fox asks:

I’m unclear on how condoms are supposed to be effective in preventing female-to-male contamination during “plain” sex, I mean insertion of the penis into the vagina. Let me explain.

Latex is an effective barrier to virii and germs. I get that. As far as protecting the woman is concerned, I’ve no trouble believing it works. The STD virii or germs are present in the semen and/or pre-cum; these are “emprisoned” by the condom, don’t get out, and don’t get into contact with any part of the anatomy of the woman. She’s protected. The sweat of the man does not contain these virii or germs and thus no risk with the rest of the skin-to-skin contact. But in the other direction, I don’t quite get it.

From what I understand, when a woman gets sexually excited, she secretes some kind of lubrification in her vagina. I presume that for STDs, the virus / germ is present in that natural lubricant, and that the contact with that lubricant is what’s dangerous. But a condom covers only the shaft of the penis. Couldn’t the lubrication “drip” out a bit and land on the man’s crotch area, not covered by the condom? And here you are, infection! Or, similarly, your article here says that vaginal discharge / secretions will end up on the woman’s labia; when thrusting “till the end”, penis shaft completely inserted, wouldn’t these labia come into contact with the men’s uncovered crotch and, again, infect him?

If my premise is wrong and vaginal discharge/lubrification does not contain the STD virii/germs, then how does STD transmission from woman to man (during unprotected sex) happen in the first place?

Heather Corinna replies:

In the early 80’s, safer sex was called safe sex. That language was changed to reflect the knowledge that these practices — namely, latex barrier use, STI testing and limiting the number of sexual partners — couldn’t make sex “safe.” They could only make sex safer. So, know above and beyond all else that what condoms can do is reduce our risks: they cannot eradicate them nor provide absolute protection, ever. They make sex safer for us and for our partners: they don’t make sex safe.

Not all men and all women have the same kinds of bodies or genitals. Some people who identify as men have a vulva. Some people who identify as women have a penis. But for the purpose of your question, when I say “men” here I will mean people with a penis, and when I say “women” I’ll mean people with a vagina, especially since the studies I’ll be talking about typically use that same framework (and here’s hoping some day soon they start to shift out of it). I don’t want to confuse you instead of helping you get more clear.

Let’s start with some STI (sexually transmitted infection) basics. While STIs tend to differ in a lot of ways — some are parasites, some viruses, some bacteria, some are more easily transmitted than others — on the whole, we divide them into two basic groups: those transmitted by fluids, like HIV, gonorrhea, chlamydia and trichomoniasis, and those transmitted just by bodily contact, like HPV, herpes, syphilis, molluscum, chancroid and scabies.

With fluid-borne infections, infection occurs not because fluids have contact with skin like that on the thighs or testes, but with parts of the body which can or do provide a direct route to the bloodstream. So, for instance, in vaginal intercourse, your sexual fluids, and any infections they may be carrying, can or do reach the inside of the vagina, the cervix, the uterus and beyond: all places with direct routes to the bloodstream. On a female partner’s part in intercourse, her fluids, any any infections she’s got, could reach your urethra, which is often the only direct route into the bloodstream through the penis, particularly for men who are circumcised (uncircumcised men may have higher risks than men who are not). For men and women alike, other pathways to the bloodstream that can be other possible routes of fluid-borne infection are the anus, the mouth, and any shaving cuts or other skin abrasions or wounds on the body, including on or inside the genitals. Unless you have a cut or abrasion on the base of your penis, testicles or “crotch area,” these are not going to be sites for fluid-borne infection transmission. If we’re only talking vaginal intercourse, the anus is a non-issue.

You’re asking specifically about how you’d be protected during vaginal intercourse with condoms: the simplest answer is that condoms cover the opening of your urethra completely, the orifice through which you would be most likely to acquire a fluid-borne infection with that activity. So, the answer for the most part is that you’d be protected very well, especially from fluid-borne infections.

However, not all sexually transmitted infections are transmitted by body fluids. Some infections spread by only contact between or to mucous membranes like genital tissue, the mouth, the inside of our noses. Fluids are a non-issue with these kinds of infections. Condoms reduce risks of STI transmission for these kinds of infections well, well, but not as well as they can reduce risks of fluid-borne infections, primarily because condoms, dental dams or latex gloves often don’t provide a barrier to the whole genital or oral area. These are the infections to figure you, as person with a penis, have less protection from when using condoms.

When you’re expressly asking about penis-in-vagina intercourse, women tend to be a lot more susceptible to acquiring most infections than men. That’s because of physiological differences and also because of common social/gender inequities that often impact women’s health, like men as a group being tested less often for STIs, having sex more often outside relationships understood to be monogamous and more frequent refusal to use condoms. If you spend time with studies on latex barrier use and STIs, one common finding you’ll see is that men are frequently afforded better protection from condoms with most infections than women are. That does not mean you shouldn’t be concerned about your own health: you so should! I encourage everyone to protect themselves as best they can. However, I think it’s also important to just know, in having the facts, that female partners you have for intercourse will usually be at a higher risk than you will of acquiring an infection.

Another having-the-facts riff: women can and often do produce several different fluids. Self-lubrication from arousal, menstrual fluids, and fluids produced by the cervix and the vagina that are part of the fertility cycle and/or the way the vagina keeps itself clean are all typical. Some women also ejaculate. For men, the genital fluids at play are ejaculate and/or pre-ejaculate, and any fluids/oils produced by the foreskin if you have one. Both your bodies produce urine and fecal matter, and both of you have blood. Nursing or lactating women also produce breast milk. With fluid-borne infections, the fluids which typically transmit STIs are primarily vaginal fluids, penile fluids, blood and/or breast milk. Fecal matter is another biggie in terms of bacterial infections and hepatitis, but that’s not something you or a partner are likely to be exposed to with vaginal intercourse.

So, just how effective ARE condoms for you per infections? If you read public health information, you will most typically see them stated as “highly effective,” which we know them to be. Reliably expressing just how highly effective in numbers is harder to do outside any one specific study.

Read the rest at Scarleteen here.

Some stats from this today, in case you or someone you know needs them:

If you are having the kind of sex that presents a possible risk of pregnancy, you are having one of the two kinds of sex (anal intercourse being the other) that presents the biggest STI risks, too. When there is direct genital contact — including for people with the same kinds of genitals, where there isn’t a risk of pregnancy — there are always risks — a definite maybe — of STIs. And those risks are usually not smaller than pregnancy risks for people in the age group we work with most, even though a lot of people think they are.

Experts estimate that almost half of the United States’ over 19 million STI infections each year occur in youth ages 15-24. A recent study found that one in four young women ages 15-19 has an STI in the U.S. One in four: we’ve had that figure for a long time now, it’s nothing new. More broadly, people between the ages of 15 and 24 account for 50 percent of all new STIs.

In 2008, the U.S. teen pregnancy rate was 67.8 pregnancies per 1,000 young women ages 15 to 19: in other words, just under 7 pregnancies per every 100 people aged 15-19, or around 7%. And, more broadly, about 30 percent of Americans who have the ability to become pregnant do before the age of 20.

So: One in every four people aged 15-19 acquires an STI each year. But less than one in every ten in that same age group becomes unintentionally pregnant. To put it another way: 25% of young people in the United States has an STI. Only around 7% in that same age group become pregnant in a year.

You can perhaps then see how you are most often more at risk of STIs than pregnancy if you are a young person engaging in the kind of sex that poses risks of both.

More at risk. Not less. Not the same. More.

Something I notice with some regularity at Scarleteen, especially with new users, are folks showing up reporting symptoms that sound like a genital infection, be it an STI or a bacterial or yeast infection. Like discharge that’s radically changed color, especially going yellowish, grayish or greenish, things getting kind of stinky, pain with sex or even just when toileting or sitting around, unexplained spotting or bleeding.

In other words, things that sound like an infection is a big possibility, and sometimes sound like it’s probable someone has been walking around with an untreated infection for a while.

We know lots of people feel skittish about sexual healthcare, that for some, even good care is traumatic, and plenty want to put it off as much as they can, for as long as they can.  We also get that it can feel like going in with some kind of infection is much more embarrassing than when you’re in good health, even if we also know doctors and clinicians don’t tend to be grossed out by infections like people who don’t work in healthcare can be.

What can happen, though, in that situation, is that seeking out care keeps getting put off, especially as things get worse, so someone can feel like it has gotten even MORE embarrassing.

Here’s the scoop, folks: most genital infections?  As in, the vast majority of them?  Truly are no big whoop when you catch them early and get treated straightaway.  Most are easily treatable, so in no time, it can be like you never had one in the first place. 

But. When genital infections get more serious, that’s usually less often about the KIND of infection and more often about people going a long time without treatment. A long time can be months, but sometimes, even within a couple weeks things can get more serious when it comes to the impact on your long-term health (untreated infections are the leading cause of PID and infertility, for example). 

Of course, if and when someone has something they can pass on to others, going without treatment can also often mean more people winding up with illness. As well, having one infection brewing makes you way more likely to pick up others. people not getting checked out and treated while still engaging in sex is one of the biggest reasons our STI rates in the world are as high as they are.

So, we know some of you might feel freaked out about going to get seen, but please know that sooner really is better, and in some cases, is the difference between an infection years later you will seriously forget you even had, and an infection becoming the root of healthcare issues you might have to deal with your whole life. If you didn’t go sooner and you’re pretty sure you’ve got something brewing? Go now. Sexual healthcare providers have often seen plenty of severe infections, so believe us, you won’t be the first. Infections that develop and get worse do not just magically go away.  It’d be awesome if they did, but they don’t. They get worse and spread to other organs or parts of your body.

Pro-tip: before becoming sexually active (as in, having any kind of genital sex with someone else), do yourself a favor and find where you’re going to get sexual healthcare once you are. Better still? Become a new patient now, like getting your pap smear or bimanual exam there, if it’s time for that, so that if later on, you do need care for something, you don’t have to wait very long for it, and will know who to call and where to go.  Trying to find fast sexual healthcare when something is already wrong is not only super-stressful, it can mean waiting is just a given, and that’s no good.

(If lack of access to care is the issue, don’t forget that you can always come to our message boards or use our text service: we’re always happy to help our users find the care they need and can afford and reach.) - HC

About two-thirds of U.S. teens and young adults have had oral sex mistakenly thinking it’s a safer alternative to regular intercourse, according to a study released Thursday by the Centers for Disease Control and Prevention.

Women’s declining condom use during their freshman year at college may be connected to instability in their grades and alcohol consumption, reports a new study.

The study, involving 279 freshman women at Boston’s Northeastern University, found that those with lower grade point averages (GPAs), and a tendency to binge drink more often, reported up to a 10 percent decrease in condom use.

“College women often engage in serial monogamy, resulting in multiple partners during the college years, and they are often unaware of their partners’ risk,” said study leader Jennifer Walsh, a researcher at Rhode Island’s Miriam Hospital Center for Behavioral and Preventive Medicine. “This makes continued condom use important for women’s health.”

To assess the behavioral health of college freshmen for the National Institutes on Alcohol Abuse and Alcoholism, researchers questioned the students monthly on their condom use. Usage was measured on a five-point scale from “never” to “always.” Additional information was gathered on students’ socioeconomic status, substance use, and GPAs.

The data demonstrated a shift in condom use — irrespective of how diligently the students started off. Birth control pills also were shown to contribute to lowered condom use, even though they do not guard against STDs.

The report found Caucasian women and those with fewer sexual partners were more apt to use condoms from the beginning than African-American women and women with multiple sex partners. Some women who believed alcohol led to unsafe sex still were generally less likely to use condoms.

The study, “Changes in Women’s Condom Use over the First Year of College,” was published online in the Journal of Sex Research.

From The Body here.

STIgma zine: Sexualité et relations avec des ITSS

Sexually Transmitted Infections. They’re incredibly common, yet they’re shrouded in silence and shame. What gives? At Head & Hands, we know that talking about sexual health and STIs can feel awkward or scary – especially if you have an STI. Because of the stigma, people hesitate to ask for support, more information, or treatment for their STI. Fear of judgment and rejection prevents people from talking to their partners about it. Silence even prevents people from getting tested for STIs in the first place! It’s clear to us that stigma spreads STIs. So that’s why we made this zine, to get our heads out of the sand!!!

While the focus of mainstream sex education tends to be about not getting an STI, we think that it’s equally important to talk about what happens if you do get one. Where do you go to get support? Who can you tell? Can you still have sex? How do you deal? To demystify the experience of living with STIs, we asked people to tell their stories – and we were overwhelmed by the responses we got. We can learn a lot from the stories in this zine. We can learn how other people cope; how they take care of their bodies; how those conversations went when they disclosed to a sexual partner (and then another, and then another). We also learn about the power of sharing these stories – breaking the silence can really be cathartic!

You can use this zine however you want. It might be a resource, an inspiration, or even a companion, so you know you’re not the only one out there. We hope to equip people to make decisions that feel good and healthy for their own bodies and lives. In the stories that follow, you’ll find lots of examples of people doing just that.

Download the zine here, or drop by our office for a copy!

From: http://headandhands.ca

The study looked at more than 9,000 people. Those who admitted using meth in the preceding year were almost four times as likely to contract HIV, more than four times as likely to contract syphilis, more than twice as likely to contract gonorrhea, and almost twice as likely to contract chlamydia. They were compared with those who hadn’t used in the preceding year. Of all the diseases 60 percent of those newly infected had admitted to using meth in the preceding month.

In South Florida, Bolan noted, this is especially pertinent. In a 2010 study by the Centers of Disease Control and Prevention, Men Who Have Sex With Men (MSM) in South Florida showed an 18 percent increase in use of meth.

“This is a much higher rate than is usually reported in other populations,” Bolan said. “The prevalence in our Los Angeles STD clinic is 8 percent.”

So how does meth affect the spread of disease? The answer is simple: Sex.

“Because crystal meth can increase sexual arousal while reducing inhibition and judgment,” the study read, “Its use is associated with high-risk behaviors that increase the likelihood of acquiring a new STD or HIV.”

In other words, users tend to have risky sex, both in terms of the who and the how. 

Read the rest here.