A quick word about safer sex

No book on sex nowa­days is complete without some advice about keeping healthy and avoiding sexual infec­tions, including HIV infection. With the exceptions of gonor­rhoea and trichomoniasis, the numbers of cases of other common sexual infections have shown sig­nificant increases in recent years. The incidence of genital warts, for instance, showed a 225 per cent increase in one recent ten-year period.

Sexual infections used to be synonymous with promiscuity and infidelity, but today this is no longer the case. For better or worse, it is now common for men and women to have several sexual partners before committing them­selves to a long-term relationship (marital or otherwise) and some infections are legacies of previous encounters.

Many couples now take the op­portunity to have a full check-up for sexually transmitted diseases, and possibly an HIV test, before either foregoing condom use or planning a family. The stigma previously attached to attending a sexual health clinic (genitourinary medicine clinic or special clinic) is now much less. Women also commonly use these clinics to seek help for minor gynaecological problems such as thrush or cystitis.

ARE CONDOMS REALLY NECESSARY?

The best method of avoiding most, although not all, sexual infections is to use a condom always, with every partner, and to put it on before there has been any genital contact. This will help prevent infections such as non-specific urethritis, chlamydia, gonorrhoea, tricho­moniasis and HIV. It will give some protection against herpes and warts, but no protection against pubic lice.

Condom use becomes even more crucial if you are in a higher-risk situation – such as having sexual intercourse abroad, with prostitutes, male homosexuals or someone known to be an injecting drug user.

Some men find condoms dif­ficult to use, and have problems maintaining an erection with one on. The female condom (Femidom), which is available at family planning clinics and at chemists, may then be a useful option.

GOOD HABITS

General hygiene is also important in sexual relationships. Women especially may find that they suffer sensitivity and irritation in less hygienic conditions. It is good prac­tice to wash the genital area before and after sex, and for women to urinate soon after intercourse, to prevent cystitis.

It is not a good idea, however, to go overboard about washing, and sensitivity to soaps, bath ad­ditives, deodorants and douches is a common problem. Women are generally advised to avoid bubble baths and douches of any sort (especially disinfectants) because they strip away the normal bacteria in the vagina, which leaves room for other bacteria to move in. This can lead to thrush or a condition called bacterial vaginosis, which causes a creamy discharge with a fishy smell. Washing regularly with water only should be sufficient.

WHAT ARE THE COMMON SYMPTOMS?

It has to be remembered that many sexual infections can remain undetected because they cause such mild symptoms that the person does not notice them. Some infections are notorious for re­maining hidden – chlamydia in­fection in women, for instance, is often noticed only when it has caused further complications such as tubal damage leading to infertility or pelvic inflammatory disease.

Discharge and discomfort

Men may notice a pus-like dis­charge from their urethra, and women may notice a change in their normal vaginal discharge. It may be heavier or have a different col-our or smell from normal. Men may also notice pain when they urinate, or a burning irritation down along the penis. Women may have ir­ritation round the vagina, painful intercourse or stinging when they urinate.

These symptoms may be caused by non-specific urethritis, gonor­rhoea, chlamydia, trichomoniasis or thrush.

Skin ulceration

The most common cause of painful skin ulceration or blistering is herpes.

Syphilis, a rare disease nowadays, causes a painless ulcer. Other causes of broken skin include severe thrush, or trauma through vigorous sex or inadequate lubrication.

Lumps, boils or warts

It is common for people to seek help about a growth on their genitals that they had not pre­viously noticed. Sometimes these turn out to be pimples or boils, and sometimes they are warts, which require treatment. Women may get a swelling in the lower third of their vagina, on one side, caused by an infection of a gland called the Bartholin’s gland. Treatment is not always necessary, but the swelling sometimes has to be cut and drained of pus.

Pelvic pain

Women may complain of severe periodic pain in the lower abdomen or in their sides, whereas men complain of pain in their pubic region, sometimes shooting to their testicles or penis. This can be caused by infection in the pelvic organs in women (pelvic inflam­matory disease) and the prostate in men. It can be difficult to pinpoint the infection, however, and sometimes long courses of antibiotics are necessary. Such infection may be the result of untreated sexual infection such as gonorrhoea or chlamydia.

Itch

Men and women may complain of itch anywhere on the genitals or in the pubic hair. This can be caused by poor hygiene, thrush or pubic lice, or herpes. It is also possible for common skin problems such as eczema to affect the genitals.

HOW TO GET HELP

There are now 230 sexual health clinics in the UK. The best thing to do, if you suspect that you have an infection, is to attend a clinic for a full check-up and treatment, and advice about avoiding further problems. GPs are also available to help, but often do not have the full range of testing facilities.

Sexual health clinics offer a strictly confidential service, with separate hospital notes from the rest of the health service, and so nobody, not even your GP, can find out about your attendance unless you give your permission. Appoint­ments may be necessary but you do not need to be referred by any­one else.

If you do have infection, your partner will also need to be tested and receive treatment. Untreated infection in sexual partners causes the spread of infection in the general population. Some infections may also damage the unborn fetus.

If both you and your partner are receiving antibiotic treatment, it is most important that you abstain from intercourse until you have both been given the all-clear by the clinic. Otherwise you may continue to pass the partly treated infection back and forth and continue to have problems.

Many sexual health clinics also offer a comprehensive service with full-time counsellors, health ad­visers, psychologists or psycho­sexual therapists. These people provide useful advice and in­formation about dealing with sexual problems, relationships and any unwanted effects of a sexual rela­tionship – a pregnancy or an infec­tion such as herpes. They also offer advice and support concerning HIV infection.

KEY POINTS

• Regular condom use cuts the risk of sexual infection significantly

• Good hygiene is important between partners

• Women should wash their genitals regularly with water only

• For a full confidential check-up, make an appointment with the local sexual health clinic