All posts by jmascari

Puzzled BC-Taker: On birth control

Dear Sexpert,

I’ve been dating my partner for over a year now, but I fear things are not going well, and we are likely close to the end of our relationship. A couple of months into dating, I decided I was ready to begin being sexually active, and I started using birth control pills. My body seems to have adapted well to them, but I am unsure if I should continue using them if my partner and I break up. I’m afraid that if I keep taking them, others will assume it’s because I have already moved on and that I’m seeing other people. What should I do? If I stop taking them, what should I expect? 

— Puzzled BC-taker

Dear Puzzled BC-taker, 

I am sorry to hear that your relationship might be nearing its end. I hope you and your partner ultimately make the decision that is right for you, and if you do break up, do so respectfully.

Regarding your birth control dilemma: birth control pills, also referred to as oral contraceptives, are a reliable, easily reversed form of contraception, but they can also be used for various reasons beyond pregnancy prevention. Oral contraceptives are generally a combination of the hormones estrogen and progestin — two hormones necessary for the sexual development of the female and for the regulation of the menstrual cycle. Consistently taking birth control pills is a reliable form of contraception and can be easily reversed. 

Each different type of birth control pill has a unique dosage of estrogen and progestin. Those with both the hormones estrogen and progestin are known as combination pills. Combination oral contraceptives can be used to treat hormone-related health issues, such as acne, severe menstrual cramps (also known as dysmenorrhea), and irregular menstrual cycles. Birth control pills may even be prescribed to help relieve endometriosis symptoms, a condition during which the tissue that lines the uterus grows outside of it. There are also pills that only contain progestin, colloquially known as “mini-pills.”

Using oral contraceptives can have several benefits besides their main purpose, such as the lessened probability of developing cysts in the breasts and ovaries, and of developing endometrial and ovarian cancers. Of course, this depends on the person and type of combination pill used.  

Evidently, there are several reasons why someone might use oral contraceptives. Nonetheless, there can be a stigma regarding contraceptive use, so your concerns about the assumptions someone may make are completely valid. However, you know your body better than anyone else, and thus should not be afraid of what others may think of your health-related decisions. Of course, that is easier said than done.

The main thing you should consider is your well-being: What would make you feel the most comfortable? If you are not looking to become pregnant, continuing to take birth control may keep your mind at ease. It is important to note that you can become pregnant immediately after you discontinue taking regular or low-dose oral contraceptives, so consider whether you may engage in vaginal sex in the near future before stopping your regimen. Given that oral contraceptives are easily reversible, you can resume taking them at any point (before their expiration date) after stopping, but they may not be effective at preventing pregnancy immediately. Depending on the type of pill, they may become effective only after seven days of usage. If you plan to have vaginal sex, also use a barrier method, like an internal or external condom, to prevent pregnancy.

Something else you should consider before you discontinue taking birth control pills is whether there are additional benefits of using oral contraceptives and how they affect your current lifestyle. Perhaps you are experiencing a lighter menstruation flow and less cramping, which may be a relief, especially in a high-stress environment where you have less time to rest during the day. Ultimately, it is your decision, but those are two factors to consider. 

If you do decide to stop taking the pill, you should expect your menstruation cycle to return to how it was before birth control. This might mean your menstruation flow will become heavier, and you will have more cramping. It might also take a couple of months for your hormone levels to balance themselves, and this readjustment phase may lead to irregular periods. Fortunately, this readjustment phase is based on how long you were on birth control and may last less than three months.

Before making a final decision, it may be helpful to speak with your healthcare provider, or a Sexual Health and Wellness clinician at UHS, to weigh the pros and cons and consider an alternative contraceptive form — for example, an intrauterine device, patch, or hormonal shot. If you would like more guidance but do not feel ready to speak with a professional quite yet, you can schedule a Wellness Chat with a Peer Health Adviser to explore resources and create an “action plan.” Regardless of your decision, remember that there are many resources available to you on campus if you want to talk through your options or simply to have someone listen. 

Sincerely,
The Sexpert 

Information in this article is from MayoClinic, Go Ask Alice Columbia University, Planned Parenthood, and Psychology Today.

Summer Fling Seeker: Maintaining sexual health during the summer

Dear Sexpert,

I’ve been using McCosh’s services to remain diligent about my sexual health and have gotten used to the easy, accessible resources on campus. I’m going home for the summer in a few weeks, and I am worried about accessing resources at home, especially without my parents knowing about it. My home state is also extremely strict about abortions, and while I don’t plan to get pregnant, unwanted pregnancies could still happen and I’m not in a place to have a child right now. I could use some guidance regarding this matter.

Sincerely,
Summer Fling Seeker

Dear Summer Fling Seeker, 

Planning ahead and being cautious are certainly important goals! If you intend to be sexually active this summer — especially if you are engaging with new or multiple sexual partners, it is a good idea to have a plan in place to continue practicing safer sex. It’s also great that you’ve been able to take advantage of the services at McCosh while on campus. If you already have a provider at McCosh who you are comfortable with, you can message your provider through your MyUHS portal with non-urgent questions throughout the summer. They may also assist in getting you connected to resources near you. However, this should not be used for urgent or immediate care concerns or services.

If you are not connected with a care provider at home, Planned Parenthood has clinical locations across most of the United States. These clinics offer sexually-transmitted infection (STI) testing, contraception, physical examinations, consultations, pregnancy testing and prenatal services, abortion care, and sex education. Your local pharmacy may also offer consultations, evaluations, STI and pregnancy testing, and vaccinations or treatments, as needed. 

You note being concerned about unwanted pregnancies. If you do not have a consistent or reliable contraception method, consider making an appointment at McCosh with Sexual Health and Wellness (SHAW) to explore your options before your departure from campus. There are a ton of different methods — hormonal, non-hormonal, daily use, or ones that last years once inserted. Remember that external and internal condoms also prevent STIs, in addition to pregnancy.

Even with these options, no method  is 100 percent foolproof, other than abstinence. Should you suspect a pregnancy, it can be more cost efficient to get a test at a Planned Parenthood location (since they accept insurance or offer a sliding scale fee, if paying out-of-pocket) than to pick up an at-home testing at a pharmacy. But at-home testing does ensure more privacy. Just keep in mind that if you are on your family’s insurance plan and use it, an explanation of benefits (EOB) may be mailed to the policy holder. Learn about some strategies to navigate this.

If you find yourself pregnant and want to explore your options, you may want to learn more about state laws and restrictions (e.g., ultrasound and waiting period requirement, parental consent or notification) to know more about your options, including what you could expect at a provider’s office. You can also look to any of these resources for supportive talk or text lines regarding options to navigate pregnancy. Additionally, Hey Jane is a startup that connects menstruating people to healthcare providers who can educate and prescribe contraceptives and abortion medication. This company caters to those who are less than 10 weeks pregnant and over 18 years old, and in the states Calif., Colo., Conn., Ill., Md., N.J., N.M., N.Y. and Wash. (which may not be applicable to your situation). This service is private and will work with you to financially support your decision. Plan C is another resource that has up-to-date information about accessing at-home abortion pills. More than 54% of abortions in the United States are medication abortions, and they are often chosen over surgical abortions because of the desire for privacy.

Taking preventive measures to maintain your sexual health is incredibly important for your overall well-being, as well as to avoid STIs and unwanted pregnancies. Using condoms and other forms of contraception are the easiest ways to stay diligent about this, but the only way to definitively prevent STIs and unwanted pregnancies is practicing abstinence. If you choose to be sexually active, make sure you are on top of your self-protective behaviors, know your options, and can get connected to care. 

Stay safe,

The Sexpert

Information for this article is provided by the Guttmacher Institute, Plan C, Hey Jane, Bedsider and Reproductive Rights.

Sincere Survivor: Finding Intimacy After Trauma

Content warning: The following column contains references to sexual assault. If you or a friend have experienced sexual misconduct and are in need of assistance, Princeton has a number of resources that may be of use. You can also reach SHARE, Princeton’s Sexual Harassment/Assault Advising, Resources and Education service at 609-258-3310. 

Dear Sexpert, 

I feel safe and respected by my partner, but my past experience with sexual assault has made it so that I have trouble focusing during sex. I find it pleasurable, but I cannot orgasm. I have disclosed to my partner that I am a survivor, and they’ve been understanding and patient. Lately, I’ve been feeling pressure from them to orgasm, but I don’t want to fake it. Just because I don’t reach an orgasm doesn’t mean that I’m not enjoying being intimate with them. I’m so confused.   

— Sincere Survivor

Dear Sincere Survivor, 

Dealing with intimacy can be a delicate topic in any case, not only between you and your partner, but for yourself as well. Layering on the complex feelings, both physical and emotional, experienced by many survivors rarely makes things simpler. Navigating intimacy after assault, harassment, or other harm can be a confusing and variable process, as you’ve observed, but it’s not one you are alone in. Many people have explored and shared what has been helpful for them, which we will discuss a bit here, but at the same time, only you can decide what does and doesn’t work for your body, mind, and desires. 

Sex and sexual assault are not the same things, and it can take time for your body and mind to understand the different experiences and sensations since the trauma caused by an assault can actually change the way your brain reacts or how it associates sex. It is possible that you might feel ready to move on from your assault in one moment and experience flashbacks or activations in another, making it seem like you’ve taken a step back in your healing journey. No one’s experience is the same, but it is not uncommon for survivors of sexual assault to dissociate (which is often described as feeling detached from one’s body) during sex when activated by a smell, sound, touch, etc. This can make it challenging to experience or focus on pleasure. 

One helpful approach, if you would like to try it, might be to focus on solo sex or masturbation. It can also help you to reclaim your body on your terms and under your control. This can be a great way to explore your likes, dislikes, and activations without the pressure of another person’s timeline or expectations. You can even document activations, body sensations, and emotions that you experience during solo sex, so you can find what is pleasurable and safe for you.

When talking about the idea of pleasure vs. orgasm, a common shorthand is to use these terms interchangeably. This association supports a checklist-oriented mentality, which can contribute to individuals putting their sexual goals (i.e., orgasm) above others’, and supports an attitude that may uphold violence. For most people, it is possible — and not atypical — to experience pleasure during intimacy without reaching orgasm. However, this “pleasure equals orgasm” shorthand can often result in pressure to reach orgasm during sex. In your case, it sounds like you are feeling pressure to orgasm from your partner. This may come from a variety of causes — perhaps they themself have the desire to orgasm frequently and assume you have a similar one, or perhaps they worry that the joint sexual experiences aren’t bringing you pleasure at all, or it could be something else entirely. You might currently have some insight into their thought process, but gaining clarification on their thinking may be helpful for your confusion and could give you an opportunity to share your own thoughts too. 

Communicating with your partner, whether it be verbal and independent from intimate moments or any other situation which you deem fit, is an important step towards not only creating a stronger relationship but in making sure that your voice is heard. Find a time and place to chat where you both feel comfortable in sharing your perspectives and conveying your boundaries. For example, you could let them know that you really enjoy having sex with them and want to continue doing so while taking your own orgasm out of the equation, or you could start by asking if they have any concerns regarding your mutual sex life. It’s completely normal, no matter how close you and your partner may be, to have boundaries during intimacy. Identifying and communicating your boundaries and expectations to your partner and hearing about theirs is an essential, though not always easy, step in any sexual relationship, but it may be particularly relevant for yours. 

This can be a very challenging, stressful, and delicate topic, but there are many resources available to help you through it. Some resources are intended to be long-term, while others are shorter-term and often more immediate. Likewise, some resources are confidential, and others are private – both of which you may find useful when you are preparing for your conversation with your partner and afterward. If you are looking for more professionally-oriented support, consider connecting with clinicians in the SHARE office or Counseling and Psychological Services (CPS) (confidential), or chaplains in the Office of Religious Life (confidential). SHARE Peers or Peer Health Advisers (private, non-confidential) may be an option if you feel more comfortable speaking with peers. (Note: SHARE Peers are only non-confidential because they let the SHARE office know that you spoke with them. You can request that the SHARE Peer keep your identity anonymous, and just the general details will be shared.) For off-campus options, you could connect with Womanspace, a support and counseling resource that serves all survivors and their families in Mercer County. It is normal to feel anxious when accessing new resources or even talking to friends about this challenging topic.

I hope you know that whatever you are feeling is valid and that you are worthy of comfort, support, and safety. Hopefully, this information can help make intimacy with your partner enjoyable, both for you and them, and take off the pressure of orgasming. Remember that we are all here to support you. 

Sincerely,  
The Sexpert

Scared Spouter: Vaginal Discharge 101

My boyfriend and I had sexual intercourse for the first time. We used a condom, and 1 day after I showered I saw that a bit of sperm-looking liquid was coming out of my vagina, but I don’t know whether it was discharge or sperm. It was only a little bit, and it didn’t smell at all.

Scared Spouter

Dear Scared Spouter , 

Vaginal discharge is a topic that is often overlooked and underdiscussed, especially when it comes to sex, so I’m happy to give you some more information. Discharge, also known as “cervical mucus,” or secretions from the vagina, occurs as a natural part of the vagina’s “self-cleaning” process and serves, in part, to remove dead cells and bacteria from the vagina. As you have probably noticed, the amount and type of discharge you have can change throughout your menstrual cycle. Typically, you may notice that your discharge is tinted brown or red towards the end of your period, clear, stretchy, and fairly thin during ovulation (about halfway through your cycle), and more white or creamy during the other times of your cycle. This is most likely the discharge you noticed after having sex with your boyfriend. This type of discharge is normal and healthy, especially if it has a mild (or no) odor, doesn’t have any chunks, and doesn’t cause your vagina any discomfort. During arousal, whether through masturbation or partnered sex, you probably notice more “arousal fluid” coming out of your vagina, which may be clear or white. This is simply to provide extra lubrication to your vagina, to make penetration (by a toy, finger, penis, etc.) more comfortable. Many folks don’t find this secretion to be enough lubrication on its own, so adding lube is always helpful!

In general, if you notice a strong or unpleasant odor, a chunky consistency, or discomfort — such as pain, itching, or burning — associated with your vaginal discharge, this could be a sign of a bacterial or yeast infection, and would be cause for consulting  your sexual healthcare provider. These infections often have causes other than sexual transmission, including the use of antibiotics or estrogen-based birth control, especially if you are consistent about practicing safer sex. 

I’m glad to hear that you and your boyfriend are practicing safer sex by using a condom – that’s helpful even if you are monogamous or if you use a non-barrier method form of birth control. The best way to prevent both pregnancy and the spread of a sexually transmitted infection (STI) is the use of a contraceptive, such as a birth control pill, intrauterine device or vaginal ring and a barrier method, such as an external or internal condom. Condoms are an effective barrier method when used properly — checking the expiration date and making sure the condom packaging isn’t compromised can offer peace of mind as well as bolster protection against pregnancy and STIs. As long as your boyfriend wore a condom while ejaculating, there is almost no chance that any sperm entered your body. It is much more likely that the discharge you noticed was just natural vaginal discharge. Since the purpose of vaginal discharge is to clean the vagina, it’s consistency or color can change after sex, even if no semen — the fluid that carries sperm — entered the body. If any type of lubricant or spermicide was used, whether from the condom or from a bottle, it could cause a change in your discharge while your vagina cleans itself out. This could be why you noticed a possibly unfamiliar type of vaginal discharge after having sex. 

Finally, it is completely understandable to feel nervous about pregnancy or STIs even when you know that semen couldn’t have entered your vagina, especially if you are newly sexually active. The prospect of pregnancy and STIs can be  scary, and it can take time to become confident in your contraceptive / protection methods, even if you know logically that they are effective.

If you have further questions or want to learn more about sexual or reproductive health in general, you can make an appointment online with a sexual health provider through MyUHS.

Sincerely,

The Sexpert

Information for this article was obtained from Scarleteen, Cleveland Clinic and Mayo Clinic.

Date Dreamer: Finding love in college

Dear Date Dreamer,

Starting college opens you up to so many opportunities to try new things and meet interesting people, so it can be quite an exciting time! The possibility of exploring a romantic relationship adds another layer of emotions and questions about what to expect in this new environment. Perhaps you are excited about opening yourself up to your first romantic relationship, or maybe you dated in high school and want to see what college has to offer. Whatever the case, when entering this opportunity-filled environment and thinking about all the new people you are going to meet, it’s understandable that you might think about meeting someone you could eventually marry. 

It’s great that you are taking some time to think about approaching relationships before entering one, because it gives you space to think about what you want. You may be coming in with a whole set of expectations for dating and finding a partner with whom you can have the perfect relationship (i.e., free of conflict and effortless, etc.). After all, these kinds of relationships are shown in TV shows, movies, and social media all the time. You may have even had your relatives ask about your love life and make assumptions about things. This can cause you to put some pressure on yourself and bring on feelings of anxiety on what your relationships should look like or might make you feel that looking for a partner and getting married should be your priority.

Unfortunately, it can also feel like if your first relationship in college isn’t perfect, then maybe you never will get your “happily ever after.” Realistically though, there are many ways and places to find a long-term partner, and college is just one possibility. 

That is not to say that you cannot find a long-term partner in college. Princeton and other colleges host a big concentration of people with common interests and future goals, and it is not unusual for people to marry their college partner. Some students use surveys like DataMatch and Marriage Pact, normally released in the spring semester, to connect with potential partners (or just make new friends!). However, the fact that it works for some people does not mean it has to be how you find your partner. It can be helpful to ask yourself what being single or in a relationship means to you, especially at this point in your life, and maybe even make a list of what qualities you look for in a partner. Spend some time reflecting upon where you got these ideas, and if they are in fact what you are looking for. Knowing what you want in a relationship helps improve communication and contributes to relationship satisfaction for all partners involved. 

It is equally important to think about and respect the wants and needs of your partner (or potential partner). Relationships, especially committed ones, are an investment and serious time commitment when on campus, and not everyone wants to or is ready to enter one. People may also be looking for different kinds of relationships — open vs. monogamous, casual vs. committed, sexual vs. non-sexual, romantic vs. aromantic. Whether you have figured out what you want or are still thinking it through, make sure you communicate your hopes and expectations clearly before entering the relationship, so that you can be on the same page as your partner. Check out the UMatter website to explore more elements of healthy relationships.

If you are looking for a relationship that involves sexual activity, you may want to seek out University Health Services with any questions you have or to learn about protecting your health and safety. You can make an appointment with a Sexual Health and Wellness (SHAW) provider through MyUHS. As a first-year student you will also have the opportunity to participate in the Safer Sexpo, a peer-facilitated interactive FYRE program on sexual and reproductive health and wellness in your residential college. You can also make an appointment for an individual counseling session with CPS on MyUHS if you would like to talk through your relationships, as well as your personal wants and needs.

Remember, college is a time of change for many people. It can become overwhelming to try to make friends, get acclimated academically, find social groups, and discover activities you like, while also trying to find a romantic partner. Trying to focus on these activities first can allow you to get to know yourself, so that there’s more space and time for relationships later. In your first year of college, try not to put pressure on a relationship. Instead, focus on finding things you can enjoy on your own, and let a relationship with a partner happen naturally.

— The Sexpert

Tentative: Previously had sex with an undergrad in a class I’m teaching

Dear Sexpert,

I am a grad student and I had sex once with an undergraduate student, but we never saw each other again. I am teaching a course in the fall and saw this student has enrolled in the class. What should I do?

– Tentative TA

Dear TA,

It shows good judgment that you are questioning whether these previous relations (albeit brief) may impact your teaching role, and are being proactive in managing the situation before interacting with the undergraduate student.

As discussed in this Sexpert, graduate student/undergraduate student relationships can create a power differential. Even though you are no longer involved with the undergraduate student, there may be a perceived or existing conflict of interest, not to mention a potential awkwardness in seeing one another.

Regarding what to do about the situation, the first place to start would be with policies of the institution. At Princeton, Rules and Procedures of the Faculty of Princeton (Ch.V. Sec.C.) Consensual Relations with Students states that “Relationships which pre-date either this policy or the role at the University which causes the conflict must also be disclosed promptly to the parties’ respective department chairs and to the Dean of the Faculty.” Additionally, these procedures recommend that “Any member of the University community who is uncertain about how a power asymmetry may impact a relationship or adversely affect the community should contact the Office of the Dean of the Faculty, the Vice Provost for Institutional Equity and Diversity, or the Office of Human Resources.”

This indicates that you should speak with your department chair, and/or the Dean of the Faculty (depending on which you feel more comfortable starting with) about this potential conflict of interest. You need not go into the specifics of the relationship but just share generally that you have previously had sexual relations with a student who is enrolled in the class you are teaching this fall. There may be a number of ways to handle the situation, including swapping you to a different section of the class being offered.

Best wishes,

The Sexpert

what you should know about menstrual cups

I saw an email about groups on campus giving out free menstrual cups, and I was curious about trying one out. I like the idea of having a more sustainable option compared to tampons or pads, but I’m worried about it being messy or uncomfortable to insert or remove. I was also thinking about getting an IUD soon and was wondering if the menstrual cup would interfere with it. 

– Curious about Cups

Dear Curious about Cups,

Menstrual cups are a great alternative to pads and tampons and definitely worth trying out if you think they might be right for you! Not only are they more sustainable, but they can also be a super cost-effective option compared to pads and tampons. If you take advantage of the campus initiative, your cup will be free and could last you up to five years with proper cleaning and care! If you buy one later, it will cost anywhere from $6–40 depending on the brand that you chose, meaning you’re still spending less than you would on tampons or pads over several years. 

Lots of brands make menstrual cups, and they are typically bell-shaped and made of flexible, medical-grade silicone. Unlike pads and tampons, the cups do not absorb blood but simply collect it. This means it will need to be emptied about every 6–12 hours, depending on how heavy your flow is. If you are interested in tracking your menstrual fluid volume for personal or medical reasons, menstrual cups are a great choice. For many people, menstrual cups can be changed less often than pads or tampons, making them a convenient option! Furthermore, compared to tampons, menstrual cups also have the advantage of reducing period odors.

To insert your cup, you will need to fold it. There are many options for how to do this and lots of online tutorials showing different folding styles. If you are nervous, you can watch videos and/or practice folding your cup before you go to insert it. Don’t be afraid to try a couple of different shapes to find the one that works best for you! Once inserted, simply twist the cup using the stem at the bottom to create an airtight seal against the vaginal canal. If inserted properly, you shouldn’t feel the cup, and it shouldn’t leak. If you experience any discomfort, calmly remove the cup and try again. You can also use lubricant or water on the rim of the cup for easier insertion.

If you are still concerned about the insertion of your cup, you can explore different menstrual cup sizes. The size you choose may be dependent on your age, your anatomy, and whether you have given birth vaginally. Many companies sell small, medium, and large cup sizes and will have specific information to guide you in selecting the appropriate size for you! The size you select may also impact how frequently you have to change the cup. 

Mess when removing the cup is definitely a common concern and worth considering if you choose to use a menstrual cup. To remove the cup, simply pull the stem down slightly so that you can squeeze the bottom of the cup to break the seal. This is crucial for an easy and painless removal. Pull down to remove the cup and empty it into the sink or toilet. 

Ideally, you should wash the cup with gentle soap and warm water after each use. If you are in a shared or public restroom, this can be a challenge. Many companies sell wipes that can be used to clean the cups inside of the stall. If you are in a pinch, you can wipe the cup out with toilet paper and reinsert, but try to avoid doing this after more than one use and wash thoroughly afterward. 

Luckily, because they can be changed less often, you may be able to avoid changing them during the day. If you want privacy, change your cup and wash it with you in the shower! Obviously, menstrual cups are not ideal for everyone, and if doing this would make you uncomfortable, it might be worth sticking to other options. 

If you do decide to get an intrauterine device (IUD) as contraception, you probably shouldn’t use a menstrual cup. The suction of the cup creates an increased risk of dislodging or removing your IUD. However, if you still want to use a menstrual cup with an IUD, you could potentially lower your risk of IUD dislodgement by going to your healthcare provider and having your IUD strings shortened. Furthermore, it is important that you are careful when removing the cup and always break the seal before pulling it out. 

If you have any further questions or specific concerns about menstrual cups, Sexual Health and Wellness providers at University Health Services are there to help and can provide you with specific advice. You can make an appointment by calling (609) 258-3141. 

– The Sexpert

Sources:

https://www.webmd.com/sex/birth-control/features/menstrual-cup-iud

https://putacupinit.com/

https://newsnetwork.mayoclinic.org/discussion/menstrual-cups-vs-tampons-things-you-might-not-know-about-the-cup/

https://store.lunette.com/blogs/news/how-to-clean-menstrual-cup-in-public-toilet

https://www.plannedparenthood.org/learn/health-and-wellness/menstruation/how-do-i-use-tampons-pads-and-menstrual-cups

https://beyouonline.co.uk/blogs/news/how-do-you-fold-a-beyou-menstrual-cup

Curious and Careful: About PrEP

Dear Sexpert,

Pill icon

I’ve seen a couple of ads for a drug for people at risk for HIV. What exactly qualifies as “at risk” and how safe/effective is this drug?

Signed,
Curious & Careful

Dear Curious & Careful,

You’re right, PrEP, or Pre-Exposure Prophylaxis, can be used in prevention of human immunodeficiency virus (HIV). PrEP is a prescription pill (commonly sold under the name Truvada®) designed for daily use by people who are HIV-negative and at substantial risk for HIV exposure. PrEP is a combination of two drugs, tenofovir and emtricitabine. If used correctly and consistently, it has been shown to reduce risk by up to 92%. Additionally, many health insurance plans cover PrEP.

There are several situations that can qualify a person to be considered at substantial risk. The Centers for Disease Control and Prevention (CDC) recommend PrEP for anyone who meets any of the following circumstances:

  • is in an ongoing relationship with an partner who is HIV-positive;
  • is not in a mutually monogamous relationship with a partner who recently tested HIV-negative;
  • is a gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the last six months;
  • is a heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status, who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners); and
  • has injected illicit drugs in the past 6 months and who has shared injection equipment or been in drug treatment for injection drug use in the past 6 months.”

If you fall into any one of these categories, or feel that you may benefit from PrEP, schedule an appointment at Sexual Health and Wellness (SHAW) or your primary health care office to discuss with a clinician whether this is an option for you. It’s important to keep in mind this is solely a preventative drug for people with on-going risk of being infected with HIV, and is not recommended for those who have had a single incidence of potential, high-risk exposure.  (There is a different medication, called PEP, or post-exposure prophylaxis, in those instances.)

Additionally, PrEP is a drug that needs to be taken on a daily basis. Like birth control or other daily-prescribed drugs, irregular use will decrease its effectiveness. Anyone prescribed PrEP should return

to their health care provider every three months for consistent HIV monitoring and follow up. PrEP is not 100% effective at preventing HIV acquisition and does not protect you from other sexually transmitted infections (STIs). Precautions should still be taken to reduce your risks, including using a condom with every intercourse, getting HIV tested with your partner(s), practicing less risky sexual behaviors (e.g., oral sex while using a barrier method), reducing your number of partners, and/or sterilizing injection equipment or joining a substance treatment program.

Best of luck and be safe,
The Sexpert

Information regarding PrEP retrieved from Centers for Disease Control and Prevention (CDC).

Condom Queen: What if my partner doesn’t want to use a condom?

Dear Sexpert—

I just started dating a new guy, and he’s really great! But there’s one thing he does that makes me kind of uneasy: he’s really resistant to wearing condoms when we have sex. He always comes up with some excuse and tries to make me feel good about it, and sometimes I go along with it. Usually, I am a real stickler about condom use, so it worries me that he is so against using them. On the one hand, I want to tell him to wear one; but on the other, he’s made it seem like wearing one is a deal-breaker and I don’t want to lose him over it. What should I do?

–Condom Queen

 

Dear Ms. Queen,

There are a lot of different factors and attitudes that go into decision making and preferences, especially when it comes to something as intimate as sex. You have already decided that your preference is to use a condom every time, without exception. However, your boyfriend has other preferences.

Communication is the best way to improve sex. Talk with him about his dislike of condoms at a time when you’re not engaging in sexual activity. Figuring out his reasoning questions may help the two of you to come to an agreement about condom use. It is possible that he has had a bad experience with condoms in the past, or maybe he has not found one with the right fit. Trying out different condom styles or having open communication about wants and needs is a great way for him to see the fun of safer sexual experiences.

It seems like that you are concerned your boyfriend will end things if you push him. You have the right to make a decision for yourself, and he has the right for himself; but when you are making decisions that impact your partner, any and all decisions must mutually be agreed upon. I know it feels like saying something may put your relationship with him in jeopardy, but not saying something could also put your and his safety at risk (See the Sexpert archives.).

Be prepared with a response for the excuses, like “You’re just so sexy, I can’t wait” or “It’ll feel so much better without one”. Having condoms on-hand will discredit his “I can’t wait” argument, and it’ll make it easier for you to stay strong in your decision. Keep some condoms in your purse or bedside table for easy access. (You can get 10 FREE condoms, daily, at McCosh.) Also, there are many ways in which using condoms can be a fun part of the fun of your sexual experiences. Using the ultra-thin, ribbed, or heat-activating varieties or even adding a dab of lube to the inside and outside of the condom can all enhance the overall sexual experience for you both. If you aren’t interested in trying these options, you can always refer to the recent study published in The Journal of Sexual Medicine that stated that both men and women enjoy sex as much with condoms as without. This might alleviate his concerns, or at least make him more open to trying condoms.

When communicating about safer sex with your partner, feel free to be creative with ways to cooperate and come to a conclusion that makes you both happy. Just being willing to acknowledge his desires or worries may get him to acknowledge yours.

Good luck,

~The Sexpert