The Ultimate Guide to Sex and Disability (34 page)

Self-Monitoring

Safer sex information often assumes that we have the ability to be aware of our physical and mental state. But this is not always the case. Lack of privacy is one barrier to self-monitoring. If you are never alone with your clothes off, or partly off, how can you look at your penis or vulva? If you have no feeling in the area, you have no sensation of pain or tingling. If someone else puts your tampon in for you, will they notice anything unusual and will they tell you about it? If you have always been protected against risks, how will you know which feelings to trust when you are making decisions that involve risk?

These limitations don't mean that we can't self-monitor, but we do need to be acquainted with our limitations and figure out ways around them. A person who can't see may want to inspect their genitalia with their fingers regularly to feel for new lumps, areas of roughness, or areas that have a different sensation in them. If you can't arrange for privacy, ask for regular appointments with your doctor to check your genital area if you are having sex. Ask an attendant whom you feel comfortable with to hold a magnifying mirror so that you can see your genitals when they are washing you or dealing with tampons.

All kinds of sex can have effects, both positive and negative. We can figure out what these effects are when we can tell that something has changed, physically, emotionally, or mentally. As you read this chapter, consider the ways these effects might make themselves known, and if you need assistance in monitoring these effects, consider how you might get that assistance and from whom.

Sexually Transmitted Infections (STIs or STDs)

Although the common cold, mono, and the flu can all be transmitted during sex, we don't think of them as STIs (sexually transmitted infections, also known as sexually transmitted diseases, or STDs) because it isn't the sexual contact that causes this, just close proximity. Most STIs cause problems in the genitalia, anus, or mouth, although Hepatitis B is considered an STI and infects the liver. There are also things that seem to be related to having penetration but aren't usually passed from one person to another, like yeast and bladder infections in women.

Infections are caused by germs. Some germs are bacteria, which are fairly large (in the microscopic world) and can be killed by antibiotics. Some germs are viruses, which are much smaller and harder to kill, although there are some drugs now that work against certain viruses. Many people who have STI germs in their bodies have no sign of this— no discharge from their penis or vagina, no funny sores. Condoms stop many viruses and bacteria, but if the germ is in an area that isn't protected by the condom, then you can still get the infection.

Chlamydia

The fairly common STI called chlamydia is caused by something called an "obligate intracellular parasite," which means that it has to live inside cells and doesn't kill the cell. But it causes lots of problems, and like gonorrhea can go to other parts of the body. Chlamydia can cause sterility in both men and women. Most women and many men have no symptoms from chlamydia, but when there are symptoms they include discharge, burning with urination, spotting after penetration, painful penetration (in

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women), and swelling or pain in the testicles. If there is a discharge it may be smelly. If someone is going to get symptoms, they appear in seven to twenty-one days. There are two kinds of tests for chlamydia, both of which require a swab like a Q-tip. It can be treated with one dose of an antibiotic that is taken by mouth.

Gonorrhea

The bacteria that causes gonorrhea can infect both men and women to cause throat, cervical, urethral, and anal infections. About 80 percent of women don't have any symptoms when they have it. Most men with gonorrhea have symptoms, the most common being a pus-like (usually yellow) discharge from the penis or burning when peeing. Women can get a yellow or green discharge from the vagina and may also have burning when they urinate or pain during penetration. The discharge can be smelly, a very different smell from normal discharge. In women, the infection can go to the uterus and fallopian tubes and cause intense pain. If not treated this can lead to infertility or an increased chance of tubal pregnancies, which is dangerous. A tubal pregnancy is when the sperm and egg meet up in the fallopian tube (this part is normal) and then get stuck there instead of moving into the uterus. The tubes are small, and as the embryo grows, the tube can burst. Less commonly, gonorrhea can go to the joints. If someone is going to get symptoms, they start to show up within ten days of contact. Testing for gonorrhea is done by sending a sample that is collected with something like a Q-tip (for men's urethras, a tiny one) to a lab for culture. Gonorrhea is treated with one dose of an antibiotic that is taken by mouth. There should be a repeat test done two weeks later to make sure it is clear. Many people who have gonorrhea have chlamydia at the same time.

Herpes

Herpes is caused by a virus. The worst thing about it is that after it goes away it can come back many times. Symptoms can occur within a few days of being infected, but can take up to twenty days to appear. Herpes shows as one or more painful blisters that can open up to become sores.

At first they may just be red, painful lumps, but then they become filled with fluid and may look shiny. They are somewhere between soft and hard. They usually appear on the vulva or penis, in the pubic hair, or in the anal area, although they can show up in other places. If they are on the vulva or penis there can be severe pain with peeing. When the infection first happens there can be swollen glands in the groin, fever, headache, and fatigue in addition to the rash. Not everyone gets herpes back again after the first time, and you may be less likely to get it again if treated with antiviral drugs. Some people find that their recurrences are triggered by certain foods, heat, or stress. Herpes can sometimes be transmitted to another person even when there is no rash. Condoms are not always protective, as the rash can occur in areas that aren't covered by a condom. Cold sores are also caused by a herpes virus. Although one version of herpes is more common in cold sores, the other more common in genital herpes, you can get genital herpes if someone with a cold sore goes down on you, and they could get cold sores from going down on you if you have genital herpes.

Human Immunodeficiency Virus (HIV)

This virus is transmitted through oral, vaginal, or anal sex, as well as by getting infected blood into you (from sharing needles or from a transfusion) and through breast milk. Blood is now tested for HIV before being used for transfusion. HIV causes AIDS, which is a disease that makes the immune system function poorly so that the person is prone to other infections and some types of cancer. When someone first acquires HIV, they might get an illness a bit like the flu, with fever, headaches, rash, and joint pain. After that, it can be years before symptoms appear. There is no way to tell if someone is HIV infected by looking at them or at their genitalia. HIV is diagnosed with a blood test. Before having the test, you should talk with someone about how you are likely to react to either a positive or a negative test and make plans. For a while, people were recommending using a lubricant (or prelubricated condoms) containing Nonoxynol-9, a spermicide, to prevent HIV transmission. There is no evidence that this actually works, and some women get vulvar or vaginal

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irritation from this, which might increase the risk of transmission of HIV Although many treatments for AIDS have been developed, there is no cure. Much of the recent emphasis on safer sex is a result of AIDS.

Human Papillomavirus (HPV)

At least sixty human papilloma viruses exist. Some cause genital warts, which can be uncomfortable or even painful. They don't always hurt, though, and many women notice they have them when they feel a bump when wiping themselves. It is unlikely that an attendant would notice them unless there were a lot of bumps. The bumps look a bit like tiny cauliflowers. They usually feel quite hard and not smooth. There can be tiny individual ones, or larger clumps. Warts inside the vagina aren't painful. Some types of HPV have been shown to lead to cervical cancer or rectal cancer. Not every woman who gets HPV ends up with cancer. HPV is probably stopped by condoms, but may be in areas that aren't covered by condoms. People can pass the virus along even when they don't have warts, or none are visible. Treatments are available that make warts go away, but they don't kill the virus. Warts are usually diagnosed just by being looked at. Effects of HPV on the cervix are diagnosed by a Pap smear.

Intestinal Parasites

Parasites can be transmitted through analingus or if a sex toy is shared and used anally. They can cause diarrhea and abdominal pain. There are different treatments for different parasites.

Pelvic Inflammatory Disease (PID)

PID occurs in women and is a result of any number of STIs (and occasionally other infections), most commonly gonorrhea and chlamydia. The infection travels upward from the vagina to the uterus, fallopian tubes, and ovaries. PID can cause sterility, tubal pregnancy and chronic pelvic pain. You can get PID more than once, and each time it occurs your chance of becoming infertile increases. Symptoms include vaginal discharge that varies depending on what kind of infection it is, long or painful periods,

spotting and pain between periods, lower abdominal pain, fever and chills, nausea and vomiting, and pain during penetration. PID is usually treated with IV (intravenous) antibiotics. It is diagnosed by a doing a combination of procedures such as a pelvic examination, taking a swab for culture, blood tests, and sometimes laparoscopy (looking at the tubes and ovaries with a little camera inserted through a small cut in the belly button).

Pubic Lice (Crabs)

Lice are tiny insects that can cause intense itching in the genital area. They cement their eggs (nits) to the shaft of pubic hairs. Most people start itching about five days after becoming infested. They are spread during sexual contact and from contact with bedding or clothing that is infested. If you take a close look, you can see little light-colored dots moving around. With a magnifying glass they look like tiny crabs. They live off human blood. Lice are not dangerous, but they are a real nuisance. Many treatments are available from drugstores. You can also try heavily coating the whole area with petroleum jelly and leaving it on for several hours, which smothers the lice. This can be really hard to wash off, so it is a treatment to use only if you are desperate. You must wash all your towels, bedding, and any clothing you have worn since a week before you noticed symptoms. Vacuuming is also a good idea.

Syphilis

These days syphilis is not very common in North America, which is a good thing because it can have many bad effects on many parts of the body and can be fatal. It is diagnosed by a blood test. The most common symptom is a painless bump, but some people get a rash on other parts of their body. It is cured with a penicillin shot. It is transmitted through intercourse and condoms are protective, unless there is a bump (called a chancre) that is not covered by the condom.

Trichomonas

A small parasite causes trichomonas, producing a frothy, smelly discharge and causing pain during penetration for women. It can also

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cause more frequent, burning peeing. Men don't usually get any symptoms. It can take up to a month to get symptoms after being infected. Women with trichomonas have a higher risk of another germ (like gonorrhea) getting into their tubes and causing pelvic inflammatory disease. Within a week to ten days after treatment with a medication taken by mouth, it is resolved. The medication cannot be taken by women who are pregnant and can cause vomiting, especially when combined with alcohol.

Protection from STIs

You can do a number of things to protect yourself from STIs and their effects. The first is to talk to potential sexual partners about STIs. People can lie, but often they are truthful and you can find out if they have had an STI before, when was the last time they had sex with someone, and whether they have been tested for HIV or other STIs. You can ask them questions like Do they use condoms all the time? Are they willing to have nonpenetrative sex to reduce the risk of STIs? If they haven't been tested before, how would they feel about getting tested?

/ remember when I had to be tested for an STD. I was naive and trusted what my lover had told me about his sexual history. I didn't know very much about how STDs affected men, so I ended up leaving the doctor's office feeling that my partner knew and just didn't care. But when we talked about it I found out that he had no idea that he had also had an STD. We both got treated and were able to resume our sexual relationship, but we're using condoms. I didn't want to take any more chances.

It is clear from the section before this that there are often no signs of an STI and that you can't tell from looking at someone whether they are infected. You also can't be sure you aren't passing something along, particularly if you have been having penetrative sex without a condom. It doesn't hurt to get tested about two weeks after you have had sex with a new partner. You can get tested for HIV anonymously. That means that

no record of the test will show up in your medical record. Some people want to have this kind of privacy because they don't want an insurance company to know their HIV status. Others are worried that their medical record might not be confidential. The disadvantage of this kind of testing is that you have to remember some kind of code word to get your results, as they won't be filed under your name. Also, if you are HIV positive, you might want medical personnel in an emergency room to have this information if you can't communicate it to them. Public health departments usually have a list of who does anonymous testing and should be able to tell you which clinics are accessible.

Using a condom for penetrative sex makes sense. People in long-term relationships who trust each other not to have sex outside the relationship often stop using condoms, especially if they don't need them for birth control.