings is more effective than giving reasons or excuses because feelings are personal issues while reasons or excuses may be replaced by other reasons given by our friends. We should learn how to give useful advice to our friends and persuade them to do useful activities such as playing sports, playing music, studying foreign languages, studying computers, participating in community activities, etc. We may choose things to do that are based on our interest and suitable for us so that we can use time wisely.

75 2.2 General rules for making friends General rules for making friends are as follows: 1) Learn to accept positive and negative comments. Listen to comments or criticisms of others regarding oneself with willingness, impartiality and the ability to control emotions. 2) Learn to have a sense of humor and a positive attitude as well as to be able to smile easily. Persons with such desirable characteristics will be attractive and gain admiration from people they meet or work with and make such people feel happy and comfortable. This is key to receiving a warm welcome and a good cooperation. 3) Learn to be humble and not to exaggerate qualifications or to engage in comments that may be offensive or insulting to others. Learn to accept one’s own weaknesses or areas of improvement. 4) Learn to be accountable for one’s own duties. For example, learners have the duty to study and teachers have the duty to educate and train students and scholars. 5) Learn to compromise when problems or obstacles occur. Use of compromise is recommended as it is a way to help people reach an agreement fairly and reasonably. 6) Learn to demonstrate empathy. Always refrain from doing what we ourselves do not like or do not want others to do to us, and do what we want others to do to us. 7) Learn to give encouragement to others. For example, learn to show respect or honor to friends in the same classroom or colleagues at work or to express recognition, admiration or praises to them for their success.

76 8) Learn to trust others to a reasonable extent as others may also have weaknesses or areas of improvement like us. Sometimes, underestimating others’ ability may cause disappointment. 9) Learn to cooperate with others such as working willingly with a large group of people in conducting various activities for the public interest. Selfishness or exploitation is an undesirable act in society. 10) Learn to respect others’ rights such as not taking others’ property without prior permission, not infringing others’ legitimate rights and benefits, etc. 2.3 Rules for developing a good relationship with friends Rules for developing a good relationship with friends are as follows: 1) Understand yourself and others. Teenagers must understand their wants and the same with their friends. They must accept their own true selves and the differences between themselves and their friends. They should not feel jealous when their friends have more money or are more capable. They should not engage in comments or conduct that is offensive or insulting to a friend in an inferior position. They should congratulate their friend on his/her success and always seek to provide support for him/her when opportunities arise. 2) Have good interpersonal skills. Know how to speak and listen. Learn how to pick the right time to speak. Give friends an opportunity to express their opinions and listen to their opinions. Care for friends and pay attention to them with sincere intentions. Treat friends with honesty and sincerity. 3) Perceive the world as it is. Do not be too optimistic in order to avoid deception and fraud. Also, do not be too pessimistic as a person being too pessimistic could become narrow-minded and unforgiving.

77 4) Demonstrate sportsmanship. Admit your own wrongdoings upon learning of them. Say NO to things that you cannot do. Exercise your best effort to keep your promise. Learn how to sacrifice and forgive one’s friends when they make a mistake. One should seek to understand the cause of any mistake and together make improvements or corrections with your friends. When things happen to us and we become emotional, our behaviors tend to change or to be different. Sometimes this is visible but sometimes it is not and depends largely on each individual’s ability to adjust his/her emotions. Topic 3: Behaviors which encourage sexual relationships At present, there are many problems resulting from inappropriate sexual behaviors of teenagers such as early sexual relationships, HIV/AIDs and other sexually transmitted diseases, and unwanted pregnancies. Unwanted pregnancy is one of the top sexual problems facing teenagers. However, most teenage lovers do not enter into a sexual relationship due to being well brought up and educated by parents, being closely supervised by parents, not being in a situation that encourages sexual activity, thinking about the future and being concerned about various potential problems, feeling ashamed and guilty, being worried about reputation, fearing that others may learn of their status, not having a chance, practicing abstinence, etc. In most cases, the academic performance of teenage lovers would drop. Having a lover is neither a symbol of life success nor a fashion. Any teenager who still does not have a lover should not feel inferior to friends who already have one. There is no need to have a lover in order to be like other friends.

78 Teenage lovers should not ignore the differences in terms of love expectations between women and men. Understanding such matters would help them know how women and men should treat their lover. Men will mostly think about sexual experimentation ranging from touching body parts to having sexual activity. This is one of the reasons why many women have lost their virginity early and, in many cases, against their will. Therefore, female teenagers must exercise extra caution on this matter. 1. Behaviors which encourage sexual relationships Teenagers experience rapid changes and developments in terms of sexuality. Certain people may be interested in members of the opposite sex and sexuality, having a romantic relationship with a lover, sexual arousal, consumption of pornographic materials, having a sexual relationship with a lover, or having sexual activity with female commercial sex workers. Several consequences associated with the above issues include early sexual activity, which causes concerns and worries and decreased academic performance due to less interest in education, unwanted pregnancies, abortions, single-mother parenting, abandoned babies, sexually transmitted diseases, and HIV/AIDs. According to the rationale specified above, problems are often caused by teenagers themselves who demonstrate behaviors which encourage sexual relationship as follows: 1. Showing an excessive interest in sex: Normally teenagers naturally express an interest in sex at a certain age. However, if becoming too obsessed or taking chances or placing themselves in a risky situation, teenagers may have a sexual relationship without properly deliberating on the matter or thinking or planning. That means, teenagers may allow sexual relationships to occur without thinking about the associated consequences.

79 2. Being obsessed about sex: There are a number of teenagers, especially males, who are extremely obsessed with sex. They may practice masturbation frequently without attempting to avoid it or managing sexual feelings. In females, the number of similar cases is less. This type of persons is prone to having a sexual relationship. 3. Touching the body parts of someone of the opposite sex: Males are often pleased to have a chance to touch the body parts of females or to have females touch their body parts. A certain number of females also have the same inclination as males. Touching body parts can encourage sexual arousal. If there is an encouraging chance or situation, they may eventually have a sexual relationship. This is often the case when teenagers take the liberty of touching the body parts of each other and if warned about such behavior, would say that they are friends only and there is no impure intention. However, although it is possible that they do not have any impure intention, such behavior is considered inappropriate. Females would be seen as not preserving their virginity by allowing males to touch their body parts easily. Males would also be viewed as not behaving like a gentlemen as they take the liberty of touching the body parts of females. Thus, learners should avoid such behavior. 4. Thinking that having a sexual relationship is not a bad thing: Any male or female possessing this concept will considerably be likely to have a sexual relationship. Most males might feel this way since it is a part of their temperament. However, if females possess this concept, this will encourage fulfillment of the desire of males. Such a concept is considered one of the major problems in Thai families and society as it leads to early sexual relationships, followed by a number of related problems.

80 5. Consuming pornographic materials: At present, there are various forms of pornographic media sold in the market. Many teenagers know where to buy or sell such materials. Consuming pornographic materials can arouse sexual desire. As teenagers demonstrate high curiosity, sometimes they might want to try to follow the roles of the leading characters in such materials. This was evident in the news published on the front page of a newspaper regarding a group of teenagers having a sexual relationship and confessing that they just wanted to follow the pornographic materials they had seen. 6. Being promiscuous: A promiscuous person tends to have more than one lover or spouse or have as many as they like. Promiscuous teenagers will be very bold on this matter and will not be responsible for what they do. They do not have sincere love for anyone and are ready to leave those whom they no longer care for. This kind of person can easily have a sexual relationship without putting much thought into it. Females would have to carry the burden arising from what the two parties have done. For example, pregnant teenagers may decide to have an abortion or, after giving birth, may have to parent the child alone. Therefore, it is recommended to avoid a promiscuous person and not to be a promiscuous person. 7. Having past sexual experience: Males or females who have past sexual experiences may find it easier to enter into new sexual relationships. They may not think too much, may be bolder or may have little fear. They may also feel attached to the sexual pleasure and thus are prone to having repeated sexual relationships. 8. Using drugs: Drug users will feel drunk and get high. They will lack a sense of accountability and ignore their consciences. They often do things without thinking or unknowingly. This can be seen in several news reports regarding the users of ecstasy pills or ‚love pills‛ and methamphetamine pills or ‚yaba‛ or alcohol. Those persons may have

81 sexual activity because they are high on drugs or they would like to get some drugs in exchange for sex if they are already addicted to drugs. 9. Lacking deliberation: This type of person will not think about the associated consequences or potential effects of having a sexual relationship. They just fix the problems at hand and do not think about their future. They tend to make decisions without deliberating on anything in particular. 10. Being curious: Teenagers love to try new things to satisfy their curiosity. However, sexual experimentation is considered dangerous. Factors that provoke the need to experiment with new things are such as friends’ persuasion efforts and reading pornographic books. 2. Avoidance and self-prevention against un-wanted pregnancy There are a lot of women who get pregnant unintentionally because they never thought about having a sexual relationship with somebody who may be their lower, a friend, a stranger, a step-father or one of their relatives and were thus unprepared for a pregnancy. Women should, therefore, learn about how to avoid and to protect themselves against un-wanted pregnancies. The advice to do so is as follows: 1. Being with one’s lover 1.1 Do not let your lover touch you, hold hands with you or embrace you. If any such behavior is shown, show him that it is unwelcome and refuse such approaches seriously because otherwise you may be led into a sexual relationship due to an appropriate environment and a perceived willingness.

82 1.2 Do not stay in a secluded place with your lover because he may take advantage of you. Especially, if you love him you may go as far as to have a sexual relationship with him. 1.3 Do not stay overnight when you go out because this may lead to the opportunity of sexual abuse. 1.4 Do not watch pornography, especially with your lover because it would induce both of you to have sexual feelings and thus have inappropriate sexual behavior. 1.5 When going out in the evening for special occasions such as Valentine’s Day, Loy Kratong Festival, New Year’s Day, etc., such celebrations may be continued by going to a place where there could be a possibility of a sexual relationship. Therefore, special care must be exercised when going out with your lover on such special occasions and if you feel that the situation incurs a risk, do not go and find a nice way of saying no. 1.6 Be careful when going to parties or entertainment places with a lover as there is a chance of overdrinking and being unconscious. 1.7 Firmly deny a lover’s request for a sexual relationship. Do not feel sorry for him and fear that he will get upset. We should preserve our virginity. If we accidently allow a sexual activity to happen once, we should be careful and avoid repetition of such an incident. 2. When with a boyfriend, the following practices should be adopted: 2.1 Avoid unnecessary physical contact because, if given a chance, men will take advantage of women.

83 2.2 Do not trust anyone completely. There are several cases where friends deceived friends into being sexually assaulted or allowed other friends to join such sexual assaults as can be seen in the news. 2.3 Avoid an overnight stay even when travelling with a group of people. 2.4 Going out for nightlife until late hours may be dangerous. Be careful when friends offer a ride home because they may divert to some other place. 3. When with a stranger, the following practices should be adopted: 3.1 Never trust a stranger because we do not know him/her very well and may be tricked into doing something inappropriate. Be very careful especially when meeting a stranger in some place of entertainment as women may be thought to be a playgirl with whom one can easily have a sexual relationship. 3.2 Do not travel alone to a secluded place during the night as there are many cases where women have been abducted and raped in such a situation. 3.3 Do not trust people met on the Internet even though you may have been chatting and seem to have become familiar with each other because face-to-face contact has not yet been made and strangers thus remain strangers. Many women have been sexually assaulted by persons met on the Internet. In certain cases, photos can be used as a way for blackmailing and negotiations. 4. When being with a step-father or a relative: There are many women who have been sexually abused by close family members and dared not tell anyone about it. Some were sexually abused for many years. Some got pregnant. This is because family members are close to each other and see each other every day or so often that they trust each other very much. In this regard, women should adopt the following practices:

84 4.1 Observe the physical contact behaviors of such persons to see if the physical contact is made in an ordinary way for an adult to express affection for younger family members or in a sexual way. Stay away from those who make prolonged, provocative or sexual physical contact. 4.2 Always sleep in a locked room. 4.3 Do not trust those who are drunk as there is a high chance that they may lack mindfulness and do unexpected things. 4.4 Do not wear revealing clothing at home because it might arouse or provoke sexual desire in some persons. Also, taking a bath must be done in a private, closed place. 4.5 In the case of molestation by such a person, it is advised to let other family members know about it or to shout out for help. Do not be shy since such a person’s action is not proper. Considerations regarding sexual relationships Some women may think that having a sexual relationship is a common thing and is not morally wrong. They may not be concerned about Thai traditions and culture. In such a case, they should consider their self-responsibility and social responsibility by answering the following questions prior to entering into a sexual relationship. 1. If we allow ourselves to have a sexual relationship, to what extent can we deal with the associated consequences such as the negative comments of people in society, the fear that others may know the truth, pregnancy, being abandoned after having sex, worries as to whether a person whom we lost our virginity to will be our real life partner, etc.?

85 2. If we are not ready to have a child, how will we protect ourselves? How well do we understand prevention of pregnancy? Do we know that even with protection, things can still go wrong? What will we do in case of an un-wanted pregnancy and a refusal of responsibility by the man? Will we be ashamed if we have to have an abortion? How dangerous is an abortion? 3. Un-wanted pregnancy in teenagers Un-wanted pregnancy in teenagers refers to a pregnancy that occurs to a female as a result of unexpected sexual intercourse. The main reason may be due to inappropriate sexual behavior in teenagers or caused by a rape. 3.1 Problems and effects of un-wanted pregnancy in teenagers The problem of un-wanted pregnancy has grave effects as follows: 1) Direct effects on teenagers: The effects as mentioned above may lead to problems as follows: Mental and emotional problems: Teenagers having an un-wanted pregnancy usually feel guilt, shame, and assume that they are no longer loved. As a result some may show more inappropriate and violent sexual behaviors or some may not show anything externally but may feel depressed and suicidal, etc. The mental and emotional conditions of teenagers with un-wanted pregnancy vary according to the acceptance and understanding of their families. If acceptance, understanding and forgiveness is shown by the family, the mental and emotional problems will be less. Health problems: The usual problems are AIDS and venereal diseases. Unprotected sex without prevention and birth control inevitably brings about a high chance of AIDS or other venereal diseases as well as the possibility of an abortion which might result in death from hemorrhage or a severe infection as well as may hinder future child bearing. Subsequent to the abortion, there may be chronic post abortion endometritis infections resulting in the blockage of the cavity and the tube of the uterus and puncture or acute inflammation of the uterus from the abortion

86 equipment leading to uterus removal. Sometimes the expansion of the cervix during abortion may cause cervical tears or cervical incompetence, leading to an increased chance of miscarriages and also chronic health problems, particularly a chronic inflammation inside the pelvic cavity. 2) Effects on the family: When a teenage female is pregnant unexpectedly, the male partner usually denies all responsibility. The responsibility falls, therefore, solely upon the female and her family. If the maternal family has a good understanding and forgives the female teenager for what has happened and is willing to share the issue of raising the baby, her mental and emotional problems will be less. But if, on the contrary, the family cannot accept it then various problems can follow. 3) Effects on society and the nation: The un-wanted pregnancy of teenagers can cause many social problems as mentioned above. Moreover, the nation will have to bear the costs involved with budget allocations for the health of teenage females as well as for bringing up their children. 3.2 Prevention of un-wanted pregnancy in teenagers Practical preventive measures can be listed as follows: 1) Avoid any situation which may lead to sexual intercourse: Unexpected sexual intercourse of teenagers is always induced by a situation or an atmosphere conducive thereto, such as dating in a secluded area or partying involving alcoholic drinks, etc. 2) Learn to re refuse to enter a sexually risky situation: To resolve the problem practice saying ‚no‛ which shall serve as a warning to the male to stop the inappropriate sexual behavior. There are many ways of refusing to engage in risky behavior such as by saying ‚Stop, don’t do this‛, ‚I don’t like this, stop‛, ‚Don’t or I will scream‛, ‚You don’t have the right

87 to act like this‛, etc. The phrases that should be practiced and used usually contain the words ‚no‛, ‚don’t‛, or ‚stop‛. 3) Learn to honor each other. When a woman and a man think of gender equality and treat the opposite sex appropriately this is considered honoring each other, Such behaviors will help in preventing the development of sexual emotions during close encounters. 4) Dress cautiously: Current teenagers’ fashion trends, especially those of girls tend to stress the preference for close-fitting or minimalist attires which emphasize the figure. The result of such attires is that the males may be induced to have sexual arousal and lose their awareness of what’s appropriate which may lead to harmful sexual harassment and an un- wanted pregnancy. 5) Avoid travelling alone at night or in secluded places. According to teenagers’ statistics, the danger of being raped escalates at night or in secluded places with few people. Therefore, the best prevention if one travels in this situation is to have friends or relatives accompany us to prevent such risks. 4. Basic knowledge about laws protecting the rights of sexual harassment victims The law distinguishes 2 types of sexual harassment as follows: 4.1 A rape offence An offender guilty of raping a girl younger than 15 years who is not his wife whether by consent or not is subject to a prison term of 4-20 years and a fine of 8,000-40,000 baht (Criminal Code, Section 277, Paragraph One). If the offence as per paragraph one is committed to a girl younger than 13 years, the offender is subject to a prison term of 7 years to 20 years and a fine of 14,000-40,000 baht or life imprisonment (Criminal Code, Section 277, Paragraph Two).

88 If the offence as per paragraph one or two is committed in a group (joint act by more than 2 people) without the girl’s consent or using weapons such as firearms, explosives or other kinds of weapon, the offenders are subjected to a penalty of life imprisonment (Criminal Code, Section 277, Paragraph Three). There is one exception that is if the offence committed by a man to a girl older than 13 years but younger than 15 years with the girl’s consent and later the court grants permission for marriage, in such a case the offender is not subject to punishment. Also, if the court grants permission for marriage while the offender is serving his term, the court must order the release of the offender (Criminal Code, Section 277, Paragraph Four). If the offence is committed to a girl younger than 15 years who is not the offender’s wife whether with or without her consent, or to a girl younger than 13 years, causing her severe injuries, the offender is subject to a prison term of 15 years to 20 years and a fine of 30,000-40,000 baht or life imprisonment (Criminal Code, Section 277 bis (1)). And if the girl is killed, the offender is subject to a death sentence or life imprisonment(Criminal Code, Section 277 bis (2)). If the offence is committed to a girl not over 13 years of age or to a girl not over 15 years of age as mentioned above by persons with the intent of hurting her, or by persons carrying a gun or an explosive, or using arms, the offender shall be punished with a death sentence or life imprisonment in the case where the offence causes severe harm to the victim, or shall be punished with a death sentence in the case where the offence causes the death of the victim (Criminal Code, Section 277 ter). 4.2 An offence related to an indecent act on a child Whoever commits an indecent act on a child not over 15 years of age by threatening the child by any means, by doing any act of violence, by taking advantage of a child who is unable to resist, or by causing the child to mistake him or her for another person shall be punished with imprisonment not exceeding 10 years or a fine not exceeding 20,000 baht, or both (Criminal Code, Section 279, Paragraph One). If the offence is committed to a child not over 15 years of age by threatening the child by any means, by doing any act of violence, by taking advantage of a child who is unable to resist, or by

89 causing the child to mistake him or her for another person, the offender shall be punished with imprisonment not exceeding 15 years or a fine not exceeding 30,000 baht, or both (Criminal Code, Section 279, Paragraph Two). If the said offence causes severe damage to the victim, the offender shall be punished with imprisonment of 5 to 20 years and a fine of 10,000-40,000 baht. If the said offence causes the death of the victim, the offender shall be punished with a death sentence or life imprisonment (Criminal Code, Section 280). The rape offence against a minor and the offence related to an indecent act on a child not over 15 years of age, whether with the consent of the child or not, shall be a public offence for which no settlement can be made. The offence related to sexual intercourse with a woman, who is neither a wife nor a minor, and the offence is related to an indecent act on a child younger than 15 years, if not occurring in public, not intended to cause severe harm or death to the victim, or if the offence is not committed against the offender’s descendants, namely children, grand- children and great-grand-children, students under the offender’s supervision, persons under the offender’s control according to his official functions, or persons under his/her guardianship shall be an offence for which settlement can be made, meaning that the damaged person or the victim and the offender may both agree to settle or end the case and no longer make claims against each other. (Criminal Code, Section 281). Activities 1. Explain briefly the anatomy of the female and the male reproductive systems. Female:________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

90 Male:________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ 2. Write a summary of changes occurring during puberty. Female________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Male________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. Describe how to avoid behaviors which encourage early sex relationships. ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________

91 Topic 4: Sexual health ‚Happiness‛ is needed by all human beings, regardless of gender, age, or race. ‚Sexual well-being or health‛ is also needed by everyone. Under the sexual health promotion plan, the Office of Health Promotion Fund and the Women’s Health Advocacy Foundation have made continued efforts in promoting sexual health issues as the definition of sexual health is not limited to the context of sexual relationships. Sexual health has a profound meaning and refers to various dimensions. Sexuality is not only related to the body but also the accountability for one’s own health and body, the development of a good interpersonal relationship, the respect for each other’s rights and equality. Society also has genders other than male and female. A person with good sexual health will treat those whose sexuality is different from his/hers with respect regardless of whether they are transvestites, homosexuals, or bisexuals. Such a person is aware of his/her social responsibility as well as responsibility towards him/herself in terms of ensuring safe sexual relationships. Society must get rid of the negative view that sex is a dirty or dangerous issue which we must stay away from. In fact, in order to lead a happy life it is necessary for us to study, learn and understand sexuality because it is something we can express freely and happily if it is based on safety. Under the sexual health promotion plan, knowledge of sexual health is categorized by age group since people of each age group demonstrate different interests and wants. During the early years, a good sexual health foundation can be developed in children. Small children aged 5-8 years start to recognize the different sexual roles between males and females as defined by society. Activities, set behavioral patterns and rules specifying what men and women can and cannot do impede the development and create misunderstandings in children. During the age of9-12 years, it is time to prepare for the approach of adolescence. Children in this age group have to go through many changes. Getting correct and ready-to-use information will help them build

92 immunity so that they can smoothly reach the adolescent age. It is necessary for children to gain an understanding and be provided with explanations regarding such changes as well as to be given opportunities to take more responsibility within the family. They should be allowed to make their own decisions and be responsible for the associated consequences. Parents should not make all the decisions for them. Children at this stage will start to experience emotional changes and sexual feelings. Such changes are normal and the provision of correct information and knowledge to children through answering their questions straightforwardly, for example, is necessary. Children should be encouraged to learn about things that are appropriate for their age. During adolescence at the age of13-18 years, is the time when children encounter changes in every aspect. Provision of correct and comprehensive information about sexuality is necessary at this stage so that children can thoroughly understand the physical, mental and emotional changes facing them. It is necessary for children to develop skills related to safe sex practices as well as accountability for such matters so that they are able to understand that sex is not just a fun thing but that it comes with many consequences. Provision of knowledge in a straightforward manner is important so that teenagers can learn that sex is not something totally wrong and also not something to be ashamed of, thereby leading to safe sex practices and the development of a sense of accountability. Adults must understand that the human learning process is time-consuming and that a person has to gradually gain knowledge, experience and self-esteem so that he/she can enter into a safe and happy sexual relationship. Provision of information is not like ‚point out the way for the villain‛ but it enables children to have the correct concepts and skills about life so that they can grow into an adult with righteous views and accountability. Considerations related to proper sexual health practices are as follows: It is recommended to maintain a safe sexual relationship by not changing partners or not having a sexual relationship with persons other than your spouse. If you do have a sexual relationship with someone other than your spouse, then protection by the use of a condom is encouraged.

93 Focus should also be placed on personal hygiene. After sexual activity, it is necessary to clean your private organs to prevent the development of germs which may cause of itchy symptoms and genital diseases. It is encouraged to have ordinary sexual activity and not to use unusual tools or materials as part of sexual activity. Safety issues should be taken into consideration when using products designed to imitate natural items such as rubber dolls as part of a sexual activity. Birth control Birth control is a part of family planning in terms of when to have children and deciding the number of children or length of time between their births. This is to ensure that the family growth is suited to the needs and the preparedness of the married couple. Birth control is a technique used to prevent un-wanted pregnancies. Family planning and birth control Family planning and birth control consist of a couple’s plans about when to have children, decisions regarding the number of children the couple wants to have and choosing the length of time between their births in order to match theirneeds and preparedness. Birth control is a means used to prevent un-wanted pregnancies and there are many techniques available. 1.The use of a condom: A condom is an elastic barrier device commonly made from latex. It is put on a man’s erect penis during sexual intercourse. Condoms are used to prevent ejaculated semen from entering the uterus of a female and fertilizing the egg. After use, the semen will remain in the condom and it is recommended that the condom be wrapped in a tissue or tied in a knot, then disposed of in a trash receptacle. There are also condoms for females. They are normally larger than a male’s condom. However, they are not popular. 2.The use of contraceptive pills: contraceptive pills are made from 2 synthetic hormones, i.e. estrogen and progesterone, which act similarly to natural hormones in a female body by developing a mechanism to prevent pregnancy. Such a mechanism prevents eggs from maturing and blocks ovulation. It also makes the glutinous liquid around the cervix area to be sticky and blocks sperm from entering into the uterine cavity. If

94 the two steps of this mechanism fail, the uterus lining will be conditioned in such a a\\manner that it is not appropriate for the implantation of the fertilized egg. There are three types of contraceptive pills as follows: 2.1 The 21-pill pack: All of the pills in the pack contain hormones. A pill is consumed daily starting from a given day of the week. For example, if the first day of menstruation is Friday then take the first pill on ‚Fri‛ or Friday and take a pill daily thereafter until the pack is finished. This period is to be followed by a week with no pills. Menstruation will begin after 2-3 days of the no pill period. After 7 days of the no pill period, start taking the pills from a new pack immediately regardless of the menstrual flow. 2.2 The 28-pills pack: There are 21 pills that contain hormones. The other 7 placebo pills are usually smaller or larger than the first 21 pills. The start of the first pack must begin on the first day of menstruation by taking a pill designated as the starting point 1. After that, a pill is to be taken daily until the pack is finished. New pill consumption is to be continued immediately after a packet is finished regardless of the menstrual flow. The consumption of a 28-pills pack is considered more convenient than 21-pills packet due to the lack of the need to remember the no pills period. If a pill is forgotten one day, take another pill as soon as you realize your mistake and the next pill is to be taken as usual. If two pills are forgotten, take two pills daily for 2 days by taking 1 pill in the morning and another pill in the evening as well as using another birth control measure such as condoms for at least 7 days. If 3 pills or more are forgotten, the consumption of pills should be stopped until the beginning of the next menstrual period when consumption of a new pack should be started. Be sure to use birth control measures in the meantime. 2.3 Emergency contraception: These pills are to be taken 24 hours after having had sexual intercourse but should not be used more than 4 times a month. This pill is to be taken immediately or within 24 hours after having had sexual intercourse and one more pill is to be taken within the following 12 hours. The pills usually have high estrogen and have more disadvantages than benefits. The side effects include nausea, vomiting, excessive bleeding and a slow movement of the oviduct that may result in extra-uterine pregnancy. 3.Contraceptive implant: This kind of drug contains high Estrogen which acts to prevent fertilized eggs from being embedded in the Decidual. It usually consists of 6 tiny capsules implanted under the skin near

95 the inside part of the arm of a female. The drug will bleed into the body constantly and is active up to 5 years. The active ingredient is similar to the 21-pills pack. 4. Intra-Uterine Contraceptive Device: An Intra-Uterine Device is placed in the uterus by a doctor. It can last 3-5 years until a replacement is required. But some Intra-Uterine Devices may need to be replaced every 2 years. This method of birth control is not suitable for women who have not yet had any children. 5.Injectable contraceptive: This contraceptive is given to a woman every three months. The disadvantage is that it may take a long time to become pregnant when so desired and it is not suitable for women who have irregular menstruations. 6.Calendar-based contraception method (count safe period):This contraceptive method consists of counting 7 days before and 7 days after the menstrual period. During such periods, eggs are not yet mature and the uterus lining condition is changing. However, if the menstrual period is irregular, this method may be not effective. 7.Outside body ejaculation: This method consists of ejaculating outside of the vagina. However, there may be some parts of the semen that enter the vagina anyway. Therefore, this method entails a high chance of pregnancy. 8. Surgical sterilization: This form of sterilization is a permanent birth control method. Therefore, the person undergoing this birth control method must be certain that he/she does not want to have children any more. The surgical sterilization can be done on both men and women. 8.1 Male vasectomy: This is an operation which has to be conducted by a doctor and takes only 10 minutes. Patients have to lie down on a bed with a partition blocking view of the operation. During the operation, a small amount of pubic hair has to be shaved off and the doctor will give a local anesthetic to the patient. He then punctures the scrotum to tie the sperm duct with no suture being made. The wound must be kept away from water for 3 days. After a male vasectomy, males still have to use other contraceptive methods when having sexual activity. The doctor will check whether, after approximately 15 times of sperm ejaculation, the semen produced from the 15th ejaculation onwards still contains sperm. If the doctor diagnoses that there is no more sperm, males can have sexual activity without having to use other contraceptive methods.

96 8.2 Female sterilization: There are 2 types as follows: 1. Postpartum sterilization: This method is conducted within 24-48 hours after birth delivery because during this period the uterus is still large and at a position where the top of the uterus is almost at the same level as the navel which makes the operation easier. The operation is undertaken around the front of the abdomen. 2. Interval tubal resection: This method is conducted during a normal period when women are not pregnant or several years after a birth delivery. The uterus during this period is reduced to its normal size and is located deep down in the pelvic cavity. There are several types of interval tubal resection such as an operation through the front of the abdomen or the vagina, using various kinds of modern equipment. Surgical sterilization services are available at both government and private public health agencies such as hospitals, the Population and Community Development Association, the Planned Parenthood Association of Thailand, the Thai Association for Voluntary Sterilization, etc. 9.Birth control using emergency contraceptive pills is a preventive measure used in the case of an emergency such as when having sexual intercourse without any other protection, using a condom but not sure if it leaked or is broken, having forgotten to take regular contraceptive pills for two days, using intra uterine contraceptive device but it slipped off, having sexual intercourse within a fertile period, or having been raped. The consumption of contraceptive pills is certified by the World Health Organization as a safe and effective way to prevent pregnancy at a certain level. It should be noted that the use of emergency contraceptive pills will be effective only when used as directed and when needed. Usual side effects are irregular menstruation and nausea. Continued and frequent use of emergency contraceptive pills may induce extra-uterine pregnancy.

97 Abortion Abortion is the termination of pregnancy before the gestational age of 28 weeks. In Thailand, abortion is illegal no matter whether it is conducted by a qualified or an un-qualified doctor. The law permits abortion in 2 circumstances only, i.e. in the case of rape or if the pregnancy is hazardous to the mother and the baby. When an un-wanted pregnancy occurs, teenagers may have concerns due to their unpreparedness and the responsibility of having children. This may cause them to find ways to terminate the pregnancy by having an illegal abortion conducted by an un-qualified doctor. This is an immoral act because the Thai society does not condone abortions unless the doctor considers that the pregnancy should be terminated because it is life threatening to the mother such as an ectopic pregnancy, pre-eclampsia, molar pregnancy, or in the case of an infection after pregnancy such as German measles. Abortions for teenagers are usually conducted by an un-qualified person without true medical knowledge; thus, endangering the patient who may suffer a hemorrhage, an infection from tools and equipment used after the operation. The un-cleanliness of the equipment and the premises may also cause tetanus as well. The health hazards caused to the mother by an abortion is often due to the left over parts of the fetus or the placenta that remain in the uterus. Such residual parts need to be removed completely from the uterus by way of a suction machine or curettage or by taking hormones inducing a uterus contraction to expel these residues. In some cases, the doctor may use antibiotics to treat or prevent infection. HIV Infection The HIV infection is most commonly caused by having sexual intercourse with an HIV infected person and also commonly as a result of sharing syringes for injecting narcotics leading to blood exposure. People with a high chance of HIV infection neither from a sexual intercourse nor the use of a syringe are the medical staff who may be exposed to patients’ blood and lymph exposure if they are without protection which consists of wearing gloves and a mask before such an exposure. Un-prepared pregnancy

98 Early sex is becoming more and more of a problem for Thai society due to the fact that the values of women to preserve one’s virginity, or the appreciation of preserving one’s virginity until marriage is not considered as important by today’s teenagers. This may be due to lesser care and guidance received from parents. Modern day teenagers are more influenced by western culture which they consider as being more advanced and are thus less obedient to their parents than in the past. Therefore, it is necessary to educate them to create an awareness of the realities of life. The involved families, communities, schools, and institutions should all play a role in this campaign to prevent this problem of un-preparedness. Early sex is a problematic behavior that causes various problems in life, including problems and burdens to society and the community such as sexual transmitted diseases. This includes being a disease carrier if the person is a commercial sex worker. An un-prepared or unexpected pregnancy, besides affecting one’s own life, also affects the family by causing shame to the parents and relatives as well as causing social problems such as problems of abandoned children because parents do not want to keep their children or are not ready to raise the children due to the fact that they may be still studying and un-employed. Therefore, it is highly recommended that guidance be given to children in order to promote appropriate social behaviors, not to be involved with sex and to know how to protect oneself from early sex until they are ready and have a proper career as follows: 1. To enable students approaching their teenage years to have knowledge regarding sex, sexual intercourse and birth control. To help them know the pros and cons of early sex and un-prepared pregnancy and focus on the cons which include the risk of losing academic and career opportunities, and opportunities of finding a good partner in the future. 2.To enable male teenagers to know about their responsibility and how they should honor females. As the Thai society still admires males as the stronger sex, we should teach them to respect women and be responsible for their actions. It has been found that most abortion problems are due to rejection from the male concerned.

99 3.To instill a culture of preserving one’s virginity from childhood and putting more focus on the issue during the teenage years, stressing the need to dress properly, to avoid trendy but improper ways of dressing which may arouse the opposite sex and increase the risk of rape. 4.To let them know how to say ‚no‛ in an inappropriate situation such as not hanging out after school, rejecting a date with a male, rejecting sexual contact etc. The way to solve the problem of un-wanted pregnancy should begin with habits formed from early childhood about how to adapt oneself to social conditions in this globalization era. In this way, it is believed that we would be able to reduce the problem of illegal abortions

100 Lesson 4 Nutrients Main content The nutritional needs of individuals differ according to their gender and life stage. It is generally accepted that diet is extremely important in childhood for body growth and development of the bodies movement interaction system. Expected learning outcome 1. Analyze health problems caused by food consumption which is not in accordance with good nutrition principles. 2. Describe nutritional needs by gender. 3. Describe cooking methods that maintain the nutritional value of food. Content scope Topic 1. Nutrients Topic 2. Cooking methods that maintain the nutritional value of foods Topic 3. Consumption values and beliefs Topic 4. Health problems caused by food consumption which is not in accordance with good nuthition principles.