Q&A: Practicing Safer Sex

Welcome back to our ongoing Q&A series! We started writing these in our weekly email blasts to address questions on a variety of topics that we commonly hear from our customers. Eventually, we decided that we wanted to make them an evergreen educational resource, and thus this series was born. Check out our Q&A category under Lotus Blooms Life in the menu for more posts in the series.

Recently, we surveyed our subscribers for their anonymous questions about safer sex so that we can help all of you get the information you need and want to make informed choices about your sex practices. Here's a few of the questions we got:

I'm 65 and very active, but I'm new to anal. I HATE condoms. Any suggestions for practicing safer sex without them? Should I go on PrEP?

A: Congratulations on discovering a whole new aspect of your sexuality! Anal sex is normal, common, and very pleasurable for a lot of people, but it does have some health risks, and it's important to be able to make informed decisions about how to manage them. The rectum is lined with mucous membranes which are more permeable than skin, and these membranes are thinner and more delicate than those in the vagina or mouth. And although rectal fluid keeps them wet, the rectum isn't self-lubricating the same way a vagina or mouth is. That means that those tissues in the rectum are easier to infect, especially if a lack of lube causes small tears. Also, rectal fluid in HIV positive people contains HIV that can be transmitted to a partner's penis through the urethra.

That being said, none of this should scare anyone off anal sex. There are a number of choices you can make when it comes to safer anal sex. Obviously, one way to manage your STI risk is to be tested regularly yourself, and to know your partners' STI status. If you don't want to use condoms, one option is to explore anal penetration with fingers or with toys including strap-ons, anal beads, plugs, or insertion toys like Njoy wands. Using lots and lots of thick lube, and starting slowly until your anus and rectum adjust to the sensation, can also help prevent tears in the membrane during penetration with a penis.

PrEP is a daily, preventive pill that can reduce the risk of HIV transmission by as much as 90%. It's recommended for those who are at risk of HIV because of intravenous drug use, choosing not to use condoms during penetrative sex, or having an HIV+ partner. Reported side effects are mild, and it's covered by most health care plans. We can't say for sure whether it's the right choice for you, but it sounds like it might be worth discussing with a sexual health care provider. You can also start by taking Planned Parenthood's self-assessment quiz.

Two last things to keep in mind: first, anal sex without a barrier still carries risks for other STIs, even if you're taking PrEP. Second, however, if you do contract an STI or think you may have, please get treated right away-- STIs are unfairly stigmatized in our culture, but there's no shame in having one or seeking treatment for it, so please don't "punish" yourself by avoiding the doctor.

How often is routine for a cis het woman to get tested for STIs? Does it depend on the number of partners?

It depends more on your level and type of sexual activity. The CDC has different recommendations for cis women (of any sexual orientation) under or over 25, or who are pregnant, but their baseline (e.g. that women 18-34 should have an HIV test "at least once") may not be often enough for a sexually active woman.

If you're in a monogamous or polyfidelitous (multiple partners committed only to each other) relationship, you've shared test results, and your partner(s) are negative for STIs and are not intravenous drug users, you can probably be tested once a year. If you don't know your partner(s)' STI status, if you or they are intravenous drug users, if one or more of your partners is positive for an STI (even if you're using barriers or other safer sex practices), or if you're not using safer sex methods during sex where there's a risk of transmission, you might want to be tested every 3-6 months. Some STIs are quickly detectable, but others can take as long as 90-120 days to show up on a test. If something changes in your life that presents you with a new risk factor, you might want to be tested about a month after that so that you can be treated quickly if you need to be, and again at the four-month mark (and perhaps every 3 months if that factor stays present in your life).

An honest conversation with a sexual health care provider can help you determine how often you should be screened. It's worth taking the time to find one who makes you feel comfortable talking frankly about your sex life, even if it's not your regular doctor. Also, if you haven't received the three-dose Hepatitis B vaccine, ask your provider about getting it. Finally, when you get tested, make sure you know what exactly you're being screened for-- it may be fewer things than you think. HIV, chlamydia, gonorrhea, and syphilis are the most common tests. Doctors rarely screen for herpes and HPV, however, because they're so common. If you want to be tested for those, you may need to specifically request them.

How does a female condom work?

We're pleased to say that it's becoming more common to refer to these devices as "internal condoms", because they can be used for both vaginal and anal penetration by people of any gender!

An internal condom is a nitrile sort of tube that resembles an external condom, except that it has two flexible rings, one at either end. They help prevent pregnancy and STI transmission the same way that external condoms do-- by providing a barrier during penetrative sex.

To use them for vaginal penetration, first apply some extra lube if what comes on the condom doesn't seem like enough. Pinch the sides of the inner ring (at the closed end) together and insert it into the vagina, kind of like a tampon without an applicator. Once the ring is inside, you or your partner can put a finger or two inside the condom and push it farther in, all the way up to your cervix. The outer ring and some of the length of the condom should still be outside your vagina; lay it flat against your vulva to provide a barrier to the area around the opening of your vagina. You will probably need to use your fingers to hold the outer ring in place while your partner enters you; it's important to make sure the condom isn't twisted, pushed aside, or pushed inside. Use lots of lube on your partner's penis to help keep the condom from being shifted around during thrusting.

To use one anally, follow the same steps, except that you should remove the inner ring before inserting the condom, and make sure you leave a little length outside your anus. To remove a used condom, if your partner has ejaculated inside it, twist the outer ring to close the end of the condom before you pull it out.

One last note about the internal condom: They can be a little harder to find, and only the FC2 brand is FDA-approved. Most stores don't carry them and drugstores require a prescription for them. They're also more expensive than external condoms. You can check with your local Planned Parenthood or other family-planning or reproductive health services organization, where you may be able to get them for free.

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