Sex Made Easy (11 page)

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The news.
Many health care providers are sensitive to the fact that being naked and covered only in a paper or cloth gown with one's legs spread open can be a vulnerable position to be in. Many women find it an uncomfortable, or at least awkward, experience. For this reason, after the exam is over many providers will leave the room and ask the woman to get dressed, then meet with you in their office. Sometimes the health care provider simply returns to the exam room to talk. By regrouping after the exam, fully clothed, some women feel more comfortable talking about their health issues with their provider and asking any additional questions.

Some health care providers also conduct what's called a
rectovaginal exam
as part of the pelvic exam. This involves their briefly inserting a lubricated, glove-covered finger into your anus and rectum at the same time that a lubricated, glove-covered finger is inserted into your vagina. This brief exam is done to check for any masses that might signal problems such as large cysts or even early signs of uterine or ovarian cancers. Although my gynecologist does this annually, about half my friends say their doctor has
never done this. I'm not sure why this is: rectovaginal exams are a widely recommended practice, don't typically hurt or cause discomfort (their gloved finger should be very well lubricated), and are actually quite quick to perform. And, at least as far as I'm concerned, the potential benefits of my doctor finding out something important about my health far outweigh any momentary awkwardness I experience from having his finger in my butt. (There's really no delicate way to put that, is there?)

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ost of us take risks when we have sex—at least some of the time. I've certainly walked away from sexual encounters wondering if I stopped using condoms too soon with my boyfriend at the time. Even those who are good about using condoms don't always take every possible step to protect themselves. Sometimes people start having sex without a condom on and then put it on halfway through sex (not the best idea).
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And how often have you truly worn latex gloves for fingering or hand jobs? Then there's the issue of using condoms for fellatio (blow jobs) and dental dams for cunnilingus (oral sex performed on women): although most of us know that STIs can be passed through oral sex, condoms and dams are rarely used during oral sex.
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The truth about sex is that people often touch, lick, kiss, and suck on each other's body parts, skin to skin and tongue to skin. We get naked and, for better or worse and often in spite of knowing better, we take risks with one another. Sometimes these risks feel “worth it” and other times we regret them. For these reasons, we should all be better informed about STIs, testing, and treatment.

STI testing is included in some, but not all, GYN exams. In the US, the American College of Obstetricians and Gynecologists (ACOG) and the US Centers for Disease Control and Prevention (CDC) recommend that sexually active women age twenty-five and younger receive routine testing for chlamydia and gonorrhea. This is because a large number of women in this age group have these two common bacterial STIs and, if left untreated, either one can cause a range of reproductive health problems, including problems with fertility. However, not all health care providers follow these
recommendations, and in 2007 ACOG issued a statement about this problem, noting that more than half of women who should be getting routinely screened are not. This means that there are an enormous number of women who are at risk of STIs such as chlamydia and don't even know it, and there are also many women over age twenty-five who are also at risk and who aren't regularly tested for STIs. My professional advice is to:

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Tell your health care provider about your sexual behavior,
including whether or not you have oral sex, vaginal sex, and anal sex as well as how often you use condoms (if at all) and the number of sex partners you have had. If your health care provider doesn't ask you about your sex life, try opening the conversation by saying something like, “I have some questions about my sexual health. Can we talk about that for a few minutes?”

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Ask if you are being tested for STIs and, if so, which ones you are being tested for.
Although young women are often tested for chlamydia and gonorrhea, that's usually it—and again, many don't get STI testing at all even though they should be. When STI testing does occur, health care providers typically don't test for everything (even though many women mistakenly believe that if they are having a GYN exam, they're getting a thorough STI test). If you want to know if you have HPV, herpes, chlamydia, gonorrhea, syphilis, HIV/AIDS, or any other STI, you need to ask your health care provider about STI testing.

Remember: this is your health so ask anything you want to. Gynecologists often take care of many aspects of women's health, so it's okay (and encouraged) to ask about health issues such as cholesterol, diabetes, thyroid function, feeling tired or stressed, feeling sad or depressed, or wondering if you have a cold or the flu. In fact, many insurance plans will allow women to identify their gynecologist as their primary care physician. Rather than seeing two different providers each year for primary care and gyn exams, it can be convenient to only see one. If you've decided you want your gynecologist to serve as your primary care physician, let them know
this; that way, they can be sure to do all the other kinds of health care exams (like occasional blood work) instead of just paying attention to your “down-there care.” Think of it as one-stop shopping for your health.

1. There are more than a hundred strains of the human papillomavirus (HPV).
Some of these are called “high-risk” strains, as they are linked to cancers of the cervix and vulva (in women), the penis (in men), and the anus, head, and neck (in both women and men). Others are called “low risk” strains and are more often linked to non-cancerous health issues such as genital warts, which can come and go. Genital warts are sometimes more likely to reemerge when a person's
immune system is stressed. Smokers may be more likely to have wart reoccurrences. Trauma to the skin, such as shaving, can provoke warts to return too—one young woman I know found that her genital warts would return when she shaved her bikini area.

2. HPV is the most common STI in the US.
A 2007 study in the
Journal of the American Medical Association
found that 26.8 percent of women in the US ages fourteen to fifty-nine had HPV (prevalence was highest—44.8 percent—among women ages twenty to twenty-four).
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HPV can be transmitted during vaginal sex, anal sex, and (it seems, based on some studies) likely during oral sex too. Using male or female condoms during sex can reduce the risk of transmission. There is no known cure for HPV, and the course of HPV is not entirely clear. What we know is this: most sexually active people are exposed to HPV infection; however, it doesn't cause problems for most people. The problems that it sometimes causes (e.g., cervical changes that result in abnormal Pap test results and genital warts) often improve on their own; however, HPV infection can lie dormant for months or years without causing noticeable symptoms. Therefore, just because a person has never noticed a genital wart or had an abnormal Pap test, this doesn't mean they don't have HPV.

3. Chlamydia is the most common bacterial STI in the US
and is particularly prevalent among women ages fifteen to twenty-four. Chlamydia can be passed during oral, vaginal, or anal sex. Again, condom use can greatly reduce the risk of transmission because it blocks fluid sharing between partners. The good news is that chlamydia can be cured with certain antibiotics prescribed by a health care provider. This is one of the most important STIs to get tested for because, if left untreated, it can result in fertility problems for women and men.

4. The herpes simplex virus—commonly known as “herpes”—can affect the genitals or a person's mouth.
When the herpes simplex virus (HSV) shows up on the genitals, it's called “genital herpes” and
when it shows up on the mouth, it's called “oral herpes” (or you might have heard people call them “cold sores” or “fever blisters”). Herpes can be transmitted during oral sex, vaginal sex, and anal sex, though condoms can reduce the risk of transmission when used from the start to the end of sex. According to the CDC, about one in six Americans ages fourteen to forty-nine has genital herpes.
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Although some people think that herpes can only be passed during an outbreak, it can actually be passed even when no sores or lesions are present. That means that even though your partner's genitals “look good” they are not necessarily STI-free.

5. There is no known cure for herpes; however, some prescription antiviral medications can greatly reduce how often and how severe a person's herpes outbreaks are.
Antiviral medications can also reduce the risk of passing it to a sexual partner, so couples in which one person has herpes and the other does not should talk to their health care providers about this possibility. People who get herpes often notice symptoms (such as painful sores or lesions on or around their genitals) within two weeks of transmission. But again, not everyone will notice symptoms. I know one woman who didn't have her first genital herpes outbreak until fifteen years after transmission. She knew it had been fifteen years because she hadn't had sex with anyone in the fifteen years since her divorce from her husband, who she later learned had genital herpes.

6. You can't judge a book, or someone's genitals, by its “cover.”
Many people mistakenly think that if their partner's genitals “look fine,” there is no STI risk. This isn't true: For example, herpes isn't only contagious during an outbreak. A person can get herpes from their partner even if their partner doesn't have any visible sores or lesions. The same is true of genital warts, and many genital warts are so small they can't be seen well with the naked eye, or else they look like little pimples. Also, most people with chlamydia don't have any noticeable symptoms, which is why STI testing is so important.

7. Syphilis is sneaky.
It's sneaky in the sense that, because it's a bacterial STI, many people think that it's easily protected against by using condoms. And while it's true that condom use can greatly reduce the risk of getting or passing syphilis, there are exceptions. In cases where someone has a sore or lesion from syphilis, if the condom doesn't cover the sore/lesion, syphilis may be passed even with good condom use. Syphilis can be passed during oral, vaginal, or anal sex and can cause death if left untreated (which is rare in the US and UK). On the bright side, it can be easily cured when caught in an early stage.

8. Gonorrhea is becoming more difficult to cure.
It used to be that gonorrhea was very easy to cure. While it still is in most cases, certain strains of gonorrhea have developed that are resistant to antibiotics typically used to get rid of the infection.
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If you test positive for gonorrhea, follow your health care provider's recommendations regarding treatment, and follow up to make sure that the infection goes away. Like most STIs, gonorrhea can be passed through oral, vaginal, or anal sex. Condom use can greatly reduce the risk of transmission.

9. HIV/AIDS doesn't only happen to gay men.
Although men who have sex with men make up a disproportionately large share of HIV infections, they're not the only ones infected with HIV/AIDS. Myths that suggest HIV/AIDS is a “gay disease” hurt everyone: they further stigmatize gay men and they also put at risk other people who perhaps don't take the precautions they should to protect themselves and their partners. Talk to your health care provider about HIV. Get tested for HIV and make sure your present and future partners get tested too. Know that condom use can enormously reduce the risk of HIV transmission, so use a condom from start to finish when you have sex. HIV is most easily transmitted through anal sex or vaginal sex but can also, more rarely, be passed through oral sex.

10. Having an STI doesn't have to ruin your sex life.
Most women
and men will have an STI, or have a partner with an STI, at some point in their lives—even if they don't know it. STIs only have as much stigma attached to them as we allow. If we would all start talking openly about getting tested for STIs and asking partners to get tested for STIs, including HIV, it would go a long way toward normalizing safer sex and making everyone feel more accepted and reassured about their STI status. Some STIs can be cured. Even those we don't yet have cures for (such as herpes, HPV, and HIV) can be treated or managed in ways that make people's lives, including their sex lives, easier. In short, having an STI can change some aspects of your life—prompting you to talk to sexual partners about your STI status or to begin using condoms every time you have sex—but you can still have a happy, meaningful, fun, experimental, and sexy sex life.