Monthly Archives: December 2011

playing safe and having fun…sexy, safer sex after an STI diagnosis

Hello, friends! I was recently asked if i had any thoughts for folks continuing their sex lives after learning they have an STI. I put together this post with that in mind, but it’s useful for anyone who is sexually active. Also, it’s long so I have bolded STIs as I go along so you can hone in things most applicable to you. Resources are included at the bottom.

Disclaimers… I have done my best to make the content of this post comprehensive, accurate, and applicable to people with a wide range of bodies, gender identities, sexualities, and play preferences. That said, I’m sure it is lacking in important ways. So… Please share other good resources and information! Please comment with your gems of safer sex wisdom! Share what you know! Correct me if I got something wrong! Also, note that this post focuses on STIs other than HIV. There are many excellent online resources for + folks and I encourage you to check them out. * This is not intended as medical advice. Please see your provider! *

Safer sex looks different for different folks, depending on their anatomy, gender identity, sexual orientation, play practices, etc. How someone thinks about safer sex may change after learning that they have an STI. An STI diagnosis can be a scary, difficult, sobering, and stressful event – but it can also provide an opportunity to take stock of our lives, hone in on our priorities, build our communication skills, and approach our sexual and sensual lives with renewed creativity and sensitivity.

First, for people who know that they have an STI, disclosure is the first step to safer sex. It may also be the hardest step. It might be useful to talk through it with your health provider and ask what their other patients have found to work well. If you have a friend that has disclosed to you that they have an STI, you could also ask them what they have found helpful. Or, you could role play with a trusted friend to get some practice communicating confidently and easily. Some of the resources below also provide guidance.

Remember that you will build your communication skills over time, and stay grounded in the importance of full and meaningful consent. Consent isn’t limited to “permission” or “agreement” to engage in sexual or sensual acts; consent also means entering into these acts with all the information needed to make good choices about one’s health, safety, and well-being. Your commitment to disclosure will play an important role in building a culture of health, respect, and consent in your community. As you do this important work, be mindful of the impact that alcohol and drug use can have on your ability to communicate and make safe decisions. Also, remember that you still need to protect yourself, in addition to protecting your partners. Some STIs increase your risk of getting other STIs and even when that’s not the case, you can always get an STI you don’t already have. No one wants that. Continue to get regular STI testing, since many STIs can fly under the radar for a long time.

In terms of safer sex itself, a basic starting point is barriers and lubrication. Many STIs require contact with mucous membranes, blood, or other bodily fluids or secretions in order to be transmitted. For these STIs, barriers from mucous membranes and fluids are your best prevention. For sex purposes you can think of mucous membranes as the skin lining the soft, wet, protected areas of your body that open up to the outside world – for example, the inside of the mouth, vagina, anus, and urethra. Barriers greatly reduce the risk of getting or transmitting HIV, gonorrhea, chlamydia, trichomoniasis, and HPV. They also prevent unintended pregnancy, if that is a risk of the sex you are having.

Penises, dildos, sex toys, etc. should always be covered with a condom before they make any contact with your genitals, anus or mouth or those of the person you are playing with. Sex toys should also be properly cleaned on a regular basis. Anuses and vaginas can be covered with a dental dam for oral sex or rimming. Hands can be covered with nitrile or latex gloves during genital, genital area, and anal touching. Under those gloves, fingernails should be kept neatly trimmed and filed. For genital and anal play, plenty of lube should be used to prevent latex barriers from tearing, and to prevent damage to the sensitive tissues of the vagina and rectum. When engaging in sex that poses an especially high risk of tissue damage (rough sex, anal sex, fisting, penetration with large toys, etc.) lube is especially important. Consider having a thick lube on hand for these kinds of play. Also, avoid sex toys that are absorbent or cannot be effectively cleaned. And remember: barrier doesn’t equal boring! Safer sex can be just as sexy, only with more props!!

Dental dam side note… A little lube on the genitals or anus can go a long way for heightening sensation when a dental dam is used. Condoms or gloves can be opened up and used as dental dams if you aren’t able to find dams easily in your area, or if you don’t have one with you. Several of the resources below provide instructions.

Also remember: barriers are not the be all and end all of safer sex. Things get more challenging when you move on to the aspects of sex that you can’t just slap a condom or a glove on. Some STIs are easier to protect partners from than others. If you have an STI such as herpes, warts, or syphillis you need to think beyond fluids. These STIs, as well as things like crabs and scabies, can be transmitted by skin-to-skin contact regardless of whether body fluids are swapped. With the exception of syphillis, they don’t even require a break in the skin. I know that sounds daunting. But having one of these STIs does not mean you have to stop having sex forever. You just need to be more careful and communicative. How, you ask?? Here’s some suggestions…

Safer sex when living with herpes:

  1. Consider treatment to reduce your number of outbreaks, and take good care of yourself. Anti-viral meds don’t cure herpes, but they can greatly reduce the number of outbreaks you experience. There are also a lot of things you can do to take care of yourself, reduce outbreaks, and decrease discomfort when outbreaks do occur: clean sores with saline twice a day; soak your genital and anal area in warm water with baking soda when you are having an outbreak; soak a clean cloth in cold milk or witch hazel and use it as a compress on sores; and boost your immune system and prevent outbreaks by getting adequate rest, reducing your stress levels, and eating a diet rich in vitamin C, B vitamins, zinc, and calcium.
  2. Herpes sores are very contagious. Always avoid skin-to-skin contact during an outbreak. Herpes can be transmitted even when active sores are not present (due to viral shedding that you would have no way of noticing), but it is less likely. Don’t put your partner/s at risk when you have sores (which can be on your genitals, thighs, or butt). Also be careful not to share towels, washcloths, or clothing that comes in contact with your genital and/or anal area.
  3. Know your body, and know your virus. Herpes outbreaks usually have what is called “prodromal symptoms,” AKA warning signs. This is often a tingling, burning, or pulsing feeling in the affected area before a sore forms. Get to know your warnings signs, and listen to them. If you feel like an outbreak is coming on, find other forms of sexual and sensual expression until your sores have come and gone and healed completely.
  4. Cold sores are herpes too! “Cold sores” and “fever blisters” in the mouth or on the lips are Herpes Simplex Virus type 1, while genital sores are Herpes Simplex Virus type 2. You can transmit type 1 (“oral herpes”) to someone’s genitals or type 2 (“genital herpes”) to someone’s mouth! Apply the golden rules from #1 and #2 to oral sores as well as genital ones.
  5. Check out resources by and for sexually active people who have herpes – these resources provide information about preventing transmission, address the emotional aspects of learning you have herpes, discuss disclosure to partners, discuss safer sex practices, etc. A herpes support network resource is listed below.

What to do if you find out you have syphillis:

  1. The first stage of syphillis is a painless sore on the genitals. Sometimes there can be more than one sore but, unlike other STIs that cause genital sores, syphilis usually produces a single sore that does not cause pain. Because the sore doesn’t hurt and can hide itself away in a hard-to-see spot, people can pass through this stage without noticing. If you find a sore, go see your health provider. Do not have unprotected sex or skin-to-skin genital contact while the sore is present – it is highly contagious.
  2. Get treated! Syphillis can be treated with antibiotics. Follow your health provider’s instructions for taking your medication, then follow-up with your provider to confirm that treatment was successful and the infection is resolved. Ideally, you should avoid sex until you get the all clear.
  3. Continue to have safer sex after successful treatment for syphillis. You don’t gain immunity against syphillis so it is always possible to get it again, or to get another STI.

Safer sex when living with HPV warts:

  1. HPV stands for Human Papilloma Virus. It is a very common STI that can play out in a number ways for people who have it: it can cause no problems at all, it can lead to cervical cancer (over a long period of time), and/or it can cause genital warts. Genitals warts from HPV are soft and fleshy growths in the genital and/or anal area. They tend to grow in big cauliflower-like bunches and are usually slightly lighter than the skin color of a person’s genitals, but in some cases may be darker. Similar to herpes, HPV cannot be cured and is contagious through skin-to-skin contact.
  2. Get treatment, and take good care of yourself. While HPV can’t be cured, your health care provider can use a number of different methods to remove the warts caused by this virus. There are also a lot of things you can do to take care of yourself and reduce discomfort while the warts are present: take oatmeal baths (super soothing), keep your genitals and anal area dry after baths and showers by using a hair dryer, wear cotton underwear and loose fitting clothing, and boost your immune system with eating healthy foods, getting adequate rest, reducing your stress levels, and staying active.
  3. Always avoid skin-to-skin contact when warts are present. Like herpes, HPV warts can be transmitted even when active sores are not present, but it is less likely. Don’t put your partner/s at risk when you have sores (which can be on your genitals, thighs, or butt). Also be careful not to share towels, washcloths, or clothing that comes in contact with your genital and/or anal area.
  4. There aren’t as many easy to find resources for sexually active people who have warts, but you can look at resources for people with herpes (see above) – most of that information will be useful for you as well.

Okay, that’s it for now. I hope this info will help anyone diagnosed with an STI continue to have a fulfilling, consensual, and satisfying sex life. For more good info, check out the resources below:

tell me what you want what you really really want. or whatever.

finals are almost done! three more days to go.

and once i’m through with the quarter, i’m excited to spend the next month working on my research, trying to re-learn spanish, and – YAY! –  blogging.

on my current list of blog topics are:

safer sex while living with an STI
postnatal vaginas
gender-variant gyn care basics (geared toward providers)
stirrups be damned! tips for creating the best possible gyn experience

please feel free to post a comment letting me know what else ya’ll would like me to blog about. anything vagina-related, pregnancy or birth-related, or sexual health-related is totally on the table! it may take me awhile to get thru the list, but it’s a great learning opportunity for me as well as for readers (hopefully!), so i’m committed.

also, if you are a gender-variant/trans/genderqueer/etc. person and have specific DOs and DON’Ts you want me to include in my gyn care basics for providers, please email them to me at they will be blended anonymously into my blog post, as well as into discussions with my fellow student midwives, gyn preceptors, etc.

thanks for your feedback!

xo, simon