Fend Off STDs
Well, it might not be the sexiest topic in the world, but there's no getting around it, considering that your hot dog runs the risk of coming into contact with HIV, gonorrhea, chlamydia, syphilis, or genital herpes—and that it could cause unwanted pregnancies. Worldwide, fewer than 40 percent of guys discuss STDs or sexual histories before having sex with a new partner.
And that's just not good enough. AIDS diagnoses in the United States are rising again after declining for a decade. Worse, up to 15 percent of new HIV infections may be drug-resistant strains of the virus.
While you probably know all about the dangers associated with the big sexually transmitted diseases, even your garden-variety STDs can cause a whole world of trouble. For instance, did you know that chlamydia, long linked to female infertility, has been shown by a Swedish study to affect male fertility as well? And most men never even realize they have the disease because they have no symptoms, says study author Jan Olofsson, MD, PhD.
A study by the Centers for Disease Control and Prevention in Atlanta calculated how many years of healthy life Americans lose because of sexual diseases. Here's the annual breakdown, by disease.
Every year, sexual behavior accounts for . . .
Nearly 30,000 deaths (1.3 percent of deaths)
7,666,200 incidences of men contracting STDs
HIV: 557,021 healthy years lost (among US male population) Hepatitis B: 279,624 years
Genital herpes: 7,014 years
Chlamydia: 2,026 years
Syphilis: 1,598 years
Gonorrhea: 1,352 years
And yes, we have quite a bit to learn from much of the world on this count. US rates of premature death and disability attributed to sexual behaviors are triple those in other wealthy nations.
It's high time we reversed the trend. As you'll see in this chapter, the best way to protect yourself is to (a) practice safer sex, and (b) get tested frequently.
After all, you don't want to be a literal ladykiller.
What Is Safe Sex?
Safe sex means taking precautions so that you and your partner don't expose one another to sexually transmitted diseases (otherwise known as STDs). It can also mean using birth control methods to prevent pregnancy.
Most sexually transmitted diseases are passed from one person to another in one of the following ways: through bodily fluids (saliva, ejaculate, or vaginal fluid) or the exposure of mucous membranes to other mucous membranes (her vagina, your penis) or to a cut or a sore. Safe sex means introducing a barrier so that these kinds of contact are less likely to occur (a condom to catch your ejaculate, for instance).
THE ULTIMATE OUCH
One vigorously misplaced thrust is all it takes to rupture the corposa cavernosa, the elongated “erectile chambers” that run the length of your penis. Don't believe us? Try aiming your erect penis at the trunk of a tree—it's roughly the same density as your partner's pubic bone. A complete rupture will require surgery within 24 hours to stanch internal bleeding and reduce the risk of permanent damage. A partial tear isn't as serious, but later on it may cause problems such as Peyronie's disease; as the linings of the corposa heal over with scar tissue, they lose their elasticity—leading to curvature, pain, and, eventually, impotence. By some estimates, more than a third of impotent men have a history of “penile trauma,” and one-third of all penile ruptures occur during lovemaking.
To protect yourself, be especially careful when she's on top. That's the position most likely to cause damage.
Safety, of course, is relative; no sex is entirely safe. Is kissing safe? Pretty much—although it does include an exchange of body fluids, and therefore a very small risk of transmission. And when you're talking about sex, although no condom is 100 percent guaranteed (accidents will happen), rubbers are still the best form of protection. Do condoms break? Rarely, but yes (and much less commonly when they're used correctly).
Unless your partner is someone you know and trust, who has tested negative for STDs a minimum of 3 months after her last episode with someone else, you should always take the following precautions.
Use a condom for intercourse, vaginal or anal.
When she gives you oral sex, use a condom.
Use a dental dam or a cut condom when you give her oral sex.
Get tested regularly.
A few more things to think about, so you're not ambushed with any unpleasant surprises:
Double up. If you're with a woman who's on the birth control pill, you should know that powerful antibiotics such as rifampin can interfere with hormone levels and make birth control pills less effective, according to Marc Feldstein, MD, an ob/gyn at Northwestern Memorial Hospital in Chicago. Many doctors suspect that more commonly used antibiotics like penicillin and tetracycline can also interfere with birth control pills, though that has never been proved. To be safe, you need to use a condom for a week after she takes her last antibiotic pill. (She shouldn't stop taking her birth control pills when she takes antibiotics.)
Just say no. If your partner has a cold sore on her upper lip, take a rain check on oral sex, or wear a condom. Yes, what you heard in the school-yard was correct: The herpes virus behind cold sores and the ones behind genital herpes are different. But that won't necessarily stop them from setting up shop elsewhere.
“The herpes simplex 1 virus has a preference for the oral area, while herpes simplex 2 has a preference for the genital area,” says Stephen K. Tyring, MD, PhD, professor of dermatology, microbiology, and immunology at the University of Texas Medical Branch. But it's possible for a cold sore to transmit HSV-1 to your penis, giving you the same painful sores and flulike symptoms that characterize the genital variety. If she gets them a lot, make a condom standard operating procedure when she's down on you.
YOUR GET-OUT-OF-PARENTHOOD-FREE CARD
For protecting yourself against STDs, condoms are your best bet. But if you and your partner are monogamous and have been tested, your big worry is making sure you don't end up with rug rats that you're not ready for. Here's a reminder of your contraceptive options.
Condoms: Good protection against STDs—also very good birth control. Easy, inexpensive, widely available—and one of the only birth control methods where the man's in the driver's seat.
The Pill: Not for nothing did it start the sexual revolution. It's safe, cheap, and effective—as long as she remembers to take it.
Female condom: Effective; slightly more expensive than the male version. Some men who dislike condoms swear by these; others say it's like having sex with a plastic baggie. If you're looking for an alternative to rubbers, it might be worth trying to see which side of the fence you're on.
Diaphragm: A barrier method that's available with a prescription from her doctor or a family planning clinic. Not quite as effective as a condom or the Pill, especially for women who have already had a baby. Fit is everything; she may need to be refitted after a pregnancy or a big weight change.
Sponge: Said to be very effective with “perfect use”; anecdotal evidence suggests that perfect use is harder to come by than you might think.
Spermicide: Best used with another form of birth control, such as a diaphragm.
The Patch, the Ring, the Shot, the Implant: These are all hormonal solutions available with a prescription from her doctor or a family planning clinic. Since these have to be replaced infrequently, they're better for the absent-minded than the Pill.
IUD: Although the IUD has had some PR difficulties, it's a very effective, comfortable solution for women who have already had a child. It has to be inserted (and removed) by a medical professional.
Vasectomy, tubal ligation: His-and-hers sterilization options. Although both are reversible in many cases, changing your mind is expensive and nothing's guaranteed; better to be sure before you sign up. Worried about getting snipped? It sounds worse than it is—after the procedure, you'll walk out of the doctor's office under your own power, and you'll be just fine after a weekend's rest.
Some Good Ways to Get Yourself One of Those “World's Best Dad” Mugs
Abstinence: Abstinence works, of course—if you can do it. Which you usually can, right up until the moment where you can't—and then you'll probably want to have something a little more reliable on hand.
Withdrawal: Withdrawal. Doesn't. Work. Pre-ejaculate contains sperm, and sperm makes babies. Any questions?
Continuous breastfeeding: Breastfeeding does have a contraceptive effect, but it's most reliable in the first 6 months postpartum, and then only if she's nursing constantly and a lot. Again, explore alternatives if you're serious about not wanting another child.
Getting tested regularly is important because many STDs present without symptoms in men, which means you may not know about an injection until your girlfriend comes down with a case of crawling cooties—and by then, the damage is done. How often you get tested depends on what you're doing and who you're doing it with. Once a year is standard, and you may want to increase the regularity if you're sleeping with lots of new people or engaging in high-risk behaviors.
Good news: Ask your doctor about the Aptima Combo 2 Assay. Getting tested for chlamydia and gonorrhea used to require a painful swabbing of your urethra. But the Aptima Assay, a urine test recently approved by the FDA, is 100 percent swab-free. “This test is as effective as traditional STD tests,” says Harold Wiesenfeld, MD, assistant professor of gynecology at the University of Pittsburgh.
More good news: The OraQuick HIV test takes 20 minutes. Let the tech take a drop of blood, then have a seat in the waiting room. You'll have your answer before you can finish that 1998 National Geographic article on “Fascinating Finland.”
The old way, it took up to 2 weeks to get results, and roughly one in three who were tested never came back for the verdict. With the new test, very few are expected to bolt. This is good: People who learn they're infected tend to take themselves out of circulation.
Let's Talk about Sex
Before you do the deed with her, you'll have to have a conversation about it. For many people, that conversation goes a little something like this: “Hold on while I get a condom.” That's fine.
THE CONDOM, TRANSLATED
Denmark: gummimand (“rubber man”)
France: preservatif (literally, “preservative”)
Germany: lummelute (“naughty bags”), Pariser (“Parisian”)
Greece: kapota (“overcoat”)
Hong Kong: pei dang vi (“bulletproof vest”)
Hungary: osver (“safety tool”)
India: Nirodh (a government-supported brand), parda (“veil”)
Indonesia: koteca (“penis gourd”)
Mexico: angel custodio (“guardian angel”)
Nigeria: okpuamu (“penis hat”)
Philippines: kapote (“raincoat”)
Portugal: camisa de Venus (“Venus's shirt”)
Spain: globo (“balloon”)
United Kingdom: raincoat, hazmat suit, French letter
United States: rubber, jimmy hat, love glove, Coney Island blowfish (Okay, nobody calls them that outside of the comics, but someone should start.)
WHAT THEY SAY
“For me, I think it is very easy to be the man. You simply take out the condom and put it on. No conversation necessary,” says Andre, from France.
“I simply say, ‘I never do it without one.’ And then it's not an issue of trusting the person, or judgments, just a personal creed. And it makes it easier for me, too, when she's saying it might be okay and I've had a few. All I have to remember is that I never do it without one,” says James, a British banker.
“I hate waiting for the test results—you know, when you're sitting in the waiting room and looking at all the posters, and then they call your name, and even if you're sure everything's all right, there's still that feeling in the pit of your stomach, like ‘Oh my God, what if?’ That's the moment I think about when I'm tempted to do it without,” confides Ian, an Englishman living in Bali.
“It's never been an issue—I've never had a girl complain about me using one,” says Friedrich, a sales rep from Mainz, Germany.
If there's pushback, you may actually have to talk some more. It can be uncomfortable, but it's completely necessary; and on this, we agree with the after-school specials: If you're not mature enough to talk about it, you're not mature enough to be doing it.
“In this day and age, you have to overcome your reluctance to talk about sex,” says Isadora Alman, a California sexologist who writes a syndicated column called Ask Isadora. “It's stupid to jump into bed together and then check to see who's got the condom. Those with severe inhibitions just have to practice until they get over being uncomfortable discussing safe sex.”
Remember that using drugs or drinking too much lowers your inhibitions and impairs your judgment—pretty much a handcrafted recipe for agreeing to engage in unsafe sex, or (worse) engaging in it without meaning to because you're too hammered to get the thing on properly.
Condoms: A User's Guide
The best way to protect yourself is by using latex condoms every time you have sex. Actually, the best way to protect yourself is by using condoms correctly—otherwise they're not effective for contraception or protection. And a study in the journal Sexually Transmitted Diseases reads like a horror show: Half of people visiting a Colorado STD clinic reported condom-use mishaps.
We asked David Fletcher, MD, Men's Health advisor and medical director of SafeWorks Illinois in Champaign, to give us a refresher course on safety. Here are the points to remember.
Do use a widely recognized brand. Durex, Lifestyles, Trojans. This is on the list of things (Valentine's Day presents, toilet paper) that you shouldn't buy at the dollar store, okay?
Do use latex condoms and water- or silicone-based lube. No Vaseline, no lotions, no moisturizers, no cooking oil, no mineral oil, no oil-based lube.
Don't carry them around in your wallet. You know how it gets all bent and worn and then your wife gets you a new one for Christmas? All that bending and wearing is really, really bad for condom integrity.
Do check the expiration date. Old condoms are more likely to break.
Don't tear the packet in half, or go at it with your teeth. Rip off the top of the packet, making sure not to damage the condom.
Do get the kind with the reservoir tip. Or make one, by pinching the very end of the condom as you're rolling it on, so that there's a little extra space right at the tip. Otherwise, you run the risk of breakage.
Don't even get us started on people who start having sex, stop, and put on a condom to finish. That's like hollering for defensive help after your man has driven the lane for a layup.
If your bits are anywhere near her bits, let alone in them, you should be wearing a condom. You're probably familiar with “pre-ejaculate” (that spot on the front of your boxers when you're really turned on). The longer you're hard, the more pre-come you produce. Problem? For the purposes of disease prevention, a body fluid is a body fluid. And if you're worried about pregnancy, pre-come contains sperm. And it just takes one, baby.
ROOM TO GROW
Trojan's Ultra Pleasure condom is shaped like a lightbulb, giving you a little more room at the business end. For once, your penis won't feel like a shrink-wrapped convenience-store snack. In the interest of healthy sex, a few Men's Health staffers gave them a whirl and reported that Ultra Pleasure gave us the best condom experience we've ever had.
JUST LIKE THE REAL THING—ALMOST
This is such a great trick, we can't imagine why everyone doesn't use it. Obviously, one of the real sensations that you're missing out on when you're practicing safe sex is that wonderful wetness that tells you you're home. Fake yourself out by adding a tiny drop of lube (a little goes a long way in this instance) inside the rubber before you put it on. It heats delightfully once it's in play, and feels much closer to the real thing.
Do wait until you're ready for intercourse. You don't want to be doing too much rubbing up against her while you're wearing it—even the silkiest panties can snag and damage latex.
Don't flip it. Start unrolling it on a finger first. If you start putting it on backward, don't flip it over and continue—toss it and grab another. If you put it on wrong, toss it out and grab another. Yes, even if it has spermicide on it.
Do roll it all the way down. All the way down. To the very base of your penis.
Don't hang out too long after the party's over. Pull out right after you come. And when you pull out, hold the bottom.
DEPENDING ON YOUR EQUIPMENT
The technique for putting on condoms does differ for uncircumcised men. In order to avoid the condom “creeping up,” the foreskin needs to be retracted before the condom is unrolled onto the penis. When the condom is unrolled about one-third of the way down the shaft, one hand should be used to pull the foreskin with the unrolled part of the condom upward while the other hand continues to unroll the condom to the base of the penis.
ONE MORE REASON NOT TO LEAVE HOME WITHOUT ONE
If you find yourself wading in the Amazon, you'll be glad to have a condom handy. Wearing one will prevent a small fish, known as the candiru (also known as the toothpick fish, or the vampire fish of Brazil), from swimming into your urethra.
Sleep well tonight!
Don't flush! Latex is a notorious drain clogger. Tie it in a knot (trust us on this one) and throw it in the trash instead.
Don't reuse. We're sorry that we have to include this one, but some things, apparently, aren't obvious.
Uh-oh: What do you do if the condom breaks?
Get your postorgasmic butts out of bed; the clock is ticking. “Sperm can be in the cervical mucus within minutes,” says Katherine Forrest, MD, MPH, a public health physician in northern California. Translation: Your little guys are about to do the hibbity-dibbity with her possibly fertile egg.
First option: Hope she has contraceptive foam with the spermicide nonoxynol-9, so she can spray (while you pray). Or, failing that, a vinegar douche (1 to 2 tablespoons of vinegar to 1 quart of warm water), which is acidic enough to kill sperm. Medicine cabinet empty? Dr. Forrest recommends that your partner take a morning-after pill within 72 hours of intercourse. Have her call (888) NOT-2-LATE for a pharmacy that carries emergency contraception; it's now available over-the-counter for women over 18.
The Condom Shelf, Decoded
There are a wealth of condom choices out there. Here are some pros and cons of the various types, according to experts at the Mayo Clinic (www.mayoclinic.com).
Latex: These provide highly effective barriers against pregnancy and STDs, and they're the most reliable preventive measure against the transmission of HIV.
Plastic: Proven in recent, limited lab studies to be an effective barrier against HIV, but unlike latex condoms, they're prone to slip off.
Animal skin (lambskin): They can stop sperm, but viruses and bacteria can get right through the pores. Lambskin condoms are also more likely to break than latex condoms.
Female condoms: On the plus side, they protect against STDs and pregnancy, and they're her problem, not yours. On the minus side, it's kind of like having sex with a Baggie.
Novelty condoms: Avoid them. You are not a “novelty,” and these condoms won't protect you against STDs or pregnancy. In fact, some of these fun condoms are factory rejects that legitimate condom manufacturers have sold to novelty packagers.
If it was given to you by your Secret Santa or comes attached to a penis-shaped pen, or if you have to break a piece of plastic to get it out, it's probably not a real, working-order condom.
Having trouble telling the difference? Real condoms come from legitimate retailers like drugstores (i.e., not the store with the wind-up Jesus toys), and they're sealed in sterile cellophane or foil wrappers. You should see a brand name, an expiration date, and a lot number.
“More sensitive”: A euphemism for “thinner,” with more risk of tearing.
“Stronger”: A euphemism for “thicker,” meaning less breakage risk and less sensation.
Size: In condoms, it does matter, so be honest. If it's too tight, it's likely to break. If you buy XXL and you're not, the slippage factor is huge.
Ribbed: Same protection for you, a little more tickle for her. Most women report that the thrill is underwhelming, but it's worth a shot.
Lubricated: May reduce the risk of tearing, but no good for oral sex.
Spermicidal: These offer slightly more protection against pregnancy, thanks to the spermicide nonoxynol-9 (N-9), but they aren't HIV or STD killers, according to the Centers for Disease Control and Prevention. Watch out for allergies.
WHO'S CALLING WHO DEPRAVED NOW?
In the 17th century, Spain boasted that it was free of sexual deviance; when referring to bestiality, the Spanish nicknamed it “the Italian vice.” Meanwhile, syphilis was known as “the French disease” in Italy and “the English disease” in France.
Let's Go Shopping
CondomDepot.com features a World's Best Condom Sampler Tin, featuring a selection of condoms from Japan, Britain, the United States, and elsewhere.
Or go in person: The Condomania boutiques in New York, Miami, Las Vegas, Los Angeles, and San Francisco are devoted exclusively to the sale of condoms, with more than 300 styles from six countries in every store. The latex selections include minty, studded, textured, extra-large, extra-small (not many takers for these, say the owners), ultra-thin, lubricated, and the ever-popular “Wrap Your Knight in Shining Armor,” a glow-in-the-dark contraceptive. (You can order sized-to-your-penis They-Fit condoms at condomania.com.)
TO THE RESCUE
Swedes in Stockholm, Malmö, and Gothenberg can summon a “condom ambulance”—a white truck featuring a red condom with wings on the side—by phone and get a packet of 10 delivered.