safe practices

[youngnparanoid]

First I want to say I really appreciate this site and its information, as many doctors I have visited are usually short with their time and explanations.

My situation is this: I am 23 y/o female. I started having sex at 13 and have had a rather promiscous past, about 20 partners (mostly with condoms except for my long term relationships (3) and oral sex). I am regretful of my past and constantly worry about it. I have always been a hypochondriac. I get tested every year for STDs, except for HIV (not smart, I know, but I couldnt live with a postive result). The only test I came up positive for is a high-risk strain of HPV, which I am monitoring. (I actually came up negative, postive, negative, postive for Herpes in that order with an IGM test, which as Ive read here is unrealiable and have never had symptoms). Since the HPV result, I've decided to abstain. However, abstinence requires real self-restaint, especially since every male I meet wants some sort of physical action.

Basically my question is what is safe to do without having sex. You make mention in other threads about it being safe to "finger" or give "hand jobs", but is that true when he has touched himeself and then touches me or if he licks his fingers and then inserts them? Is kissing risky when its so-called "passionate" or when there's cuts in your mouth? Is "dry humping" safe if the only clothing between genitals is underware? Is it extremly risky to have unprotected oral sex (I've always thought it wasn't but so many people on here make reference to symptoms after unprotected oral sex). I want to belive I am being careful since I'm not actually having intercourse, but I'm not sure if other sexual acts carry a heavy risk. It's kind of depressing to have to constanly worry about what you're doing, and I'd really just like to be able to get physical with someone but also rest a little easier.

I really appreciate your time for answering this and any advice you have for me.

[H. Hunter Handsfield, M.D.]

First, congratulations on your new dedication to sexual safety.

Second, keep up the regular STD testing, and start including HIV.  It is irrational to avoid it because you "couldn't live" with a positive result.  To be honest, I simply have no patience with such demented reasoning.  (Sorry if this sounds harsh.  Call it tough love.)

Third, the main keys to safe sex are:

1) Know your partner.  Hopping in the sack with someone you just met, especially bar pick-ups and the like, is very high risk.  Ask about symptoms or recent STD diagnosis, and always specifically ask whether a partner has HIV or is at particularly high risk for it (bisexual men, injection drug uers, etc).

2) A corollary to knowing your partner:  Avoid situations that are obviously tempting or that impair judgment, e.g. getting high or drunk in a bar or other meat market setting.

3) Use condoms for vaginal or anal sex with new or non-committed partners.

4) Oral sex is much safer than vaginal or anal sex, for all STDs except for exposure to type 1 herpes simplex virus--and that is pretty effectively avoided by asking and looking for active cold sores (or any unexplained sores on or near thhe mouth).  The risk of oral sex is low enough that most people don't think condoms or barriers for cunnilingus (dental dams, plastic wrap) are worth the hassle.  However, it is a personal decision and some people use barriers even for fellatio or cunnilingus.  But I agree with you that it really isn't practical and I don't think it's all that important.  Obviously, you're going to avoid oral contact if either partner has a genital or oral lesion, discharge, or other abnormality.

5) Genital apposition ("outercourse", ie genital contact without penetration) is pretty safe; some risk of HPV and herpes remains, but much lower than with intercourse.  It's probably just about as safe as condom-protected intercourse.  Of course if clothed there is zero risk.

6) Don't worry at all about kissing or hand-to-genital contact.  They carry no risk of STD/HIV transmission.

Finally, I agree with monkeyflower's advice below.  Don't get so hung up on all this that you forego a satisfying sex life.  With the protections above, you can expect to remain free of new STDs.

Good luck--  HHH, MD

[monkeyflower]

First of all, you cannot possibly judge sexual safety by the standards most posters on this board suggest. This board tends to attract people who are highly anxious about their own (almost always) minimal exposures, so they definitely overstate the risks involved. Sex really isn't nearly as scary as the religious right would like you to believe, and I certainly can't see any physical reason to abstain entirely, even from intercourse.

So, while you wait for Dr. Handsfield's reply, I thought I'd offer some suggestions on how to stay safe. Get tested for STDs regularly (which you already do :-)). Talk to your partners about their STD status. Keep condoms with you and always use them for vaginal and anal intercourse. Unprotected oral is pretty safe; most people don't use condoms or dental dams for oral. Dry humping is safe. Deep kissing is safe. Handjobs/fingering are safe.

But my main suggestion would be to consider seeing a sex therapist, because it sounds like your fear and anxiety is seriously interfering with your enjoyment of life. Your past certainly doesn't seem unusual or extreme in any way, but it clearly bothers you a lot - much more than I think sounds healthy. After all, for most people sex is an integral part of a fulfilling, healthy, and happy life. You may also want to consider talking with your regular doctor about your anxiety in general, and whether medication might be helpful :-)

[whyme2006]

young-

monkey is correct in what he states in regard to HIV

other sexual practices such as oral are definately NOT safe for other STI such as gonorrhea, syphilis, herpes, chlamydia, & molluscum - since many STIs often do not present with symptoms, they can be easily aquired and spread through casual unprotected activities without the partners even knowing they have STIs - I find it highly irresponsible to state that unprotected oral is safe when it is known to be a vector for other STIs - this board addresses STIs - all of them - not just the "big one"

just my thoughts

[petrified]

This was a great thread, very informative.  I did a search on risks of "figering" (I am female)....and I am confused by your response on another thread versus this one re: risk of handjob/fingering.

I recently "made out" with a man I knew little about (I know, stupid........).  Fast forward - - he fingered me until I came and I gave him a hand job (no ejaculation).  Our genitals never touched.

Per this post, there was no risk of any STD or HIV given the incidence.  However per my search on fingering you stated in a 1/30/2006 post the following:

"There have been rare case reports of gonorrhea acquired by exposure of cuts on the fingers, and there undoubtedly is a small risk of herpes. These risks are miniscule, however...."

My question is twofold:

(1)  Is the statement above related to risk of the male?  Is there added risk to a female if she is fingered if the man has cut on his finger?

(2)  I assume you should check the person's hands to ensure there are no visible cuts before you either give a handjob or get fingered?

Thanks.

[H. Hunter Handsfield, M.D.]

Never, never, never assume that a particular response to a particular question in settings like this--which preclude body language, eye contact, etc--is applicable to other situations.

The situation I referred to in the post you cite (from last January) had to do with catching gonorrhea OF THE FINGER due to contamination of a preexisting cut with vaginal secretions.  In theory, I suppose the guy with a gonorrhea infection of his finger had in turn fingered a partner, she could be infected.  But what are the odds of that???  My response to your question is that you should totally, absolutely, and forever disregard the risk of getting an STD because an person's hands come in contact with your genitals.  It has never been documented to occur, for any STD.

See what I mean about not extrapolating specific answers to other situations?

HHH, MD

[youngnparanoid]

Thank you all for being so helpful. And to monkeyflower, your advice about a sex therpist might be taken. I've been to regular therapists in the past, and I actually didnt even know there was a specialty in sex. I really do have issues regarding my sex life, that I might be able to sort out with the right therapy.

Thanks everyone

[htsu1]

you couldnt live with it being positive?? this makes no sense, you test for everything but hiv   what are you thinking?

[petrified]

Thank you.............I put too many pieces together (obviously incorrectly)..........sorry!

[monkeyflower]

I'm really glad to hear you're considering sex therapy. Sex therapists are regular therapists with additional training in sexuality, which makes a *huge* difference in their approach and understanding of the varieties of experiences and sexual response. Although not all sex therapists are AASECT members (American Association of Sex Educators, Counselors and Therapists), checking their website for a listing of therapists in your area might be a good place to start. www.aasect.org.