How to talk about STIs | Life Kit

Nothing in life is risk-free some of the hardest things that people give you are not STIs it could be broken hearts they may mistreat you there's a lot that we are willing to take risks on when we start becoming intimate with people STIs is just one of those things that we take a risk on hey everybody this is NPR's life kit I'm Marielle segarra and that's eveline dacker a family physician in Oregon a big focus of my work is to destigmatize sexuality as part of our wellness and health care and look there are risks to

having sex STIs exist so we're going to talk about them and give you some language to have these conversations with a partner about STIs and more broadly about sex because for something that's so fun sex can be really hard to talk about I think this all starts really young and it's been happening for a long time but I have to say from my personal experience in high school they brought in someone who was an abstinence only sex educator and the message that she sent was a really harsh one I remember her saying if you had

sex before marriage with anyone other than the one partner that you were going to have for the rest of your life that you would be like a ball of tape that would roll through life picking up stuff and then by the end of it you were going to be just this disgusting piece of tape with all this like lint and dirt and whatever stuff to you and told in some cases medically inaccurate information about these infections what do you think is the biggest misconception about STIs that once you have them you wear a Scarlet Letter

that you are marked as being something other than pure even our language around STIs like when somebody says that they don't have an STI they use the word clean versus negative so STIs in our current education is really used to put fear into people versus really educate people of how to navigate them right even thinking about that word it's what's implied in its shadow if I'm clean because I don't have an STI what does that make someone with an STI exactly dirty exactly I like to tell people it's like the worst STIs that we give

each other are shame guilds and fear and we walk around without a law we walk around with that baggage of oh my gosh if I have sex with more than one person in my life then there is this thing that's going to give me this shame and if I ever come back with something positive then that's going to Mark me as not desirable just a primer on STIs there are two main categories right there's bacterial and viral can you talk first about bacterial yeah so bacterial infections the main ones that we talk about are gonorrhea

chlamydia and syphilis the difference between those and and viral are that they're treatable with an antibiotic okay so once you treat them they go away entirely they go away unless you get reinfected with them yes and then what about viral so the viral infections are HIV HPV and herpes our body does tend to suppress these with our own immune system so this people who have a strong immune system may never even know that they had something such as HPV some viral infections though aren't suppressed just by our immune system like HIV and we have to

take medications to actually decrease the virus so it doesn't become transmissible I wonder given that nothing is risk-free how someone can come up with what their rules are for themselves or what their guidelines are for themselves because I feel like when you go into these conversations with a new sex partner you kind of need to know what you're comfortable with there's no answer of like what is right and and really I think that as we navigate our own bodies and our own health we start discovering the things that are right for us you know when

we're young we're willing to take more risks that as you start learning your life a little bit better in your body you're like oh no I can't do that that doesn't feel good to do that I don't want to do that right people ask me like how often do I get tested or when should I get tested and I'm like every three months or three thousand miles you know a lot of it has to do with your uh how you are having sex with people if you were my sex educator and you're talking to ninth

grade Marielle right now what would you say about STIs where would you start I would start with saying that one of the things that sex education doesn't do is teach you about relationships and they don't teach you about yourself in relationships things that we need to talk about to build the foundation of sexual self-awareness eveline has a framework for conversations around Sexual Health called Stars she's going to tell us what that means star's framework is about what are your sexual health needs what do you need in terms of STIs how often do you test how

do you discuss that the t is your turn-ons what do you want what do you need to feel safe the A's or avoids your boundaries what don't you want and all of these things like you figure them out as your living life nothing is stagnant you don't know the answer to all of them right away the r is a relationship intentions what is it that you want what does sex mean to you and what is it that you need from somebody and the last s is one of the most important and that's her safety needs

how do you feel safe and it's more than just using barriers and protecting against undesired pregnancy but like what do you need to say physically emotionally spiritually and culturally as you understand yourself better and you understand your needs better it becomes much easier to communicate that with somebody and communicate it early in the relationship versus later on now that we have the science and the tools let's get into some role play where we walk you through what this conversation might sound like if you have a negative or a positive STi test we've got two scenarios

for you I think the first thing I want to ask though before we get into this is where are we having this conversation and when I always think that the ideal time is before your clothes come off okay you know when when it's starting to look like oh this may be going into a more intimate sexual Exchange that's the right time so hopefully it happens before we are kissing of course it's never too late to have this conversation even if your clothes have already come off so let's start with scenario one Dr eveline dacker and

I are at the bar on a date we haven't had sex yet or even talked about it but we did brush shoulders earlier and that felt pretty electric we want to have a conversation about STIs and Dr Docker is going to bring it up a small disclaimer here this might sound kind of awkward Dr Docker and I had just met but these conversations are worth having so here we go I I like you and maybe you know we might decide to move into some more intimate space are you wanting to talk with me about this

yeah sure okay yeah the last time I was tested for STIs was in December and I was tested for gonorrhea and chlamydia and I was tested for HIV and syphilis and they were negative how about you when was the last time you were tested pink five months ago and everything came back negative but I have had a couple Partners since then okay great right do you use barriers with your partners um for some things I really like to use barriers with my partners until I know that we both have been tested negative part of this

too is like I want to tell you a little bit about what I like and and some of my turn-ons and I really enjoy I love what we're doing right now I love really good conversations and I think like when I'm engaging in good conversations with somebody I feel safe I don't really like to uh engage sexually with somebody if we're drunk especially in the beginning like the amount that we've had tonight does that feel yes it feels true yes so like what are some of your needs after if we are to have in you

know any sexual exchange do you have any I think you'll feel really good if you stayed over okay and if you're not really ready to do that then I would just say maybe let's not have sex tonight it's really important for me that we do say in some kind of communication and also if during any period that we're together that you feel like oh my gosh this doesn't feel well or this might be something I want to avoid please speak up with it I know sometimes we assume that we're supposed to do something to please

each other and it's really important for me that we continue to stay in this communication and that's part of what this framework that I I like to do the stars talk because it could kind of be fun okay cool let's break for a second and talk about that a little bit I think this conversation would feel a little sexier than it just did um you know like the conversations are really hard yeah talking about sexuality is really challenging because we have never been taught how to do it we have no models to do it we

all know we're supposed to we're supposed to check in we're supposed to like communicate these important things before we're intimate but we have very little guidance in in doing so which is why I created this framework to sew so we have a language so we have a model so that we can actually fall back and say oh yeah I'm supposed to check in on what the person's boundaries are I'm supposed to let them know what I how I like to be touched and for sure we're supposed to know each other's STI uh status so that

we can feel good about what we're doing I think when we don't talk about STIs we have we carry a little bit of guilt about something that brings us pleasure and by actually bringing it out into the open and even if it's really awkward in person even acknowledging that like even acknowledging that wow these conversations are kind of hard and I'm feeling a little nervous about it it's totally okay we're not going to be able to change how we relate to one another until we start practicing it all right let's get into scenario two Dr

dacker and I are at the same bar only this time she's going to disclose a positive STI status to me I really like you and we've been having so much fun together I really enjoy our conversations and sexual health is important to me and I would like to let you know that I do have herpes I was diagnosed with herpes about five years ago I break out maybe once a year usually if I'm very stressed out and I am really happy to take an antiviral to help minimize any risk of transmission do you have any

questions about that or concerns yeah I actually don't know anyone who has Herpes so I might have some questions what do you mean when you say take an antiviral what is that the biggest risk of transmitting herpes is if I have a breakout which is kind of like a rash I get my sores along my genitals but usually I feel a burning sensation and that tells me to not touch anybody or not to have any skin to skin contact an antiviral will just help reduce that and help reduce how much virus that could come out

so I'm really I don't take them usually if I'm not engaging in the sexual relationship with somebody but when I am and if they want me to I'm really happy to take something every day to help reduce you getting herpes and to be honest I have never known anybody that I actually passed it to because we have these conversations but I could understand that there could be concerns for you okay um what if we kind of took it slow and we can do stuff that like doesn't involve that kind of contact tonight yeah absolutely and

if you need any resources I could definitely point you to get more information to people who can who talk about that and places where you could read a little bit more about it to make you feel comfortable and if any time you don't that's okay too okay cool well um do you want to try this other bar sure let's go okay so that feels like a healthy exchange I wonder I can imagine there would be other situations where someone would receive that information and then for instance clam up or get really um uncomfortable maybe they

feel and have have absorbed a lot of the messages that all of us have about STIs now let's say I as her hypothetical date don't react so well to this information what might that sound like I don't know it just makes me feel a little weird like I wish that you've told me before we went out a few times you know I don't know if I'm gonna be comfortable with it yeah some people are really uncomfortable with the idea that you can get an STI you know from a partner so I understand that you might

feel a little bit conflicted I'm here if you want any more information or support around that and it's also okay if we don't engage in any sexual activity I I really enjoy having conversations with you and you know we can continue doing that I think it might be ready to head home soon actually okay yeah I'll call you sure it was a nice light thank you yeah good to hang out well oh my gosh it's so hard to say stuff like that it's it's hard because I mean you're not going to convince somebody who's scared

yeah already I mean there's really like the people respond in one one of three ways okay no thank you tell me more and so I wonder if you have any thoughts on if you are the person who's disclosing and someone reacts in this way how to not internalize that when you've had an STI and you're living with a chronic STI such as herpes sometimes you know that people are going to reject you and that it can be scary I know that some people only date other people who have herpes or herpes positive because they're scared

of being rejected there's no one answer of like how to not feel upset or disappointed or rejected because we're human and we have those emotions especially if we really like somebody or want something from them by having a bigger conversation around intentions desires needs actually helps take off the onus just from the person who's disclosed losing and and normalizes the whole conversation so that's that's one way that I help people who have chronic STIs not just feel like oh my God I have to be the person who brings it up and when do I bring

it up it's really about like hey let's see if we're even on the same page in what we want or if we like each other and then if we are then it's important that the other person knows this about me if you were picking a word for how people should approach this conversation around STIs what would it be it would be curiosity curiosity about that person curiosity about what they want and and if you approach specifically the STI conversation with curiosity then it means that you're open it it almost implies that you can't be judgmental

about it sure there may be fears that are part of the conversation but approaching it with I want to know who you are is a really great way of Leaning into a relationship starting a sexual relationship with someone yeah I love that it's like whatever it is Bring it on right okay time for a recap there are two types of STIs bacterial and viral the bacterial STIs are treated with antibiotics and the viral STIs can be suppressed by your immune system but if they're not you can take antiviral medications for some of them those make

it less likely that you'll pass the virus to a partner there are several things you can do to try to prevent STIs get the HPV vaccine take prep use barriers like condoms when having sex but again nothing is risk-free not sex not driving a car not going out with your friends nothing but we do these things because it's important for us to connect with other people when you bring up this conversation with your sex partner don't just focus on STIs talk about what you're into what turns you on and what doesn't and trying to have

the conversation before your clothes come off it's easier that way but it's also never too late there's more of my discussion with Dr eveline dacker in the podcast version of this episode where we get much deeper into the science of STIs and break them down one by one foreign