Articles

Adolescent sexual health education program before COVID 19. Bahía Honda, 2021

0000-0002-9865-0786Grisell Mirabal-Martínez^{1  *}  , 0000-0001-7419-2226Neisy Alfaro-García¹  , 0000-0002-9266-0713Dunia Caridad Cuesta-Martínez¹  , 0000-0001-8156-3814Laigne Conde-Acosta¹  , 0000-0002-3996-7687Yanel Paradela-Marrero¹  , 0000-0003-2803-2963Aniubis Nazco-Zorrilla¹ 

¹University of Medical Sciences of Artemisa. Manuel González Díaz Teaching Polyclinic. Teaching Department. Bahía Honda. Artemisa, Cuba.

ABSTRACT

Introduction:

the emergence of COVID-19 has altered the biological and psychological states of many people, including children and adolescents, all of which has a direct impact on aspects of sexual and reproductive health.

Objective:

to evaluate the educational program on sexual health in adolescents in the face of COVID-19, in Clinic 23 of the "Manuel González Díaz" Polyclinic, Bahía Honda, Artemisa province during 2021.

Methods:

an educational intervention study was carried out. The universe consisted of 67 adolescents and the sample consisted of 58 intentionally selected adolescents who met the inclusion and exclusion criteria. A questionnaire was prepared to collect the necessary variables and to evaluate knowledge on the subject, the intervention was designed for six weeks and then its impact was evaluated. Descriptive statistics were used to tabulate the data.

Results:

the diagnosis proved that the frequency of sexual relations in adolescents decreased during isolation in both sexes, they refer to sexual activities with their partner and manifest online activities; both sexes manifest to be unprotected in their sexual relations with the increase of risks, most of them present a restricted criterion on sexuality and evaluate their knowledge between regular and bad, with the intervention developed, these deficiencies were corrected.

Conclusions:

the educational program designed constituted an alternative to achieve responsible sexuality in the face of COVID19, once again highlighting the role of the physician and the family nurse in promoting health in adolescents and young people.

Key words: ADOLESCENT; SEXUALITY; COVID 19; INTERVENTION

INTRODUCTION

The emergence of COVID-19 has altered the biological and psychological states of numerous individuals, including children and adolescents and all have a direct impact on the aspect of sexual and reproductive health.¹

The SARS-Cov-2 coronavirus causing COVID-19 disease was first reported in Wuhan China on December 31, 2019, it was until March 11, 2020 that the Sars-Cov-2 pandemic was declared.^1,2) This event brought a series of social, economic and health difficulties to people.³

As part of the mitigation of the pandemic, health authorities worldwide established social distancing as a measure to prevent COVID-19, which was considered one of the most effective strategies, since it is an easily transmitted and spread disease, close contact between people including sexual relations and face-to-face encounters were restricted, as a consequence, sexual behavior was modified and new forms of satisfying sexual pleasure were acquired.^4,5,6

The idiosyncrasy of adolescents, with their low perception of risk and the long-term consequences of their actions, make them a population at high risk of contagion and transmission, making it necessary to give clear and concise messages through the means of communication they use.³⁾

Several studies have documented sexual behavior during confinement, where a decrease in the frequency of sexual intercourse was observed, but masturbation increased.^7,8) In addition, different ways of satisfying their sexual desires are incorporated, such as cybersex, i.e. the use of the Internet for sexual purposes, such as pornography and sexting.⁹⁾ It should be noted that cybersex is associated with sexual risk behaviors in young people, such as oral sex, sex with casual partners and sex under the influence of alcohol or other drugs.¹⁰

Various associations and organizations have taken advantage of the pandemic to include clarifying messages on their websites about what is and is not safe sex in the COVID era and have done so by answering questions that may even seem obvious.¹¹

According to a study by the United Nations Population Fund (UNFPA), adolescent women may have 20 % more limitations in accessing contraceptive methods, so that the marginal increase in the number of early pregnancies could vary to figures that would represent an increase in the specific adolescent fertility rate.¹²

The development of the family doctor and nurse program in Cuba allows for the implementation of actions that integrate hygienic, sanitary and social components from the community space, emphasizing care for at-risk adolescents.¹³⁾ In view of the COVID-19, knowledge on these issues is essential to enable responsible sexual behaviors that will lead to a future with a rewarding, enriching and humanistic sexual and reproductive health. For these reasons, the present research is carried out with the objective of evaluating the educational program on sexual health in adolescents before the COVID19, in Clinic 23 of the Manuel González Díaz Polyclinic, Bahía Honda, Artemisa province during the year 2021.

METHODS

The research classifies as quasi-experimental intervention, with the objective of implementing an intervention for the care of the sexual health of adolescents before COVID, 19. The study universe was constituted by the 67 adolescents of the CMF23, belonging to the Manuel González Díaz Teaching Polyclinic in Bahía Honda during 2021 and the sample was conformed by 58 of them who fulfilled the inclusion and exclusion criteria.

Inclusion criteria

Adolescents between 15/19 years old, who belong to the aforementioned clinic, who have a computer or mobile device and whose parents gave their consent to participate in the research.

Exclusion criteria

Adolescents with some type of mental disability and who at the time of the research were not in the area.

The variables studied were: sex, sexual frequency, use of contraceptive methods, general knowledge before and after the educational program.

The research consisted of three stages: diagnosis, intervention and evaluation:

Diagnosis: A questionnaire was applied with the objective of identifying variables such as sexual frequency, sexual behaviors and use of contraceptive methods (MAC) during isolation, as well as evaluating the knowledge that adolescents have regarding sexuality and COVID 19 this question of the questionnaire had five items, each was assigned a value of 20 points for a final value of 100 points. We defined the level of knowledge as High, if the correct answers reached 80 or more points; acceptable if they ranged from 60 to 79 points; and Low if they achieved less than 60 points. The data collection instruments were prepared by the authors, where questions were selected and adapted according to the adolescents, which were validated by experts.

Intervention Stage. Once the learning needs were identified, the health education program aimed at adolescents was designed and implemented, prepared by the authors and subsequently validated by expert criteria, with the following topics: Once the learning needs were identified, the intervention was designed and implemented virtually through a computer device such as a computer, tablet or mobile device, addressing the following topics:

The methodology was virtual and personalized. Six weeks later, the post-intervention questionnaire was applied.

Evaluation Stage. Six weeks later, the questionnaire was applied again.

Descriptive statistical methods were applied with mathematical procedures to organize, classify and interpret the qualitative indicators obtained in the empirical research, which were presented in the form of tables, with the calculation of absolute and relative frequencies. Inferential statistics were used. For this purpose, the Diagnostic Tests module of Epidat 3,1 was used, and the Pear-son Chi-square test was determined by the likelihood ratio for a significance level of 0,05, with a confidence interval (CI) of 95 %.

The research is based on the principles of medical ethics, which specify the rights of the persons who undergo the research, the voluntary nature of the research and the strict confidentiality of the results.

Oral and written consent was obtained from the persons who were selected. In addition, the confidentiality of the data collected was guaranteed, which were used for scientific purposes that complied with ethical parameters.

RESULTS

44,8 % of adolescents of both sexes reported a decrease in sexual frequency. This was more significant in the female sex with 29,3 % as opposed to 25,8 % in the male sex with an increase in sexual frequency. There was statistical significance between sexual frequency and sex in the sample studied (X2= 6,3482, p=0,04). (Table 1)

Table 1 Distribution of adolescents according to sexual frequency and sex during isolation. CMF23. Manuel González Díaz Teaching Polyclinic. Bahía Honda. 2021. 

Sexual frequency during isolation	Female		Male		Total
	No.	%	No.	%	No.	%
Less	17	29,3	9	15,5	26	44,8
More	6	10,3	15	25,8	21	36,2
Same	5	8,6	6	10,3	11	19,0
Total	28	48,3	30	51,7	58	100

Source: Questionnaire X2 = 6.3482 P=0,04

Regarding sexual behaviors during isolation in both sexes, it was observed that these adolescents have sexual relations with their partner (89,7 %), they also have sexual relations with occasional partners (41,4 %) and have sexual relations online (63,8 %). Statistical significance p<0.05 was observed among the variables studied (X2= 7,9499, p=0,0471). (Table 2)

Table 2 Sexual behaviors during isolation. 

Sexual behaviors during isolation	Female (n=28)		Male (n=30)		Total (n=58)
	No.	%	No.	%	No.	%
Sexual intercourse with a partner	25	43,1	27	46,6	52	89,7
Sexual relations with casual partner	11	19,0	13	22,4	24	41,4
Online sexual activities	16	27,6	21	36,2	37	63,8
Masturbation	1	1,7	13	22,4	14	24,1

Source: Questionnaire X2= 7,9499 p=0,0471

Only 39,7 % acknowledge having protected themselves with some contraceptive method compared to 60,3 % who did not use protection. There is no statistical significance between the variables studied (X2= 0,2320 p=0,6301). (Table 3)

Table 3 Use of Contraceptive Methods (MAC) in Sexual Relations. 

MAC USE IN SEXUAL RELATIONSHIP	Female		Male		TOTAL
	No.	%	No.	%	No.	%
Yes	12	20,7	11	19,0	23	39,7
No	16	27,6	19	32,7	35	60,3
Total	28	48,3	30	51,7	58	100

Source: Questionnaire X2= 0,2320 p=0,6301

The knowledge of sexuality and Covid 19 showed that 43,1 % presented a regular level of knowledge, followed by 37,9 % with a low level of knowledge. There was no statistical significance between the variables studied (X2= 2,4674 p=0.,8721) (Table 4).

Table 4 Knowledge of Sexuality and COVID 19. 

Knowledge	Female		Male		Total
	Nº	%	Nº	%	Nº	%
High	6	10,3	5	8,6	11	19,0
Regular	14	24,1	11	19,0	25	43,1
Low	8	13,8	14	24,1	22	37,9
Total	28	48,3	30	51,7	58	100

Source: Questionnaire. X2= 2,0207 p=0,3641

After the educational intervention, 91,3 % of the adolescents showed knowledge on the subject, with statistical significance among the variables studied (X2= 61,2036 p=0,0000).

Table 5 Level of knowledge after the educational intervention. 

Knowledge	Before		After
	Nº	%	Nº	%
High	11	19,0	53	91,3
Regular	25	43,1	6	10,3
Low	22	37,9	0	0
Total	58	100	58	100

Source: Questionnaire. X2= 61.2036 p=0.0000

DISCUSSION

The results of the research show changes in the sexual frequency of adolescents during isolation, which have decreased, showing a difference in terms of gender, where males report more frequent sexual relations, while no significant changes in frequency are observed in females.

Coinciding with the literature reviewed, social isolation has meant for the youngest, an impossibility to meet people, interact with the group and have sexual relations.¹ Both males and females during isolation report sexual activities with their partner and manifest online activities. This coincides with the research conducted in 2022 by Hernández Figaredo et al.¹⁴

Sexting is the act of producing and sharing sexual or erotic content through the Internet, especially through cell phones, and is a widespread practice among adolescents. It has the advantage that it allows couples to enjoy each other at a distance and with the immediacy that is usually required for the encounter. Although sexting has many negative connotations associated with it, it also has benefits for the people who practice it, if it is done well: it allows the exploration and expression of one's own sexuality, expands the repertoire of erotic behaviors, allows the establishment and protection of individual limits, and reduces the chances of suffering physical violence, unwanted pregnancies or sexually transmitted infections.¹⁵

Calero Yera E,¹⁶ points out in his research ¨that more than half of all adolescents do not use contraceptives in their sexual intercourse; and raises the lack of concern about the protection of sexual activity". Alfonso Figueroa,¹³ found similar results to this research in his study.

The literature refers that COVID 19 may be affecting consultations related to contraception, with the implications that this may entail, especially in terms of unwanted pregnancies.^17,18 The authors consider that most of the adolescents had some knowledge about the different aspects of sexuality in relation to COVID 19.

There is currently no evidence to indicate that SARS-CoV-2 is found in fluids such as semen or vaginal fluid. For this reason, it is unlikely that the virus is transmitted through practices such as vaginal or anal penetration. However, it is important to pay special attention to hygiene measures, important both before and now, washing hands and any erotic toys with soap and water.¹⁹ In a study conducted with young Cubans on the subject, insufficient knowledge was also found, which improved with the intervention, coinciding with these results.²⁰

CONCLUSIONS

With the intervention developed, they improved their knowledge on the subject. Confirming once again that as long as they know about human sexuality, they will be able to have a responsible, full and happy sexuality. It constituted an alternative to achieve a responsible sexuality in the face of COVID19, once again highlighting the role of the physician and the family nurse to promote health and contribute to the human improvement of adolescents and young people.

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Funding

The authors did not receive funding for the development of this research

Received: October 27, 2022; Accepted: March 22, 2023

The authors declare that there is no conflict of interest

GMM: participated in conceptualization, research, project management, supervision, visualization, writing - original draft, writing - revision and editing.

NAG: participated in conceptualization, research, visualization, writing - original draft, writing - review and editing.

DCCM: participated in conceptualization, research, visualization, writing - original draft, writing - review and editing.

LCA, YPM, ANZ : participated in conceptualization, research, writing - original draft. All authors approved the final version of the manuscript.