Medicine / Emergency
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On Sexual Health: Keeping It Clean While You're Keeping It Real

January 14, 2018

Jeffrey Francis - Medical Student1, Matthew Vasey MD2

1MD Candidate, University of South Florida Morsani College of Medicine, Class of 2018
2Department of Emergency Medicine, Tampa General Hospital | TeamHealth, an affiliate of University of South Florida Morsani College of Medicine

Disclosure: Opinions reflect neither employer nor affiliated institutions, soley those of the author(s).

Every infection you have ever had has a simple basis. Infections follow many paths but they all begin with stasis. Stasis is medical jargon for not moving. Ever leave your drunk-dial pizza out on the counter for a couple days and then give it a whiff? Ever leave your camelback full for a couple weeks and try to drink the murky stank? If you leave things to sit, the naturally occurring and small amounts of bacteria begin to multiply. And this is on a logarithmic scale (read- the more time it has, the more the rate of growth increases). Bacteria divide to grow. Each division creates new parents to divide more. Say a cycle of E. Coli takes 2 hours to go through its growth cycle. Start with one. At 2 hours you have 2. At 4 hours, you have 4. At 6 hours you have 8. Then 16, 32, 64… you get it. The point is that when you let things sit, bacteria, fungi, viruses, and all the nasty parts of the world get to expand. There is a certain threshold number, which is different for each infectious agent and each host (read person) that becomes clinically significant.

I have E. Coli and C. Diff (read bacteria that can cause potentially deadly diarrhea) in my guts right now. However, my guts are perfectly healthy. I take fiber regularly and I make crap move... literally. If those bacteria outgrow their ecological balance, then I will begin to have diarrhea. The picture I am trying to paint is two-fold:

1. Stasis is the enemy.
2. We coexist with infectious agents all over and inside of our bodies.

With those basic principles, I want to address general sexual health. Medicine is the simplest thing in the world. If you want something to be healthy, use it. If you want your body to be capable, then go exercise and stretch. If you want your heart and lungs to be strong, then do cardiovascular exercise. If you want to have great balance, then go get on a balance beam and try not to break a hip. If you want your mind to stay sharp, then go read and learn new things. Research shows that the more "cognitive reserve" (read brain power gained through life-long learning) you have, the more you maintain brain function in old age i.e. even with Alzheimer's, you will be functional for longer. I personally love learning new languages because it forces you to utilize memory and cognitive function and it allows you to have secret conversations - ideally with desirable people of the opposite sex…. Or same sex… or whatever sex you are interested in… no judgment here.

And this brings me to the point of all this: how to keep your pipes clean.

First and foremost is partner selection. It is a simple life fact that some people are just not clean. If someone uses IV drugs or has sex for money, then they are at high risk to carry sexually transmitted diseases. If you find one of these folks desirable, I am not going to tell you not to sleep with them. I am not here as a moral compass. Call your parents or minister or whatever else for that. I am here with the sole purpose of reducing infection and improving health/well being. So if you find that you want to have sex with a "high risk" person, then you need to use every possible precaution you can. The best precaution of course is abstinence, but life is short. So let's talk about the simple, but effective things to do:

1. Pick your partner more wisely. Again, if you don't put your parts in danger, then they don't get infected. If you see lesions or abnormalities in someone's genitalia, then do your best to stop and go find another partner. I know. I know! By the time you see it, it is probably too late. The launch sequence has been activated.

2. Wear a condom. Or require your partner to wear one. Don't budge. Carry one in your back pocket. Not your wallet because then you leave a ring and look like an idiot when you buy groceries. Do not start by sharing juices and then putting a condom on. Mucosa (read inside of a vagina or anus or mouth or penis) harbors infectious agents. If you touch these areas before putting on a condom, you are exposing yourself to infection. So before any spit or other fluids are mixed, put on a condom.

3. Do not get blood into any orifices or open wounds of your own. Blood can contain the big bad HIV as well as many other infectious agents.

Facts- Chances of HIV spread from various activities:
1. Blood transfusion from a known HIV host- 90%
2. Childbirth (to the child from the infected mother) - 25%
3. EVERYTHING ELSE: less than 1% (In descending order of danger)

i. IV needle sharing (most dangerous)
ii. Receptive anal intercourse
iii. Insertive anal intercourse
iv. Receptive penile-vaginal intercourse
v. Insertive penile-vaginal intercourse
vi. Receptive oral intercourse vii. Insertive oral intercourse

DO NOT make the mistake of reading 1% and thinking "Oh, so it is safe." For one, this only represents one disease of many. For another, some diseases are permanent and life threatening. Finally, each time you do these things, you take on that risk i.e. each time you have sex, you roll a ~100 sided dice and may wind up with something that will permanently or temporarily affect your life. Some mistakes cannot be undone. Protect yourself. Lessons: it is safer to be the one inserting than it is to be the one receiving. This is, at the most basic level, because when you receive, there is more opportunity for the fluid and funk to sit -remember stasis?

4. Cover open wounds with a waterproof barrier and if you do see blood, immediately wash it off. See above info on HIV. Additionally, blood carries other infectious agents. I wont bore you with details.

5. Pee after. If your camelback gets nasty, you drain out everything that was in it, clean it and then start fresh. The same goes for your downstairs. For men this is especially effective because men only have one tube. Curious? Google images "male urethra anatomy". Urinating clears out a lot of what may have made its way into the urethra.

6. Shower after, immediately. Don't let any funk sit around and work its way into an infection. Clean the whole area thoroughly- inner thighs, testicles, penis, vagina, anus… whatever was involved- clean it now! For the receptive partner, you should use a gentle, unscented soap on the outside of your vagina. Using Soap inside the vagina can disturb the acidic pH, which can in turn predispose you to infection. If you are concerned because of potential contact with your partners bodily fluids, you can use water to clean out the inside. Just understand that your vagina is cleaning itself on its own already.

7. Do not perform or allow your partner to perform oral sex on you without a condom. This is really only for high risk partners! While the likelihood of infection is lower for someone receiving oral sex, there is still a risk. We are discussing ideal protection. Be aware that semen and vaginal mucosa generally contain more infectious agents per volume (assuming they are present at all). Therefore, performing oral sex is the bigger risk.

So those are some basic take homes. For every single new partner, absolutely wear a condom! Do not risk yourself. That said; use discretion. If you trust someone, say in a long-term relationship, then you can consider a step down of precautions. Stay clean and classy. Work what yo momma gave ya!

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