Sexually Transmitted Diseases
Sexually Transmitted Diseases
Can you imagine what it must have been like trying to buy condoms on Walton''''s Mountain? Must have been tough for John-Boy or Jim-Bob to spit out the big question to ole Ike Godsey: "I want to buy some ccc . . . ccc . . . cccondoms, please."
My, how times have changed.
Instead of being stashed away behind the counter, condoms now congregate in clusters of showy packaging, filling drugstore shelves of their own. Why, there are even entire stores--such as Condom Kingdom in Philadelphia--dedicated to selling them. They come in different shapes and sizes, even various colors and flavors. There''''s even a female condom. Wonder what Mary Ellen Walton would have made of that.
Mention condoms, and it won''''t be long before the terms HIV and AIDS enter the discussion. AIDS certainly brought condoms out of the closet and into the limelight. During this age of AIDS, condoms have gone from being just a means of pregnancy prevention to the prime mode--aside from abstinence--of disease prevention. And that''''s important, because AIDS isn''''t the only threat out there.
Unequal Opportunity Infections
There are more than 50 sexually transmitted diseases (STDs), including gonorrhea, trichomoniasis, bacterial vaginosis, chlamydia, hepatitis B, the herpesvirus, genital warts, HIV/AIDS, pelvic inflammatory disease (PID), syphilis, chancroid and others.
When it comes to certain STDs, women "seem to have an unfair disadvantage when compared with men" says Cheryl Walker, M.D., assistant professor of obstetrics and gynecology at the University of California, Irvine. Of the estimated 12 million people who get an STD every year, about 6 million, or 50 percent, are women. The problem with just looking at the numbers is that they don''''t reveal the whole story: In the case of certain STDs--namely, chlamydia and gonorrhea--women are twice as likely to get them as men are. The toll that these infections take on women''''s health can be far greater than it is for men. Women''''s fertility can be threatened, childbirth can be complicated and a newborn''''s health can be endangered.
| How to Use a Condom When asked whether most women know how to put a condom on a man, Katherine Forrest, M.D., principal research scientist at the American Institutes for Research in Palo Alto, California, will answer you plain and simply: "Nope." "I think that most women are not learning how to do this," says Dr. Forrest. "When they do learn how to do it, it''''s usually by trial and error." But using a condom properly shouldn''''t be left to chance. Here''''s what Dr. Forrest recommends. Rehearse ahead of time. Before you are in a situation where a condom is needed, go get 
1. Start by unrolling the condom just enough so you can press the air out of the tip between your thumb and forefinger. | 
2. Unroll the condom smoothly down the shaft, from the tip all the way to the base. Try not to allow air bubbles between the condom and skin. |
some condoms and practice, says Dr. Forrest. Practice taking the condom out of the package so that it''''s oriented properly, learn how to open the package without tearing it with your teeth and learn how to hold it and how to unroll it. Need a prop? You can practice on a large carrot or banana, says Dr. Forrest. Have it ready. If you are going on a date and anticipate that you might have sex, take condoms with you, says Dr. Forrest. If you are at home and anticipate an evening of lovemaking, you can get one condom ready an hour or so ahead of time and have others available. To get ready, open the condom packet, orient the condom so it will unroll easily and put it in the drawer of the bedside table. That way finding and using the condom will be easier. Check the lube tube. Be sure to use only water-based sexual lubricants, such as K-Y jelly or Replens, since other kinds can deteriorate the latex. Look for the term "water-based" on the label. If the lubricant contains oil, you don''''t want it. Examples of substances you should not use are hand lotion, massage oil or petroleum break, don''''t trust a condom if the expiration date is long past. Keep them cool and fresh. Condoms should be stored in a cool, dark place, since heat and strong light can damage them. Squeeze and roll. To put a condom on properly, follow the steps shown above. Start by unrolling the condom just enough so you can press the air out of the tip between your thumb and forefinger. Set the condom on the end of your partner''''s erect penis and unroll it smoothly as shown above. Once it''''s in place, there should be about ½ inch of empty space at the tip of the condom. After your partner ejaculates, hold the condom at the base of his penis while he withdraws from your vagina; this will prevent the condom from coming off inside of you and spilling the semen. Your partner should pull out before his penis is completely soft, says Dr. Forrest. |
Since it''''s essential to protect yourself, here''''s what experts recommend.
Be sure you''''re disease-free. If you''''ve had unprotected sex with a partner who''''s carrying a sexually transmitted virus or bacteria, you may have already been exposed to an STD. But with some STDs, you may have the infection without any symptoms. To be on the safe side, you should ask your doctor to do a full battery of tests for STDs, says Eddie Sollie, M.D., associate clinical professor in the Department of Obstetrics and Gynecology at the University of Texas Southwestern Medical Center at Dallas and author of Straight Talk with Your Gynecologist. Detecting infection can enable you to get the treatment you need.
Send him to the doctor. Before sleeping with a new partner, ask him to undergo STD testing, experts recommend. It''''s not just a matter of trusting someone to tell the truth. A man can be infected and not know it.
Make condoms the only way. Before beginning sexual relations with a new partner, make up your mind that you''''ll only have sex if he uses condoms, says Katherine Forrest, M.D., principal research scientist at the American Institutes for Research in Palo Alto, California. Establish that understanding with him, "before you get in bed, before your clothes come off," she says. "Alternatively, now that female condoms exist, you can make that a rule that applies to you rather than to him. Condoms should be used for anal and oral sex, as well as for vaginal sex."
Bring in the reserves. While latex condoms are the best means of preventing STD infection, barrier methods such as the diaphragm and contraceptive foams, gels and creams also offer some protection, Dr. Forrest says. By covering the cervix and blocking this entryway into the uterus, the diaphragm can help prevent organisms from infecting the upper genital tract. Laboratory studies also suggest that nonoxynol 9, the spermicidal agent in some vaginal contraceptives, may protect from disease as well.
| Tests You Need to Ask For Every year you have a Pap smear. The results come back normal, so you''''re free of sexually transmitted diseases, right? Not necessarily, experts caution. The Pap smear can''''t detect chlamydia, gonorrhea, HIV/AIDS or syphilis, to name a few. If you want to know your status on these diseases, you need to ask for other tests. Among them: Gonorrhea and chlamydia culture. Since the Pap test won''''t show whether you have chlamydia or gonorrhea, you need to ask your doctor to take a culture for these sexually transmitted diseases. This test is not automatically part of your annual gynecological exam. HIV/AIDS test. To find out if you are infected with the HIV/AIDS virus, you need to have an HIV blood test. You can choose between anonymous and confidential HIV testing. In anonymous testing you never give your name; instead, you are assigned a number. The advantage of this kind of testing is that no one else can find out your HIV status unless you tell them. The downside is that you may forget the number and not be able to get your test results. Also, counseling about your risks and how to protect yourself may not be automatically provided. Be sure to request this information, says Katherine Forrest, M.D., principal research scientist at the American Institutes for Research in Palo Alto, California. With confidential testing, the facility doing the testing knows your name but agrees to keep the results confidential. The advantage of this kind of testing is that counseling is usually automatically provided, both before testing and at the time the results are given to you. But there''''s a drawback that you have to consider: If the results go in your medical record, your insurance company may find out that you are infected with HIV and deny future medical coverage. Syphilis test. Syphilis can be detected through a blood test at your doctor''''s office. Syphilis testing is not done routinely as part of an annual exam, though it is required in many states before you can get a marriage license. |
Do it with the lights on. The first time you have sex with a new partner, make love with the lights on, says Dr. Forrest. That way it''''s easier to see your partner''''s skin and penis and detect any signs of STD infection before you have intercourse, she says. Things to look for include irregularities in the skin surface, sores, bumps, discharge from the opening of the penis or any signs of irritation and inflammation.
The Big Threats
There are so many STDs that it''''s hard to know what to worry about most. Certainly, all STDs are of concern, but the top three threats for women today are chlamydia, the human papillomavirus (HPV) and HIV/AIDS, says Dr. Forrest.
Chlamydia
This is a type of bacteria that poses a major threat to women, because it threatens their fertility, says Dr. Forrest. The disease is extremely prevalent--an estimated half a million cases are diagnosed and reported to the Centers for Disease Control and Prevention (CDC) in Atlanta each year, says Dr. Walker. That figure might be misleading, however, because chlamydia infections are not officially reportable diseases. Some doctors estimate that the real figure is between three and ten million cases each year in the United States.
The tricky thing about chlamydia is that you can have it and not even know it, says Dr. Forrest. There are often no symptoms to help a woman detect the infection. If chlamydia goes untreated, it can travel up into the fallopian tubes, causing blockage and scarring. This upper tract infection, called pelvic inflammatory disease, or PID, is what often causes infertility. Tubal scarring from chlamydia infections can also lead to ectopic pregnancy.
Here''''s what you can do about chlamydia.
Take a yearly test. If you''''ve had a new partner in the past year, or if your partner has had other partners, get checked for chlamydia once a year, says Dr. Forrest. "Get tested even if you don''''t have symptoms."
Don''''t skimp on treating it. Chlamydia can be treated with an antibiotic, but it''''s essential to follow the doctor''''s directions. Be sure to complete the full course of the antibiotic, even if you have no symptoms and are feeling fine, says Dr. Forrest.
Make your man go. If you''''ve contracted chlamydia, be sure your partner goes to the doctor and gets tested and treated, too, says Dr. Forrest. If he''''s infected, treating you alone won''''t do much good, because he can just reinfect you.
Human Papillomavirus
More commonly known as genital warts, human papillomavirus (HPV) is another disease that should be of particular concern to women, says Dr. Forrest. That''''s because certain strains of the virus are associated with the development of cervical cancer.
"HPV infection is by far the most common STD in women," says King Holmes, M.D., Ph.D., director of the Center for AIDS and STDs at the University of Washington School of Medicine in Seattle. An estimated 24 million people are believed to be infected with the virus, according to officials at the CDC. Yet, "most women who have it don''''t know they have it," says Dr. Holmes. That''''s because women may be infected without developing warts. Or the warts may be located where women can''''t see them.
| Battle of the Condoms: Male or Female? Finally, we have a choice. In addition to male condoms, female condoms are now available in stores. Called Reality, the female condom consists of two plastic rings connected by a polyurethane sheath; one ring is inserted inside a woman''''s vagina where it goes around the cervix, and the other ring stays outside. Studies show that the male and female condoms may be nearly comparable in preventing pregnancy, says Katherine Forrest, M.D., principal research scientist at the American Institutes for Research in Palo Alto, California. But not enough research has been done on the female condom to know whether it protects against sexually transmitted diseases as effectively as the male version, she says. Preliminary study suggests that the female condom should help decrease risk, experts say. The female condom may be more protective against STDs that are spread by skin-to-skin contact, says Dr. Forrest. That''''s because the end of the female condom that stays outside of the vagina can prevent the skin around the opening of your vagina from coming in contact with your partner''''s penis. |
Here''''s what doctors recommend for HPV.
Have an exam. See your doctor yearly for a pelvic examination and Pap smear. The Pap smear can often detect the virus, and if you have the strain of HPV that causes warts, your doctor may be able to see them during a pelvic exam. The virus currently has no cure--once you''''re infected you have it for life--but your doctor can remove any warts and monitor you more frequently for any cervical changes. If you have the virus, some doctors advocate having a Pap smear every six months, because of the increased risk of cervical cancer associated with HPV.
Go for the greens. If you have HPV, reach for green leafy vegetables and citrus fruits and juices. Researchers at the University of Alabama at Birmingham found that women with one type of HPV were less likely to develop precancerous cervical changes if they had high levels of folate in their systems. While food sources of folate are best, such as spinach, oranges and lentils, many multivitamins also contain folate in the form of folic acid. The Daily Value is 0.4 milligram.
Human Immunodeficiency Virus (HIV)
The virus that leads to AIDS is among the top three STDs that women should be particularly concerned about. That''''s because of the fatal nature of the disease, says Dr. Forrest. By 1992 the disease was the fourth leading cause of death in women ages 25 to 44, with the death rates in women steadily climbing.
One possible reason for the sharp increase is that many women have assumed they were in a low-risk group. The fact is, if you have unprotected heterosexual sex with an infected partner, you run a risk of contracting the disease. More than one-third of HIV-infected women have contracted the virus through heterosexual sex.
Having a monogamous relationship with a partner who is also monogamous (and HIV-free) is one way to avoid this virus. If you''''re not in that kind of relationship, here are some other ways to protect yourself.
Stock up on condoms. The best means for preventing HIV infection, other than abstinence, is to use latex condoms during sex, experts say. "There is no doubt whatsoever, when used consistently and correctly, that latex condoms are highly effective in preventing the transmission of HIV," says Herbert Peterson, M.D., chief of the women''''s health and fertility branch at the CDC.
Get tested. HIV can be present in your system for years before you show any symptoms, doctors say. The sooner that you get treated for the infection, the better. So if you''''ve had unprotected sex with a partner whose sexual history you''''re not sure of, go for an AIDS test.
Know your partner. "That means more than just knowing he''''s a nice guy and seems clean and honest," says Dr. Forrest. It means knowing about all the people he has had sex with in the past--which is extremely difficult. But anything that you can find out about his sexual history can help you know him better and help you make your decision about whether or not you want to have sex with him. Questions to ask him about himself should include: Has he ever had an STD, has he always used condoms and has he been checked for HIV and other STDs recently?
See also Reproductive System, Sex
