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Join me in Love

STI Risks: Research and Threats (1/4)

Published by hartmans on 2016-01-03
Throughout my life I've struggled to balance my desire to be sexually open with the risk of a sexually transmitted infection. Contemplating sacred lover work brings a new emphasis to this struggle.
I've finally reached a point where I have comfort with the approach I'm using. I feel like I've understood my feelings and met both my need for safety as well as my need to be sexually open. I'm planning to write four posts discussing some of the process I've gone through. This post frames the problem, discusses research and threats. The next explores feelings.

No Quick Answer

My hope was that I could assemble information and present it so that others who had similar goals could save effort. Increasingly though, I'm coming to the conclusion that approaching STI risk, like so many aspects of personal growth is a path we must each walk.
However, managing risk is not really a question of science or medicine. When we're lucky, science can give us a good answer to the question of "What is my risk of consequence x if I do y?" We're left deciding which consequences we care about and how much risk we're willing to accept. That's a really hard question of self-empathy. We're understanding our needs and negotiating between our desire to do things and the pain of our future Schrodinger's self facing some consequence. If we do our best job, when we face a consequence some day, we'll say "ow, that hurts, but the risk was worth it."
doing that for myself stretches my capacity for introspection, communication and self-love. I will not commit the hubris of pretending to know someone else that well.
As an example, in this last round of introspection, I realized that I actually have fairly good confidence that I know how upset I'd be if I contracted oral or genital HSV. Gaining this confidence is one of the things that has been a slow and involved process. Because of that and many similar things, I cannot usefully share the answer I've found for myself. However, I can describe the path I've walked in hopes that others may find value in understanding it.

Read and Research

Throughout the process, I've been reading what I could find about STI risk. Sometimes reading with curiosity, sometimes with frustration. Unfortunately, we just don't have as much data as would be helpful in evaluating this risk.
I recommend avoiding material that tries to evoke fear. Fear is the mind-killer. While fear can alert us to something we need to consider, fear leads to bad decisions around sex just as in other aspects of life. All too often I've seen teens and adults make poorly considered decisions. They are afraid and unable to carefully consider the risks. As a result, they become frightened as sexual beings. When love and desire eventually demand action, the lack of understanding combines with an inability to escape fear; decisions and actions lead to regret.
I recommend looking for material that helps you understand what risks you face and helps you make decisions about this risk. I don't find material that focuses on telling me what I should do or tells me what activities are safe useful. Part of embracing the strength of love is the idea that our needs matter. If our needs matter, then no one can give recommendations about what our practices should be without considering our needs. It's much more helpful if they give us the information we need to make our own decisions and to gain strength as lovers. I cannot think of a single activity that is so risky that no one should "do it," regardless of their needs and desires. On the other hand, things I do regularly would be too risky for someone with different needs.
Here are some resources I've found particularly helpful:
  1. CDC guidelines on treating STIs. I don't have the current set bookmarked, but they aren't too hard to find.
  2. Sexually Transmitted Diseases by Lisa Marr. I particularly like the discussion of communication and the discussion of HSV (Herpes). If I'd found this book back around 2000, I could have saved myself years of frustration.
  3. this article on HIV. Also includes a great discussion of pitfalls in using statistics to evaluate risk.
  4. Bibliographies in any source you find valuable
  5. Fact sheets about infection rates in areas where you'd like to have sex.
I'd like to anti-recommend the discussion of disease in Joy of Sex (and for that matter other than the excellent discussion of smell, anti-recommend the entire book).

Observations

Here are some observations that seem common to many people's exploration of STI risk.
  1. The most important factor in whether you will get an infection is whether the people you interact with sexually are infected. Condoms and other "safe sex" approaches are valuable but have high enough failure rates that I find myself needing to think a lot about frequency of infection in potential partners.
  2. That said, condoms (and female condoms) do significantly reduce risk. Also, there's a lot of very-low-risk sexual interaction possible with hands, words, or simply being together while you and your lover masturbate yourselves.
  3. HSV is often the hardest disease to approach. It's neither curable, nor fatal. Many people don't find a significant medical impact from having it, but there can be a huge social impact. Facing HSV risk has been a hugely frustrating decade's work.
  4. Caring too much about HPV is a pit I'd recommend avoiding. There is a vaccine; that's the only effective measure to impact HPV spread we have. Scientifically we can't even agree about whether the infection clears. It's easy to spread, we don't have much we can to prevent spreading it besides the vaccine. It's very common but can lead to cancer. However, with regular medical care, we're good at treating things that might become cancerous. Focusing on HPV is a good way to feel powerless and frustrated.
  5. This doesn't quite belong here, but it should be said somewhere. If someone is telling you to use a dental dam for protected oral sex, you've probably met someone who doesn't enjoy oral sex much, or someone who is trying to torture you. I've made that work for my lover, but AAAARGH! tongue burn and lack of pleasure for both sides. For myself, female condoms are the answer. I'm told (but have no personal experience) that plastic wrap can be great. It's important to get the right kind.

Unknown Threats

For a long time I was trying to adopt practices that would be effective both against today's infections as well as things that might pop up. I was trying to make sure in many cases that my goo didn't interact with their goo. That may be a valid strategy for some people, but I've decided to abandon it and focus on specific named threats.
I found that it was really hard to reason about unknown threats. So long as I was willing to be very careful and demand that my lovers, all their lovers, and so on, were really careful things seemed to work.
However, I had no way to answer a lot of questions that were important to me. How much should I care if my lover wants to be more accepting of risk than I am? What can I do when approaching a potential lover who uses different practices? How big of a risk am I taking when I relax my practices?
Unknown threats are by their nature hard to quantify. That leads to a lot of fear. I found that I was focusing on this fear, unable to answer questions that were important to me, and had no confidence that my practices actually provided any protection.
So, I started focusing on specific threats.

Threats

I sat down and identified the consequences I was trying to prevent. Here is what I came up with:
  • Pregnancy. While this is not an STI, it's worth thinking about in the same context. I'd particularly recommend deciding whether you trust condoms alone as a sufficient defense against pregnancy.
  • HIV
  • Gonorrhea
  • Chlamydia
  • Syphilis
  • HSV. Many people consider oral and genital HSV separately. A lot of discussion seems to equate type 1 HSV with oral and type 2 HSV with genital. My understanding is that new genital HSV infection rates are reaching the 50% levels, so I'd recommend against equating type and location.
  • Hepatitis. Note that there are vaccines for Hep A and Hep B, but not Hep C.
There are many other threats to consider. I could think more about the fungal and yeast threats as well as parasites. For Lovers Grove, we may end up caring about some of these
I then ranked my threats. In tribute to the fear culture. of 1984, I ranked threats as doubleplusunwant, plusunwant, and unwant.
A lot of people seem to focus on a couple of threats as part of reasoning about their practices. For myself, most of my effort is spent thinking about pregnancy, HSV and HIV. If I did much with blood play Hep C would require significantly more reasoning. At the end of the day I check back and make sure the conclusions I draw about HSV and HIV are sufficient to address other threats.

Looking Forward

I mentioned that ultimately this discussion is about self-empathy and meeting our needs. Understanding my needs and facing my feelings is something that has taken years. I don't know if that can be compressed, but I plan to share the types of experiences that have guided me. Perhaps thought experiments can help you gain an understanding more quickly. I'll also talk about testing. "Testing belongs with feelings?" you ask. O, yes, yes it does.

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