Hey guys! We're Shan Boodram and Dr. Ina Park, and we'll be answering your questions about all things sexual health and STDs today. Let’s do this… AMA! Or should we say... Ask US Anything!

What can someone on antidepressants do to help increase their sexual desire?

IP: Hi, this is such a common issue with certain antidepressants, where some people really have a dip in their desire or their ability to have orgasms.  The SSRI antidepressants such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) tend to have the most side sexual side effects.  Buproprion (Wellbutrin) tends to have less sexual side effects, as does duloxetine (Cymbalta) and escitalopram (Lexapro). 

Can oral herpes be spread to your partner as genital herpes during oral sex? How long should a person wait after an oral herpes breakout before giving oral sex? Edit:spelling

IP: Yes, you can definitely spread oral herpes to the genitals if you give your partner oral sex.  If you have a sore on your lips/mouth, wait until the sore is completely healed before giving your partner oral sex.  The virus sheds the most during an active outbreak.  

I (f) used to have a really high libido until my child was born, now sex feels like a chore. No one (my doctor, for instance) seems to find this odd or an issue and blow off my concerns. How common is this, and is there a way to fix it? I would love to get my desire back.

Shan: This concern being SO common is both a gift and a curse. It’s a gift because (I hope you know) that a decrease in libido is likely to happen to people at some point in their life for a variety of reasons. It’s a curse because (like you’ve experienced) many people will brush it off and say “it happens to almost everyone, don’t worry about it.” But, you have every right to be upset and to want solutions for you, so kudos to you for not giving up! I often say that desire ebbs and flows between being a rollercoaster, where you just sit back and enjoy the thrills, or a push-cart where you have to manually move every inch yourself. It sounds like you’re going through a push-cart phase and knowing that is half the battle so take all the standard advice you can to see what works, but also I’d like to try a different formula that I recently read about that I thought was interesting! To jump start your drive again, see if this helps: 1) take sex off the table for 30 days with both your partner and yourself *poof pressure gone* 2) Set an intention for at least 15 minutes of touch each day that is pleasurable but not necessarily arousing 3) Both you and your partner(s) need to do something separate and exciting just for you once a week 4) Start sexting... every chance you get and start talking about sex any chance you get. This creates an environment designed to help you get sexually charged and frustrated (a winning combo) + it gives you time to reflect on your sexual fantasies and untapped desires. Again, there’s no one-size-fits-all suggestion to solving the libido conundrum, but there are a lot of tried and tested options so have fun finding what works for you.

IP: On a personal note, as a busy working mom, I totally identify with your feelings.  I think this is incredibly common.  It’s really hard right now with the pandemic going on, but if you can, carve out time with just you and your partner without kids, that is so key to reconnect and enjoy each other to feel close, which means sex will feel like less of a thing to check off your to-do list.  Some friends/patients have enjoyed using lubes with cannabis or others that warm up and increase blood flow to the genitals. Incorporating toys or a vibrator into your play can make it more fun as well.

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Shan: It doesn’t sound silly at all and I hope all of the responses you’ve received really help to highlight that for you! Tbh there’s a lot of healthy debate around whether sex or love addiction is a “real thing” but I think no matter where you lie on that debate, we can all agree that anyone who feels like intimacy isn’t an option for them because of their desires deserves support! I live in Los Angeles and have visited the Center for Healthy Sex frequently; they have a very successful and notable program available online for people who would identify themselves as love addicts. I happen to have also met a person who came out of that program and it changed her life so much that she made a movie about it! If you’ve got some time checkout Charlene Deguzman’s Unlovable.

IP: Yes, you absolutely can have a happy/healthy sex life, but some therapy around this might help.  you could seek out a therapist but my partner Shan is going to point you to some specific resources that might help. 

Is it true that if you had the chicken pox when you were younger you’ll test positive oral herpes?

Dr Park here! No, chicken pox and oral herpes are caused by different viruses, (although they are closely related) having one should not cause you to test positive for the other.

Hey Shan! My goal is to become a sexologist because if YOU. I just started studying psychology and I've been loving it so far. 1. What is your #1 advice when it comes to studying/notes/books? 2. What to do when you feel like you could be doing more? 3. What is the most harmful way of discourse when it comes to talking about sex/sexual health and how does one improve?

Good luck on the AMA! I will be sending positive thoughts your way beginning of november.

Shan here: I’m in awe of you and congrats on already being on the right path to starting your INCREDIBLE career. I may be biased but I think it’s THE MOST interesting, rewarding and expansive vocation. I’ll answer all of your questions:

What is your #1 advice when it comes to studying/notes/books?
Google Drive!!! Use folders and sub-folders and keep all of your work organized by topics/ classes etc. Whatever you can do to remember where different information is because you’re going to LOVE yourself down the line when you can easily access your own intellectual property to reference as you go along. Also, listen to audiobooks whenever you can and use the notes section so you can tag parts you like. If you loved the audiobook buy the physical and dog tag the pages you liked. I found I could consume a lot more information when I had both audio and physical books to tag team each other.

What to do when you feel like you could be doing more?
Excellent question. I could always be doing LESS social media scrolling smh so I could do more of the insane workload I have. If you’re going to be a public-facing sex educator and social media becomes a part of your business, invest in a social media manager as fast as you can because that thing is an attention blackhole.

What is the most harmful way of discourse when it comes to talking about sex/sexual health and how does one improve?
I think the most harmful way is the prideful way. Even the leading experts in this field are learning new things every day, so never be too prideful to be corrected. I am very grateful to have access to much smarter people than me in this space so that I can adjust with the findings. Shoutout to American Sexual Health Association who I’ve been working with since 2017!!!! (can you believe it) I love you and am grateful for all of our collaborations.

What are some tips for women who find it hard to get aroused during sex?

Shan: In Dr. Ian Kerner’s book, “The Big Fun, Sexy Sex Book,” he references a study that found that many people with vulvas don’t experience arousal until they’re sexually engaged. So that may mean that your sexual response cycle (arousal, plateau, orgasm and refractory) might come in a different order. Meaning your brain might be interested in engaging in sex before your body gets the memo. However, it’s also important to acknowledge that arousal isn’t linear or one-size-fits all and it’s possible that you haven’t found your size yet. A book I LOVE is, “She Comes First,” by Dr. Emily Morse and in there she has a huge chunk so sexual accelerators and sexual breaks (+there’s awesome activities you can do to figure out yours). So, in short, if you don’t mind doing a bit of sexy work, I hope you’ll find an explanation that suits and helps you! xoxo

So my partner(f) has genital herpes. I really care about her and we've had protected sex in the past, I've gotten tested since and im negative. I would like to stay that way of course but now I'm off put by sex with her since I had a pimple that I thought was a herpes sore pop up(this prompted the testing).

She has had other people not as concerned with it who wore condoms as well. She is not on a retroviral or anything of that nature. I am just not clear on transmission rates, I found a couple figures here and there online but I can't really understand it on a practical level.

I dont know if she's who I want to be with forever so it's making this more confusing. Do you have any advice? I just feel like it's selfish of me to not have sex but im also just concerned and I don't know what to do. And if it matters she performs oral on me and I can finger her which gets us both off but I miss having vaginal intercourse. Thanks Doc, I really appreciate your advice and opinions here

Hi, Dr. Ina Park here, I agree with Shan, I can tell you’ve given this a lot of thought and it’s great that you want to figure out how to maximize your mutual pleasure with genital herpes in the picture.  Part of it depends on how long she has been living with genital herpes.  The risk of transmission is highest in the first two years when people are having the most outbreaks.  Even if she hasn’t had outbreaks for years, she will still shed virus on about 10% of days, and it’s impossible to know what days those are.  I’d ask if she’d be willing to go on an antiviral to suppress shedding of the virus, because if she takes a daily antiviral, (example: valacyclovir 500 mg daily) it cuts the risk of transmission to you by 50%.  I know that isn’t a guarantee, but it is a huge reduction in risk.  If you added in condoms, the risk to you becomes even lower.  

Shan: I’d just like to chime in to say how kind and thoughtful this question is. I think it’s awesome that your partner has had a clear and upfront conversation with you about their sexual health status and that you’ve taken that information and challenged stigmas to explore what is the safest, happiest way of approaching sex with your partner for both of you. I’d say to keep doing what you’re doing now: consulting healthcare providers, utilizing healthcare clinics, having honest check-ins with your partner and most of all having real conversations with yourself about what your truth is. As you know, one of the biggest side effects of herpes is stigma and you’re right to consider how that side effect could impact your life should the two of you not stay together. So no advice just a head nod to say there’s no easy answer here and I think it’s inspiring that you’re putting in the work to find the right answer for you.

Hi! How do you go about getting tested? Do you usually go to your PCP are are there other good services out there.

IP here: Your PCP can definitely order testing. If you are a man who has sex with men, make sure your PCP can also do swabs of the throat and butt for gonorrhea/chlamydia. Most PCPs have access to this, but definitely check. And if you are having a hard time accessing your PCP, you can go to www.yesmeanstest.org to find another place to get tested.

It's Shan: I LOVE seeing questions like these, bravo for taking the first step to taking control of your sexual health. Second step is to know what you need to ask for to advocate for your health. Many people assume STD screening is part of a regular check-up. While some clinicians may test for it, others may not unless you ask. So ask! And be honest about your sex life.

Know PreP can be taken to prevent HIV, but will taking it after you’ve been exposed lessen your chances of contraction?

Dr. Park here! Yes, there’s a way to take anti-HIV medication after exposure to prevent catching HIV. It’s called Post Exposure Prophylaxis, or PEP. You take three medications after exposure for 28 days, and that’s highly effective in preventing HIV after exposure. Starting it right away is best, but you have up to 72 hours after exposure to start. You’ll need an HIV test prior to starting, and if you need to find a location to get tested, go to www.yesmeanstest.org. If your closest clinic is closed, you can go to any emergency room.

If you have genital warts, do you have them for life? Also how common are genital warts?Also what are they caused by ?

Thank you! 😅😊

IP: No, you definitely don’t have them for life.  They are caused by an STI called HPV, they can be treated and you can clear the virus. Some people will need more than one course of treatment, because about ½ of people will get a recurrence after their first treatment.  About 5% of people in the population had warts prior to the HPV vaccine being released.  If you get the vaccine, then you are VERY unlikely to get warts, so I’d definitely recommend talking to your doctor about it.  It’s available for folks from the age of 9-45)

Hi Dr Park!

I also wanted to get your opinion on the types of STD tests people should be getting! When is a blood and urine test sufficient And when should Individuals get swab tests (rectal, oral, etc) ?

IP:Hi, this is a great question.  It depends on your age, gender and the gender of your sex partners.  

For women under 25 years of age, they should get a urine or vaginal swab for gonorrhea and chlamydia at least once a year.  Also they should get tested for HIV at least once if they’ve never been tested, some states also recommend testing for syphilis, check with your clinic on that one. 

For men who have sex with women, there actually isn’t any routine testing recommended, but lots of places will do a urine test for gonorrhea/chlamydia for men under 25. But they should get tested for HIV at least once if they’ve never been tested.

For men who have sex with men, they should get swabs of the throat and rectum (if they are having oral/anal sex), blood tests for HIV and syphilis, and a urine test for gonorrhea/chlamydia, at least once a year, but if you have multiple partners, then every 3 months is a good idea. 

Finally, for transgender folks, they should get testing similar to men who have sex with men, so swabs of the throat and rectum, urine testing, and blood for HIV/syphilis. 

If you’re thinking about testing, I encourage you to go for it!  It’s easy/painless, and you’ll feel relieved to know that you’re taking care of your sexual health.  If you need to find a place, go to www.yesmeanstest.org. Good luck! 

Is it true that if you get a std and wait too long to get it treated, it can cause infertility issues in women?

IP: Yes, unfortunately it’s true, but mostly for gonorrhea and chlamydia.  Those infections can climb up from the cervix into the uterus and the fallopian tubes silently and they can cause scarring, which can lead to fertility issues in the future.  The risk of infertility goes up with every infection, but testing and treating right away can avoid those risks.  That’s why women who are under 25 should get tested for gonorrhea/chlamydia at least once a year.  If you need help finding a place to get tested, visit www.yesmeanstest.org. 

BTW, HPV, herpes, syphilis don’t cause infertility, but can be passed to the baby once you are pregnant. 

Can you contract herpes if your partner isnt flaring?

IP: Absolutely you can.  Even if your partner isn’t having a flare, they can still be shedding virus from the genital or anal area.  The virus being shed can be transmitted and cause a partner to contract genital herpes. 

Shan what is the hardest part of being pregnant? By the way you look beautiful as always

Shan: Not feeling well! I realized through this experience how privileged I’ve been before when it comes to feeling good both mentally and physically! I am so so so unused to feeling this crappy all the time! It makes you really appreciate how important health really is and I can’t wait to have more control over how I feel. That’s why I champion #YESmeansTEST and #HealthYES because it is so empowering and not to mention lifesaving, to be aware and in control of your sexual health. Check out www.YESmeansTEST.org to learn more.

Shan again: And I know some women who are happily pregnant, not to take away from those who love it!

HPV is the most common STD, and almost all sexually active adults get infected at some point in their lives. Many questions about HPV remain unanswered. Have we made headway in determining who will clear the virus from their body over time and how to test men for the HPV? Might the pandemic put a hold on further HPV research, and where can we turn to for updates on HPV advancements?

IP: This is a great question. HPV is my favorite STI because it really does affect all of us.  About 90% of folks will clear HPV in two years, but we don’t know what are the common factors that make people more likely to clear it.  We know that people with immune systems that are compromised, (like folks who are HIV positive) and people who smoke cigarettes are less likely to clear it.  Because cancer of the penis is so rare, there isn’t any routine testing of the penis recommended for HPV.  But for men who have sex with men, some people are doing anal Pap tests to look for HPV-related pre-cancers.  HPV research hasn’t stopped during the pandemic! There are lots of studies going on.  If you are really into HPV research, then you could go to the International Papillomavirus Society https://ipvsoc.org/ or sign up for updates on their public platform: www.askabouthpv.org

I’m asexual. Physical connection just doesn’t come easy for me. What is your favorite part of sexuality? Why should I spend time learning about and exploring sex?

Shan: My favorite part of sexuality is autonomy! I often tell people that as members of mainstream society there’s SO MUCH that we HAVE to do, it’s really nice to have something (sex) that you really don’t have to do if you don’t want to. As a result, sex should be something you do because it brings value to your life OR something you don’t do because presently, you just don’t see the value it would add to your life. To answer your last question, I think even as someone who identifies as asexual learning and exploring sex is useful because it’s a part of the world we live in. So, it might be nice, but again not necessary, to be able to contribute to the conversation in a meaningful way even if it is to educate others about the way you personally have chosen to engage with your sexuality.

Is it true that if you’ve been on birth control for a few years, it takes a few years for your body to readjust before you can get pregnant again? Does being on birth control for an extended period of time damage a woman’s fertility and lower their chance of pregnancy in the future?

IP: It really depends on the person.  For most people taking birth control pills, their normal cycles and fertility return in the first month or two once they are off the pill.  For Depo-Provera it can take longer, many women don’t have their cycles/fertility back to baseline for 5-7 months.  Being on birth control does not damage your fertility or your chances of having a healthy pregnancy in the future.  Having an STI can do this though, so it's important for folks on birth control to get tested to catch infections early, because they can often be silent and not produce any symptoms.  If you need a place to get tested, check out www.yesmeanstest.org

Do you have any recommendations for treating anxiety regarding sex? Mental health and therapy options have been insufficient, and i've found myself withdrawing from sexuality entirely as a result of the various mental barriers.

Shan: Understanding your anxiety is key! Knowing if it’s triggered by the circumstances in your present physical world, your past experiences, a physiological response or a mix of both can help you seek out YOUR solution. It can be really discouraging when you try the go-tos and they don’t work for you, but that’s your cue to dig more vs. throw in the towel. So again, digging more to discover the root of your anxiety can open up new ideas on solutions that could be effective for you. The more information you can share with your healthcare provider(s) the more useful they can be in presenting new and hopefully more helpful options for you!

IP: Hi, I'm so sorry that sex has been such a struggle for you.  It sounds like you’ve tried talk therapy but I don’t know if you’ve specifically tried a sex therapist? I know that can be helpful for some people.  I don’t know if masturbation is still pleasurable for you or if it’s just partner sex that is the problem, but I’d seek out additional help if you can and take the pressure off yourself to have to “fix” it right away.  

I’ve noticed that when I get STD test results not every STD I’ve heard of ends up listed on my results. When I ask for an STD test am I actually getting every test I need? Are there STDs I should make sure are included in every test even if I’m asymptotic?

IP: You’re right, many STDs don’t have symptoms, so the only way to know for sure is to get tested. So a comprehensive STD/HIV panel will usually include gonorrhea, chlamydia, syphilis, and HIV.  Most of the time, we don’t recommend testing for herpes unless you think you’ve been exposed, have symptoms, or have a partner who has herpes.  That is because the test can produce false-positive results, so we don’t recommend using it on the general population unless there is a specific reason to test. Other newer tests out there include Mycoplasma and Trichomonas, but typically those are done on people when they have symptoms. 

How do you suggest having the conversation about checking in on STIs and testing in a relationship? If you're positive, how do you recommend communicating with current/recent partner(s)?

Hi! It's Shan: I truly believe that our conversations about sex should mirror the vibe that we want to have DURING sex so even though these conversations seem like they should be heavy, serious and stiff who says they can’t be intimate, playful and collaborative? When checking in on STI testing my go to is to GIVE to GET. Talk about yourself, your relationship with testing and how you value your sexual health then casually ask them what their relationship is with their sexual health. When you’re positive communicate with partners the way you’d want it to be communicated to you: be thoughtful, helpful, honest and as informative as you can be so they can make the best decision for them on their health. Resources like www.YESmeansTEST.org rock because they not only share info on clinics but they provide digestible knowledge on STIs, STDs and sexual health in general.

What do you suggest (ie. sex toys, website, books) for people who do not enjoy clitoral stimulation? It’s either verging on painful or feels like nothing.

Shan: **sings Michael Jackson’s* You Are Not Alone** YES! In recent years sexual educators have REALLY pushed the public to understand the importance of the clitoris in sexual pleasure for people with vulvas and in the process many people who DON’T experience pleasure this way have felt misrepresented. For some people the EXTERNAL part of the clitoris (the head that is at the top of the vulva above the vaginal opening) is either too sensitive or not sensitive enough. It is important to note though that there is more to the clitoris than this (the external part is only the tip of the iceberg) so what you may enjoy instead is stimulation of the internal part either through vaginal penetration, anal penetration, humping or perineum stimulation. Once you nail down which of those feel good for you, take that info to a local sex store and ask them to load you up with the best tools. I love the resource omgyes.com because it provides people with the language to describe how they receive pleasure. That can be massively helpful in learning how to both understand and communicate your pleasure needs to others. 

I've heard conflicting information on HPV. A gynecologist said to me that even 2 formerly-virgin, now sexually engaged adults could contract HPV, leading me to believe that it is something within us, dormant in some genes. Can you clarify & expand on HPV?

IP: It’s definitely not something within us, HPV is something we catch from each other.  But penetrative sex is not the only way to catch HPV.  Even just rubbing up against one another (any skin to skin contact of the genitals) can transmit it.  And studies have found HPV under people’s fingernails and on people’s hands.  Meaning someone with HPV could touch themselves, and then touch your genitals or anus and transmit it, even without actual penetration.  Oral sex can transmit it too.  Lots of ways to catch HPV, and penetrative sex is just one of them.

For starters... I am a virgin in my 30s. I was waiting until I was married to have sex. Now that I’m in my 30’s, I have decided that I no longer want to wait for marriage and that I want to start having sexual intercourse. What is a sexy and sensual way to tell my partner that I have never had intercourse and that I would like for them to be my first partner? Also, what are some tips to make my first time enjoyable for both of us?

Thanks!

And Shan...Game of Desire has been my saving grace ❤️I bought it for 3 friends and they paid it forward and bought it for other friends. Thank you for all that you do!

Shan: You can’t see this, but I hope you can feel it... I smiled SUPER BIG when reading this question. I don’t know how or why this happened, but it seems like our society went from obsessing over adults waiting to have sex TO shaming or undermining the value of people who’ve waited to have sex. Both are bogus. A person who hasn’t had sex isn’t necessarily more healthy than those who’ve had sex (especially if those individuals are taking health precautions and getting tested regularly *insert shameless plug www.[YESmeansTEST.org](http://www.yesmeanstest.org/)\*). And a person who hasn’t had sex isn’t necessarily less skilled or fun that someone who has been sexually active. There are various ways to be confident/ apt at something: scholarly knowledge, street knowledge, social knowledge, mentorship or personal experience. So, I’d assure your partners that just because you lack personal experience that does not mean you lack skills in the bedroom 😊. And the best way to make the first time enjoyable? Don’t put so much pressure on the first time! I approach it like it’s one of many, not one of one. Your first time doesn’t have to be perfect; it just has to be what any good sex should aspire to be: consensual, curious, explorative and enjoyable. And if you say yes to sex, then say yes to test!

Hi Shan! I want to know when you’re gonna start doing Make up or Break up again? It was a guilty pleasure for my wife and I

Shan: Aww this is really sweet thank you! Currently I have a daily show on Quibi called Sexology with Shan Boodram so it would be impossible for me time wise to also do Makeup or Breakup if Facebook did want to start it again. But never say never! Now that I know this, if I ever chat with them again I’ll let them know that the show still has fans even a couple years later 😉 appreciate you!

Is it normal to get cramps after clitoral orgasm and bowel movements? This is a serious question

IP: This can definitely happen.  It’s not super common, but your body might be releasing hormones during orgasm called prostaglandins that could be affecting your GI tract, if it’s sensitive. 

Why won't my doctor give me an STD test if i don't have symptoms? I'm very sexually active and have multiple partners at a time often, and sometimes I just want to know early to prevent spreading anything.

IP: Hi, it’s wonderful how you are taking charge of your sexual health, and that you’re being proactive about testing. STIs are so common—1 in 2 sexually active people will get an STI at some point. And since many STIs have no symptoms, testing is the only way to know if you have one.

You may want explain to your doctor that you’d like to be tested regularly for peace of mind. And honestly, it’s appropriate to look for another healthcare provider if your doctor isn’t meeting your needs. Unfortunately, not all healthcare professionals are comfortable talking about sexual health, and your doctor should know that the CDC recommends STI testing regardless of whether you have symptoms. 

Are STDs passed down, such that if a parent has one their child will too?

Hi! Dr. Park here. Yes, that can definitely happen. Gonorrhea and chlamydia can be passed to the baby during birth and infect the eyes, syphilis can reach the babies bones, skin and brain. HPV and herpes can be passed to the baby during childbirth as well. Of course, HIV can also be passed to the baby during pregnancy, but with treatment of the mom, that is completely preventable. It’s so important to get tested, especially as early as possible during pregnancy. If you need to find a place to get testing, visit www.yesmeanstest.org

Shan here: I am eight months pregnant currently and I can’t stress enough how important it is to not just do the lab work your doctor requests but to request the tests that you want for your health + peace of mind during your pregnancy. I asked to be tested for sexual transmitted infections during my eight-week appointment. I also continue to discuss any changes in my lifestyle or body with my doctor at every visit to see if additional tests have been necessary as my pregnancy has progressed. The more your doctor knows about your health, the better they can advise you on how to ensure the health of your baby.

hey Shan and Dr Park,

So here's my question. For starters when it comes to unprotected sex,take away the risk of stis, the main thing being pregnancy,when can women get pregnant,is there like a safe date when you can be certain you wont get pregnant and can skip the protection?

Then again. Have you encountered people who fear the risk of pregnancy more than the risk of some Stis cause well kids just happen to be a big cost despite them being wonderful and all.

​

Thank you!

IP: Yes, there are dates where you are very unlikely to get pregnant during your cycle.  If you have regular periods on a 28 day cycle, the most likely times to get pregnant are the dates around ovulation (like days 10-17), and you are less likely to get pregnant at the beginning of your cycle and right before your period.  But unfortunately, you can get STIs anytime.  I have definitely seen patients who are more afraid of getting pregnant than getting an STI.  Luckily, STIs are generally treatable and will go away, whereas as you mentioned, the kid is a lifelong commitment! 

Shan: I’m excited to be soon giving birth to my first lifelong commitment. I’m also REALLY excited that I am EXCITED! We actively chose to try and conceive and prior to that, I actively chose NOT to conceive with the help of a copper IUD, which is a long-acting reversible contraceptive. LARCs are highly effective and can takeaway a lot of the stress when it comes to family planning when used WITH a barrier method to prevent STIs. Talk to your doctor about what birth control method, plus barrier method could work wonders for you. There’s a lot of awesome options out there designed to help support whatever choices you want to make for your body and future – take advantage by taking a trip to your healthcare provider!

Hi folks,

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Is much known about the rate of false positives for Herpes (HSV2) antibody tests? Is it worth seeking further tests/blood work if one has a positive test but no symptoms?

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Thanks!

IP: HSV2 antibody tests usually come with a numerical value called an Index Value.  Anything over 1 is labeled as positive, but anything between 1.1-3.5 is more likely to be a false positive.  The definitive test is a Western Blot.  It is performed at University of Washington’s virology lab, their number is 1-800-713-5198, and their email is [[email protected]](mailto:[email protected]).  Also, some other private labs do a test called an immunoblot (LabCorp is an example of one).  I’d ask your doctor whether they could send out a confirmatory test if you have a test with a low index value (1.1-3.5).  If the value is higher than that, it is likely a true positive test, but you may never have had symptoms—that’s true for the majority of people with HSV-2.

Growing up gay in a small Christian school (and then graduating from a small Christian college) has left me pretty uneducated when it comes to sex... especially gay sex. I know embarrassingly little. Are there online resources out there that can help give me some of the gay sex education I've never had?

Shan: I LOVE and have worked with Advocates for Youth many times. Not only do they have tons of great info on there for the LGBTQ+ community, but they also have many LGBTQ+ staff and youth mentors that bring their personal experience and passion to their work. Highly recommend checking www.AdvocatesForYouth.org out and the resources they suggest, I know I’ve learned a lot from them.

How can you prevent getting chlamydia and getting reinfected? When should you retest for a full STD screening?

IP: Condoms are very effective at protecting against chlamydia, so if you want to protect yourself, then that is the way to go.  To prevent getting reinfected, the most important thing is to make sure any partners are treated close to the same time that you are treated, and waiting at least 7 days after both are treated before you have sex again.  If you do get chlamydia, it's important to get retested 3 months after treatment.  Most reinfections happen early, and reinfections are more likely to lead to later complications with fertility, so its important to get that repeat test. If you need to find a place, go to www.yesmeanstest.org. Good luck!

If ur still doing the AMA can you really get hepatitis through skin to skin contact?

IP: Hepatitis A, B, and C cannot be spread through skin-to-skin contact.  Hep A can be spread through contaminated food/water, and can also be transmitted via oral-anal contact such as rimming.  Hepatitis B and C are bloodborne viruses, so they can be sexually transmitted due to small breaks in the skin that occur for both partners that might allow contact with a partner’s blood.  But skin/skin contact doesn’t spread hepatitis. 

What are the chances of contracting HPV for a male who wears a condom properly?

IP: It’s great that you want to protect yourself, but HPV is like glitter, and it can be found all over the genital and anal area, in areas where a condom can’t cover.  So I would say, condoms are great at protecting the penis during vaginal/anal sex. They are also great protection against other STIs such as gonorrhea/chlamydia, syphilis and HIV. 

Back to HPV, it can also be transmitted through oral sex, and many people don’t use condoms for that.   I always tell my patients it’s a natural consequence of being sexually active, and unavoidable.  Luckily, most people don’t develop any issues, it just hangs around silently and your immune system will clear it.  Don’t let it stop you from having sex and enjoying yourself!

I’ve got an extreme fear of needles and medical procedures in general, which makes it nearly impossible to get through things like pelvic exams or to even go in the first place. What can I do to still get tested?

IP: STI testing can be quick and painless. It’s usually just a quick vaginal swab or pee in a cup for gonorrhea and chlamydia.  Testing for HIV can be done with an oral fluid test (OraQuick), which can actually be purchased at most pharmacies.  Some places are offering self-collected testing for cervical cancer screening, but this isn’t common yet.  I think it would be great to seek out therapy/counseling because dealing with needles and procedures is something you will need to do your whole life.  You can definitely overcome this, but it will likely take time and effort on your part.  Hang in there! 

How are you handling getting tested now that so many testing centers are closed?

IP: Check out www.YESmeansTEST.org to find a clinic. I would check with the clinic before you go to see what STD testing is available. There are options for “at-home testing” which allows you to collect your own vaginal, rectal or throat swab or blood sample and take or mail it to a lab for testing. There are several companies and laboratories that provide this type of testing including LetsGetChecked.com, Quest Direct,  LabCorp Pixel and Nurx. Your insurance may or may not reimburse for these services, so sometimes you have to pay yourself.  It’s worth exploring to see what will work best for you. If you have any STD symptoms, contact your healthcare provider and go in for care right away. You should also go in person if you have had sex with someone recently diagnosed with an STD, because you need an exam and treatment. 

Shan: Early into my relationship with my husband we did at-home testing as a date night! It was actually so fun in the weirdest way and a very nice bonding experience. Highly recommend if it’s financially feasible for you or if you’re having trouble locating a testing clinic at this time.

I have read about success with Turkey Tail and Reishi mushrooms at clearing HPV. One source: https://www.reddit.com/r/MushroomSupplements/comments/b83zan/controlling_hpv_with_medicinal_mushrooms_turkey/

paywall source: https://pubmed.ncbi.nlm.nih.gov/25271984/

Do you think there may be more treatments we can find in mushrooms, or that this is coincidental, or something else entirely?

IP: I certainly believe this is possible. One of the newer treatments for genital warts is derived from green tea, so it is possible that an extract from mushrooms might be useful to clear HPV.  Based on the research that has been done though, I don’t think it’s ready for prime-time.  I really think more studies need to be done. Right now, the best way to prevent oral, genital or anal infection with HPV would be vaccination.  I agree though that these potential treatments are exciting, and will be keeping a lookout for more studies. 

Can you get chalmidia or ghonarhea from oral sex?

Dr. Ina: Chlamydia and gonorrhea can definitely be transmitted through vaginal, oral or anal sex, and even genital skin-to-skin contact can spread some STDs.  In terms of breaking oral sex down further, oral sex where you put someone’s penis in your mouth can definitely expose you to gonorrhea/chlamydia.  Oral sex where you put your mouth on someone’s vulva/vaginal area is not so clear in terms of transmission risk.  

What is your suggestion for people who faps 4 times a day?

It's Shan! My rule of thumb for healthy sexual behavior is checking in to ensure your actions aren’t impinging on your health or happiness or the health and happiness of others. If masturbating four times a day is bringing you joy and you’ve found a healthy way to fit it into your life, then I like it if you love it. If it’s something that’s getting in the way of your responsibilities, relationships or self-esteem then I’d suggest seeking out other forms of self-care that you could use interchangeably with fapping.

Is there a correlation between oral and genital herpes? Like if you get one are you more or less likely to get the other?

IP: They are definitely closely related.  Most people get HSV-1 (the virus that causes oral herpes) during childhood, although not everyone will have actual cold sores, you’ll develop antibodies.  It doesn’t prevent you from catching HSV-2 (the virus that causes genital herpes), but people who already have HSV-1 who catch HSV-2 tend to have milder outbreaks and less severe symptoms.  So those antibodies do help, but they don’t provide complete protection. 

For people who still love with their parents/Roommates and can't easily have the place to themselves.

What do you recommend they do when the sex conversation happens where/when/how?

Shan: We’ve all been here! Honestly the first and best option is to have a conversation about those you live with about your sexual needs and see if you can work something out with them, e.g. them leaving the place for a bit OR if it’s your parents seeing how they feel about having sexual partners as guests over. This is because in-person sex in a stable place is the BEST and likely safest sex because you have access to tools to help you clean up before/ after + your sexual health tools and contraceptive should be most handy at home. However, if this is not an option: a) the safest sex possible right now is digital sex so why not try to have fun together, apart on video? B) car sex can work if you make sure you pack a barrier method, wipes, a blanket, pillows, lube and whatever toys your bodies desire C) If you can find a private, legal public space pack the same kit plus some extra nerves!

First, I’d like to say that I just listened to the episode of Ologies where you, Shan Boody, were a guest speaker and I absolutely enjoyed listening to that podcast.

My question is about endometriosis. I have pretty bad cramps during my menstrual cycle and recently (the last few years) I’ve been having sharp pains during intercourse. My physician thinks it’s endometriosis and sent me to see an gynecologist last year. However, the gynecologist only saw me for a few minutes and chalked it up to my vagina being small and told me it’s a spacing issue and told me there’s nothing she could do for me and brushed me off. However, I’ve been with the same partner for 7 years and the pain only started recently. How can I get a doctor to take my pain more seriously? It’s starting to become a problem in our sex life.

IP: Wow, I’m really sorry that happened to you.  Unfortunately, some providers don’t always take patient’s concerns seriously, and that can be really discouraging.  If your pain is causing you difficulty during sex, then I would talk to your original physician and seek out a referral to a different gynecologist.  There are many caring gynecologists who will believe you and work with you to figure out how to manage endometriosis (if that is what it is), or at least do further testing to figure out the cause of your pain.  You deserve a provider who is going to partner with you on this, not someone who brushes you off.  

Shan: I LOVE Ologies and Allie Ward, very grateful for the opportunity to be exposed to her awesome audience. So first off, thanks to you for the love! Second, the response “I sought a second opinion” is popular for a reason! I think your relationship with your doctor is a relationship and not all relationships work or last forever. In my opinion, there’s always something that can be done to bring someone closer to health and happiness, I think it’s important for my healthcare providers to feel the same way.

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IP: LOL.  My whole life!  Right now I’m in a chair, in a room, in an office.  But FYI, my first name rhymes with “vagina”, which may explain how I got to where I am in life!