This document covers a reproductive health session presentation on topics related to adolescence. It discusses puberty and the physical and hormonal changes that occur. It also covers consent, sexual assault, and female circumcision (FGM). Regarding puberty, it describes the physical signs and responsible hormones. It defines sexual consent and assault, including types of assault. For FGM, it outlines the different types and associated health consequences. The goal is to educate adolescents on these important reproductive health issues.

1. REPRODUCTIVE HEALTH SESSION
Max B Tungaraza
RN, BScN, DHPEd, FP Trainer

2. PRESENTATION LAYER OUT
 Introduction
 Puberty
 Consent and sexual assault
 Female circumcision (FGM)
 Pregnancy and its challenges to youths
 Family planning (contraceptives)
 References

3. INTRODUCTION #1
 WHO defines adolescents as an individual aged
10 – 19 years, and young people aged 10 – 24
years. It is a transition between childhood to
adulthood.
 Adolescence is characterized by physical,
emotional and cognitive changes in the
relationship between the adolescents, their
parents and peers.

4. INTRODUCTION #2
 At the same time, the adolescent is going
through a process of acquiring knowledge
and skills to enable them live as autonomous
individuals.
 However, adolescence if not well handled,
may ditch the adolescent into problems. And
sometimes, adolescents suffer traditional
norms and culture, e.g. FGM, early marriage
and so on.

5. PUBERTY #1
What is puberty?
 Sexual secondary characteristics
 The time in life when a boy or girl becomes sexually
mature.
 It usually happens between ages 10 and 14 for girls
and ages 12 and 16 for boys.
 It causes physical, emotional, and cognitive
changes , and affects boys and girls differently (see
on the table)

6. PUBERTY #2
Characteristics associated with puberty?
In girls:
 The first sign of puberty is usually breast development.
 Then hair grows in the pubic area and armpits.
 Menstruation (a period) usually happens last.
In boys:
 Puberty usually begins with the testicles and penis getting
bigger.
 Then hair grows in the pubic area and armpits.
 Muscles grow, the voice deepens, and facial hair develops as
puberty continues.

7. PUBERTY #3
Characteristics cont…..
 Both boys and girls may get acne (pimples)
 Both boys and girls get a growth spurt (a rapid
increase in height) that lasts for about 2 or 3
years.
 This brings them closer to their adult height,
which they reach after puberty.

8. Adolescent Development
AREA OF
DEVELOPMENT
EARLY: 10-13 MIDDLE: 14 - 16 LATE: 17 +
Physical Pubertal changes End of pubertal changes Sense of responsibility for one’s
health
Emotional Wide mood swings , Intense feelings
Low impulse control , Role
exploration
Sense of vulnerability
Risk taking behavior peaks
Increased sense of vulnerability
Able to consider others and
suppress ones needs
Cognitive Concrete thinking
Little ability to anticipate long term
consequences of their actions
Literal interpretation of ideas
Able to conceptualize abstract
ideas such as love, justice,
truth, and spirituality
Formal operational thoughts
Able to understand and set limits
Understands thoughts and feelings
of others
Relation to family Need for privacy Peak of parent conflict
Rejection of parental values
Improved communication
Accepts parental values
Peers Increased importance and intense of
same sex relationships
Peak of peer conformity
Increase in relationship with the
opposite sex
Peers decrease in importance
Mutually supportive, mature,
intimate relationship

9. PUBERTY #4
Responsible hormones in Puberty
 Gonadotropin – releasing hormone (GnRH) – from
the hypothalamus
 Luteinizing hormone (LH) – from the pituitary gland
 Follicle stimulating hormone (FSH) – from the
pituitary gland
 Testosterone (Male hormone) – from testicles
 Progesterone and estrogen (Female sexual
hormones) – from the ovaries

10. REPRODUCTIVE ORGANS

11. REPRODUCTIVE ORGANS
CONTS…
Internal Reproductive Organs

12. REPRODUCTIVE ORGANS
CONTS…
External & Internal Male Reproductive Organs

13. FEMALE REPRODUCTIVE CYCLE

14. QUESTIONS

15. CONSENT & SEXUAL ASSAULT #1
SEXUAL CONSENT
 When it comes to sexual activity and sex, you
have the right to decide when you do it, where
you do it, and how you do it.
 For any sexual activity to happen, both people need
to consent, or say yes, willingly and freely.
 Sexual activity does not just mean sex, it includes
kissing, hugging, making out, cuddling, and
touching someone’s body in a sexual way.

16. CONSENT & SEXUAL ASSAULT #2
SEXUAL CONSENT ….
 Consent is the “conscious and considered agreement to
voluntarily engage in sexual activity with another.”
 Consent is the foundation of all healthy sexual activity
and is a key part of a healthy, happy sex life.
 If you decide to become intimate with someone, both of you
should give consent and be sensitive to the acceptance or
non-acceptance of the other person.
 Check in with your partner often about their comfort level
around certain sexual activities and clearly state if you want
to stop the sexual activity at any time.

17. CONSENT & SEXUAL ASSAULT #3
 SEXUAL CONSENT ….
 There are some people who cannot give consent
for sexual activity according to the law, including
those who are mentally compromised or intoxicated
– sometimes called “diminished capacity.”
 There are also situations where the victim of sexual
assault is not required to consent in situations
where there is fear of great harm, threats with real
or alleged weapons, the use or threat of physical
injury or brute force

18. CONSENT & SEXUAL ASSAULT #4
SEXUAL ASSAULT
 Sexual activity should always
be safe, sane and consensual
 However, this does not always happen – for a wide
variety of reasons. When sexual activity occurs without
consent, it is SEXUAL ASSAULT
 For many, the term sexual assault usually equates to
rape. However, the term sexual assault can involve any
type of unwanted (non-consensual) sexual activity
including (see next slide)

19. CONSENT & SEXUAL ASSAULT #5
SEXUAL ASSAULT CONT….
 Inappropriate touching
 Vaginal, anal, or oral penetration
 Sexual intercourse or actions that you say no to
 Rape
 Attempted rape
 Child molestation

20. CONSENT & SEXUAL ASSAULT #6
SEXUAL ASSAULT CONT….
 Sexual assault can be “verbal, visual, or anything
that forces a person to join in unwanted sexual
contact or attention.
 Examples of this are voyeurism (when someone
watches private sexual acts), exhibitionism (when
someone exposes him/herself in public), incest
(sexual contact between family members), and
sexual harassment.”

21. CONSENT & SEXUAL ASSAULT #7
 According to the law, sexual assault is “sexualized
contact with another person without consent and
by force (compulsion).”
 This force doesn’t have to be physical – it can also be
through fear, deception, coercion, or the use of
intoxicants such as alcohol and drugs.
 However, sexual assault laws vary by state and can
include laws about age of consent (sometimes called
statutory rape laws), types of sexual assault, and level
of punishment for the different types of sexual assault

22. CONSENT & SEXUAL ASSAULT #8
TYPES OF SEXUAL ASSAULT
 Date (or Acquaintance) Rape. Date rape is a sexual assault that
occurs when you already have a relationship with the person who
assaulted you. This can include friends, current or former sexual
partners, or other acquaintances.
 Sexual Exploitation By A Helping Professional. Sexual contact of
any kind between a helping professional (doctor, therapist, teacher,
priest, professor, police officer, lawyer, etc.) and a client/patient.
 Spousal (or Partner) Rape. Sexual acts committed without a
person’s consent and/or against a person’s will where the
perpetrator is the individual’s current partner (married or not),
previous partner, or cohabitator.

23. CONSENT & SEXUAL ASSAULT #9
NOTE
 Regardless of the sexual act, everyone has a right to not
consent, or revoke (cancel) consent.
 Violations of that right are considered sexual assault.
 If sexually assaulted, a girl should:
√ Do not wash, comb, or clean any part of your body.
√ Do not change clothes if possible, so the hospital staff can collect evidence.
√ Do not touch or change anything at the scene of the assault.
√ Report to police office
√ Go to your nearest hospital emergency room as soon as possible. You need to
be examined, treated for any injuries, and screened for possible sexually
transmitted diseases (STDs) or pregnancy.

24. QUESTIONS

25. FEMALE CIRCUMCISION
“FGM”
 Female genital mutilation (FGM/C) is a
traditional practice with severe health
consequences to girls and women.
 It refers to all practices involving partial or
complete removal of or injury to the external
sexual organs of women and girls for non-
medical reasons.”

26. FGM – TYPE I [SUNNA]
 The prepuce or the
clitoral hood is
removed.
 The clitoris is left intact.
And the larger part of
the minor labia is left
untouched
 It is the least severe
form of FGM

27. FGM – TYPE II [REDUCTION]
 The procedure
involves the removal
of the prepuce
(foreskin) and the
glans of the clitoris
together with
adjacent part of the
labia minora or
whole of it, leaving
the majora intact,
and no closure

28. FGM – TYPE III [INFIBULITATION]
 It is the most severe
form of FGM.
 It involves the excision
of part or all of the
external genitalia and
stitching or narrowing
of the vaginal opening

29. FGM – TYPE IV [UNSPECIFIED]
 It includes;
√ pricking, piercing or incising of the clitoris and/or
labia; stretching of the clitoris and/or labia
√ burning of the clitoris and surrounding tissue;
scraping of tissue surrounding the opening of the
vagina
√ introduction of corrosive substances or herbs into
the vagina to cause bleeding or to tighten or
narrow the vagina

30. MYTHS & FACTS ABOUT FGM
 Myth: clitoris will continue to grow as the girl gets
older and so it must be removed.
 Myth: external genitalia of a woman are unclean
and can cause death of an infant during delivery.
 Myth: Girls who have not been cut will never get
married and will be shunned by their communities
 Myth: In Singida region, it is believed that FGM
cures a disease called ‘lawalawa’

31. FGM – HEALTH CONSEQUENCES
Immediate health consequences
 Severe pain
 Excessive bleeding
 Shock
 Genital tissue injury
 Infections (bacterial, HIV, HepB)
 Urination problems
 Death

32. FGM – HEALTH CONSEQUENCES
Long term health consequences
 Keloids, chronic pain
 Impaired female sexual health
 Obstetric complications i.e. difficult labour, Fistula, Operative
deliveries, etc
 Perinatal risks: obstetric complications can result in a higher
incidence of infant resuscitation at delivery and intrapartum
stillbirth and neonatal death.
 Psychological consequences: some studies have shown an
increased likelihood of post-traumatic stress disorder
(PTSD), anxiety disorders and depression.

33. QUESTIONS

34. PREGNANCY AND ITS CHALLENGES
TO YOUTHS #1
What is pregnancy?
 Pregnancy, also known as gestation, is the time
during which one or more offspring develops inside
a woman womb.
 Any woman at a child bearing (reproductive) age
(15 -49years) can get pregnant.
 Girls get a number of risks when become pregnant
especially when they are at a very tender age or at
school age

35. PREGNANCY AND ITS CHALLENGES
TO YOUTHS #2
Educational challenges
 Likelihood of drop out of school (truancy). Many
girls continue to leave school because of
unwanted pregnancies
 Dismiss from schools
 Failure to reach their dreams (good Job, Good
level of education, etc)
 Finger pointing – disappoints and contribute to
girls feel uncomfortable, may decide to drop out

36. PREGNANCY AND ITS CHALLENGES
TO YOUTHS #3
Medical challenges
 Likely to end in illegal pregnancy termination. Half
the women seeking abortion care services in public
hospitals are adolescent girls
 Obstetric complications (i.e. Obstructed labour,
prolonged, fistulae, operative deliveries, injuries,
seizures, bleeding, etc)
 Some develop psychological blues (psychosis) due
to stresses during pregnancy

37. REFERENCE LISTS #1
The United Nations Children’s Fund [UNICEF], (2005).
Female genital mutilation/cutting: A statistical
exploration. New York: Author.
“Training course” (n.d). Health Effects of Female
Circumcision, Module five. Geneva: Author.
UNPFA, (2014,June). Female Genital Mutilation/Cutting
(FGM/C). Available at
http://tanzania.unfpa.org/sites/default/files/resource-pdf/l

38. REFERENCE LISTS #2
Health risks of female genital mutilation (FGM).
Available at:
http://www.who.int/reproductivehealth/topics/fgm/h
Teen Pregnancy: Medical Risks and Realities.
Available at:
https://www.webmd.com/baby/teen-pregnancy-me