Teen sexual health is about how sex affects your physical and emotional health. It means knowing how to form healthy relationships and making decisions about sex that are right for you.

As your body changes during puberty, how you think, feel, and interact with others also changes. You may have new feelings and thoughts about sex. Understanding who you're becoming as a sexual young adult is also part of teen sexual health. For some teens, that includes understanding gender identity, gender expression, and sexual orientation.

For all teens, taking responsibility for sexual health is part of growing up. Whether you choose to have sex or wait, responsibility includes knowing about:

• Sexually transmitted infections (STIs)
• Birth control
• What a healthy relationship is

Sexually transmitted infections (STIs), or sexually transmitted diseases (STDs), are caused by bacteria, viruses, and parasites that spread from person to person, usually during vaginal, oral, or anal sex. Some STIs are spread by skin-to-skin contact. Without treatment, some STIs can cause long-term health problems.

There are more than 20 types of STIs, including:

• Chlamydia
• Genital herpes
• Gonorrhea
• HIV
• HPV (human papillomavirus)
• Pubic lice
• Syphilis
• Trichomoniasis

STIs don't always cause symptoms. So it is possible to have an infection without knowing it and then pass it on to someone else. The only way to know for sure whether you have an STI is to get tested.

The most reliable way to avoid infection is to not have vaginal, oral, or anal sex. Saying "no" to sex is the right choice for many teens.

If you decide to have sex, "safer sex" practices will lower your chance of getting an STI. They include:

• Talking with your partner about preventing STIs and getting tested before having sex. If you can't talk about STIs, you aren't ready to have sex.
• Getting the HPV vaccine. You can be vaccinated between ages 9 and 26.
• Using condoms correctly every time you have vaginal, oral, or anal sex:
  • External (male) latex condoms provide the best protection against STIs. If you or your partner is allergic to latex, you can use polyurethane condoms.
  • Internal (female) condoms, made of nitrile, are placed inside the body (vagina or anus). They may be less effective against STIs than latex external condoms.
  • Don't use both type of condoms together because that increases the chance they'll rip
  • Use a dental dam (a square piece of latex, polyurethane, or nitrile) to protect the mouth during oral sex
• Having sex with only one person who has sex only with you (mutual monogamy). But first, both of you should get tested for STIs.
• Not mixing alcohol or drugs with sex. You need to think clearly to make safer choices about sex.

The only sure way to avoid pregnancy is not to have vaginal sex.

If you decide to have vaginal sex, birth control can help prevent pregnancy. There are many types of birth control that work in different ways. Your health care provider can help you choose birth control that's best for you.

Condoms are the only birth control method that protects against STIs. But condoms alone aren't the most effective form of birth control. It's safest to use condoms with another form of birth control to prevent both STIs and pregnancy.

Healthy sex starts with a healthy relationship, so it's important to take an honest look at how you and your partner treat each other. Your relationship may be healthy if it includes:

• Respect. You and your partner value each other's feelings. Neither of you pressure the other to do things they don't want to do.
• Trust and honesty. You always tell the truth and trust your partner to do the same.
• Good communication. You feel safe talking openly about your feelings, STIs, and other relationships. And you both listen.

Your relationship may be unhealthy if it includes:

• Jealousy and control. One of you wants to make all the decisions and tries to keep the other from spending time with their friends and family.
• Disrespect. One of you makes fun of the other person's ideas and feelings.
• Pressure. One of you tries to bully the other into doing sexual things they don't want to do.
• Violence. Hitting, shoving, grabbing, and sexual assault should never be part of a relationship. If you don't know how to end a violent relationship, get help.

Your decisions about sex can affect your future health. Make sure that you know the facts so you can decide what is right for you.