Sex Made Easy (13 page)

This can be a challenging issue for many people. If you feel only so-so about the person or feel only mildly sexually or romantically interested in
them, then you might feel it's not worth the risk to have sex with them and possibly wind up with genital warts. You might decide that, as nice or as attractive as they seem, you would rather not gamble with getting the infetion. Of course, if you have genital warts yourself, there is little risk in that sense, but you should still consider using condoms to prevent passing other STIs.

If you decide you'd like to have sex with this person, remember that using condoms offers some (but not complete) protection against genital warts and significant protection against HIV, chlamydia, gonorrhea, and some other STIs. Remember, too, that there need not be a “rush” to have sex. If your partner has warts and you do not, why not talk to your health care provider about the Gardasil vaccine for HPV? Two of the strains it protects against are linked to most cases of genital warts (see sidebar on HPV vaccines). If you have had the Gardasil vaccine, or if you get it before you have sex with this person, then you will have a very low risk of acquiring genital warts.

It's worth noting, too, that although genital warts aren't painful like herpes sores can be, they may be linked to some health risks. For example, women who have a skin disorder called lichen sclerosus (LS) on their genitals have a slightly increased risk of developing vulvar cancer at some point in their lives (albeit the risk remains small at about 4 or 5 percent). However, women who have genital lichen sclerosus
and
who have genital warts appear to be at an even greater risk for vulvar cancer, for reasons that are not well understood. This is not a reason to panic. After all, LS can be very well managed by thoughtful health care providers and good follow-up care and there are many things women can do to reduce their cancer
risk, such as manage stress, eat a healthy diet rich in colorful vegetables, and not smoke (all steps that many of us can benefit from). It is a good reminder, though, that decisions about STI risk are important and that they're different for every woman.

Genital herpes is very common: according to recent data from the Centers for Disease Control and Prevention, about one in five women and about one in nine men ages fourteen to forty-nine are infected with herpes simplex virus-2 on their genitals.
¹²
Unfortunately, many people have no idea that they have genital herpes and they may spread it to sexual partners without meaning to. If you have genital herpes, ask your health care provider about antiviral medications that may reduce how often you have outbreaks, how severe or painful your outbreaks are, and the likelihood of transmitting herpes to sexual partners. Even if you're being treated for herpes, you can still transmit it to others—the risk is just lower—so you should still tell sexual partners about your diagnosis. Keep condoms in mind too: when used correctly and consistently, they reduce the risk of transmitting herpes (even though they cannot completely protect against herpes, as condoms cannot cover all of one's genital skin). Finally, some people with herpes find it helpful to connect with local or Internet-based herpes support groups, particularly in regard to tips for talking to sexual partners about their diagnosis. Check out
www.datingwithherpes.org
for a variety of resources related to sex, dating, and relationships for people with herpes.

This one is never “easy,” but I do hope some of this information makes it easier to figure out what it means for you. It's important to know that one cannot get an STI such as chlamydia, gonorrhea, trichomoniasis, HIV, genital HPV, or herpes from a toilet seat or from shaking hands with another person. That said, there have been instances in which people appear to have contracted herpes from using a hookah, and if you or your partner got oral
herpes that way and then performed oral sex on one another, one could conceivably get herpes on the genitals that way. That would be a rare and unlikely instance.

In most cases, however, if you think you are in a monogamous sexual relationship with your partner (meaning that both of you have agreed not to have oral, vaginal, or anal sex with other people) and you suddenly get an STI—even though you had both tested negative for STIs earlier in your relationship—then it is highly likely that your partner has had sex with someone else. Unfortunately, people sometimes lie about having sex with others. Even if you confront your partner, they may not admit to having had sex with another person. They may tell you that you're crazy or even accuse you of cheating (of course, if you are the one who had sex with another person, you should own up to your behavior and make decisions in the future that protect you and your partner from infection).

If you suspect that your partner has had sex with someone else—or if you are the one who has strayed—it is time for a discussion about your romantic and sexual relationship. What expectations do you have for one another? What makes it easy or difficult for you to stay monogamous? If you stay together, do you want to stay monogamous or do you both want to open your relationship so that one or both of you is allowed some form of sexual expression with other people? If you open up your relationship, you will also want to be clear about “rules” such as the importance of using condoms with other people (and maybe even when you have sex with each other) and getting regularly tested for STIs. You may decide, too, that you no longer want to stay together, which is another option. Whatever you decide, know that you can get through this, alone or together, and move on with life.

Women should always let their health care provider know if they experience vaginal bleeding during or after vaginal intercourse. It may be that you have fragile skin because of low estrogen or a skin disorder and the fragile skin is giving way to tears or cuts during sex. Then again, the bleeding may be coming from inside your body. It could be due to what's called
a friable cervix or to fibroids (lumps that grow on your uterus). More rarely, bleeding during sex can be a sign of ovarian cancer. Although bleeding during or after sex is often benign, it is always a symptom that deserves a thoughtful conversation with one's health care provider. And if you feel your symptoms are being ignored or not given the attention they deserve, consider getting a second opinion from another gynecologist.

There are two types of women who get yeast infections: those who get them sporadically and those who have recurrent yeast infections, which are often defined as four or more yeast infections in a given year. If you get yeast infections only every now and then, chances are that you sometimes mistake vaginal itching or irritation for a yeast infection; many women think they have a yeast infection when they don't. If you are a woman who only has occasional yeast infections, count yourself lucky—and call your health care provider before you rush to the store to stock up on yeast medication or cream. Why? Because if you're wrong, you may make your symptoms worse and make it more difficult for your health care provider to eventually figure out what's causing your symptoms. Calling your nurse or doctor first gives them a chance to ask you a few basic questions about
your symptoms, which increases the likelihood of a correct diagnosis, appropriate treatment, and you getting better.

If you are a woman who gets recurrent yeast infections, you're likely to be more in tune with your symptoms and may be just fine running out to the store to get the cream or medication you need. It's still a good idea to ask your health care provider their opinion on whether you should call their office each time or treat it at home on your own.

Just as there are two types of women who get yeast infections, there is also more than one type of yeast that affects women. Candida albicans is the most common culprit that overgrows and plagues women's vaginas; this kind is often treated reasonably well with over-the-counter creams or with medications. There are other kinds of yeast, however, that require different treatment options. If you have a yeast infection that is difficult to treat and that doesn't seem to improve, ask your health care provider if he or she has tested for the particular type of yeast you have (they don't always do this)—and if not, if they would be willing to. Or you might try to get a second opinion from a vulvovaginal specialist who has significant experience treating yeast infections and other vulvovaginal health issues. After all, sometimes women's vulvovaginal health issues aren't limited to yeast infections and something else may be causing you to have ongoing symptoms.

I
f I had a dollar for every time I've been asked a question about women's orgasm, I would be a very wealthy woman. Orgasm is an experience that, if it happens at all, lasts only about twenty seconds or so on average. For such a fleeting experience, it sure occupies a lot of people's sexual concerns (and excitements too). In this chapter, get ready to learn key information about women's orgasms, including