Frequently Asked Questions You Should Know

STIs (STDs) aren’t just for kids

Sexually Transmitted Infections (STIs, which we used to know as STDs) aren’t just for teenagers and 20-somethings. While STI rates in the 40+ population aren’t as high as in those aged 15-24, women over 40 are by no means protected by our age.

You might not know you have an STI -
Your partner might not know they have an STI

You might think you wouldn’t have sex with someone who has an STI (someone “like that”). Really though, there’s no special moral or class designation to protect people from STIs. Anyone – including professionals like lawyers, managers and accountants- can get an STI, and you can’t tell by looking at someone whether they have one. Some STIs can be asymptomatic (lacking obvious symptoms). Don’t be the one who ends up infected because you thought your sex partner would be okay because they’re a teacher /financial planner/ computer analyst….

STIs can be viral, bacterial, or parasitic. Some STIs don’t produce obvious symptoms, or may not produce symptoms until years later, like HPV or HIV. A common STI is chlamydia, which may go undetected. Another potentially asymptomatic and very common STI is herpes. It’s also an infection you’ll live with for life, and if you’re having an outbreak, it can be easier to get other STIs as well. Undiagnosed infections can lead to pelvic inflammatory disease (PID), so all this to say that even if you haven’t been sexually active for some time, getting tested for STIs should be part of your health care plan when you launch back into the dating scene. (That annual Pap smear tests for the effects of HPV infection, which can take years to develop after infection.) Talk to your sex partner about safer sex and getting tested. Starting with the knowledge about where you both are at can prevent unhappiness later on.

Get tested and advocate for the tests you need

Talk with your doctor honestly about whether or not you’ve had safer sex and what other risks for transmission might exist – a history of STIs, or partners with unknown sexual histories. STIs without obvious symptoms are still readily transmitted from person to person.

Comprehensive STI testing includes HIV testing, but women who ask for STI testing might not always be tested for HIV because their doctors presume they haven’t been exposed. Don’t let your doctor’s presumptions rule. More than one woman has had to advocate for testing against her doctor’s presumptions. STIs can be curable (treatable) or incurable (yet treatable), so if you have one, it’s good to know and get treatment.

I have an STI- how do I tell my partner?

If you have an STI, you owe it to your partner to tell them. If it’s a lifelong virus like herpes or HIV, being honest is even more important. In the case of HIV, you can be criminally charged if you don’t disclose your status to sex partners.

Safer sex can reduce the risk of STIs

Safer sex decreases the risk of STI transmission, but can’t rule it out completely unless you’re not touching each other at all. Use condoms for vaginal and anal penetration, If you’re doing both, always use a fresh condom if you go from anal to vaginal to avoid bacterial infection. This also applies to sex toys: new partner, new condom and anal to vaginal penetration, use a new condom. For oral sex, use condoms and dental dams which cover the anus or vagina. Our safer sex page offers more detail on transmission and prevention. The BC Centre for Disease Control can give you info on specifc STIs as well as testing and treatment.

The simple answer is yes. If you’re having sex with someone new (or someone you haven’t had sex with in a while), safer sex is a good idea until you both know you won’t end up with something you hadn’t bargained for- sexually transmitted infections (STI’s) don’t always produce symptoms.

When we were teenagers, “safer sex” meant birth control. For those of us who haven’t been out and about sexually in a while but are wading back into the pool in our 40s and beyond, safer sex could be new. While you still might need to think about avoiding an unplanned pregnancy, these days safer sex is so called because it limits the risk of getting STIs like chlamydia, herpes, gonorrhea, HIV, etc.

STI transmission

Generally, STIs are passed sexually from partner to partner through exchange of infected body fluids (semen, vaginal secretions, anal fluids, and blood in the case of microscopic tears in the skin) during unprotected vaginal, anal and oral sex. Using male or female condoms can prevent the transmission of many STI’s, including HIV,but some can also be passed through skin-to-skin contact even if condoms are used, so talk to you partner about STIs.

STI prevention

Safer sex prevents the exchange of body fluids or blood. Male or female condoms can be used for vaginal or anal sex. If you’re having both vaginal and anal sex, going from vaginal to anal is okay, but going from anal to vaginal can spread bacteria, so use a new condom. For oral sex, use condoms and dental dams (easier still is to cut a condom up the side to create a sheet that can be put across the person on the receiving end). If you or your partner has an active STI infection, you can switch from high contact sex to an alternate- masturbating together, phone sex…

Some men don’t like condoms – they say they’re too tight, too small, too uncomfortable, and take away sensation and pleasure. Using a water-based lubricant can change the way condoms feel for both partners. If it’s new to both of you, it can be a fun thing to make safer sex feel better, and sexier. Try different kinds of condoms- there are plenty of shapes and textures available.Check your packaging for expiry dates and to ensure your choice protects against STIs – for example, lambskin condoms don’t.

Use condoms with confidence and celebrate lubricant in its many forms! Lube is slippery, fun to apply to your partner, and makes sex feel so much better! It also reduces the risk of abrasion (to your body and your condoms). Lube is great. Use a water-based product, as oil-based products will break down latex (they’re okay with polyurethane). Most major drugstores stock a range of lubricants, or you can go to a sex shop, whatever’s comfortable. Some are thick, others are thin as water. They’re available flavoured and scented. Experiment on your own if you think you’d feel shy doing so with a partner.

A note on sex toys

Sex toys can be a great addition to your sex life, either alone or with a partner. If you’re using them with a partner, do so safely: use a fresh condom or barrier for each person, and use a new one if you’re going from anal to vaginal penetration. Clean them according to instructions so they’re good for years.

You and your doctor are a team. The doctor is trained to know about the workings of the body and you provide the personal details for diagnosis and care. Without the details, the doctor can’t provide you with thorough treatment. Easy enough for the mystery bump on your arm, but when it comes to talking about sexual health, it might not be so straightforward.

It’s Not Easy To Talk About Sex, but…

Talking about sex related details can be a challenge- it’s very intimate stuff. Telling a doctor graphic specifics about your sexuality can be embarrassing and awkward because you’re aware that the doctor has to think about what you’re doing in bed. There’s a power imbalance going on- the doctor is the professional with power, and you’re the patient in the nude, metaphorically and literally. It will be just as embarrassing, and possibly worse, to go see your doctor for help after you have caught an STI.

If the doctor is our age or younger, it can add to the awkwardness. We’re moving into a time in our lives where this will gradually happen more. What we need to keep in mind is that these are our bodies and we have a lifetime of experience in them. We need to use our learned experiences to talk to the doctor and explore our questions with dignity. It’s the job the docs signed on for and they too should approach it that way.

Test Results You Need to Know

Ensuring you’re being tested and treated for sexually transmitted infections and assessed for possible cancers (breast, cervical) is essential in looking after yourself. Get screened for STIs when you have a new sex partner (ideally, before you begin having sex) lets you know where you stand (and where they stand), and can also be a good place to start communicating with your partner about safer sex. The request may feel awkward, like a teenager asking for birth control, but explaining to your doctor that you’re in a new relationship (or interested in one) and want to ensure you’re knowledgeable about your health status will likely earn you more respect.

HIV may be one of the STIs you should consider testing for. If you’ve looked at the HIV transmission equation and think you’ve been at risk, a test can tell you for sure. Some doctors who have long-term patient relationships or think they know you well might be surprised if you ask for an HIV test. If you’re discouraged from any kind of STI testing, (it’s happened to other women), speak up! It’s your body. Or if this is the final thing in a series of disappointments, perhaps it’s time to look for a new doctor.

Your Doctor Can Help with Body Changes Too

A dip in sexual desire and decreased vaginal lubrication are common once we reach our 40s and move through perimenopause (the years leading up to menopause) and beyond. Using a vaginal lubricant (lube) like K-Y or Astroglide will enhance your sexual experience. If over the counter lubricants don’t help, you can ask about a prescription option.

Doctors can be our allies, advocates, and caregivers. Their responsibility is to provide us with the best care suited to our situations. They have the skills to care for us, and we need to provide them with the information they need so they can do so. Doctors are human, and may also wish to avoid uncomfortable discussion. While some uncomfortable moments can arise in talking about the intimate details of sexuality, we must be our own best advocates.

Getting to know someone new is part of the deal in any relationship, whether it’s about sex or dinner. Where will we meet? What movie would you like to see? Your place or mine? As teens or young adults having sex, any “prevention” focus tended to be birth control. Now we need to talk about sexually transmitted infections (STIs). Oh great.

What’s Your Bottom Line? Decide, and Honour It

Determining your own bottom line on safer sex and condom use before you even talk to a partner is a powerful place to start. Learn about safer sex so you have knowledge to inform your decisions. Using condoms can significantly decrease the chances of getting infected with an STI, and you are worth protecting, no matter what a partner says.

Talking to your partner about safer sex is stressful, even for sex educators who talk about sex all the time! Sex is a primal connection between people and the idea of bringing in our past partners and risks can seem mistrustful and a downright desire killer. There’s also the risk of being rejected for bringing it up- definitely not what we’re looking for with a new lover. But whether we comfortable talking about it or not, risk is an issue.

“Let’s talk about what’s going to make sex the best for both of us….”

If you need something to start with, that line could work. You can talk about what turns you on, introducing the idea of safer sex and STI testing at the same time. Another script could have you saying “I want to tell you what turns me on…” and include the idea of safer sex. Or you can take Susie Bright’s approach and just assume your partner has herpes (and potentially other things) to make it easier on them and go from there: “We should use condoms so we’re not sharing anything, right? Let’s talk about what else we can do.”

Safer Sex is Good Sex

Good sex and safer sex aren’t opposed to one another. Because we’re in our forties, the chances of having been exposed to some STI are astronomical, so why wouldn’t we talk about it? We’re not gaping teenagers anymore. Assume your partner wants sex to be good and safe for both of you too.

Ideally, you want to share info with your partner. Have you both been recently tested for STIs? Does either of you have a STI (like herpes or HIV? Talking about condom use is part of it. You may not want to use them, but they’re the best protection against STIs.

If you and your potential partner have a hard time talking, imagine how uncomfortable you’d feel if you got a new STI. Your health is worth protecting. If your partner isn’t bringing up safer sex, or keen to talk about it, do you want to be with them? If talking about safer sex seems daunting, remember it’s not easy for anyone but it’s wise for everyone. Contact us if you’d like support.

Use Condoms (and Dams) with Confidence

Condoms are an integral part of safer sex forvaginal, anal or oral penetration. You can use male or female condoms depending on your preference and what you’re doing.Male condoms are the old tried and true for straight intercourse, although the materials and lubricants have changed since we were teens. Some STIs can be passed via-skin to skin contact, so if you’re having intercourse, you may prefer to use the female condom, as it provides morecoverage. They’re great with partnerswho don’t like traditional condoms. The drawback is they’re expensive and pharmacies don’t always carry them, but sex shops worth their salt should.If sex includes sex toys, use a fresh condom for each partner. When it’s your turn for oral sex (or a female partner’s turn), usedental damsorcut up condoms as a barrier.Whatever you choices, keep these important points in mind.

Material Matters

Check what your condoms are made from. Historically, condoms have been made from a whole bunch of materials: animal skins, leather, linen (ouch!)rubber. These days they’re made from lambskin, latex, polyurethane, and the latest, polyisoprene. Polyisoprene condoms are made from a new formulation of latex that has been altered so it can be used by those allergic to latex, and manufacturers claim sensation very closely mimics skin-to-skin contact. Only latex, polyurethane or polyisoprene block STIs. Lambskin condoms can only prevent pregnancy, so check the label.

Female condomsare made from polyurethane or nitrile and protect against pregnancy and STIs. They’re also prepared with a lubricant, to make insertion easier and sensation better.

Say Yes to Lube

Lubricant (lube) improves sensitivity and has the bonus of easing the effects of vaginal dryness that can occur during perimenopause and post-menopause. A tiny drop inside the condom can increase sensation for a man, although don’t use too much, or the condom could slip off. Slicking lube on the outside of the male condom will increase sensation for bothyou and your male partner. Because the female condom is pre-lubricated, experiment with how much, if any, you want to add. For oral sex, a little lube on the the skin side of the dental dam can increase sensation.

Water or silicone-based lubes are readily available in pharmacies and sex shops. (You can use oil-based ones for polyurethane condoms, but not with latex or polyisoprene ones, as the oil can cause them to break). Silicone-based lube lasts longer, but can be difficult to wash off sheets (!), so trying sample sizes of lubes is one way to go as you figure out what you like. Women-specific sex shops are a great place to learn more about lubes in a non-intimidating way- it’s their goal to make you comfortable!

… And No to Spermicide

Never use a condom (or product) treated with nonoxynol-9. Nonoxynol-9 is a spermicide that has been found to cause micro-abrasions or tiny breaks in the skin that can allow bacteria and viruses to enter the body. In studies testing it as a potential microbicide for HIV prevention, it was found to increase the likelihood of transmission.

Expiry Date Matters

Check your date before you check out your date. Condoms can break down even if they haven’t been used, particularly if they’ve been stored close to the body, or in a bag where they may have been speared by a pen or key. If the package looks intact, open it and remove the condom carefully. Check the condom itself before you put it in or on.

Application Matters

Male condoms need to beput on anerect penis before any penetration occurs (if he’s uncircumcised, there’s an extra step). Make sure you’re putting them on with the right side out- they should unroll easily. Immediately following ejaculation, yourpartner needs to withdraw while holding the tip of the condom so that no semen can spill out.

Female condoms are great, as they can be inserted hours before you anticipate using them. There are two flexible plastic rings at each end of the female condom- one is insertedup against your cervix, the other stays on the outside of your body. They’repretty easy to put in once you get the hang of it – remember your first tampon? After ejaculation, your partner doesn’t need to pull out right away, but once he does you should twist the condom’s outer ring so no semen can escape and remove it by pulling gently before you stand up.

If you’rehavinganal and vaginal sex, always use a new condom for vaginal sex to avoid bacterial infection. And if you’re using condoms with sex toys, a new condom for each partnerwill prevent potentialinfections.

Condoms should only be used once and then thrown away.

Does Size Matter?

Some male partners will tell you that condoms are uncomfortable because they aren’t big enough. Condoms can stretch to amazing lengths when they’re on something other than a penis (try blowing one up like a balloon some time). That said, different kinds of condoms can produce different sensations to both partners. There are many textures and shapes you can try. Product names like “Big Boy” can put a little fun into things, and using lube will ramp up the experience for both of you.

When to Cut it Up: Oral Sex

Male condoms can be used as is for oral sex on a man. For you or a female partner, you need a barrier to cover the whole vulva, and you can use a condom or a dental dam. If you use a condom, cut itup the side to make it into a flat sheet to cover the vulva.Latex gloves can be used for penetration, and if you’re using sex toys, keep in mind thefresh condom for each partnerrule.A little flavoured lube can be fun too.

If you’re not familiar with condoms, or haven’t used them in some time, you’ll find there is a range of options and uses. They’re a great tool in your safer sex toolbox, protecting you against STIs, introducing a conversation piece, and a little fun into your sex life.

If you’re menopausal (at least a year since your last menstrual period), you can still get Sexually Transmitted Infections (STIs). In fact, because of the changes your body has gone through, you could be more vulnerable than when you were menstruating regularly. Why? Hormone level changes during perimenopause(the yearsof menstrual cycle changes that lead up to menopause) and after menopause cause vaginal tissue to becomes less elastic and thinner. There also can be a decrease in natural vaginal lubrication. These changes can mean that the vagina is more likely to tear during penetration, even if they are tiny tears you can’t feel. These tiny tears can be the perfect entry point for infections and viruses.

New Sex Partners

If you’re having sex with a partner whose sexual history or health is unknown to you, talk to themabout safer sex. Use male or female condoms for vaginal or anal sex, dental dams or condoms for oral sex and lots of lubricant (or lube). There are lots of different kinds available these days, many of them at major pharmacies. You might not have used lube before, but it will help you enjoy sex so much more! It helps with vaginal drynessand increases sensation for both partners. It can be especially helpful if it’s been some time since you used condoms and you feel out of practice.

If in doubt, talk to your doctor about changes in vaginal health and your sexual health overall. If you’re at a point where pregnancy and/or birth control aren’t an issue, you certainly don’t want to have to worry about other things in its place.

We all want our kids to be safe. When it comes to sex, we will feel differently about our children’s sexuality depending on our own values, beliefs, comfort zones, and knowledge. One mother may buy her kids condoms once they reach fourteen, another will tell her kids she hopes they wait to have sex until they’re married.

Talking About Sex Doesn’t Mean “Do It”

Delivering accurate sexual health and safer sex information doesn’t have to clash with the hope that your kids won’t have sex when they’re too young. What it can do is support your kids with knowledge and confidence to meet situations head on: speculative sex talk with peers, interactions with dates. Knowledge is important, and you can convey your values in how your kids use it. Another way of looking at it is that if we don’t give our kids sexual health info, the media, their peers and potential predators will. Only you can ensure the information will be accurate.

Children Are Sexual Beings From The Beginning

Childrenhavenatural curiousity abouttheir bodies, and our job as parents is to help them find ways to express it in healthy ways. Sex educators of children emphasize that a healthy sexuality includes knowledge of the proper names of body parts, and how they function. It also includes a clear understanding of who can and cannot touch a child in private areas. Doctors may be okay with permission, but an uncle is not, for example. A child always has the right to speak about any trespasses that occur. We can support their exploration of their bodies as long as it’s safe and appropriate. We tell our three year olds that it’s not okay to have their hands down their pants in the grocery store, but it’s okay in private at home. We tell our fourteen year old that it’s not okay for a boy to insist on sex when she’s said no.

Educating children and teens about their bodies (termed body science, by nurse educator Meg Hickling, who has written a number of excellent books for kids an adults*) wasn’t in place when many of us were children. For those of us who have experienced abuse, talking about sex with anyone, let alone children, can be tough. We don’t want our children to be abused, and those who have accurate knowledge about their bodies and relationship boundaries are less likely to be victimized.

If talking to your kids about sex is new to you, it could feel awkward, and resources are available. Not surprisingly, it’s easiest to start talking about healthy sexuality and safety in relationships when kids are little- three or four isn’t too young to talk about the names of body parts and that they’re private and worth protecting. Introducing openness, pride and confidence leads the way to further conversations down the line, when safer sex conversations will be appropriate. Developing a positive stance on sexual health is a model for kids to follow- if mom feels okay talking about this, why shouldn’t I? No matter what the age of your kids, offering them positive messages about their bodies, sexual health and making choices about having safe sex will help them. Even if you have teenagers who tune you out, they’ll listen to talk about sex, although they might pretend not to.

Tell your kids they matter. Offer them resources. And be brave: talk with them.

* We get no cut from this advertising!

Women and HIV: Cut Your Risks

Do women get HIV?
Absolutely.

Is it common in Canada?
About 1 in 4 new infections are in women. (See page 27 of PHAC’s HIV/AIDS Epi Update for more info on HIV and women in Canada)

Is HIV a concern for the average woman?
While HIV is not as common a STI as chlamydia or herpes, heterosexual transmission is on the rise (see the Epi Update citedabove for more detail).

What is HIV?

HIV stands for Human Immunodeficiency virus. It enters the body through direct access to the bloodstream and attacks specific cells in the immune system called CD4s (some of the “fighter” cells in our immune systems). HIV takes over CD4 cells and makes copies of itself. The body responds to the destruction of CD4 cells by making more CD4 cells, which HIV takes over, and so the cycle goes. Eventually, the body can’t keep up with the cycle and HIV becomes more dominant, weakening the immune system. HIV doesn’t create infection, but creates an environment in which the body is vulnerable to infections. This can lead to Advanced HIV Disease, which is replacing the term AIDS.

HIV has been a global epidemic for three decades. Depending on where you live in the world, treatments areavailable. Nevertheless,HIV remains an incurable virus that weakens the immune system, eventually leading to life-threatening infections. Treatments can slow down the process, improving length and quality of life, but they have their own set of concerns for long-term use.

How is HIV transmitted?

Sexual transmission can occur when infectious body fluids of a person with HIV gain access to the bloodstream of another person. Think of this equation:

Body fluids with high concentration of HIV
Body fluids with high concentration of HIV include, blood, semen, vaginal and anal fluids. Tears and saliva are not infectious.

AND
activities which exchange body fluids
Activities that readily exchange body fluids with high concetration of HIVinclude unprotected vaginal and anal sex and sharing sex toys between partners without cleaning them or using a condom. Oral sex is potentially risky – unless you’re using condoms or dental dams, there’s bound to be an exchange of body fluids. If you’re into recreational drugs, sharing equipment can be high risk.

EQUAL
risk of infection with HIV or other STI
Your risk is dependent on your interruption of the equation. Talk to your partner about past and present STIs, and about getting tested, including an HIV test. Doctors may be biased against testing women, particularly if you’ve been in a long-term relationship, because they don’t think there’s a risk, but if you want to get tested, press for it. Make your activities safe: use condoms for penetration, and for oral sex use condoms and dental dams. If you’re sharing any kind of drug use equipment, don’t.

What can I do to avoid it?

Safer sex can help you avoid a number of STIs, including HIV. This means using a condom for vaginal or anal intercourse, using condoms on shared sex toys, and using barriers or condoms for oral sex. If you feel uncomfortable talking about condom use, consider the alternative- disclosing an STI like HIV(a legal obligation in Canada). A little practice can make condom use easier, fun and freeing- taking charge is powerful.