Sex can be scary. Maybe you just gave birth and got the okay from your doctor to get busy but you can’t help thinking, “I can barely poop without flashbacks, there’s no way I’m sticking a dick in there.” Or maybe you weren’t ready to be pregnant and you are late again, only to discover you are regularly irregular. Or maybe your new partner wants to go at it without a condom, and you’re too scared to say otherwise. As amazing as sex is, it comes with great responsibility: consent, possible pregnancy, feelings, self-esteem issues, questions around commitment, and of course, health considerations. What I have noticed over the years is while we, as a society, are more open about gender, bodies and consent, so many of my patients are still too scared to discuss health status, theirs or their partners’.
Recently, a patient came to my clinic, let’s call her Ms. Fancy, because she is. So Ms. Fancy had found a new play partner, one that said he was “clean.” There was alcohol involved and one thing led to another and the result was an indeterminate Hepatitis C result. Before receiving the result, I had discussed the possibility of using PrEP (Pre-Exposure Prophylaxis for those bodies that may be at high risk for exposure to HIV) for fear that the scary sex she was having might cause her irreparable danger. The next morning before heading to the clinic, I stood in the shower thinking, was the PrEP suggestion too much? Is the medication too severe for her actions? Maybe I should call her when I get to the office and advise she discusses PrEP with another medical professional?
She enjoys the company of multiple partners
See, Ms. Fancy and I go back a few years. She enjoys the company of multiple partners, at one count, when we started our therapeutic relationship, she had three, she also has chlamydia and was trying to figure out where she got it, who she might have given it too, and how she would inform them all. At that time, Ms. Fancy was angry and used sex as a way to “blow off” steam. My suggestion was to find a munch (a munch is like brunch with people exploring BDSM, fully clothed, through conversation and mimosas, where she could explore dominating individuals without fluid exchange. Needless to say, she didn’t take my suggestion … so fast forward to more relationships, children and the need for testing before fluid exchange or at least using a barrier with anonymous sex, resulting in an indeterminate Hep C result.
I called Ms. Fancy to inform her that further testing would be needed. Hep C is a virus that affects the liver and is transmitted through blood, so think unprotected sex and tattoos, much like HIV, but unlike HIV there is a “cure.” Although Hep C is treatable, she would need to continue to be tested for both Hep C and HIV as there is a strong link between the two.
Sex can be scary, but it doesn’t have to be. It takes communication and a barrier method to remove the fear and get to the fun. People don’t disclose, they don’t want to have those hard conversations like, what’s your status, or I’m not monogamous, but I love you. Others are too fearful to state what they need for fear they will be rejected and
alone.
As for Ms. Fancy, it turned out that she was the 1% with the false positive. Ms. Fancy is Hep C free, but the tears shed will hopefully change her practices in the future.
And speaking of best practices, this Halloween, make sure when you put on that pussy (cat) costume that you pack a couple condoms because there’s strength in safety.
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