154 - Getting Real about Sexual Health

How many people would you need to have unprotected sex with in order to catch an STI? 4? 50? 1000? This week we get real about the language we use around sexual health as well as your real-world chances of catching an STI (hint: you probably already have one.) 

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Jase: On this episode of the Multiamory Podcast, we're keeping it real about sexual health.

Emily: Yes, we are. [laughs]

Dedeker: I like to -- I just really like to envision some really 90's text floating in at an extreme angle.

Jase: Yes. With like the trails behind the wheel as it's flying in.

Dedeker: Yes, definitely. So this is the intro to your health class. Your ninth grade health class video?

Emily: That's the thing though. I wish that this would have been like the intro and kind of the schtick -- the spiel that we got in our health class, because so much of what is taught in health these days, and especially when we were kids, was just terrible and just about scaring you. It was awful.

Dedeker: It really depends on the school district also. There's no standard for what’s taught at least in the United States, that can so vary by school district to school district. We still have a lot of places that are teaching abstinence-only education and it's really not helpful for us.

Emily: No, not helpful for anyone especially not the kids of today.

Dedeker: Yes, the kids of today.

Emily: The up and coming children of tomorrow. So basically I had an idea that we needed to revisit this episode simply because, I learned recently that two of my best friends who are monogamous, they were talking about the fact that they were about to go get ready to have a doctor's appointment. One of them had not been to the doctor and therefore not had an STD test in over ten years. This person is male. He has not had an STD test in over 10 years. In that time, he has had sex with a lot of people and yet has never ever seen if he has anything. So because of this, I was flabbergasted. I was like, "Well, what--?"

Dedeker: Can I cut it real quick? How did this conversation come about between the two of you?

Emily: We were-- When you run a show on sex and relationships, sex relationships come up from time to time.

Dedeker: Funny how that happens.

Emily: Exactly. So I think it just became a topic of conversation and then all of a sudden he was like, "I'm about to go get tested because I haven't in 10 years." and I'm like, "What? What? Wait. Really?" And now with -- scare me any -- if I were to go out on a date with them, I would be really worried if I knew that my partner or that my potential new sexual partner had not been tested in this amount of time. His current girlfriend has been with him for two years and that entire time has never known his sexual history. I was like, "Let's talk about this a little bit."

Jase: I mean in terms of talking about dating someone who hasn't been tested in so long too, aside from even just concerned about the fact that they don't know and that you don't know either, but also just a person who doesn't take that seriously or doesn't prioritize that is also a bad indicator of what other things might they not be actively maintaining about their health or about their effect on other people and all these things. I think there's a few troubling things there.

Dedeker: I don't know either -- I mean to be fair, when I first started getting sexually active that wasn't -- this is -- I don't know why this is. It wasn't even a thing I thought to concern myself about for a number of years. I had gotten health class stuff about STIs and about getting tested but for some reason it's just -- I don't know. My dumb little 20-year-old self was just like, "La-la-la-la-la." I guess it doesn't apply to me, I don't feel I have an STI.

You know I think that -- and I don't know what that is-- I don't know why if that's a product of what we learned in the school system, if it's a product of just not talking about sex or about sexual health enough that it just doesn't become a part of what we're normally thinking about. I'm not sure.

Emily: I think it's twofold and this is a vast big generalization but I think a lot of kids these days, I know I did when I was a child, they -- Sorry, I am almost 30, I'm no longer a kid.

Dedeker: Kids these days.


Emily: I think a lot of young people think that they're invincible in a lot of ways, and so it just doesn't even necessarily cross their minds. Also on the other flip side of that, I think that there is potential fear involved with getting an STI check, just because it's like there is so much stigma surrounding so many things which I think is very unfair and people may just be worried like, "What am I going to do? Am I going to have no sex life if I find out that I have something or blah blah blah blah blah."

Jase: Definitely. I think fear is a big factor in that. I was going to say I was lucky, I guess, in that in high school I had a part-time job and there was another girl, I guess we were both in high school, boys and girls here. There was another girl who was about my same age who worked there but she was very actively involved in sexual education amongst our peers. We went to different schools but in the same general area. We had a little bit of a flirty rapport and I was into her but because that gave me my motivation to really listen to what she's saying be like, "Yes. Gosh. Right. That's so cool. That's really cool."

Dedeker: "Yes, sexual health. That's great. Wow."

Jase: I guess I was lucky in that way that -- and that was at a point in my life where I had not had sex yet. To get that kind of education with a little motivation behind it if why I should care.

Dedeker: I mean sex is a great motivator, including for learning about sexual health, I guess. Obviously this is such a broad topic and we can't cover the entire scope of sexual health or STI risk or managing that or disclosing that or talking about that. What are -- We boil down just a couple intentions that we have for this episode.

Jase: The first of those is to get real, as I said in the intro. To keep it real about what are your chances of being exposed to and being infected with different STIs in your sex life.

Emily: We also wanted to talk about the importance of testing -- We'll delve a little bit more into that. It's important to get tested and it's important to talk about those test results with your partner or potential partners.

Dedeker: Then of course I have to give the disclaimer that we are not doctors, we are not health professionals of any kind. You can find lots of great information out there about all of this from the CDC or from Planned Parenthood. But as always, be aware that information comes with an agenda often, so find multiple sources. Anything that you hear from us, double check it as well with different sources. Talk to your doctors, not just one doctor, multiple doctors. If you can get a variety of professional opinions and really make sure that you're making an effort to educate yourself as well along with any information that you receive from somebody else, including us.

Jase: Definitely. I think today, with the internet being such an easy resource, it's both a bad thing and that there's a lot of not reliable sources out there. But the advantage we have is if we are proactive ourselves, we can check things and see what the sources of that. Can I get sources from a lot of different places? Can I read about different studies? Can I try to find places that seem to have more of an even approach to this? Or like this episode, we tried to look at a lot of different sources for this information. We're not just like, "Hey, we're doing an episode based on one article we read on the CDC."

That this is pulling together a lot of different things and being like, "Ha. That doesn't seem to fit with other things I've heard. Let me try to find another source and try to get to a more realistic view of these." With that, another thing that we wanted to cover real quickly is just about talking about STIs and a few guidelines that we want to be mindful of ourselves and also we would love for more people in their community to be mindful about the way that they talk about STIs.

Dedeker: I definitely see a big disconnect in the ways that STIs and sexual health are talked about within alternative communities versus more traditional communities. Often -- I think I often see especially people who maybe have been in more traditional relationships their entire life and are starting to explore non-traditional relationships will often still bring with them a lot of old tired out ways and unhealthy ways of talking about STIs and sometimes bring that in.

We just wanted to lay this down on some standards for talking about things. The first thing being to -- when you're talking about STIs either by yourself or somebody else or two somebody else, avoid using cleaner-dirty terminology in talking about it.

Emily: People don't often say dirty -

Dedeker: But they do say clean

Emily: - but realize that there was some point --

Jase: Every time you're saying clean, like, "I'm clean for STIs." or "I only have sex with people if they have a clean bill of health." By saying 'clean' you are implying that the opposite of that is somehow dirty. That's not the case. Would you say someone was not clean because they'd had the flu, or because they had chickenpox in their life? That's absurd. So because we are so uncomfortable with sex in our culture, we give it this whole dirtiness thing just like we used to talk about people - especially women who've had sex at all as not being clean anymore and not being dirty.

Emily: Just horrible.

Dedeker: Make sure that you avoid that kind of language, just get more specific with it, talk about like, "I tested negative for these things." or "I've tested positive for these things." or "My partner has tested negative for all these things." or "I've tested positive for this." As opposed to just being the sweet bubble of a clean bill of health or "My STI results are clean."

Emily: You can be more clinical about it. In addition, there's a lot of talk out there still regarding jokes and STIs, specifically herpes that are really damaging and continue that stigma of this is an unclean or not a good thing or you somehow are dirty if you have this. Obviously --

Jase: Especially jokes that add like a value judgment to the people that have something. Again, like you wouldn't give a value judgment to someone because they have the flu or not. That these are in both cases are still infections and diseases that you get from other people. That's how all of them pass, it's not just spontaneously is given one of these. They're spread from people to people, either way these ones just happen to be related to our genitals sometimes, not even all the times.

Emily: Definitely avoid that.

Dedeker: This reminds me as well, we'll talk about this a little bit later on but Ella Dawson who is someone who identifies as polyamorous and I believe queer as well, maybe I might be getting it wrong, but also is very open and vocal about having herpes as well. She talks about actually calling people out when they make a herpes joke. Her first choice and -- she talks about the first time that she did it was at a party and she was sharing a cup with somebody and he was like, "Don't worry I'm not sick and also I don't have herpes either. So don't worry about that." It was really hard for her but she was like, "Actually, that's not funny because I do have herpes and it's actually a very normal thing."

She says that at first it was scary but the fact that his reaction was not like, "Oh, that's so gross." It was like, "Oh my God. That's so embarrassing for me that I just insulted you to your face." and also hold a whole swath of the population essentially. People remember instances like that, so might be something to consider. Even if you do not have a HSV but just to bring that up, you would be like, "Actually, you probably have herpes." Maybe that's a little bit too provocative. [laughs]

Jase: We'll goinf to talk more about that later.

Emily: Or change your language regarding this like, "It's just fucking funny."

Dedeker: Definitely encourage -- People are making jokes about STIs, do don't be afraid to say something. It doesn't have to be provocative, it doesn't have to be picking a fight. It can just be like, ”You know actually, a lot of people deal with that. So it's not very funny to minimize it or to make a joke about it."

Jase: I think also regardless of your status, whether you have herpes simplex virus or not, you can still be one to stand up for that. I remember in high school, it was gay jokes was the thing. That was made a lot and I made this decision at one point just because I had a lot of friends who identified as gay and I did not at the time identify that way but still was like, "I'm in a position where I'm not the one who's going to get beat up for this or who's going to be get made fun of to my face like why don't I be the one to stand up and say, 'Hey, could we not make that joke because that's not cool, that's not nice to real people who could have their feelings hurt.'"

Emily: If you're saying the word retarded or anything along those lines, it all is in the same categories.

Jase: It's all related.

Emily: Not nice, not kind.

Jase: I also just want to quickly cover the difference between STD and STI. For a long time -- First, it's called Venereal Disease and then --

Dedeker: Good old VD.

Jase: Good old VD. Then we move to STD which stands for Sexually Transmitted Disease. More recently -- I guess not that recently, probably 10, 15 years ago, we started transitioning to saying STI instead of STD. Basically the difference is that an infection means that you've been infected with some kind of a virus or a bacteria or a fungus or something like that but it might not have any symptoms. Something's only classified as a disease when you're having symptoms, when the cells in your body have been affected by that to the point where you're having symptoms.

The reason why the switch to STI is to point out the fact that not everyone has symptoms. In fact, as we're going to cover, a lot of people don't have symptoms for these things even if they have them. STI is more inclusive, I guess. All STDs are STIs but not all STIs are STDs because it's based on whether or not there are symptoms present.

Dedeker: The last thing, just as a note. Don't talk about this on your dating profile. What I mean by that as in what I usually see is people being like, "No drama, no STDs." or "I want you to be disease free." or whatever.

Jase: I will say though on the other hand, there are a lot of people who feel like it's very important to state on their dating profile, "I have HSV." or something so that's not what we're talking about.

Dedeker: That's your choice if you want to do that, that's fine. But more of I feel like I see it all the time and obviously is rooted in a lot of issues around stigma, around the way that we reduce people to whether they're positive or negative for something. It's okay for you to obviously not want to expose yourself, however, do that in your actions, in the choices that you make about your safe sex rather than trying to filter out somebody and trying to find somebody who's disease free. We'll get into later that's probably going to be a lot harder than you think that it's going to be.

Emily: Along those lines, if you are having sex, you probably have something or have had something during the time that you've been sexually active, even if you didn't know it. Really, some of the most highly stigmatized STIs are absolutely the most common ones. If you heard a vision of that being the sex slave that involves never having to think about STIs, never being exposed to them, any of that stuff, you're probably honestly not really ready to have sex because most likely, it's going to happen at some time or another and that's okay.

Dedeker: I feel -- I've had a number of clients and just a number of friends also who for some reason, their vision of the ideal sex life is like, "No one that I have sex with has any kind of STI or has never had any kind of STI." Like, "I never have to even think about it, I never get exposed to it. Everything is just -- I don't even have to touch it or think about it at all."

Emily: The probability of that happening is so ridiculously small, that’s insane today.

Dedeker: That's the thing. It's if you're going to have sex, whether it is having sex with one person, whether it is having sex with multiple people over the course of your life, whether it is having sex with multiple people overlapping, within a multi-partner relationship or something like that, you are going to have to address this topic and you're going to have to deal with likely someone testing positive for something or having symptoms for something.

Whether it's yourself or partner or partner's partner, you are going to have to deal with it. Doing the whole ostrich with head in the sand tactic of just not dealing with it or just thinking like, "Oh, that's fine. I'll just find all partners who don't have any STIs." That's not going to work.

Emily: Good luck with that.

Dedeker: Yes, good luck.

Jase: It's not going to work. Also a lot of the people who are the most worried about that, very likely have something that they don't even know about that maybe they've had since childhood. That's the other thing too is that these infections that we classify as STIs which we're going to cover the main ones, there are others as well, but a lot of these can be contracted other ways too.

So the idea that we put all this importance on a sexual thing. Actually, a really good reference and I wish I could remember, this might be from one of Ella Dawson's TED talks or might have been somebody else, but was talking about the fact that in every doctor's office, every sexual health clinic, every sexual information place, they're required if they get any state money especially, but are pretty much always required and always say that sort of disclaimer of like, "All sex has some risk. There is no such thing as safe sex. yada yada yada." All that.

Then she brought up these charts about the number of incidences of STIs and then the number of incidences of people who actually die from that or are debilitated from that and these relatively small numbers. She brought up a chart of the number of people who are crippled or injured or killed in automobile accidents and she's like, "How come when we go into the DMV, there's not required to be a sign that says, 'All driving is risky. There's no such thing as safe driving. Drive at your own risk.'"

Emily: There's not a stigma surrounding driving.

Jase: Exactly. We're taught that abstinence is the only way to stay safe with this whereas we don't even think about that when it comes to driving which is much, much more dangerous than having sex.

Dedeker: What we're going to do, we're going to hit the big players in the world of STIs. I think the important thing is -- because obviously, you as listeners you can go out like I said to the CDC or Planned Parenthood and get whatever statistics or information about transmission or transmission rates or how to protect yourself or whether it's curable or stuff like that. What we found was Mark Manson, he made this blog post that was him doing this -- Again, him also getting real about what are your chances of getting an STI. He actually breaks it down.

He created something called a raw score which essentially boils down to the number of people that you would have to have unprotected vaginal sex with in order to catch this STI on average. The way that he does this just to break it down that further. He says STD, sorry. For STIs that are curable, he took the estimated number of cases per year and then factored it into the number of individuals in the US to get a percentage of those individuals that would contract that.

For the incurable ones, he just took the percentage of the American population that has that STI and he admits that it's a flawed method. Obviously, it's not 100% accurate, it's not going to be like, "If you sleep with a 129 people, then on number 130 is when you're going to get gonorrhea." However -- Of course, don't take it at face value. However, I really like the raw score thing because it really gives a better image of in your mind of how realistic it is that you would catch this STI or not more so than just me telling you, "You have a 15% chance or a 50% chance or whatever." For each of those, we're also going to include the raw score which I think is just a really interesting way of looking at it.

Jase: The point of that raw score though as he mentions here is that because these numbers are very flawed, the point is more to look at the difference between them. The huge, huge differences between this number for different ones rather than saying, "One in this much number. Okay. That means my odds are this so I can take that gamble." That's not what this is about. It's more just for the sake of giving some perspective on how common these things are.

Dedeker: We're going to start out with the typical STI panel that you get tested for, what you're chlamydia, gonorrhea, syphilis, and then HIV, we'll hit a little bit later. Those first three: chlamydia, gonorrhea, syphilis, all of them are curable, chlamydia specifically. Chlamydia usually does not present any symptoms. 25% of men don't experience symptoms, but 70% of women don't experience symptoms either.

That's why it's really important to make sure that you're getting checked out because it's not something where you just notice there's symptom and then you can run to the doctor and check. The raw score that Mark Manson gives it is you would have to have unprotected vaginal sex with 36 people before catching it. Again, that's the rough estimate. That's in comparison to something like gonorrhea which the raw scores 179 or 179 people that you'd have to have sexual experiences with or vaginal sex with before getting exposed to gonorrhea.

Gonorrhea has been in the news a little bit more lately, it seems to make the cycle every couple of years of them talking about more antibiotic-resistant strains coming up. However, it's not as much of a major threat as you might think that it is according to Doctor Xavier Didelot. [laughs]

Jase: I don't know how you say that. [laughs]

Emily: Did a lot.

Dedeker: Didalot? Didelot?

Jase: She's not sure about it.

Dedeker: He was a senior lecturer in the Department of Infectious Diseases at Imperial College of London, says, "At the moment, all cases of gonorrhea are still treatable using some combination of available antibiotics." I think I remember us looking into this when it was last in the news cycle is that like there's no strain of gonorrhea that is untreatable. It's just that the ones that are more resistant require different combinations of antibiotics in order to be treatable. It is still curable. There is yet to be a strain of gonorrhea that is incurable.

Jase: Many doctors-

Emily: People don't talk about that.

Jase: Well, many doctors now by default will also prescribe a combination of antibiotics for gonorrhea as well to just make sure that you get it on the first try because if you -- I don't know if you've heard this when you have strep throat or something else you're taking antibiotics for, if you don't complete your antibiotic course and the virus or the bacteria survives the antibiotics, it's going to be more resistant the next time and it's going to take more antibiotics to treat it.

There are now a lot of doctors just by default right away are prescribing two different antibiotics that are the two ones that have been found most effective so that one way or another it's going to get that in that first treatment rather than developing more resistance. Anyway, when people do talk to you about that one again, it is still treatable and there have not yet been any cases that are incurable. That is, of course, antibiotic-resistant strains of different things come up, but just don't let people convince you that like, "Why bother getting tested because it's untreatable now." They're wrong.

Dedeker: Or to scare you out of having sex at all.

Emily: Or just the media being like, "This is a big thing. Oh my God. People are freaking out." I'm like, "Chill hills."

Jase: I did want to point out for both of these, these are really good example of the importance of getting tested because like with chlamydia, that fat can cause fairly serious health concerns especially for women later down the road even if they have no symptoms. You might not even know that you need to get tested for it unless you just go do and find out and then it's like, "Okay. Great. I take antibiotics for a week and then it's gone." That this isn't some like, "Oh God. Why would I get tested? It will ruin my life."

Dedeker: As opposed to waiting until there is a major health problem.

Jase: Exactly.

Dedeker: Then the last one, just to knock this one out is syphilis. In America at least, syphilis is not really a major problem anymore, in developing countries it's much more of an issue.

Jase: I have heard that syphilis has made a little bit of a comeback-

Dedeker: Oh, has it?

Jase: -amongst gay men specifically-

Dedeker: Oh, I see.

Jase: -but it is an entirely treatable-

Emily: Curable disease.

Jase: -curable disease.

Dedeker: It's another one just on antibiotics for a couple of weeks then you're fine.

Jase: This was a cured in the 1800's. [laughs]

Dedeker: Yes, syphilis is one of those weird ones where it comes in stages, where it starts out with sores and then a rash and then it's gone for 15 years and then all of a sudden you die. [laughs]

Emily: You go crazy.

Dedeker: That's really oversimplifying it, but then 15 years, suddenly your body starts deteriorating.

Emily: Justine, you say something about blindness too, that it can still cause blindness in people?

Dedeker: Yes. In developing countries, it's still the leading cause of blindness.

Jase: Anyway, again, one that's really easy to treat if you know you have it, but if you don't, you could end up having organ failure 20 years down the road. Just get tested. It's not an--.

Emily: Get an STI test.

Dedeker: You probably have at least 15 years.

Jase: Just go do it.

Dedeker: Go get that checked up on. Again, I lumped all those into one category, but they're the ones that are most commonly tested for if you walk into any clinic can just ask for an STI test, those are the ones that they're definitely going to test you for. They're the ones that are arguably the easiest to treat.

Jase: I don't even think there's an argument, there they are just the easiest to treat.

Dedeker: They are just the easiest to treat.

Emily: That's just a urine test for all three of those? For syphilis, a blood test still.

Jase: You know what, I don't remember now. I always have them to--

Emily: You just go in and I'm like, "Do my blood, do my urine, do my pap smear. There you go."

Dedeker: I just go and let them take all of my bodily fluids. "Just take every bodily fluid you can get out of me."

Jase: "What do you want? Blood, saliva, urine--"

Dedeker: Blood, saliva, urine, whatever, I got it. You want it? I got it.


Emily: Go for it.

Jase: It's a fire sale.

Dedeker: It's a fire sale. [laughs]

Emily: Oh gosh. All right. Calm down now. Let's move on to HSV.

Dedeker: We haven't yet moved on to needing to have stool samples for training STI testing.

Jase: That's true, it's true.

Dedeker: Hopefully, that day doesn't come.

Jase: Hopefully not. All right. With that, we want to move on to the herpes virus also known as HSV. This one I often will mess up saying HSV and HPV, because those seem very similar even though they're in different families of viruses. Anyway, HSV which stands for the Herpes Simplex Virus. This one is a big one because there's a lot of stigma to it. However, it's important to realize that more than 500 million people are estimated to have a genital infection of HSV.

Now, the thing to know about HSV here is that it can be in different parts of your body. It's something that attaches to nerve centers in your body. It's not just like the flu or the chicken pox that's an all over systemic infection, that this one is localized. This is only people who have it genitally, this doesn't include orally or anywhere else on your body.

Dedeker: It can be anywhere, I think it's more likely to break out in mucous membranes, but if you could have it on your foot. It literally could break out anywhere on your body.

Jase: It's incredibly common. It's estimated that one out of every six people has HSV-2 and then if you also add the people who probably have HSV-1, that number jumps to about one in every four people who have either strain one or two of the Herpes Simplex Virus. Now, for those of you who are not aware of this, take a moment, take a breath and don't freak out, because this isn't such a huge deal and we're going to get into that in a second.

Danica wants me to cover the raw score too because I skipped that. The raw score as we talked about for this one is 13 people.

Dedeker: Again, if you're just using it as a comparison, that's in theory fewer people that you would have to have unprotected sex with than the ones that we just covered: chlamydia, gonorrhea or syphilis.

Jase: 1/3 of the people who you would have unprotected sex with to be likely to get chlamydia, 1/3 of that number to have Herpes Simplex Virus. All right. I think there's a lot of people out there hyperventilating. Go get a paper bag to breathe into or something like that. This number really scares people especially because how much we've been taught to be scared of herpes or think that this means you're a dirty person or your a bad person.

Emily: Sex life is over.

Dedeker: That your sex life is over.

Jase: That no one will want to have sex with you again.

Emily: Exactly.

Dedeker: You want to know a fun thing I learned?

Jase: Sure.

Dedeker: I learned that --

Jase: Is it actually fun or is it going to be a bummer?

Dedeker: I think it's fun. [laughs]

Jase: Okay. All right. Go ahead.

Emily: What's the fun thing?

Dedeker: In countries and cultures where in the language there is not a different word for cold sore and herpes, like in Spanish for instance. It's the same word for both herpes and for a cold sore. There's much less stigma in those cultures and in those countries than in English speaking countries for instance, where we do make a distinction. Even though it's literally the same exact thing.

Jase: Let's cover that real quick. A cold sore, that a lot of people have, a lot of people are not so worried about, that is the Herpes Simplex Virus. Most often, it's HSV-1 which people often think of as like, " Oh, HSV-1 is the oral one and HSV-2 is the genital one." That's not true. You can get either one in either place. That's entirely not true. It happens just a little bit more frequently, but that's not true at all. Anyway, cold sore is the herpes virus. You can have it in your mouth and we call it a cold sore, or you can have it in your genitals and we call it herpes and all of a sudden you freak out about it.

An important thing to know about these two is that if you go into your doctor and just say, "I want an STI test." or you go into Planned Parenthood or whatever, they most likely will not test you for this. This surprises a lot of people.

Emily: You got to cook some --

Dedeker: You really, got to convince them.

Jase: This surprised me, too. It's interesting because the reason why most doctors don't test for this - and by most I mean almost all, this is very universal. Why they don't test for it is the doctors have found that the social and psychological negative effects of finding out that you have been exposed or that you have HSV-1 or 2, is so much more damaging than the actual disease itself which is a little bit of an inconvenience. Other than that, poses virtually no health risk to you whatsoever. They found that they don't test for it because it's more likely to cause psychological damage.

Dedeker: I have mixed feelings about that because I think there's a little bit of a backfire to that. I get doctors -- I think that it comes from a place of wanting to reduce obviously that psychological damage, maybe even wanting to reduce stigma. You are trying to tell people " You know what, you don't need to worry about it unless you have symptoms. So I'm not even going to test you for it." but that's set's up more situations where for instance, let's say maybe I catch HSV-2 from someone I'm sleeping with and I'm like, " Oh, they told me that they didn't test positive for anything." They told me that they didn't have any STIs, they lied to me. That person is like, " Well, I didn't know. My doctor wouldn't even test me."

A lot of people also don't even realize that they are not getting tested for HSV and when they receive back test results that are all negative they assume, " I'm all negative for everything." That serves to further create the stigma of, " People with STIs or HSV are liars and scoundrels." That they are liars and they are shady and you can't trust them. I feel --

Emily: I think there's nothing wrong with knowing.

Dedeker: Exactly. I feel like doctors really not wanting to test is like, "I get that you as a doctor understand that this doesn't have a huge health risk and I get that and you are trying to protect people but at the same time, it leaves people the opportunity to be ignorant. Then unintentionally end up hurting other people as well."

Jase: For example, I went to my doctor couple of years ago now - two three years ago and said, "I want to be tested for HSV. I haven't had any outbreaks or any symptoms but I have some partners who have it and I just want to know my status." I had to essentially convince him, because he was like, "I don't know" I had to convince him, I was like, "I know, I get it, I probably have it, and I understand that that's not a big deal. I would rather know than not know." He was like, "Well, okay, sure. I will do a test for you but what you do with those results is up to you." Those are the words he said. He just--

Emily: What does that mean?

Jase: I think --

Dedeker: I think he's trying to be like, "Don't come crying to me about it."

Jase: "Don't come crying to me if you are upset at actually getting these results." I've heard similar stories from other people who've gotten resistance from their doctors about testing for it. Anyway, I did that and my test results showed that I have antibodies for HSV-1 which is another way of saying I have had or been exposed to HSV-1 in my life. It could've been as a child, it could've been through sexual partners, it could've been from kissing somebody, who knows. I don't know where I got that and I personally have not had any outbreaks that I've been aware of.

My likelihood of passing that on to other people is fairly low and it makes me a little more resistant to getting HSV-1 in another location because I have antibodies to it already. It's like that's the information I have and I like the fact that I have it. Honestly for me, I feel like it would be more stressful to test negative for everything because then it's like, "Oh God, now I have to maintain this straight A report card."

Dedeker: Like it's a report card?

Jase: We have that psychological thinking about it. For me it's like, " Okay, cool." It's funny too, my doctor in giving me the results, was explaining that, "You have HSV-1, you don't have this thing so you are not actively having an outbreak and you haven't recently been exposed to this or this number would be higher." Then he said, " But for HSV-2, you don't have that one yet."


Jase: He just threw it in the "Yet" because he's like, "You are probably going to get it, but t's not the end of the world. There's your results, do with it what you will."

Emily: Have fun with that.

Dedeker: I guess this is really related but the whole stigma surrounding it is so frustrating because of how arbitrary it is. I really started to see that when I got shingles a couple of years ago. Shingles is herpes virus. It's herpes zoster. It's in the same family but a little bit different. The symptoms --

Jase: Related to chicken pox as well.

Dedeker: Related to chicken pox as well. The symptoms for shingles are very similar to herpes. You get blisters -- It gets itchy, you get blisters, they scab over then they fall off, similar transmission rates. Again, it can be exposed if you have open sores then you can transmit it that way. There's also some asymptomatic viral shedding just like normal herpes simplex does but with herpes simplex, we associate it with sex and then with shingles we associate it with old people.

It's the same thing, I have shingles in my body. It's not curable, I have it in my body the same way that someone can carry HSV in their body for their entire life. I have it, but it be a very different conversation for me to say to somebody, "Okay. I have this infection on my head area somewhere, I can expose it to you asymptomatically. It results in these blisters. You have it for your entire life and its called, shingles." Versus when it was like herpes, the very different reactions you get from people even though it's almost literally the same exact impact and the same exact same thing. It's just so, so arbitrary.

Emily: Unfortunately, TV and media continue to keep this stigma alive and well. It is really unfortunate. One of the articles that I read talked about the movie, The Hangover and how they said, "What happens in Vegas, stays in Vegas except for herpes." and I'm like, " Ugh. God." It's awful that they fucking had to throw that in there. People don't even think about it.

Jase: If we look at the statistic that most likely one in every four people has one or the other or both strands of HSV --

Emily: There were four people in the Hangover so probably one of them has it at least.

Jase: At least. It's just --

Emily: Fuck you, guys.

Jase: Just that kind of joking especially because those jokes are so often made by people who have no idea about the reality of HSV or how likely it is that they have it and have no idea. It really is unfortunate and I do think -- I encourage you out there who feel like you are in a position you can do this safely as to call people out on it, you don't have to be mean about it, you don't need to shame them in return about it, I don't think that's very effective.

Just saying, "Hey. Actually, that's a really hurtful thing to say because it's this common. If you want to educate them about it." If you are in a position to do that, please do it. Let's stop this trend. Stop allowing this to be an easy joke that we all just accept as something that's okay to say.

Dedeker: Right. Again, we talked about her already, but Ella Dawson has this fantastic, fantastic blog where she is just very out and open about having herpes. She is also a fantastic writer on top of it. She's a great resources to check out. She has a really great blog specifically aimed to people who have just been diagnosed and who are freaking out. My favorite blog post of hers that she wrote that I read, she wrote and I liked it, is called, "Why should I date someone with herpes?" because she gets that question all the time.

It's freaking fantastic, definitely recommend the read. If you are asking that question of yourself, "Why should I date someone with herpes?" go give it a read, might help give you some perspective and --

Jase: It's super valuable if you are someone who's just been diagnosed with herpes or you think you might have it and you are freaking out thinking, "Oh God. I can't be polyamorous anymore, I can't have casual sex anymore, I can't--" any of these things. That's a really great resource for that. I know so many people who have been really scared and had those concerns, like, they've had their sex card revoked because of this. Until they actually start educating themselves and educating the people around them and learning about it and realizing, "Okay this is actually not a big deal and not something that's going to dramatically change my life in the way that I thought it was." If that's relevant to you - but definitely check out Ella Dawson.

Emily: Alright, so the next thing that we wanted to talk about is HPV. So, this one jumps up even more in the raw score, it is four - so only four people might it take for you to potentially get HPV [laughs] of some strain because there's a ton of strains of this. More than 290 million women have HPV and about 80% of sexually active people are infected with HPV at some point in their lives.

Then in 90% of cases, this infection is cleared by the body within two years but really each year about 39,800 new cases of cancer are found in parts of the body where HPV is found. However, that's not, obviously, a huge amount in comparison to the number of people who have it but this is another reason to get tested and screened for it, why women especially need to get screened for it on a yearly basis.

Because there is a potential that it can lead to cancer. But this is also a thing that now has a vaccine for it, and men and women can get the vaccine for this if you're still under young.

Dedeker: The vaccine also only protects you from the cancer-causing strains, which is actually fine because those are the ones that you need to be worried about.

Emily: In my research it's not just the cancer-causing anymore there's one that's-- yes.

Dedeker: I think the one I got was just the cancer causing strains.

Jase: Also some of the wart-causing strains.

Emily: Yes, the wart-causing as well. I think it's nine strains at this point and I got--.

Jase: Used to be like four or five and now it's up to nine.

Emily: Exactly, but it's a series of three shots, I believe.

Dedeker: I got a 1.0 version OF [laughs] strains.

Emily:  Exactly, but it's for young people - 26 and younger - but now, like, kids are getting it too but people in their teens can get this vaccination as well. This is a thing that I have gotten twice, I have had two different cancer-causing types of HPV. Once - first in 2011 and then I got the vaccine, and then I got it again in 2015 and so it's like well --

Dedeker: Wait and those were the cancer causing strains or the regular strains?

Emily: Yes, both of them were the high-risk strains, both of them. They were different ones but, again, I’ve definitely had sex with far more than four people and so clearly I was bound to get it potentially more than once.

Dedeker: But your experience of having it, I mean, what was your experience of having it and what was your experience of recovering from it?

Emily: Well, the first time I was monogamous with Jace and I was devastated. I was absolutely devastated at the time because I really did have that idea of like, "I'm a disgusting gross human who has," this like, "blah blah blah blah blah, it's awful," and I just felt very down and awful about myself. My mother even when I told her about it she's like "Just calm the fuck down."


You're going to be fine, seriously." I'm pretty sure she said that to me and she was right - she was absolutely right, because my body cleared it within six months.

Dedeker: That was fast.

Emily: You have a colposcopy which is just to basically do a biopsy of the tissue and then you have another pap smear in six months and in that time of six months it completely cleared and the same thing happened the second time. I attribute that, maybe, in nothing more than I am vegan and I have great immunity.


Basically yes, in most people it will clear within two years of getting a strain.

Jase: Right, but again like with herpes whether it does or not, this one doesn't really have any adverse health effects besides increasing your risk for certain types of cervical cancer or cancer where the HPV virus is. Which is something that, yes, it is important to know that so that you can have your doctor check for that because as we all in today's world know about cancer now, the earlier you detect it the easier it is to treat and not have that become a problem or something that's going to really affect your life as much.

Dedeker: Bear in mind I’ve seen this happen a lot, if you contract HPV it's not going to be immediately clear who you got it from.

Emily: Oh god no.

Dedeker: It can take a long time to show up. I've seen like a lot of pain and a lot of tears over people being very angry at their ex or very angry at the person that they're with right now because, "you gave me HPV," but there really isn't a way to prove that.

Unless the person that you're sleeping with, if they happen to be presenting some type of symptoms like genital warts for instance, and along that note when it comes to men there is no way to test men for HPV unless they are presenting warts, then it can be tested. But if they're not they can be carrying it have no symptoms and have no idea.

So that one is a hard one because the fact that if someone tells you, if you are sleeping with a partner who has a penis and they tell you, "Oh I've tested negative for everything," there is no way for them to test for HPV. That may not be a good basis for you to be like, "Okay we'll just have unprotected sex and it'll be great," because there is no way for them to know. Just bear that in mind.

Jase: Then also, just on the subject of safer sex is that with a lot of these both HPV and HSV these are also transferred through skin contact as well, so even using things like dental dams or condoms are not 100% effective. They're going to make it less likely for this to be transmitted between people but it's not a fool proof thing which again I would love for that information to not go toward abstinence education but instead just destigmatizing these things.

So we can just be realistic about them and not put all this emotion into something that's really just like, "Okay great, I have this thing that might occasionally give me some kind of a rash or irritation and that's it. That's all.

Emily: Get tested but don't freak out. Don't take the route that I did back when I was a wee lass in 2011 and get really down on myself, instead just continue your yearly screening and then you should be fine. You'll clear it within two years, most likely, if anything does happen.

Dedeker: So moving on to, again, the one that usually comes up on the standard STI testing panel which is HIV. So the raw score for this one is 1,250 people - so that roughly you'd have to have unprotected sex with 1,250 people before you'd be exposed or would catch HIV. That number drops significantly less if you're engaging in anal sex or if you're engaging in needle sharing practices of some kind, that definitely increases your risk.

So HIV these days it's certainly not the death sentence that it was in the 80's, of course catching it is going to change your life and it's going to be expensive but a person who takes their HIV medicine as prescribed and stays virally suppressed they can still stay healthy and they effectively, end up having no risk of sexually transmitting HIV to HIV negative partners.

So it's like - if you live in the US and you have access to health insurance you will probably be able to maintain a normal healthy life even after contracting HIV of course people--

Jase: Especially the earlier--

Dedeker: The earlier that you catch it, the better. Of course people who live in developing countries or less privileged areas it's a totally different and much sadder story.

Jase: Certainly. This one also just a few other things about this is there are also drugs out there that they're not, what's the word I'm looking for, they won't make you immune to it.

Dedeker: Prep drugs.

Jase: Right. They won't make you immune to it but can make you significantly less likely to catch HIV and that especially if you are someone who is doing things that puts you at a higher risk such as being a man who has sex with men regularly, especially for doing that without condoms, that there are other ways to further decrease your risk for this.

But the thing that I always like to point out about HIV that makes it a little bit different from some of these other ones is that this is specifically through body fluids like semen and blood. That this is not transmitted through saliva and it's not transmitted through urine things like that. That this is fairly specific and this is one that actually condoms are much more effective in preventing than the other ones.

Dedeker: It's not just like a mucous membrane.

Jase: To a very high degree, yes, and this is one too that. Last time I looked into this, unless there's some other complicating factor exposing more of your blood, like in your mouth, if you have open sores in your mouth or something like that, if it's combined with having a cold sore outbreak or something, that even having unprotected oral sex with someone with HIV is -- there haven't actually been documented cases of it being passed that way.

Even through, I think they did studies that it's like you would have to drink the equivalent of like a gallon of another person's saliva who had it. Something's just awful.

Dedeker: Let's not. Let's just not --

Jase: That's absurd, right? This is one that I do like to stress to people, is one with just a reasonable amount of safe sex practices, you don't even need to go all out with gloves and-

Dedeker: You don't have to go and have [unintelligible 00:51:47]

Jase: -[unintelligible 00:51:46] and everything, to really dramatically reduce or even eliminate your risk of transmitting this one. I do like to emphasize that, in terms of people being like, "If everything's just 'whatever no big deal,' then why use condoms at all?" This is one that is worth it. Why the fuck not? Why not? That brings us to our other, I would say, the most common sexually transmitted infection, which is having a baby [laughs].

Emily: [laughs]

Dedeker: Someone's feelings are going to be hurt by that.

Jase: Someone's feelings. No. There was an episode of House MD, where he had a woman came in with symptoms worrying she was sick and he's like, "I'm afraid to tell you that you have a parasite." Most people though, grow attached to it. They even name it and it will probably affect you for at least 18 years. You're pregnant.


Let's be real about this. This one, you have a raw score of 100 sexual encounters. This one's a little different that this isn't number of people because this one, your risk goes up the more times you have sex with even the same person over and over again. Again, this is penis and vagina sex that we're talking about here, about one in a 100 times of having unprotected sex will lead to pregnancy.

Now, this one is interesting because we often-- I think for a lot of people, this one's kind of like an afterthought, or we think, "if the woman's on the pill or some other kind of hormonal birth control," whatever, they don't need worry about that. Or, it's like, "STIs affect me for life. I could take care of a pregnancy," or however you want to think about it.

Dedeker: The STI affects my sex life for the rest of my life. A baby does too, but--

Emily: A baby most likely will as well.

Jase: Right. This is one that I feel like a lot of people don't take as seriously as they should, in my opinion here. I guess I don't like to say 'should', but really though, take this one more seriously. Because a pregnancy, even if the woman in this case has decided that she's not going to have this pregnancy and is going to terminate it, it's expensive and rough on your body. This is not a pleasant-

Emily: Potentially on your psyche -

Dedeker: Potentially, yes.

Jase: This is not a pleasant experience to go through. Even people who are like, "I'll just take the morning after-pill," have you guys ever taken the morning after-pill-

Dedeker: Yes.

Jase: Yes?

Dedeker: Most definitely.

Emily: A lot of times. Probably like four.

Jase: If you could sum up in a word what that experience is like --

Dedeker: You want to know?

Emily: $50 of freak out

Jase: [laughs] $50 - $50 of freak out?

Dedeker: I don't know. For me, it's more the annoying. I have not taken it a tonne in my life and I've never used it as my go-to plan. Some people have where it's like, "Okay,

whatever. We'll have unprotected sex then I'll just take the morning after pill and be great," which I don't think is a great plan to have.

Emily: More like, the condom broke. That's happened.

Dedeker: Yes, that's basically the only time I've used it is if a condom broke. Basically, I don't know, the experience that I've had is just that like something maybe it might make you a little bit sick to your stomach, and it might kind of mess up what your menstrual cycle is like. I don't know, I don't think it's not impactful, honestly-

Jase: My experience of you taking it [laughs], it's definitely had a lot of effect on you, just sort of physically and emotionally just feeling shitty and it's like being in a-

Emily: I've taken it with you too Jace, I'm pretty sure.

Jase: Yes. I can say from the outside, I feel like I perceive it having a fairly large effect.

Emily: I think it just-

Jase: I think it varies from person to person but still--

Emily: Just the idea there is the pregnancy scare that potentially is happening, that's, I think, psychologically-

Dedeker: It's not a good day, the day that you have to take the morning after pill.

Jase: Right.

Emily: Just like, "Fuck. Let's [laughs] make sure we're okay."

Dedeker: It's not a good day any time you're in a position where you're having a pregnancy scare.

Jase: I also have a special message for the men out there with this one. It's that so often, the role of planned parenthood, the role of controlling pregnancy falls to women because-

Dedeker: People who have uteruses.

Jase: -people who have uteruses. They're the ones who have pills they can take or have injections they can get, or have things done that are not permanent. It's like, "Okay, it's their job to do that then. A lot of men, in their interest in having sex without condoms with women, will be like, "Okay, she's doing that. That's going to be her responsibility."

Something that I do like to stress to men is a lot of us are not fully aware of the fact that if, even, nothing's 100% effective, but even if you do get somebody pregnant, that you actually have no say in whether or not that child ends up being born.

You have no legal rights to that at all, to decide whether there is an abortion or there isn't. You have legally no control over whether this does affect your life for the next 18 years. I think that while that might seem like, "Oh God, I'm trying to scare you." I'm just saying, "Wear a fucking condom. Be a man about it," if I can be a little cliche.

Just like fucking, take some responsibility for your role in this as well. I just can't stress that enough, how significantly this can affect your life and that this is definitely something worth taking responsibility for and not treating this as something that only women have to worry about.

Dedeker: I think if you were going on and your plan in your head is just assuming like, "If my female partner gets pregnant, we'll just have an abortion or we'll take care of it." It's like, "Sorry, that's actually not your choice."

Jase: Exactly.

Dedeker: We've actually been fighting for a long time to make sure that it is the woman's choice or the person who actually has that uterus to be making that choice. What that means is that if you're thinking like, "Whatever, if she gets pregnant, I won't have to worry about it because we'll take care of it." It's like, "But you might. You might still end up on the hook for-

Jase: Especially if this is someone that you haven't had that conversation with-

Emily: Jesus --

Jase: -especially with more sexual partners, someone that you've just started dating even, because those are the people we don't think about it with.

Dedeker: No, and don't ever make assumptions.

Jase: Don't make assumptions.

Dedeker: Don't make assumptions about what is going to happen. Have that conversation.

Jase: Yes. With that-

Emily: Why is it important [laughs]-- Why is it important to get tested for STIs?

Dedeker: Why in deed. I think as we've hit a couple of times in this is that, pretty much, a lot of these things are treatable or manageable but only if you know that you have them in the first place.

I've met a lot of people, I've come across a number of clients, people who think like, "Oh gosh, I'd rather just not know." Or "If it's not that big of a deal then I'm just not going to get tested, and I'd rather just give myself the peace of mind." It's like, "I get what you're going for, but it's a head-in-the-sand kind of tactic." It's like, "It's only if you know, then you actually have the power to make decisions about it and the power to actually take care of yourself and to help take care of your partners as well."

Emily: Yes, and you really can't have any type of meaningful conversation about safe sex, if you yourself don't know your own status. You can't be honest about your status if you don't know it, and you can't expect someone else to be honest about their status if you don't know your status to talk to them about it. "No, figure it out and get tested."

Jase: Different people have different expectations for how often they or their partners will get STI testing. We've talked about this a little bit earlier in the episode, but I think this one's an important one to educate yourself through some of the resources we've talked about in this episode. Educate yourself so you have your own feelings about it.

You have your own choices you can make instead of just relying on other people's insistence on yes or no to STI testing or putting that responsibility on someone else to make that choice for yourself and make your own decisions about what kind of risk you want to take versus being able to have sex. Let's give them some actionable takeaways.

Emily: Yes, for sure. Encourage your partners to get tested as well.

Dedeker: Its, again, if you have gotten tested, if you know what your status is, that just makes it a lot easier especially if you're re hooking up with someone new for the first time or just connecting with someone for the first time, that you are able to proactively be like, "This is what my status is because I know, because I was tested relatively recently." I would love you to know the same thing or, it gives you a place to start that conversation from.

You can go back and revisit our episode that we did on making pre-sex talk sexy. Of being able to have these conversations about your status, about what safe-sex practices you want to use, about what safe-sex practices you use with other partners, and if you need to disclose something. About making that talk not this, like, really awkward, rigid, uncomfortable thing, but something that can be fun, can be comfortable and can be even sexy.

Jase: Also, by educating yourself now, both about your own status but also just about STIs in general, like lot of the common misconceptions we've talked about in this episode. By doing that now, rather than waiting until you're confronted with it, until you have a partner or you yourself has [sic] one of these things and you freak out and you don't know how to respond to it, that by knowing beforehand you can know how to respond to that.

So if you meet someone who you really like and then you find out that they have HSV-1 or 2, that the first couple of times that happened to me was, "I don't know how to respond to this." So my answer to them was, "I don't know enough about that. I need to think about that. Sorry, I'm not sure we can do this right now".

Whereas later on, after having learned more on my own, not specifically being motivated because I want to have sex with this person, but just learning more in general, then when I was presented with that in the future I knew what questions I wanted to ask about it. What they were doing to, you know, minimize their outbreaks or their risk of transmitting it, and then also what kind of safe-sex practices I wanted to take.

Then also, at the end of the day, realizing that it's not the end of the world. It's not something that I needed to be so scared about. Then I've been able to have a number of fantastic relationships with people who have HSV-1 or 2, and not been worried about it but I wouldn't be able to do that if I hadn't educated myself beforehand.

Dedeker: That goes along with, take your sexual health into your own hands. Don't outsource it, don't rely on other people to protect you. I mean, I see this happen a lot where it's like, "Well, I want to be able to unprotected sex with this particular partner so I need to make sure that all my partner's partners are the ones who are getting tested all the time, and who are having super, super safe, protected sex so that we can take more risks."

Jase: Right.

Dedeker: No, protect yourself. Protect yourself. Don't rely on somebody else, or somebody else, even further on, down in your polycule, or in your network to be the one carrying all the load of that responsibility. You need to carry that responsibility as well. I say responsibility like it's a big burdening thing, but no, it's like a good thing, it's empowering. It means that, you can be in situations, for instance, where you meet someone you connect with, you really like them and then they reveal, "Oh, I have HPV" or, "I had HPV two years ago". Then you can be like, "Well, I know what decisions I made about myself, to protect myself and so I can take care of that knowledge and those practices into this without having to worry about it. Without having to scramble and without having to go ask 20 people in my polycule to change their practices or-

Jase: Exactly.

Dedeker: -you know things like that.

Jase: Right.

Emily. Wow.

Dedeker: Wow. I mean, I still feel like we only scratched the surface of this.

Jase: Gosh, I know.

Emily: No, no. It's a huge topic.

Dedeker: There's so much to talk about in this topic.

Emily: Hopefully, we gave you something.

Jase: Yes, hopefully. I think we hit on a lot of the most common subjects that come up. There's obviously so much more to all of this. If you have a specific question about this or, something that you want to discuss about this, you can leave that in the comments for the episode. You can tweet at us, on Twitter, stuff like that. Please, continue this conversation.

This isn't something that has to end right here, and this is all the information. This is something that medical science and everything is constantly developing and learning about this as well.

Dedeker: Yes