Sex and STI Risk Assessment and Reduction
At this very moment, people are still having sex, In a downtown condo, or street in the projects. Although you can’t see them, or hear their breathing sounds, Someone in the world is having sex right now. ~LaTour
To quote another famous music maker, George Michael
Some of the risks include procreating, getting hurt emotionally (which is not so much sex, but what happens after), and giving or receiving a sexually transmitted infection (STI). Today we are talking about disease and infection risk reduction.
Sex is a part of most romantic relationships. I personally believe that it is irresponsible to talk to others about sex, especially, about how to get more or have better sex, without also including a discussion on disease.
I am not saying do not have sex, I am saying:
With more information, you are better able to make a decision that is right for you and your future. This includes knowing about the downsides and mitigating them.
When I was a teenager, I went to a high school that required community service work. I volunteered with the Peer Education Program in my city, and we were educated about sexually transmitted diseases, infections and their consequences, with an emphasis on HIV. Then we went out to high schools, and told them “Abstinence is the best policy to avoid HIV. And the reality is, many of you will not choose that and so we will tell you what your risks are, ways you can mitigate those risks and what happens if you are infected.”
Tools for STI Prevention:
1. Abstinence
Tools for STI Reduction:
1. Self Esteem and Assertion
2. Latex or Polyurethane condoms
3. Latex or Polyurethane dental dam
4. water
5. Communication
6. Regular testing and treatment if positive
The discussion for the tools of prevention is pretty short: Don’t do it. The discussion for reduction is a bigger one, and I still don’t feel like I’ve covered all of it. I make the distinction between reduction and prevention, because using the methods of reduction do not ensure that you will prevent yourself from contracting or sharing an STI if you are having sex.
Reduction methods have the ability, when used properly and consistently to make smaller the likelihood of transmission.
Regular testing can help reduce the likelihood that an infection will spread or worsen. Assuming a test result is positive, the reduction effect due to this method is dependent on prompt and thorough treatment. If incurable, the ethics and communication skills of the person who contracted it are a key factor in their future partners ability to do an accurate risk assessment for themselves.
I recommend testing at least once a year if you are having sex whether or not symptoms are present. Get tested more often if you have more than one partner per year. I knew a girl who thought she had a recurrent mild yeast infection for three months, it turns out she had a chlamydia infection.
If you want to be tested, you can find places via a Google search with search terms “STD testing” and the name of your city and state. Planned Parent Hood and local LGBT centers may test or be able to refer for testing.
The tests available are for syphilis, hepatitis, HIV, herpes, hpv/cancer causing variety (for women only), warts (visual inspection), gonorrhea and chlamydia. There are also other STIs like molloscum and crabs. There is a vaccine for 4 types of hpv, and I will discuss that in a later post.
I have heard from friends, particularly white males 25 and older, that get told by their doctors that they do not need to get tested because they are not a high risk group.
A member of a high-risk group is someone who, by virtue of their behavior, sexual orientation or race, belongs to a group of people considered more likely to contract an STI. For example, gay men are considered to be a high-risk group. However, world wide, 70-80% of the HIV infected are heterosexual.
Communication
In addition, communicating your desire to use condoms and dental dams before having sex can be useful for actually using them. It can be a conversation over dinner, or as simple as “Shall I get the condom?” If your partner says no, then either, they do not want to have sex with you, or you may want to seriously reconsider having sex with them.
Communication with your Dr. or someone informed can also be useful in prevention. A friend of mine in college only had two partners; however, she contracted herpes on her genitals. Why? Her boyfriend had cold sores and did not know that cold sores were herpes. Now, she has the gift that keeps on stigmatizing and giving.
Lubricant. Water or silicone based lubricant. Using condoms can sometimes interfere with or reduce the body’s natural lubrication. If you find you need lubrication water or silicone are latex friendly. Lubricants such as baby oil, Crisco or olive oil with cause a latex condom to break down, reducing its efficacy. Too much friction can also reduce the structural integrity of the condom. It is less likely to result in error if you always buy latex friendly lube. This article (in the middle) has a list of safe and unsafe lubricants, with the exception of the spermicide due to it showing an increase in risk of infection due to the irritation caused to the lining of th vagina and anus.
Dental Dam. What on earth is a dental dam? It is a square/rectangular piece of latex or polyurethane placed over the vagina or anus before oral stimulation begins. It is useful in reducing transmission of certain STIs because it inhibits the exchange of body fluids that carry these things. Really, do you want gonorrhea or warts in your throat?That college friend may have prevented her genital herpes with a dental dam.
Condoms. For the best prevention results, the penis should not be in contact with the skin surrounding whatever its owner plans on penetrating. This is because of a substance men have called pre-cum. Two links regarding instructions for properly putting on a condom are here and nsfw video here.
Latex and polyurethane help reduce the risk of contracting an STI, animal skin does not. For people with latex allergies, polyurethane is an alternative. Four infections may be transmitted in spite of proper condom use: hpv/warts, herpes, crabs and molluscum, because a condom does not cover all of the skin that may be infected.
If you operate from the (incorrect, imho) assumption, like Dr. House does, that “Everybody lies” you will always use a condom no matter what other people tell you.
Self Esteem and Assertion. Sometimes, during sex, especially with a new partner, we aren’t thinking clearly, especially if intoxicated. There is sometimes an intense short-term impulse or pressure pitted against your knowledge of what is actually good for you as a whole, long term. Loving your self enough, having enough self-esteem and confidence in ones ability to be assertive enough to resist the in-the-moment inner-impulse or outside-pressure that says: go bareback.
Men and women have found themselves manipulated into having sex, when they did not really want to, or into not using condoms. This is unethical, and some feel that it is coercion. Hartwick, Desmarais and Hennig in The Canadian Journal of Human Sexuality (3-22-07) have defined coercion as:
In the current study, we adopted the definition proposed by Struckman-Johnson and Struckman-Johnson (1994), who defined sexual coercion as “an experience of being pressured or forced by another person to have contact which involved touching of sexual parts or sexual intercourse–oral, anal, or vaginal” (p. 96). Their definition incorporates “psychological coercion, including verbal persuasion, threat of love withdrawal, bribery, and use of intoxication” (p. 96) without physical force or the intent to harm.
Alternatively, self-love/esteem may reduce the number of partners you have (therefore reducing potential exposure) because it means that you are not seeking validation from your sexual partner.
I had a male friend who was a virgin at the age of twentyfive, at which point he started dating a very beautiful girl. He told me of one night wherein they were getting hot and heavy. He did not have any condoms and she really wanted to have sex with him. He said “no.” She pleaded with him that she was “clean” and on the pill and that there was nothing to worry about. He still said no. A while later, he found out through the grapevine that she did have an STI and had at that point in time with him. The pill would not have protected him.
Self-esteem may mean not having sex at all, a fewer number of partners, or it may mean using condoms every time until you are in that long term monogamous partnership with whom you have had a very lengthy discussion on STIs. I’ve included links to articles with more detail here, here and here regarding the very personal decision of when to discontinue condoms.
If you are a heterosexual couple and you don’t want to have children and do want to discontinue condoms, use appropriate alternatives to condoms for birth control.
I’ve known people with fewer than three partners that have contracted an STI and I’ve known people with greater than 50 who have not. It is up to us to make the best decisions for ourselves and be willing to deal with the consequences, if any.
In order to make good decisions, it helps to be as informed as possible, and our ability to be informed has limits. Baring being able to be 100% informed about everything, it is up to us to know the risks and take appropriate action to minimize them, while understanding that minimization is not foolproof. Don’t take my word for it, check with the CDC or your local Planned Parent Hood or LGBT Community Center.
Cheers to risk reduced sex,
Lexi.
Don’t guess on the occurring symptoms; have an STD test to diagnose the symptoms properly.