Pillow Talk

by Tracy Austin, M.D.

Turn on the television or radio today and there’s no shortage of sexual commentary or new sex scandals. Channels like HBO and FX feature sexual content so graphic that they are required to run warnings before episodes, and “Angels” rolling around in bed in their underwear figure prominently on Victoria’s Secret commercials. But in a country so inundated with sexual imagery, there’s a surprising lack of knowledge about how to keep ourselves sexually healthy.

A few months ago, a friend of mine, a fellow physician, shared a story about a guy she briefly dated. “We were hanging out at his house and things started to get pretty serious. We were kissing and he started to unbutton my jeans, but I stopped him. I decided to pump the brakes and ask him some questions. I asked him how many people he’d been with and if he’d ever had an STD.” She paused, and we both smiled, taking a sip of wine. “I know it was kind of killing the mood. But girl, can you believe he looked at me all puzzled and said, ‘Why do you want to know about that?’ ”

Think of indiscriminate sexual practices and misinformation, and more than likely, it’s teenagers that come to mind. But I hear friends, acquaintances― people of all ages―use phrases like “hooking up” and “friends with benefits” all the time. And there are no academic or gender boundaries. During one conversation, an Ivy-league graduate, who described himself as “celibate,” tried to argue that oral sex is not actually sex. I later learned that he recently had a sexually transmitted disease (STD), which he explained as his “ex-girlfriend’s fault.” And once, as I performed a pap smear on a 19 year old, she nonchalantly informed me that she was sleeping with two different guys, and not consistently using condoms. She said that the guys did not inquire about her sexual practices or if she was even on birth control. When I asked her about whether the guys were currently sleeping with other women or if they regularly got STD testing, she admitted to not knowing. I continued her examination, when she added in an uncertain tone, almost as if she was seeking affirmation from me, “I don’t think it’s any of my business who else they’re sleeping with. I mean, neither one of them is my boyfriend.”

This may seem shocking to some, but I can assure you that it is not uncommon. Many men and women have adopted an “ignorance is bliss” mindset about sex. There are many reasons and much psychology behind this. My intention is not to delve into the psychology, but to offer the best advice I can about sexual health. Because ultimately, I don’t care how hot the other person is, nobody has a “body to die for.”

According to the Centers for Disease Control and Prevention (CDC), STDs are on the rise. There’s been much in the news lately about herpes, HPV, and HIV, but even diseases like syphilis, once on the verge of elimination, are on the rise. Many people believe they’re immune to these diseases. They think there’s an injection or pill for anything. I’ve even heard more than one person comment that they don’t even worry about HIV because drugs “can make you live a lot longer than before.” These kinds of beliefs are very dangerous. It leads to a lot of needless suffering and stigma. I know women who have passed painful and unsightly genital warts onto their babies, men who have developed genital scarring, and countless people who are terrified about having to explain to their significant other that they have an STD that may “pop up” in the future.

It’s really unfortunate that so many people compromise their sexual health. But fortunately, I also meet people who embrace responsible sexuality. And now, if you haven’t, I’d like you to make that same commitment. Here are 5 important steps you can take right now to protect your sexual health:

1. If you don’t have some standards, get some. I’m not saying this to be rude or judgmental, but you need to take a good, hard look at the physical or emotional toll your sexual practices could take. Actions have consequences, and now is the time to decide what type of risk you are comfortable taking, and what type you aren’t. Get some standards, stick to them, and ditch anyone that tries to get you to act contrary to your standards. You, and only you, are in control of your sexual health.

2. Talk about safe sex and your expectations before the “heat of the moment.” Like the patient I mentioned before, many people, for whatever reason, do not discuss sex and birth control with their partner(s). I don’t care if you’re engaged in a monogamous relationship, a random hook-up, or a “friends with benefits” situation, you have to discuss sexual history (previous or current infections), sexual expectations (whether your relationship is monogamous), and means of protection/contraception. If you feel like you can’t discuss these things with your partner(s) or if your partner gets upset about you asking questions, then my next suggestion is very simple―do not have sex with them.

3. Use protection. Do not rely solely on what someone tells you about their sexual past or present. The reality is people lie, for various reasons. Also, some sexual diseases may lie dormant or show no symptoms in one partner, meaning they could possibly pass on an infection without even knowing it. So, don’t give someone else control over your health. No matter the type of sex (oral, vaginal, or anal), use protection. And protection extends to asking someone to be tested for STDs before having sex with them.

4. Make sexual health a priority. Men and women should be regularly visiting their doctors for STD testing and wellness exams. And because of STDs like HPV, the leading cause of cervical cancer, women should be visiting their physicians for regular pap smears, and inquiring about preventive measures like the HPV vaccine Gardasil, as well as birth control.

5. Be prepared for a sex emergency. I like to ask my patients if they’ve discussed what they would do in case of a sexual emergency. I actually had one patient answer, “Well, usually we try to wait until we get home. But if we want to do it that badly, we just find an empty room somewhere.” Unfortunately, that’s not what I’m referring to. A sexual emergency means things like unplanned pregnancy or STD infection. It takes two to tango. So, men and women are both responsible in the event of a sexual emergency. You and your partner should have a plan in place in case of failed contraception, failed protection, and/or infection. If you don’t know what you would do, you need to hold off on sex.

Indeed, sex is a serious thing―but it can be wonderful, too. So if you’ve chosen to experience it, I also want you to make a personal decision to become more educated about your sexual health. No matter what anyone tells you, you’re not “killing the mood.” You’re bringing sexy back. Because sexual health is what's hot.