Opening Up: A Guide to Creating and Sustaining Open Relationships (37 page)

If a toy is made of a nonporous material like silicone, acrylic, glass,
or metal, you can also cover it with a condom, or you can disinfect it
before using it in a different orifice or with another partner. Silicone
toys can be cleaned with hot water and antibacterial soap, a sex toy
cleaner, or a diluted bleach solution (10:1 water-to-bleach); they can
also be boiled for 5-10 minutes or put in the top rack of the dishwasher without detergent. Acrylic and glass toys can be cleaned with
soap and water or the diluted bleach solution, and alcohol can be used
on glass but not acrylic; always dry acrylic toys with a soft cloth, as
paper towels can scratch them. For toys made of metal or other nonporous materials, follow the manufacturer's instructions for cleaning.

All sexually active people should get medical checkups and genital
exams (and for women, pelvic exams and Pap tests) on a regular basis.
If you suspect you have an STI or you experience any unusual symptoms-bumps, rashes, sores, persistent itching, irritation, abdominal
or pelvic pain, burning or pain during urination, any unusual discharge, irregular bleeding or cramping, or discomfort or pain during
sex-you should see a doctor as soon as possible. Many STIs may occur
without any symptoms at all and can only be detected through medical
exams and laboratory tests. Most STIs can be treated and cured fairly easily with antibiotics or managed with other medications if they are
caught in their early stages. Untreated STIs can lead to more serious
complications, including sterility and cancer, so please take care of
yourself. The information in this section should be used only as a
guideline and is not a substitute for the advice of a doctor.

It is crucial that you find a health care professional you respect,
trust, and feel comfortable talking to about your sexual health and
practices. Many people feel embarrassed talking about health concerns, especially when it comes to their sexual health, but you need to
be able to speak candidly about your symptoms and sexual practices
to give your health care provider all the information needed to make a
proper diagnosis.

In the discussion below about the transmission of STIs, I use the
following terms for various forms of unprotected sex (sex without a
safer sex barrier):

• Rubbing: manual external stimulation with fingers, without
penetration, without a glove

• Fingering: vaginal or anal penetration with a finger or fingers,
without a glove

• Oral sex: cunnilingus, fellatio, or analingus, without a barrier

• Vaginal intercourse: vaginal penetration with a penis, without
a condom, with or without ejaculation

• Anal intercourse: anal penetration with a penis, without a
condom, with or without ejaculation

• Sharing sex toys: transferring a sex toy from an infected
person's orifice to another person's orifice without putting a
condom on it or disinfecting it first

Chlamydia is a sexually transmitted bacterial infection and the most
common STI in the United States; it is estimated that there are 3 million cases every year. Chlamydia is found in semen, vaginal fluids, and secretions from the cervix. It can infect the vagina, urethra, cervix,
anus, penis, eyes, or throat. It can be spread through vaginal and anal
intercourse and oral sex, and more rarely from hand to eye, by sharing
sex toys, or through rubbing and fingering if there are cuts in the skin.

Seventy-five percent of women and 50 percent of men with
Chlamydia have no symptoms. If they do occur, symptoms can begin
from five days to a few weeks after infection. In women, common
symptoms include vaginal discharge, abdominal or stomach pain,
painful penetration or urination, "breakthrough" menstrual bleeding
(between periods), bowel movement discomfort, fever, swelling and
soreness of the lymph nodes, and vaginal or rectal bleeding. Men may
experience penile discharge, pain or burning during urination, and
swelling and tenderness in the testicles or rectum. In cases of throat
Chlamydia-most often passed to the partner who performs fellatioyou may develop a sore throat. Chlamydia is diagnosed by genital,
pelvic, or rectal exam and treated with antibiotics such as doxycycline
or azithromycin. If left untreated, Chlamydia can cause other serious
problems, including pelvic inflammatory disease (PID) and infertility
in men and women.'

Gonorrhea is a bacterial infection transmitted through various types of
sexual contact, including vaginal and anal intercourse and oral sex,
and less frequently by sharing sex toys and rubbing or fingering if
there are cuts in the skin. Gonorrhea affects about 650,000 Americans
every year. Approximately 75 percent of all reported cases are found in
people aged 15 to 29. Gonorrhea is found in semen, vaginal fluids, and
secretions from the cervix and can infect the vagina, urethra, cervix,
anus, penis, or throat.

Up to 80 percent of women and about 10 percent of men who
have gonorrhea have no symptoms; women are more likely to be
asymptomatic in cases of rectal and throat gonorrhea than with vaginal gonorrhea. Symptoms appear within three to seven days of exposure
and include, for men, penile discharge, pain or burning during urination, frequent urination, and rectal pain and discharge if gonorrhea is
present in the rectum. Women may experience symptoms similar to those
of Chlamydia: vaginal discharge, abdominal or stomach pain, vomiting,
painful penetration or urination, "breakthrough" menstrual bleeding
(between periods) or other irregularities with their period, fever, swelling and soreness of the vulva, and vaginal or rectal bleeding. Gonorrhea
is diagnosed via a sample of urine, discharge, or cells from genital
tissue and is treated with antibiotics, including penicillin, tetracycline,
and ceftriaxone. Untreated gonorrhea can lead to ectopic pregnancy,
pelvic inflammatory disease, and infertility in men and women.

There are more than 100 types of the human papillomavirus (HPV),
and more than 40 different strains can be sexually transmitted, affecting the vulva, vagina, cervix, penis, scrotum, anus, and rectum. Some
strains of HPV are low risk, do not cause symptoms, and do not require
treatment. Some strains cause genital warts, which are treatable. Highrisk strains of HPV can cause abnormal cell growth, which may lead to
cervical cancer in women and anal cancer in men and women.

According to Planned Parenthood, "At any time about 20 million
people in the US have [genital HVP infections]. Between 10 and 15
million have high-risk types that are associated with cervical cancer.
HPV is so common that about three out of four people have HPV at
some point in their lives." The most common way to spread HPV is
through vaginal and anal intercourse, but it can also be spread through
rubbing, fingering, oral sex, or by sharing sex toys. Condoms protect
against HPV, but because HPV may be present in skin that is not
covered by a condom, gloves and dental dams should also be used.

When an HPV strain manifests as genital warts, warts can appear
in as little as three weeks or as much as six months after infection. The warts begin as small pink bumps that look like tiny cauliflower florets
in or around the genitals; they tend to spread rapidly, forming clumps
that may be itchy or painful. Their incubation period is usually one to
six months, but they can grow more rapidly if you are pregnant or
have a compromised immune system. A person with HPV may have no
external symptoms at all; in these cases, a physician will be able to see
them during a genital, pelvic, or rectal exam. Some genital warts go
away on their own. Or they can be removed by applying chemicals
(usually acids), burning with an electric needle (electrocautery), freezing with liquid nitrogen (cryotherapy), or with laser treatment. Even
after visible warts are removed, HPV remains in your body, and the
warts can recur.

To test for high-risk strains of HPV that may cause precancerous
or cancerous cells on the cervix, women can have a pelvic exam and a
vaginal Pap smear (a swab of cells sent to a laboratory for analysis).
The Pap test can detect abnormal cell changes; if the Pap results come
back abnormal, the woman should have the cells tested specifically for
the HPV virus. If the HPV virus is detected, doctors often perform a
colposcopy to get a closer look at the cells before deciding on a treatment plan.

Men who contract HPV may develop genital warts or show no
symptoms, remaining carriers of the virus who can pass it on to their
partners. Men can be tested for HPV with a penile cell smear. At least
one strain of HPV has been linked to cancer of the penis, which is very
rare in the United States.

HPV is much more likely to cause precancerous or cancerous cells
in the cervix than in the rectum; however, HPV can also occur in the
rectums of both men and women and can lead to anal cancer. Men and
women can be tested for rectal HPV with a rectal exam and an anal Pap
smear. HPV can be spread from a woman's ass to her vagina, and vice
versa, so if it has been discovered in one place, you're advised to get
the other orifice checked.

Persons diagnosed with a high-risk strain of HPV should get regular exams to monitor recurrences and prevent complications.
Depending on the strain, the part of the body where HPV is found, and
the severity of cellular changes, precancerous cells may be removed by
cryotherapy, laser treatment, or a loop electrosurgical excision procedure
(LEEP).2

In 2006, a vaccine for girls and women was released that can
prevent four strains of HPV: two strains account for 90 percent of cases
of genital warts and two account for 70 percent of cervical cancer
cases. The vaccine, currently marketed under the name Gardasil, is
recommended by the FDA for girls and women aged 9-26. However,
women over 26 who have not been exposed to all strains of HPV can
also benefit from the vaccine. Several drug companies are conducting
clinical trials on the vaccination of boys and men.

Herpes simplex virus type 1 (HSV-1) is the virus that usually causes
oral herpes, found in an estimated 50-80 percent of the US population. According to Planned Parenthood, about 25 percent of American
adults have herpes simplex virus type 2 (HSV-2), the virus that usually
causes genital herpes. Genital herpes is transmitted through sexual
contact, including vaginal and anal intercourse and oral sex, and, less
commonly, rubbing or fingering with cuts in the skin and sharing sex
toys. The virus can be transmitted by skin-to-skin contact if one
person is currently having an outbreak or during a period known as
"asymptomatic shedding," when the person has no symptoms but is
still infectious. Condoms and dental dams can help reduce the risk;
however, if a sore is present on a part of the body not covered by the
condom or dam, the virus can still be spread.

When a person first contracts genital herpes, there may be few or
no noticeable symptoms. If symptoms develop (usually within 2-20
days after infection, but as late as several years afterward), the initial outbreak is often worse than subsequent outbreaks. The person may
experience a tingly or burning sensation in the genital area; then
bumps, blisters, or open sores appear in the affected area, which can
be itchy, sore, or painful. Women may experience flulike symptoms,
swollen glands or lymph nodes, a vaginal discharge or yeast infection,
and painful urination. Initial sores usually heal in one to three weeks
without treatment.

Once you become infected with the herpes virus, you have the
antibodies in your system and cannot be reinfected in the part of your
body where you were previously infected; however, though is much
less common after the initial outbreak, you can be infected in other
areas. So, if you've only had outbreaks in or around your vagina, you
can still spread genital herpes to other parts of your body by having
unprotected sex with another herpes carrier.

Herpes is a chronic infection, and symptoms can recur during
outbreaks. These outbreaks can be brought on by stress, a compromised immune system, or prolonged exposure to the sun; they can last
for up to three weeks. During an outbreak, most experts recommend
that you refrain from oral sex and intercourse, even with a barrier.
Although a person is most contagious during an outbreak, transmission of the virus can occur during inactive periods as well (especially
during the two weeks after an outbreak), with or without visible blisters or other symptoms. Doctors prescribe medications such as acyclovir,
famiciclovir, or valacyclovir to both treat and prevent outbreaks, but
there is no cure for genital herpes.'

People who have multiple sex partners must be aware of certain
daunting aspects of genital herpes. If you have a cold sore caused by
type 1 herpes and perform cunnilingus on your partner, she can
develop type 2 genital herpes." People with herpes can be symptomfree for quite some time, believing they are free of the virus, yet still
pass it on to others. People with herpes often assume that they're not
contagious if they aren't having an outbreak, but they are actually contagious. If a potential partner is symptom-free, you have no way of
knowing they have genital herpes unless they tell you. Even if you
always use condoms, you can still give genital herpes to someone or
get it from them.

In the US fewer than 40,000 cases of syphilis are reported each year.
Syphilis is a bacterial infection that is transmitted by touching a sore
on an infected person; sores can appear on the mouth, penis, vagina,
anus, or skin. You can spread it through vaginal and anal intercourse,
oral sex, rubbing or fingering (especially but not exclusively if there are
cuts in the skin) and very rarely, by sharing sex toys.

Syphilis has an incubation period of two to eight weeks. Ten to
90 days after exposure, infected persons experience the primary stage
of the virus. A round ulcer (called a chancre) erupts in the affected
area, usually where the bacteria entered the body; common locations
are the vulva, labia, foreskin, scrotum, or the base of the penis. Sores
may also appear on the cervix, tongue, lips, and other areas. The chancre and surrounding area may ache or burn-or not. The infected
person may have swollen lymph nodes.