Chapter 42: Sexual Health

Sexuality is a big part of being human. Love, affection, and sexual intimacy all play a role in healthy relationships. They also contribute to your sense of well-being. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.

Your sexuality is your own private business, of course, but whether you abstain from sexual intercourse or decide to become or continue being sexually active, the decisions you make can affect the health and safety of your sexual partner(s)—just as their decisions can affect yours. Therefore, it’s important to get the facts about what you can do to protect yourself (and your partners) from sexually transmitted disease, unwanted pregnancy, and sexual violence.

Sexually Transmitted Infections (STIs)

STIs are diseases that are passed from one person to another through sexual contact. These include chlamydia, gonorrhea, genital herpes, human papillomavirus (HPV), syphilis, and HIV. Many of these STIs do not show symptoms for a long time, but they can still be harmful and passed on during sex.

You can get an STI by having sex (vaginal, anal, or oral) with someone who has an STI. Anyone who is sexually active can get an STI. You don’t even have to “go all the way” (have anal or vaginal sex) to get an STI, since some STIs, like herpes and HPV, are spread by skin-to-skin contact.

STIs are common, especially among young people. There are about twenty million new cases of STIs each year in the United States, and about half of these are in people between the ages of fifteen and twenty-four.

Types of STDS

Chlamydia

Chlamydia is a common STI that can infect people of all genders. It can cause serious, permanent damage to the female reproductive system, making it difficult or impossible to get pregnant later on. Chlamydia can also cause a potentially fatal ectopic pregnancy (pregnancy that occurs outside the womb).

You can get chlamydia by having vaginal, anal, or oral sex with someone who has chlamydia. If your sex partner is male you can still get chlamydia even if he does not ejaculate (cum). If you’ve had chlamydia and were treated in the past, you can still get infected again if you have unprotected sex with someone who has chlamydia. If you are pregnant, you can give chlamydia to your baby during childbirth.

Most people who have chlamydia have no symptoms. However, symptoms can include a burning sensation when urinating and/or discharge from the penis or vagina. If you do have symptoms, they may not appear until several weeks after you have sex with an infected partner. Even when chlamydia causes no symptoms, it can damage your reproductive system.

Chlamydia can be cured with the right treatment. When the medication is taken properly, it will stop the infection and could decrease your chances of having complications later on. Repeat infection with chlamydia is common. You should be tested again about three months after you are treated, even if your sex partner(s) was/were treated.

Genital Herpes

Genital herpes is an STI caused by two types of viruses. The viruses are called herpes simplex type 1 and herpes simplex type 2.

You can get herpes by having vaginal, anal, or oral sex with someone who has the disease. Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. You can also get herpes from an infected sex partner who does not have a visible sore or who may not know they are infected because the virus can be released through your skin and spread the infection to your sex partner(s).

Most people who have herpes have no or very mild symptoms and, as a result, don’t know they have it. You may not notice mild symptoms or you may mistake them for another skin condition—like a pimple or ingrown hair.

Genital herpes sores usually appear as one or more blisters on or around the genitals, rectum, or mouth. The blisters break and leave painful sores that may take weeks to heal. These symptoms are sometimes called “having an outbreak.” The first time someone has an outbreak they may also have flu-like symptoms such as fever, body aches, or swollen glands.

Repeat outbreaks of genital herpes are common, especially during the first year after infection. Repeat outbreaks are usually shorter and less severe than the first outbreak. Although the infection can stay in the body for the rest of your life, the number of outbreaks tends to decrease over a period of years.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STI or symptoms of an STI, such as an unusual sore, a smelly discharge, or burning when urinating.

There is no cure for herpes. However, there are medicines that can prevent or shorten outbreaks. One of these herpes medicines can be taken daily and makes it less likely that you will pass the infection on to your sex partner(s).

Gonorrhea

Gonorrhea is an STI that can infect both men and women. It can cause infections in the genitals, rectum, and throat. It’s a very common infection, especially among young people ages 15–24 years.

Gonorrhea often doesn’t have recognizable symptoms—or they may be mistaken for bladder or vaginal infections. Symptoms include a burning sensation when urinating, abnormal discharge from the penis or vagina, and bleeding between periods. Rectal infection symptoms include itching, burning, and bleeding.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STI or symptoms of an STI, such as an unusual sore, a smelly discharge, burning when urinating, or bleeding between periods.

Gonorrhea can be cured with the right treatment. Although medication will stop the infection, it will not undo any permanent damage caused by the disease.

It’s becoming harder to treat some gonorrhea, as drug-resistant strains of gonorrhea are increasing. If your symptoms continue for more than a few days after receiving treatment, you should return to a health care provider to be checked again.

HIV/AIDS

HIV stands for human immunodeficiency virus. It kills or damages the body’s immune system cells. AIDS stands for acquired immunodeficiency syndrome. It is the most advanced stage of infection with HIV.

HIV most often spreads through unprotected sex with an infected person. It may also spread by sharing drug needles or through contact with the blood of an infected person. Women can give it to their babies during pregnancy or childbirth.

The first signs of HIV infection may be swollen glands and flu-like symptoms. These may come and go a month or two after infection. Severe symptoms may not appear until months or years later.

A blood test can tell if you have HIV infection. Your health care provider can perform the test, or call the national referral hotline at 1-800-CDC-INFO (24 hours a day, 1-800-232-4636 in English and en español; 1-888-232-6348 – TTY).

There is no cure, but there are many medicines to fight both HIV infection and the infections and cancers that come with it. People can live with the disease for many years, especially if they are diagnosed and treated early. Early diagnosis is also important to reduce the risk of transmitting HIV to others.

Human Papillomavirus (HPV)

HPV is the most common STI. HPV is different from the viruses that cause HIV and HSV (herpes). HPV is so common that nearly all sexually active men and women get it at some point in their lives. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening.

You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms. You can develop symptoms years after you have sex with someone who is infected, making it hard to know when you first became infected.

There is no test to find out a person’s “HPV status.” Also, there is no approved HPV test to find HPV in the mouth or throat.

However, there are HPV tests that can be used to screen for cervical cancer. These tests are recommended for screening only in women aged 30 years and older. They are not recommended to screen men, adolescents, or women under the age of 30 years.

Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Some people find out that they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers.

There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause:

• Genital warts can be treated by you or your physician. If left untreated, genital warts may go away, stay the same, or grow in size or number.
• Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment.
• Other HPV-related cancers are also more treatable when diagnosed and treated early.

Syphilis

Syphilis is an STI that can cause long-term complications if not treated correctly. Symptoms in adults are divided into stages. These stages are primary, secondary, latent, and late syphilis.

You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores can be found on the penis, vagina, anus, in the rectum, or on the lips and in the mouth. Syphilis can also be spread from an infected mother to her unborn baby.

Syphilis has been called “the great imitator” because it has so many possible symptoms, many of which look like symptoms from other diseases. The painless syphilis sore that you get after you are first infected can be mistaken for an ingrown hair, zipper cut, or other seemingly harmless bump. The non-itchy body rash that develops during the second stage of syphilis can show up on the palms of your hands and soles of your feet, all over your body, or in just a few places. Syphilis can also affect the eye and can lead to permanent blindness. This is called ocular syphilis. You could also be infected with syphilis and have very mild symptoms or none at all.

Syphilis can be cured with the right antibiotics from your health care provider. However, treatment will not undo any damage that the infection has already caused.

How You Can Protect Yourself Against STIs

1. Practice abstinence: The surest way to protect yourself against STIs is to not have sex (practice “abstinence”). That means not having any vaginal, anal, or oral sex. There are many things to consider before having sex, and it’s okay to say no if you don’t want to have sex.
2. Practice mutual monogamy. Mutual monogamy means that you and your partner both agree to only have sexual contact with each other. This can help protect against STIs, as long as you’ve both been tested and know you’re STI-free.
3. Get tested: If you do decide to have sex, you and your partner should get tested beforehand and make sure that you and your partner use a condom or other barrier—every time you have oral, anal, or vaginal sex, from start to finish. Know where to get protection and how to use it correctly. It’s not safe to stop using protection unless you’ve both been tested, know your status, and are in a mutually monogamous relationship.
   Many STDs don’t cause any symptoms that you would notice, so the only way to know for sure if you have an STI is to get tested. You can get an STI from having sex with someone who has no symptoms. Just like you, that person might not even know that they have an STI.There are places that offer confidential and free STI tests. This means that no one has to find out you’ve been tested. Visit GetTested to find an STI testing location near you. If you find out that you have an STI, it’s important to seek treatment—since some STI can be fatal if left untreated. Although certain STIs (like herpes and HIV) aren’t curable, a doctor can prescribe medicine to treat the symptoms.
4. Know your healthcare options: Make sure you get the health care you need. Ask a doctor or nurse about STI testing and about vaccines against HPV and hepatitis B. You can get health care from your student health services on campus or from organizations like Planned Parenthood, which offers free or reduced-cost sexual health services and reproductive planning. People with female reproductive organs, should talk to their doctors or nurses about regular cervical cancer screening and chlamydia testing.
5. Avoid excessive use of alcohol and drugs. If you use alcohol and drugs, you are more likely to take risks—like not using a condom or having sex with someone you normally wouldn’t have sex with.

Before you have sex, talk with your partner about how you will prevent STIs and pregnancy. If you think you’re ready to have sex, you need to be ready to protect your body and your future. You should also talk to your partner ahead of time about what you will and will not do sexually. Your partner should always respect your right to say no to anything that doesn’t feel right. If you are living with an STI, it’s important to tell your partner(s) before you have sex. Although it may be uncomfortable to talk about your STI, open and honest conversation can help your partner(s) make informed decisions to protect their health.

Unplanned Pregnancy

Seven in ten pregnancies among single women between the ages of eighteen and twenty-nine are unplanned.[1] As with STIs, the surest way to avoid unintended pregnancy is abstinence, since no birth control method is 100 percent reliable (even though a combination of methods, like intrauterine devices (IUD) and condoms have a very high rate of effectivenes). However, if you are sexually active, it’s important to protect yourself and your partner(s) from pregnancy and HIV and other STIs. Birth control (such as the pill, patch, ring, implant, shot, or an IUD) provides highly effective pregnancy prevention, but it doesn’t protect you from HIV and other STIs. Protection, like condoms, can reduce the risk to both of you for pregnancy and most STIs, including HIV. Even if you or your partner is using another type of birth control, agree to use a condom every time you have sex.

Condom +  hormonal birth control or IUD = DOUBLE PROTECTION.

If a condom breaks or you have unprotected sexual intercourse, it’s possible to take an emergency contraceptive pill (ECP)—sometimes called a “morning-after pill”—which may prevent a pregnancy from occurring. ECPs generally contain a higher dose of the same hormones found in regular oral contraceptive pills, and they are most effective when used shortly after intercourse (not the next morning, as the name suggests). It’s important to note that ECPs are not abortion pills, and they do nothing to either prevent or cure STDs.

Visit your campus health center, Planned Parenthood, or your doctor to get more information about birth control, condoms, and other reproductive and sexual health issues.

Sexual Assault

Sexual assault is any type of sexual activity that a person doesn’t agree to. It can include touching that is not okay: putting something into the vagina, sexual intercourse, rape, and attempted rape. Sexual assault happens on college campuses as well as in communities. It can happen between people in a range of relationships, as well. Even if you are in a long-term, monogamous relationship, you can still be the perpetrator or the victim of sexual assault by your partner. However, sexual assault is especially common in college environments. One in five women has been sexually assaulted while in college and 80 percent of female rape victims experience their first rape before the age of twenty-five. The following statistics show that sexual assaults usually aren’t random acts of violence carried out by strangers: ^[1]

• Approximately 4 out of 5 rapes are committed by someone known to the victim.
• 82 percent of sexual assaults are perpetrated by a non-stranger.
• 47 percent of rapists are a friend or an acquaintance.
• 25 percent are an intimate partner.
• 5 percent are a relative.

Consent is a very important part of a healthy sexual relationship. Watch the following video and think about how consent should be as normal as asking someone whether they want a cup of tea.

Video: Tea Consent

Drug-Facilitated Sexual Assault

One of the great things about being in college is having the chance to meet and get to know so many new people. Protecting yourself against sexual assaults doesn’t mean you have to sacrifice exciting social opportunities. It just means being informed about risks and taking common-sense steps to protect yourself.

One very real risk on college campuses—and elsewhere—is the use of drugs to assist sexual assaults. These are  powerful and dangerous drugs that can be slipped into a drink when someone is not looking. The drugs often have no color, smell, or taste, so the victim can’t tell if they are being drugged. The drugs can make a person become weak and confused—or even pass out—so that they are unable to refuse sex or defend themselves. If a person is drugged, they might not remember what happened while they were drugged. These drugs are used on and by people of all genders.

The three most common drugs used to facilitate sexual assault are Rohypnol, GHB, and Ketamine:

• Rohypnol (Roofies/La Rocha) comes as a pill that dissolves in liquids. Some are small, round, and white. Newer pills are oval and green-gray in color. When slipped into a drink, a dye in these new pills makes clear liquids turn bright blue and dark drinks turn cloudy. But this color change might be hard to see in a dark drink, like cola or dark beer, or in a dark room. Also, the pills with no dye are still available. The pills may be ground up into a powder. The effects of Rohypnol begin around 30 minutes after consumption and can last up to 8 hours.
• GHB has a few forms: a liquid with no odor or color, white powder, and pill. It might give your drink a slightly salty taste. Mixing it with a sweet drink, such as fruit juice, can mask the salty taste. The effects of GHB occur 10-20 minutes after ingestion and can last up to 4 hours.
• Ketamine (Special K) comes as a liquid and a white powder. It can also be added to cigarettes or joints. The effects of Ketamine can begin as soon as one minute after consumption and typically last up to one hour.

Alcohol and Other Drugs

Alcohol is also a drug that’s commonly used to help commit sexual assault. Be aware of the risks you take by drinking alcohol at parties or in other social situations. When a person drinks too much alcohol,

• It’s harder to think clearly.
• It’s harder to set limits and make good choices.
• It’s harder to tell when a situation could be dangerous.
• It’s harder to say “no” to sexual advances.
• It’s harder to fight back if a sexual assault occurs.
• It’s possible to black out and to have memory loss.

The club drug “ecstasy” (MDMA) has been used to commit sexual assault. It can be slipped into someone’s drink without the person’s knowledge. Also, a person who willingly takes ecstasy is at greater risk of sexual assault. Ecstasy can make a person feel “lovey-dovey” toward others. As with alcohol, it also can lower a person’s ability to give reasoned consent. Once under the drug’s influence, a person is less able to sense danger or to resist a sexual assault.

How and Where to Get Help

Take the following steps if you or someone you know has been raped, or you think you might have been drugged and raped:

• Get medical care right away. Call 911 or have a trusted friend take you to a hospital emergency room. Don’t urinate, douche, bathe, brush your teeth, wash your hands, change clothes, or eat or drink before you go. These things may give evidence of the rape. The hospital will use a “rape kit” to collect evidence.
• Call the police from the hospital. Tell the police exactly what you remember. Be honest about all your activities. Remember, nothing you did—including drinking alcohol or doing drugs—can justify rape.
• Ask the hospital to take a urine (pee) sample that can be used to test for date rape drugs. The drugs leave your system quickly. Rohypnol stays in the body for several hours and can be detected in the urine up to 72 hours after taking it. GHB leaves the body in 12 hours. Don’t urinate before going to the hospital.
• Don’t pick up or clean up where you think the assault might have occurred. There could be evidence left behind—such as on a drinking glass or bed sheets.
• Get counseling and treatment. Feelings of shame, guilt, fear, and shock are normal. A counselor can help you work through these emotions and begin the healing process. Calling a crisis center or a hotline is a good place to start. One national hotline is the National Sexual Assault Hotline at 800-656-HOPE.

The Hunting Ground documentary film is another source of information to learn more about sexual assault on college campuses.