the intersections of sex and squeamishness

I meant to post an essay on this a couple of months ago, but never got around to it. Here you go.

I've been pondering a lot about responsibility, trust, openness, and desire this last year.

There's something about our culture that just seems to promote an ostrich approach to anything that makes us feel uncomfortable- like the monsters in the closet, we hope if we screw our eyes shut that maybe they won't see us and will move on. If we can't see it, it doesn't exist.

Plausible deniability.

Added to that a national penchant for risk-taking- always assuming that *we'll* be in the X percent that will make it through fine, and not in the Y percent "sucks to be you" category... well. Suddenly, even kissing someone can seem like a deadly activity.

It's not easy to be responsible. It requires having hard (frequently mood-killing) conversations, explicitly asking what we need to know when we'd prefer to defer- trusting that the *other person* has done all of the hard work. It's much easier to consciously or unconsciously let our own personal safety rest on them- "but I shouldn't have had to ask. I trusted you."

Oi.

We trust our providers, too. Assuming that we've cleared the hurdle of our own inertia, and have actually gone to the doctor or clinic, we tell them straight up "just give me a full STD panel". Like ripping a bandaid off, we just want it over with quickly, with no involved discussion. And they do, and we do, and when we don't get an ominous phone call in a week or two we breathe a sigh of relief. Thank god *that's* over with.

Except, not so much.

The CDC and the clinic have much different priorities than you or your potential partner. The economics of scale and treatability, and the politics of reporting are at the top of their list. A "full panel", depending on how much the tests are underwritten and where you go, may cover as little as just chlamydia and gonorrhea. Sometimes chlamydia and gonorrhea and syphilis- all three generally easily curable with a run of antibiotics, and so underwritten testing serves a point other than merely informational.

Of course, HIV is always going to be a separate test, due to the different and involved reporting required, as well as the additional emotional and irreversible life impact.

Many clinics don't even do a genital exam unless you actually think you *have* something- and even then, it seems common to hope that any questionable bumps or blotches or itches or discharges will be noticed without having to be explicitly pointed out.

So what about the other STDs? Almost no one is tested for HPV directly, and there are no tests for men. The annual PAP smear checks for any cell changes on the cervix- and despite the fact that pretty much the only thing that causes those cell changes is an HPV infection, I haven't known anyone who had an abnormal PAP come back be explicitly told that they had HPV. If abnormal cell changes are noticed, only then is the PAP followed up with a DNA test for HPV.

The CDC page is pretty wishy-washy, anyway- they say that "Most people who become infected with HPV will not have any symptoms and will clear the infection on their own." Basically, current thinking is that HPV isn't normally a persistent viral infection, and cervical cancer only results in women who can't, for whatever reason, clear the virus. But no one really knows for sure.

Herpes is another fun one. No one bothers to test for HSV unless you explicitly ask for it. It's not curable, so why bother? A HSV-2 blood test is available, and generally speaking if it comes back positive you have genital herpes. (False positives are rare, and are usually caused by contamination of the test slides in the lab. Negatives are somewhat inconclusive, so you'd need a run of negatives to be sure that you don't actually have HSV-2 after a positive.) However, herpes lesions in the genital area can be caused by HSV-1, and it's not like the blood test can tell you *where* you're infected. There exist swab tests to determine if active shedding of the virus is going on, but I've never heard of them being used outside of clinical research settings.

On the other hand, I find it interesting that many strains of herpes are historically generally tolerated in this country- chicken pox, shingles, and cold sores don't result in the moral freak-out that HSV-2 is likely to engender.

So, what are the conclusions? Well- based on a purely informal survey of clinic waiting rooms and general conversation, a large percentage of those "drug and disease free" people looking for same are probably just relying on a combination of wishful thinking and certification by proxy. "well, my ex was tested a few years ago, and they came up clean..." "I only have sex with smart people." "Everything looks fine." "What kind of person do you take me for?"

Lest you think that these are merely cliches, I can source actual people who have said them in my hearing. That last quote came from the person who raped me 9 years ago (I'd asked him if he had any STDs after he'd informed me that he had not used a condom) and probably was the reason I obsessively was in and out of clinics for repeat tests for the better part of a decade.

I've learned all of this the hard way.

Of course, I'm also a woman, and the plain fact is that women are just more likely to get infected, even with barrier protection. Oral and vaginal tissue is delicate- it's mucous membrane, porous and more subject to tears and cuts. A blow job seems like a reasonable alternative to sex- if all you're worried about is pregnancy. (True, blow jobs *are* possible with condoms, but most condoms taste awful.) A lot of these infections are completely asymptomatic in guys, so there is less incentive for testing. Why risk getting bad news? It's hard enough to get laid *without* having disclose things.

When were *you* last tested? When were your partners?

In conclusion-

Know yourself. Know your body. Protect yourself. Ask questions. Be direct. And happy fucking.