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People who have genital ulcer diseases, such as herpes, are more vulnerable to becoming infected with HIV since breaks in the skin (even if they are not noticeable) make transmission of the virus easier. Having other sexually transmitted diseases, such as gonorrhea, can also facilitate transmission of HIV. Thus efforts to control the spread of other sexually transmitted infections can also help prevent the spread of HIV and routine testing for STDs can provide information that can help protect one from becoming infected with HIV It is very important to be tested for other STDs as a part of routine health care and not to assume that an HIV test is a complete screen for infections.

A person who puts himself or herself at risk of acquiring other STDs puts himself or herself at risk for acquiring HIV infection.

Women who use oral contraceptives (the pill) as their birth control method and do not use a barrier method to protect against STD transmission may also be at slightly higher risk of acquiring HIV infection. This is because in many women oral contraceptives cause changes in the cervix that make the inner columnar cells more visible (a process called ectopy), and it is these cells that are most vulnerable to infection (by HIV as well as the agents responsible for other STDs) during unprotected sex.

Most birth control methods—such as progesterone shots or implants, intrauterine devices, and sterilization—do not offer any protection against STDs, and some may actually increase the risk if condoms aren’t used as well.

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The most common symptom of a gonorrheal infection in a male is discharge from the penis, along with burning with urination or just an irritated feeling in the penis. If there is discharge, it is usually copious and yellow—though it may be scant and clear, like the discharge caused by a chlamydial infection. Occasionally the penis becomes slightly swollen, and the urethral opening can become inflamed.

If gonorrhea is not treated, the urethral symptoms may eventually disappear, but prostatitis and epididymitis can occur as complications. If gonorrhea causes prostate infection, there can be pain between the testicles and the anal area (where the prostate is located), difficulty in urinating, and the need to urinate frequently. In epididymitis, the scrotum becomes inflamed and tender, usually on only one side. Epididymitis can cause scarring that may interfere with a man’s fertility. These infections have become less common as complications of gonorrhea since the introduction of antibiotics, but they may still occur if treatment is delayed. (See the section on epididymitis and prostatitis.)

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In addition, the human papillomavirus (HPV), the virus that causes genital warts (probably the most common STD in the United States), is also very common among women who have sex with other women.

Studies have shown that greater than 70 percent of sexually active adults have antibodies to the virus that causes genital warts. One study among lesbian women revealed a similar prevalence of the virus, having antibodies on a blood screen for HPV As with heterosexuals, the types of the virus that are linked with cervical cancer are those that are the most common. This finding underscores the need for yearly Pap smears for all women, including those who have sex with other women. Unfortunately, lesbian women are often told that they don’t need Pap smears, in the mistaken belief that only women who have sex with men can get cervical cancer.

In addition to routine screening for sexually transmitted infections, safer sex practices are recommended for women who have sex with women, just as they are for any sexually active person. This means using latex barrier methods for any genital-genital, oral-genital, or oral-anal contact with a partner whose status for sexually transmitted infections is not known. As discussed earlier in this chapter, options include dental dams and condoms that have been cut open (usually the un-lubricated kind, since nonoxynol-9 has an unpleasant taste), or latex gloves can be used for hand-genital contact. If any sex toys are used, it is a good idea to cover them with a new condom before they are used by each partner, or else each partner can use her own sex toy and not share. Spermicides can also be useful in helping prevent the transmission of STDs, since in addition to killing sperm they also have the ability to kill many sexually transmitted organisms in the laboratory.

If partners have been fully screened for sexually transmitted infections and are beyond the waiting periods for infection to show up as positive on the tests, and if they are mutually monogamous, then it is safe to have unprotected contact.

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Because regular STD check-ups are an important part of maintain where you feel comfortable discussing issues of sexual health.

All adolescents and adults must have a health care provider with whom they can talk. The person you choose to provide you with medical advice in the area of sexuality may or may not be your regular health care provider. Sometimes people do not feel comfortable bringing up these issues with a long-time health care provider or someone who also provides health care to other family members. Another consideration in choosing a medical person to advise you in the area of sexual health is that certain family practitioners, internists, and pediatricians who don’t specialize in STDs may not have access to the most up-to-date information about them.

Clinics that specialize in treating sexually transmitted infections and promoting sexual health may be a good alternative to the family physician. You can find listings for them in the phone book for your community under “sexually transmitted diseases,” or you may want to contact one of the national hot lines in the reference section of the book, which can assist you in finding a local provider. There are family planning clinics, state and county health department STD clinics, infectious disease clinics, women’s health clinics, and private STD clinics from which to choose. Many clinics offer these services at reduced fees or on a sliding-fee scale.

It’s extremely important to feel comfortable with your health care provider and to trust that person to provide sound advice and good medical care. Only under these circumstances can you be honest about what’s worrying you and about your symptoms. And only if you are honest can a health care provider help you. Health care providers aren’t mind readers—they make decisions about your care based not only on what they find during the examination, but also on what you tell them. Keep in mind, too, that your health care provider is bound by the rules of practice to protect your privacy. This also goes for adolescents: All adolescents in the United States have the right to diagnosis and treatment of sexually transmitted infections without the consent or knowledge of their parents.

Testing can be done confidentially or, in some instances, anonymously. Confidential testing means that your medical records are not released to anyone without your written permission. Most medical records are confidential; however, the people who work where you were tested, and possibly your insurance company, will have access to your records. Anonymous testing means that you do not use your whole name when you are tested. You may use only your first name, or you may use a name other than your real name. You will usually be assigned a number that corresponds to the number on your tests, and you must give this number to receive your results. In this case, there is complete anonymity, and only you know that you are being tested and what the results of the testing are.

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Vulva is the term used to describe the outside, visible parts of the female anatomy. This includes the labia (lips), the clitoris, and the urethral and vaginal openings.

Labia

There are two sets of labia: the labia majora, or outer lips, and the labia minora, or inner lips. The outer lips extend from the clitoris to the bottom of the vaginal opening. They are covered with hair and are composed of fatty tissue. The labia minora sit inside the labia majora and are not visible until a woman reaches puberty. The labia minora have little or no hair and extend from the clitoris, covering the urethra and the vaginal opening. Several STDs can cause visible symptoms in this area, including herpes, genital warts, and syphilis.

Clitoris

The clitoris is a small (about 2-3 cm) structure that sits at the top of the vulva. It is very sensitive and is analogous to the glans of the penis in men. It is partially covered by the labia minora. Stimulation of the clitoris is important in sexual arousal and orgasm.

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