Sex Made Easy (12 page)

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indings from my research team's National Survey of Sexual Health and Behavior were clear: teenagers were overwhelmingly good at using condoms.
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Most sexually active adolescent men and women reported using a condom with their most recent partner, whether that person
was a relationship partner or a casual partner. But adults? The data were less encouraging. Take a look, for example, at the low numbers of adult women and men who reported using a condom during their most recent sexual event with a casual partner:

• Among those ages eighteen to twenty-four, only 47 percent of men and 31 percent of women used a condom with a casual partner.

• For those ages twenty-five to twenty-nine with casual partners, 53 percent of men and 42 percent of women used a condom.

• Fifty-eight percent of men and 31 percent of women in their thirties used a condom with their casual partner.

• Among those in their forties, 36 percent of men and 20 percent of men used a condom with their casual partner.

• Twenty-eight percent of men and 24 percent of women in their fifties used a condom with their casual partner.

• For those in their sixties with casual partners, 18 percent of men and 32 percent of women used a condom.

• Among those ages seventy or greater, only 7 percent of men and none of the women in our study reported using a condom with their most recent casual partner.

The bottom line is that we adults can learn some things about sex from teenagers. Whatever your age, it's important to become comfortable buying condoms, keeping them on hand, and carrying them with you when you go out if there's even a slight chance you'll wind up having oral, vaginal, or anal sex with someone you don't know or whose STI history is anyone's guess. Of course, condoms aren't only for those who are hooking up or dating; even some long-partnered or married couples use condoms when they have sex. After all, condoms are highly effective methods of birth control.

Then there's the issue of condoms and oral sex. There is increasing evidence that HPV, possibly transmitted through oral sex, is linked to head and neck cancers
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—something that has made major news headlines in recent years (HPV, sometimes transmitted through anal sex, is also linked
to anal cancer). For many people, these headlines have served as a reminder that STIs can be transmitted through oral sex. Chlamydia, gonorrhea, herpes, HPV, syphilis, and, rarely, HIV can all be transmitted through oral sex whether your partner is a man or a woman. The best protection is to use a male condom during fellatio (oral sex performed on a man) or a dental dam during cunnilingus (oral sex performed on a woman). If you're turned off by the way condoms taste, choose an unlubricated condom or dental dam and put flavored lubricant on it. Not only is it tastier but if you add lubricant to both sides of the condom or dam, it can make oral sex feel more slippery and more pleasurable for your partner.

For all its many benefits (bike riding can be fun, it's an environmentally friendly “green” form of transportation, and it can be great exercise), bike riding can also cause some uncomfortable or unusual symptoms in women and men. For example, some women experience numbness or tingling sensations on their vulva in association with bike riding. Some women notice these sensations during or immediately following a bike ride. Other women notice these genital symptoms only sporadically but during times when they are riding more often, or for longer periods of time, than usual. There have also been documented instances of women having one of their labia majora swell up to be noticeably larger than the other, something that has also been linked with bike riding.
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Some research shows that men who are avid cyclists have a higher risk of erectile difficulties.
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Fortunately, none of this means that people should necessarily give up bike riding. Rather, if you have genital sensations related to numbness, tingling, or swelling that you feel may be related to your bike riding, mention this to your health care provider. It is possible that he or she may refer you to a neurologist: a doctor who specializes in issues related to nerves. Alternatively, your health care provider may simply suggest some changes to your bike riding. He or she might suggest wearing padded bicycle shorts,
changing your bike saddle (the seat) to a more genital-friendly version, or occasionally rising up from the saddle during flat, easy parts of the bike ride to give your genitals a break. After all, sitting on a bike seat for long periods of time can put pressure on the genitals. To the extent that you can ease this pressure, it will be better for your genitals.

First, don't panic. Many women get abnormal Pap test results. The (amazingly) good news is that the vast majority of women—about 85 percent—who have abnormal Pap test results go back to having normal ones within a year. Chances are, you will be one of them.

Second, do follow your health care provider's recommendations for follow-up care. Based on certain elements of the Pap test results as well as your own personal health history, your health care provider may ask you to return in three or six months for a follow-up Pap test. Another option is that they might ask you to return sooner than that for a colposcopy, a test that involves looking more closely at your cervix and possibly taking small biopsies from your cervix to check more specifically on its health and to make sure you don't have cancer.

If you're scheduled for a colposcopy, ask your nurse or doctor what you
can do to help minimize discomfort during the procedure. Some health care providers will recommend that their patients take something for pain (such as ibuprofen) or relaxation before the exam. Other health care providers do not. The procedure is not necessarily painful. However, women are all different. Just as some women find it painful to get a shot or to have their blood drawn, some women find a colposcopy more uncomfortable than other women do. If you are sensitive to pain or anxiety during medical exams or medical care, let your health care provider know. And remember: one of the best things you can do for your sexual and reproductive health is to have a GYN exam once each year or as recommended by your health care provider, and to have Pap tests and follow-up care as recommended by your health care provider.

Third, try to remember that getting an abnormal Pap test is common. Many women can relate, including perhaps several of your friends, coworkers, or family members. Some women feel ashamed to learn that they have an abnormal Pap test result, particularly as many abnormal Pap test results are linked to HPV infection, which is linked to sex. I would love for us to get to a place in society in which sex isn't linked to shame. Having had sex—even lots of sex, or with a number of partners—doesn't make you a bad person. Going to see a health care provider and getting a Pap test, at least in my opinion, makes you a very responsible, smart person. Good for you for taking care of your health.

Easy: let your health care provider know about any new, excessive, or unusually colored discharge that you notice. And if no one has ever mentioned this before, allow me: in addition to checking out your vulva at least once a month to understand what looks and feels normal for you, I would also encourage you to become familiar with your underwear. Yes, your underwear! Here's why: you've probably noticed over the years that vaginal discharge appears on your underwear. Vaginal discharge, of course, is completely normal and a fancy way that the vagina has to clean itself out on an ongoing basis. Wearing white or light-colored underwear can help you
become familiar with the shades of your normal vaginal secretions, which will typically be clear, light yellow, or white depending on the phase of your menstrual cycle. If you notice a change to the color or thickness of this discharge, let your health care provider know. If you've had unprotected sex, or if you have other symptoms (such as itching, burning, genital pain, bladder pain, or back pain), share that information with your doctor or nurse as well.

There are also some things you can do at home to try to get rid of the discharge. Steer clear of feminine hygiene products such as douches, powders, sprays, and genital deodorants, as these can irritate women's genitals and contribute to vaginal discharge. If you've recently started using a new lubricant or a new bath wash, soap, or laundry detergent, try going without that product for several days or a week to see if the discharge clears up. In some instances, vaginal discharge changes in response to an irritating product and stopping use of that product can help the discharge go away.

Most women who have chlamydia will have no noticeable symptoms at all. Those who do may notice abnormal vaginal discharge or a burning sensation while peeing. If left untreated, the infection can spread into the uterus and fallopian tubes, and symptoms may include painful intercourse, bleeding in between menstrual periods, or lower back pain.

If you receive a chlamydia diagnosis, follow your health care provider's recommendation for treatment. Chlamydia can be cured by taking certain antibiotics available by prescription. Notify your sexual partner(s) so that they can be tested and treated too. Depending on where you live and the policies of certain medical clinics, your health care provider may even send you home with a prescription for your sexual partner(s). This is because chlamydia is very easily transmitted during sex, so if you have had unprotected sex with a partner, it is very likely that you have given it to him or her (or that your most recent partner gave it to you, depending on the situation). It is also possible that you have had the infection for a long time and given it to more than one person, or that they have had the infection for a long time and not only given it to you, but to multiple partners. In any case,
if you have chlamydia, you can at least count on the fact that there's someone who gave it to you who may be in need of treatment (which is why some health care providers send home a prescription for one's partner).

Even though chlamydia can be cured with certain antibiotics, it is not an instant cure. It is often recommended that patients continue to use condoms when they have sex for at least two weeks after they begin treatment, and then that they return to a clinic to be tested again for chlamydia to make sure that it has been successfully treated before returning to condomless sex. Ask your health care provider what he or she recommends for you in terms of condom use and follow-up testing.

If you don't wish to tell your present or past partners that you have chlamydia, but you still want to do the world a favor, ask your health care provider whether they have a “partner notification” program. This involves giving your health care provider the name and contact information (phone or email) of present and/or past partners who may have given you chlamydia, or who may have gotten it from you. Rather than you having to notify them, your health care provider calls and says something along the lines of “You have been listed as a sexual contact of someone who has been diagnosed with chlamydia” and then provides information to that person about testing and treatment options. They don't share your name; rather, the goal is to get more people tested and treated so that the STI stops being spread to others. If you have questions about the confidential nature of your health care provider's partner notification program, ask them.

Remember, too, that chlamydia is the most common bacterial STI in many countries. You didn't do anything wrong or bad to get chlamydia, and you deserve to feel proud of yourself for taking good enough care of your health that you got tested for it. Going forward, remember that condom use and regular STI testing (for you and your partner) can help prevent further infections.