Our Bodies, Ourselves (57 page)

As someone who's received good sexual education from a young age, I've always thought of STIs as just part of the picture, if you're ever going to have casual hookups. That is to say, I don't get freaked out by folks who have STIs; I expect people in my community (including potential lovers) to have experiences with them, and the best thing I see to do is to keep myself educated and to continue to have open conversations about how to stay safe
.

A thirty-two-year-old woman acknowledges that it took awhile to take charge of protecting herself:

I get tested often and, as far as I know, I have not contracted anything, but it horrifies me that I have left my fate in other people's hands too often. At thirty-two, I finally have the fortitude to demand safe sex and verbal communication about any future partner's sexual history, or I will simply not get involved. It just took a little too long to get here
.

Agreeing to use protection can help both of you feel more relaxed and intimate. You may find that you are better able to explore and enjoy sex when you are more confident that you will not get (or give) a sexually transmitted infection—and being assertive about safer sex can help you be more expressive about your sexual desires and preferences.

It's best to talk with your partner(s) about STIs before having any kind of sex. It may be hard to do, but it's an important part of protecting your health and that of your partner(s). If possible, start with a casual conversation when you are not being sexual, or try an icebreaker, like, “What kind of condoms do you like best?” or “Have you ever tried flavored condoms?”

Many people find it helps to talk first with friends or health-care providers about how to introduce the topic and which conversational strategies work best. For some, humor is a great way to help pave the way for more serious discussions. If talking about safer sex is extremely difficult, either because you're uncomfortable or because there are safety concerns, see “It's Not That Easy: Challenges
to Protecting Ourselves,”

Here are some suggested questions to ask each other:

• Has either of us, or any of our other/previous partners, ever had an STI? When? What was it? Did it ever come back?

• Have we or any of our other/previous partners ever been tested for an STI or had an abnormal Pap test?

• Have we both obtained preventive sexual health care, including STI screenings?

• How many sex partners have each of us had in the last six months? Were they male, female, or both? What are we doing or have we done with our other partners to make sex safer?

• Are alcohol and other drugs involved when we have sex?

• What do we each usually do to make sex safer?

• What are we going to do right now to prevent infection?

• If we're finding it difficult to talk about these subjects, what can we do to create an environment where it's okay to talk about STIs?

If you think you or your partner may have an infection, it's best to abstain from sexual contact until both of you have been tested and treated—and until you both know the potential risks of sexual contact and how best to protect yourselves. In the meantime, enjoy safer activities, such as massage or mutual masturbation. (For more information on screening, testing, and treating STIs, see
Chapter 11
, “Sexually Transmitted Infections.”)

The “just do it” message of popular culture suggests that sex should be completely spontaneous. We rarely see couples on television or in movies discuss sexually transmitted infections or reach for the condoms before the lights go out.

But in the real world, people every day are talking, planning, and taking precautions to protect each other's health. With knowledge and communication today, we can avoid health problems tomorrow—and that makes sex a lot more fun.

If you've had unprotected sex with someone and you're not sure about the person's history, you should have an STI check before having sex with anyone else. Most STIs are symptom-free, so testing is necessary to rule out infections. It's also a good idea to talk to your health-care provider about STIs that may not show up right away after exposure and get advice on whether you should be retested later.

Some STIs can be prevented even after exposure. If you have unprotected sex with someone who you either know or think might have HIV or hepatitis A or B, you may be able to get medication from your health-care provider that will prevent the infection from developing. It's important to act immediately, if you need to do this. (For more information, see “Decreasing Risk
After
Exposure
”).

Some sexual activities carry a much greater risk of contracting or transmitting an STI. One way to think about it is to imagine a risk ladder, with the lowest-risk behaviors at the bottom and the highest-risk behaviors at the top. The higher you go on the ladder, the more you need to ensure that you have the appropriate tools to help you stay safe. The following sexual activities are rated by how risky they are when performed without protection.

This is a high-risk activity for STIs, much more so than vaginal intercourse because the tissue lining the rectum is very fragile and, unlike the vagina, the rectum does not self-lubricate. The rectum's lining tears easily, making it is easy for viruses, bacteria, or other germs to get into the bloodstream. For sufficient protection, your partner should use a male or female latex condom with plenty of lubricant. (Female condoms can be adapted for use in the rectum; see below.) Thicker lubricants are suggested for the safest anal sex.

Massaging the anus with a finger or sex toy, or oral-anal sex play, can be a pleasurable prelude to anal (or other) sex, and it may help relax the muscles so that the condom is less likely to break during penetration.

The vaginal lining can easily get tiny tears or abrasions that allow HIV and other infections into the bloodstream. Female or male condoms
offer the best protection. Use a lubricated latex, nitrile, polyisoprene, or polyurethane condom (not lambskin) with added condom-safe lubricant, if desired. No other method of protection has been conclusively proved to prevent STI transmission (including HIV). (For specific tips on proper condom use and lubricants, see
“Condoms 101.”
)

While this is not as risky as vaginal or anal sex, it still carries a risk of transmitting or contracting STIs, especially if you have just had dental work or have open cuts in your mouth. And if you have oral herpes (HSV-1), you can transmit it through unprotected oral sex. For maximum protection, use a condom as soon as the penis is
erect, before any oral contact, since the pre-cum (drops of fluid that the penis discharges during arousal) can contain HIV. Use a new condom each time. If licking plain latex doesn't do it for you, try using a flavored condom.

This carries some risk, especially if the woman has her period or any open sores, like genital shaving cuts. And if you have oral herpes (HSV-1), you can transmit it through unprotected oral sex. For maximum protection, cover your partner's vulva and/or anus with a barrier, such as a dental dam, a cut-open latex glove or condom, or a female condom.

Licking your partner's anus carries some risk of STI transmission. For protection, use a female condom inserted rectally or a dental dam.

Shared toys can transmit some STIs from one partner to another. Wash all toys thoroughly in hot soapy water between use. For extra protection, you can clean a sex toy with 10 percent hydrogen peroxide, or soak it for twenty minutes in a 10 percent bleach solution (one part household bleach, nine parts water). Make sure to rinse all toys with water after cleaning with chemicals. If you're sharing a dildo with a partner or partners and washing is not an option, use a condom on the dildo.

Deep manual sex (putting a hand or several fingers into the rectum or vagina) is low risk for the person doing the inserting, although it is possible to get an STI if you have sores, cuts, or cracks on your hands or fingers. Deep manual sex carries some risk for the person on the receiving
end, because the internal tissue can be easily bruised or worn away. While this may not by itself cause STI transmission, it could put you or your partner at risk of infection if you have unprotected intercourse before healing has occurred. Finger play (playing with the vagina or labia or touching your partner's anus) is less risky.