Sexual Health

Sex: it’s all fun and games until someone comes in contact with a herpetic lesion. Or parasitic infection. Or a rash. If I weren’t already deeply happy in my long-term, mutually monogamous relationship, thinking about the gruesome details of sexually transmitted infections would be enough to make me at least grateful for it. But not everyone walks in the sunshine of STD-free monogamy. Not everyone wants to have sex with one person forever. And even we single-partner types should be aware of sexual health issues, enough at the very least to be able to make responsible decisions about contraception. So if you’re looking for an answer to a sex-related question, trying to familiarize yourself with the symptoms of common STDs, or wondering what kind of treatment you’re going to need for the STD you already suspect you have, this page will get you started.

Sexual Health Topics

When in doubt, use a condom to protect sexual health.

It won’t give you perfect protection against anything, but it will provide a shield (ranging in effectiveness from pretty good to pretty damn good) against unintended pregnancies and most STDs.

Sexually Transmitted Diseases and Infections

Chlamydia is the most common of the bacterial STDs. It often causes no symptoms, but even asymptomatic chlamydia can lead to serious complications—think pelvic inflammatory disease (PID) and infertility—if it isn’t treated in a timely manner. When symptoms do happen, they usually involve burning with urination or unusual discharge from the penis, vagina, or urethra. Men may also experience itching around the opening of the penis and, in rare cases, swollen or tender testicles. If the infection spreads to a woman’s fallopian tubes, it may cause lower abdominal or back pain, nausea, fever, pain during sex, or bleeding between periods. Like most STDs, chlamydia is especially dangerous in pregnant women, who may go into premature labor or pass the infection to their babies during childbirth; chlamydia is the most common cause of pneumonia and pinkeye in newborns. Chlamydia can be easily cured with antibiotics, either in a single dose given by your doctor, or in pills that you take twice a day for a week. Your sex partner(s) should also be tested and treated, if necessary, and you should wait until a week after the treatment is finished to have sex again.

Box of RID lice killing shampooCrabs, or pubic lice, are just what they sound like: an infestation of your pubic area by tiny bugs (phthirus pubis). Pubic lice are translucent and only about a millimeter long, so you wouldn’t be able to see this with the naked eye, but four of their six legs feature claws reminiscent of crab legs (the better to clutch your pubic hair with, my dear). You could even say these appendages make the term “crabs” more consistently accurate than “pubic lice,” since they’ve been known to roam pretty far afield of the pubic region—it’s even possible for them to inhabit your eyelashes. The most common symptom of crabs is itching, which may start immediately after contact, but may be delayed by as much as two to four weeks after the infestation kicks off. Some people’s skin also turns bluish-gray in the affected area, or scratching the bites produces small sores. Pubic lice can be treated with an over-the-counter shampoo containing permethrin or pyrethrin, such as Rid or Nix, but a prescription treatment will be stronger and possibly more effective. Either way, eliminating crabs requires a combination attack: kill adult lice by leaving the medicated shampoo on your skin for 10 minutes (or as long as indicated by the product instructions); remove eggs (nits) with a fine-toothed nit comb; and delouse potentially infested clothes, bedding, and other objects by either washing and drying them at a temperature of at least 130° F or sealing them in plastic bags for no less than 72 hours. Repeat as necessary. Your sexual partner should also be treated.

Genital warts are scarily common; at least 50% of sexually active people will contract the virus that causes them during their lifetimes. Most infected people won’t have visible warts most of the time, but the virus is contagious even in the absence of obvious symptoms. It’s also possible to be infected without realizing it, since it can take as long as a year for warts to appear for the first time. When they do show up, they look like small bumps the same color as the surrounding skin, sometimes with an uneven surface similar to cauliflower. Warts can be found almost anywhere in the genital region: on the vulva and perineum in women, as well as inside the vagina on the surface of the cervix; and on the penis, anus, and inside the urethra in men. Occasionally, they may also show up in and around an infected person’s mouth. During an outbreak of visible warts, the infected person will be more susceptible to other STDs, including the HIV virus. Pregnant women should always have visible warts removed so their babies can’t come in contact with them during delivery. But because outbreaks usually clear on their own, and removed warts are likely to come back, treating each individual wart is not always worth the trouble. In any case, over-the-counter wart removers should never be used on genital warts. Your doctor can recommend an in-office or prescription treatment, such as imiquimod, trichloroacetic acid, or removal by freezing, burning, or excision. None of these treatments will cure the underlying virus, which is usually eliminated by the immune system within two years. Condoms are always a good idea, but they provide imperfect protection against genital warts, which are better prevented by the Gardasil vaccine that offers immunity to the types of HPV that cause warts in addition to those associated with cervical cancer.

“Gram negative cocci in pus from eye,” 2011 Nathan Reading: http://www.flickr.com/photos/nathanreading/, used under a Creative Commons Attribution License.Gonorrhea bears some similarities to that other common bacterial STD, chlamydia. In fact, the two often travel together: 50% of women diagnosed with gonorrhea are found to also have chlamydia. Neisseria gonorrhoeae bacteria take up residence in the mouth, vagina, penis, and anus, and can therefore be transmitted through pretty much any type of sexual contact. Women often show no signs of infection, and in men, symptoms can take up to a month to appear. The most common symptoms include painful and more frequent urination, unusual discharge from the penis or vagina, and a red or swollen urethra. Men may also develop tenderness or swelling in their testicles, and women may experience pain or bleeding during sex. Gonorrhea can cause infertility in both men and women if it’s left untreated long enough to damage the inner workings of the testicles or invade the uterus and fallopian tubes. If it spreads to the bloodstream or joints, it can cause serious infections and sometimes death. Gonorrhea is treated with a combination of antibiotics: your doctor will inject you with a single dose of ceftriaxone and send you home with a week’s worth of azithromycin or doxycycline pills. Because drug-resistant strains of the bacteria are common, you should go back to your doctor if you’re still experiencing symptoms a few days after you finish the course of treatment.

You don’t actually have to come in contact with a sore to catch the virus that causes genital herpes. It can also be transmitted through contact with unblemished mucosal skin surfaces, sexual fluids, and saliva. In fact, because herpes is so often asymptomatic, most people catch it from someone whose genitals look perfectly healthy—someone who may not even know they’re infected. People who do experience herpes symptoms usually report pain or itching accompanied by small red bumps or white blisters that bleed or leak fluid when they break open. A herpes outbreak can appear anywhere in the genital or anal area, or around the mouth, and may cause other symptoms, such as pain with urination, fever, head and body aches, and swollen lymph nodes. The first outbreak, within two weeks after exposure to the virus, is usually the worst one in every way: the symptoms are especially intense and long-lasting, and this is the time when you’re most likely to pass the infection to another person. Once you’ve had one outbreak of herpes symptoms, it’s likely that you’ll have more, especially over the course of the first year. The virus could stay in your body forever, but the frequency and severity of your outbreaks will probably decrease over time. Your doctor may prescribe antiviral medication to shorten outbreaks in progress or as a daily suppressive therapy to prevent outbreaks and reduce the risk of transmitting the virus to your sexual partner. Condoms are also helpful in preventing the spread of herpes, but not foolproof, since the virus can be present in saliva or on skin not covered by a condom.

“AIDS awareness in Manica province,” 2007 by Ton Rulkens: http://www.flickr.com/photos/47108884@N07/, used under a Creative Commons Attribution-ShareAlike License.HIV/AIDS is, of course, the big bad. Even if you aren’t afraid of pregnancy or any of these other STDs, please let HIV scare you into using a condom. Because the virus is spread primarily through blood and sexual fluids, you can also prevent it by employing a dental dam during oral-vaginal sex, proactively treating any infection that causes sores on or around your genitals, and just saying no to any drug that would have to enter your body through a used needle. If you tend to engage in risky behaviors, you should probably have a conversation with your doctor about Truvada, a daily pill that’s FDA-approved for the prevention of HIV. If you do contract the virus, it will immediately set about destroying CD4 white blood cells that help your body fight disease. This will make you susceptible to cancers and infections that a healthy person would be able to brush off with relative ease. HIV officially becomes AIDS if your CD4 count falls below 200 cells per cubic millimeter. This can be delayed with self-care efforts like getting vaccinated on schedule, taking whey protein supplements, and eating healthy and properly cooked foods. You can also slow the progression to AIDS by starting to take antiviral drugs as soon as your CD4 count drops below 500, you get pregnant, or you develop Hepatitis B or HIV-related kidney disease. Doctors generally recommend that patients combine at least three drugs from two different classes to prevent the evolution of drug-resistant HIV. Most drugs work by either preventing the virus from making copies of itself or blocking its way into CD4 cells, and while they may very well save your life, they tend to come with deeply unpleasant side effects such as nausea, diarrhea, shortness of breath, bone weakness, and rashes. Drugs also can’t free you from worrying about passing the virus to your sexual partner or—during pregnancy, birth, or breastfeeding—your children.

Image credit: Amber Luck Ronning, 2012.Syphilis is a bacterial STD that can be hard to identify. Its trickiness stems from a combination of factors: it progresses in stages that can stretch across months or years, with symptom-free periods in between, and its symptoms sometimes resemble those of other, more common, infections. You can catch syphilis through direct contact with a syphilitic sore, known as a chancre, located on or around the genitals, anus, or mouth. Condoms are helpful in preventing syphilis, but they obviously can’t protect you from chancres located outside their range of coverage. If you do catch syphilis, you’ll start to experience the disease’s primary stage sometime between three days and three months after exposure. Primary syphilis can be subtle: its main symptom is a firm, round, painless chancre located in the area where the bacteria entered your body. This first sore will stick around for three to six weeks, then go away on its own if you don’t seek treatment for it. Secondary syphilis is characterized by skin rashes, often on the hands and feet, and/or gray or white raised lesions located on mucous membranes or in the armpit or groin areas. Secondary syphilis can also cause systemic symptoms like fever, sore throat, head and muscle aches, fatigue, and weight loss. If you ignore them long enough, these symptoms will resolve on their own and you’ll progress into the latent stage of syphilis, which has no symptoms and can last for up to 20 years. About 15% of people infected with the disease will ultimately experience the dangerous symptoms of its late stages, when internal organs and bones start to become damaged, and the results can be as dire as paralysis, blindness, dementia, or death. Once diagnosed, syphilis is easily cured; within the first year of infection, a single injection of long-acting benzathine penicillin G will wipe out the bacteria. After that, or if its unclear how long you’ve been infected, your doctor will administer the same antibiotic once a week for three weeks. If syphilis has done any lasting damage to your body, this treatment will not undo it, but it will keep symptoms from recurring and prevent future damage. Once you’ve been treated for syphilis, it is possible to catch it again later, so you should make sure your current sexual partners get tested, and abstain from sex until your chancres heal.

Trichomoniasis, like crabs, is an STD caused by parasites. Unlike crabs, these parasites (protozoans of the species Trichomonas vaginalis) live inside the body—in the urethra or, in women, sometimes the vagina. Only about 30% of people infected with trichomoniasis will have any symptoms, which can range from mild to severe and include itching, burning, and soreness, especially during urination. Some women may also experience bleeding after sex, and both men and women may note trichomoniasis’ signature symptom: thin, smelly, greenish discharge from the urethra or vagina. Condoms provide good protection against trichomoniasis, which is contagious even when it isn’t causing symptoms, and the infection can be easily treated with a single oral dose of antibiotics prescribed by a doctor. Your sex partner should also be treated to ensure that you won’t catch the infection again, and you should avoid sexual contact for about a week after treatment, until your symptoms are gone.

Effective Birth Control Methods

I’m sure I don’t have to tell you what a condom is, but I will anyway: it’s a latex, polyurethane, or lambskin sheath that fits over an erect penis to keep semen from entering the vagina during sex. And there’s a lot of variety out there, and you can get any kind of condoms you want from Amazon.It also prevents potentially STD-infected vaginal fluids from entering the tip of the penis. (Lambskin condoms, though, should not be relied on for STD prevention.) When used correctly and consistently, male condoms are 98% effective at preventing pregnancy. Used the imperfect way most of us do it, they’re 85% effective. Aside from offering some protection against STDs, condoms have the advantage of being convenient, widely available, relatively inexpensive, and generally free of side effects. Their main disadvantage, for some women anyway, is that they put most of the responsibility for birth control on the male partner. For women who aren’t comfortable with that, there’s the female condom: a synthetic latex sheath with a ring on each end that can be inserted into the vagina up to eight hours before sex. Female condoms are slightly less effective than male condoms at preventing pregnancy (they work about 80% of the time), but because they cover part of a woman’s labia, they offer enhanced protection against STDs.

“Diaphragm, Vaginal Contraceptive Sponges,” 2008 by Ryan Somma: http://www.flickr.com/photos/ideonexus/, used under a Creative Commons Attribution-ShareAlike License.Condoms fall into a category of contraceptives known as barriers, and the barrier family also includes diaphragms, cervical caps, and contraceptive sponges. These are inserted into the vagina before sex to block sperm from passing through the cervix and into the uterus, but because semen still enters the vagina, none of these barriers are any good against STDs. In fact, because they’re only effective if used with spermicide, which can cause vaginal irritation, using them frequently may slightly increase a woman’s risk of contracting or transmitting an STD. Diaphragms and cervical caps fit over the opening of the cervix and are only available with a prescription because they come in varying sizes and must be properly fitted by a doctor. The contraceptive sponge, a one-size-fits-all polyurethane foam disc containing spermicide, is available over the counter. All of these devices are, at best, 84% effective at preventing pregnancy, but their effectiveness is diminished in women who have given birth. In order to work at all, they have to be inserted into the vagina before sex and left in place for at least six hours afterward.

Hormonal contraception is one of the most familiar forms of birth control. It consists of synthetic hormones—delivered via pill, skin patch, vaginal ring, or injection—that prevent a woman from ovulating. Hormonal birth control comes with a long list of possible side effects, some unpleasant (mood swings, reduced sex drive, weight gain, increased risk of arterial blood clots) and some desirable (lighter and more regular periods, reduced menstrual cramps, clearer skin). Pills tend to cause fewer and less intense negative side effects than the other delivery methods, but because they can be forgotten or taken at inconsistent times during the day, they are often less effective. With perfect use, hormonal contraception prevents pregnancy 99% of the time.

Don’t get caught up in the controversy; the morning-after pill does not cause abortion. It actually contains the same synthetic hormone as some birth control pills and works the same way: by preventing ovulation. When taken within 72 hours of unprotected sex (or, say, a broken condom), it prevents pregnancy up to 89% of the time. In the United States, women over the age of 17 can buy emergency contraception, under the brand name Plan B One-Step, from a pharmacy without a prescription. If you’re under 17, you’ll need to see a doctor for a prescription. Your doctor may be willing to write you a prescription to have around just in case you need it in the future, so if condoms or another barrier is your primary birth control method, it can’t hurt to ask.

“Coils (IUD),” 2007 by Ryan Somma: http://www.flickr.com/photos/ideonexus/, used under a Creative Commons Attribution-ShareAlike License.An intrauterine device (IUD) is a small, t-shaped piece of plastic inserted into the uterus to prevent an egg from implanting or even being fertilized in the first place. There are two kinds of IUDs: Mirena releases a constant low dose of synthetic progesterone, and Paragard is wrapped with copper wire. Copper IUDs turn the uterus into a toxic environment for sperm, killing them before they ever reach an egg. Progesterone IUDs thicken cervical mucus to keep sperm from swimming freely toward an egg, and, in case that fails, also thin the lining of the uterus to make it more difficult for a fertilized egg to implant. An IUD can be inserted in a doctor’s office in just a few minutes, and then left in for years. The progesterone in Mirena loses its effectiveness after five years, but Paragard stays effective for up to 12 years.

The fertility awareness method (FAM), a.k.a. Natural Family Planning, isn’t for everyone. Not to be confused with the hardly scientific and dismally ineffective “rhythm method,” which erroneously assumes all women always ovulate on day 14 of their menstrual cycles, fertility awareness involves tracking a combination of signals a woman’s body offers to indicate that she is about to ovulate or has ovulated already, and either avoiding sex or using a barrier such as a condom on potentially fertile days. FAM is over 90% effective when done correctly, but that means giving it a few minutes of your attention every single day (to take your temperature before getting out of bed in the morning and check the consistency of your cervical fluid throughout the day) and having the willpower to abstain from sex or use backup birth control for a week or two of each month. With typical use, FAM is only about 75% effective, so it isn’t recommended for women who have a tendency to be lackadaisical about contraception. And because it doesn’t offer any protection against STDs, it’s not a good fit for women who aren’t in long-term, mutually monogamous relationships.

Male Sexual Dysfunction

Men can experience problems at any point in the sexual response cycle (desire, arousal, orgasm, then resolution), and the problems can take many forms. The three most common are erectile dysfunction, decreased libido, and ejaculation before or very soon after penetration. Any sexual issue that you or your partner finds bothersome is worth mentioning to your doctor, since male sexual dysfunction is generally treatable.

There’s a particularly impressive array of treatments available for erectile dysfunction, which is medically defined as a recurring inability to get and keep an erection that’s usable for intercourse. ED can stem from any number of factors, none of which imply insufficient manliness; stress, depression, hormonal imbalance, diabetes, heart disease and its risk factors, and frequent bicycling are among the common causes. Certain drugs, including antidepressants and blood pressure medications, count erectile dysfunction among their possible side effects, as do some of their more entertaining cousins: alcohol, cigarettes, cocaine, and heroin can all have a negative effect on your sexual performance.

“One day,” 2006 by Felix E. Guerrero: http://www.flickr.com/photos/loauc/, used under a Creative Commons Attribution-ShareAlike License.The least invasive treatments for ED involve lifestyle changes. For some men, weight loss or regular exercise may be enough to resolve the problem. Psychotherapy, counseling, or sex therapy can help you work through anxiety, depression, or stress that may be keeping you from focusing on sex. Alternative treatments like acupuncture may also be helpful. If these non-chemical approaches are ineffective or too slow for your taste, you’ll probably respond well to erectile dysfunction pills such as Viagra, Levitra, and Cialis. Another medication, alprostadil, can be inserted into the urethra in pellet form or injected directly into the penis (using a very small needle, guys, I’m sure of it) to allow the blood vessels to expand and produce an erection. If there’s a medical issue underlying your erectile dysfunction, testosterone replacement therapy or surgery to repair blocked or leaking blood vessels may correct the issue. In some cases, an external vacuum-assisted erection device or inflatable prosthesis implanted inside the penis is the best, most reliable option.

Whatever you do, don’t take the “herbal Viagra” you may have seen advertised on the internet or in certain gentlemen’s magazines. Its contents aren’t policed by the FDA, so it has the potential to bring on nasty side effects, interact badly with another medication you’re taking, or cause your blood pressure to dip to dangerously low levels.

Female Sexual Dysfunction

Female sexual dysfunction is a touchy subject in some circles. It’s often defined using male sexual function as a reference point, which sometimes means that perfectly normal aspects of female sexuality end up being pathologized. For instance, surveys suggest that up to 75% of women can’t consistently achieve orgasm through intercourse alone, but many women who are part of that majority assume there’s something wrong with them. Unlike many men, women also tend to require more than just physical stimulation to become aroused, so they’re more prone to occasional libido-related difficulties that are completely within the realm of normal. In cases like these, couples can often find workarounds that help them deal with the issue: Can’t reach orgasm during sex? Find out if there’s another way your partner can get you off, perhaps using his tongue, his hands, or a vibrator. Don’t feel sexy at the end of a day that included half a dozen diaper changes, a temper tantrum, and a deadline at work? Suggest that your partner fill the tub with bubbles, light a few candles, offer you a massage, and then try to seduce you, instead of just getting handsy when you collapse into bed. You may find that a little consideration of the physical and emotional differences between men and women goes a very long way.

Of course, none of this is meant to suggest that legitimate female sexual dysfunction doesn’t exist. It’s actually pretty common, although it isn’t always chronic; many women will have temporary problems during times of stress or while their hormones are reeling from pregnancy, childbirth, breastfeeding, or menopause. If you have a consistent sexual issue that upsets you or creates trouble within your relationship, or if sex is physically painful for you, you should definitely mention it to your doctor. Women’s sexual problems often have complex origins and may require a combination of treatments, but treatment is possible. A doctor may be able to make changes in your prescriptions to eliminate medications with sexual side effects, such as birth control pills, antidepressants, and blood pressure drugs. Or she may recommend that you begin treating an underlying disorder, such as anxiety or depression, that may be related to your sexual difficulties. Better stress management can have a positive effect on your sex life, and so can improved communication with your partner. Counseling or couples therapy may help you break down emotional barriers to physical intimacy. Some women find that natural strategies like regular exercise, a healthier diet, yoga, acupuncture, and meditation help clear their heads and make them feel sexier and more capable of orgasm.

There aren’t really any medical treatments designed specifically for female sexual dysfunction; most women’s sexual complaints can’t be cured by simply facilitating blood flow to the clitoris, so the pharmaceutical industry’s frantic search for a “female Viagra” has been basically fruitless. However, treatments do exist for specific physical issues that underlie some cases of female sexual dysfunction. Vaginal dryness can be combated by using lubricant every time you have sex, applying a vaginal moisturizer several times a week, or regularly inserting a low dose of estrogen into the vagina via cream, ring, or dissolving tablet. If sex is painful for you, vaginal dilators or pelvic floor physical therapy may help to stretch your vaginal muscles or resolve involuntary muscle spasms associated with vaginismus.