We get it: No one likes to talk about sexually transmitted infections. If things are getting hot and heavy, nothing tosses a bucket of cold water over a sexual encounter quite like saying “STI.”
But in the age of super gonorrhea, it’s super important we have these conversations. Last year, we heard the first reports of super gonorrhea, a strain of the disease so gnarly it’s resistant to the antibiotic drugs usually prescribed to treat it. Oh, joy.
That’s not the only STI you have to worry about. The U.S. has the highest STI rates in the industrialized world, and it’s only getting worse. Nearly 2.3 million cases of chlamydia, gonorrhea and syphilis were diagnosed in the U.S. in 2017, surpassing the record set in 2016 by more than 200,000, the Centers for Disease Control and Prevention reported in August. (FYI: We’re using STI here as opposed to STD because not all sexually transmitted infections turn into a disease.)
“It’s scary because a shockingly high percentage of Americans know little, if anything, about STDs and STIs,” said Robert Huizenga, a physician and the author of “Sex, Lies and STDS.” “Few people have any idea what early STD symptoms to look out for, even if symptoms do occur, because many STDs present with no symptoms.”
“How are we going to get our abysmal STI rates down if we don’t feel comfortable talking openly and honestly about our sexual health with our partners?”
Part of the blame for the uptick in STIs lies in our incredibly lax use of contraceptives. A 2017 National Health Statistics Report found that condom use in the U.S. has declined among sexually active young people, with many opting to use the pullout method instead.
The rate of men who say they use withdrawal ― pulling out a partner’s vagina before ejaculating ― increased from about 10% in 2002 to 19% by 2015, according to a recent study published by the National Center for Health Statistics.
Half-assed methods of protection aside, we’re also dealing with a lack of transparency and conversation about STIs. How are we going to get our abysmal STI rates down if we don’t feel comfortable talking openly and honestly about our sexual health with our partners?
Ideally, your new S.O. or hookup buddy will alert you to any hiccups in their sexual history before you have to bring it up. (If you have an STI, we wrote a very helpful primer on how to tell your partner about it, which you can read here.)
But in the event that they don’t, it’s 100% worth speaking up. Below, sexual health educators share their best advice on how to broach the subject in a way that isn’t a total mood killer.
Ideally, bring it up before things start to heat up.
If you have the luxury of time ― say, you’ve been dating this person for a bit and have yet to have sex ― have this convo before you get naked. Avoid any potential awkwardness by employing the “sandwich method” of communication: Share something positive about your budding relationship, then share something you’re worried about (cough, cough STIs), then follow it up with another positive.
“Maybe you start by telling them how much you like them,” said Janet Brito, a psychologist and sex therapist at the Center for Sexual and Reproductive Health in Honolulu. “Then, say something like ’I really value our relationship, and want to take it to the next level. Do you, too?’”
If they agree, say something like, “Great ... I’m a little nervous about having this conversation, but maybe we should talk a little bit about our sexual health, like when was the last time we each were tested?”
Don’t end the train of thought there, though. “Tell them, ‘The last thing I want to do is to kill the mood in the moment. I find you really attractive and really want to do this.’” Brito suggested.
At this point, hopefully, the rest of the conversation will be smooth sailing.
Go into the conversation with this mindset: STIs are incredibly common, so avoid shame-filled language when you bring it up.
If we talk about STIs at all, it’s usually as the punchline for a stupid joke or headlines about “herp alerts at Coachella.” The jokes and puns not only stigmatize those with STIs, they downplay how incredibly common the infections are.
More than one in six adults in the U.S. are living with herpes, according to the CDC, and one in two sexually active persons will contract an STI in their lifetime.
With that knowledge, broach the conversation without using shame-filled language, said Boston sex educator Aida Manduley.
“Asking your partner ‘are you clean?’ shames people for getting infections,” she said. “Regardless of why or how they got infected, STI stigma is terrible for public health.”
Instead, Manduley recommends saying something like, “I’m so ready to have sex with you, and I want to figure out what type of protection we should use before we start!”
“These conversations don’t have to be super serious and sterile,” she said. “Feel free to make them juicy, weird, funny, whatever works for you. And if you’re nervous, practice beforehand so it sounds more natural in the heat of the moment.”
Don’t just ask “have you been tested?”
Unfortunately, the tried and true method of asking “have you been tested?” doesn’t always give you complete information, since not everyone gets the same STI tests, not all STIs can be tested for, and many people are confused about interpreting their results.
It doesn’t need to be a great deal more complicated than that, though. Just follow the question up with some specifics, Manduley said.
“Some of the information you should consider asking is what STIs they were tested for, what the results were (and if anything came back positive, if they completed treatment for it), when that last test date was, and what protection they’ve used in sex since then.”
Don’t think, “we’re using a condom, we’re good!”
If you’re using a condom, you’re playing it a lot safer than those who rely on the pullout method alone. But just because you slipped on a rubber doesn’t mean you’re free and clear. (Sorry!)
As Huizenga told us, condoms alone are effective at preventing STIs that are transmitted through bodily fluids, like gonorrhea and chlamydia, but they provide less protection against those that spread through skin-to-skin contact, like human papillomavirus (genital warts), genital herpes and syphilis.
He tells patients who are single or have multiple partners to get comprehensive screenings done on a yearly or biyearly basis.
That makes having the pre-sex talk so much easier; If you’ve been recently tested, you can offer up your own test results to normalize the experience or make your partner feel less shy about doing it themselves.
“When partners fully disclose STD status ― even exchanging recent lab testing ― it provides clear informed consent on multiple levels,” Huizenga said. “In the spirit of honesty, equality and transparency, I think both partners should exchange this information prior to intimacy.”
If the person says, “I’m not sure,” aim for the highest level of protection you can manage.
If your partner’s response to questions about STIs is along the lines of, “hmm, I’m not sure,” protect yourself as much as possible. That might mean postponing sex ― delayed gratification can be sexy in itself ― or using as many relevant barriers and forms of protection as possible. Maybe you don’t go “all the way,” but hey, some of the way is still loads of fun.
“If they’re not sure, you might use internal condoms, external condoms, dental dams, gloves or have sex that offers a lower risk profile ― something that limits fluid exchange and limits contact between mucous membranes,” Manduley said.
If this is a more long-term thing, Manduley suggests getting tested together. But in the heat of the moment, keep your response casual and relaxed.
“You can say something like, ‘thanks for telling me!’ and then segue into another activity,” Manduley said. “For example, ‘Well, since you’re not sure, I don’t think you should come in my mouth, but I would love it if you came on my chest,’ or ‘Since you’re not sure, let’s play it safe this time and only use our hands. I can’t wait to touch you.’”
Take a deep breath: This conversation is probably going to go over better than you think.
This is obviously a heavy, potentially uncomfortable topic, but if handled with casualness and tact, it’ll probably play out a lot smoother than you expect. (Plus, major brownie points for being so sexually responsible.)
“Shockingly, I have had patient after patient tell me how surprised they were about how well received these open pre-sex talk was by prospective partners,” Huizenga said. “Counterintuitively, it didn’t kill the mood, it actually made them more, not less, sexually desirable.”
Sex Ed for Grown-Ups is a series tackling everything you didn’t learn about sex in school — beyond the birds and the bees. Keep checking back for more expert-based articles and personal stories.
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