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Do Condoms Suck?

Wed, 22 Feb 2012 09:05:36 +0000

There's a really great opinion piece over at L.A. Weekly called, "Condoms Suck", and while I was prepared to disagree with their premise, I actually found it quite compelling. Now, it's important to say that for the critical things, condoms don't suck. They're pretty good at preventing STDs. They're quite effective for contraception. You can use them to make oral sex, anal sex, and vaginal intercourse safer, and cut them up if you want to use them as a dental dam. They're easy to use correctly (... although they're also easy to use wrong.)

That said, and more to the point of the article, condoms could be a whole lot better. Don't get me wrong, there have been improvements. Polyurethane and polyisoprene condoms have helped people with latex allergies. TheyFit condoms have made it easier for some men to find a comfortable product. Some people adore the female condom. But condoms aren't fun for everyone. Some people hate them and won't use them, and as the L.A. Weekly article suggests, not nearly enough money has been spent on making them better.

It would be great if that would change. In the mean time, let me know if you've found a condom that makes safe sex more fun. While you're at it, do you have any suggestions about what companies could do to make condoms better? If so, leave a comment below.

It's that time of year again...

Mon, 20 Feb 2012 09:50:16 +0000

A week after Valentine's Day, and the e-mails are pouring in from people who want to know if they might have had an encounter they'll regret. Questions like "what are the symptoms of STDs?" and "when will I know if I got something from that person?" come in throughout the year, but they always seem a bit more common right after the appropriately named VD. People feel so much pressure to be with someone that night that they often don't take the time to think it through first.

I have a standard answer to that question, which I suspects frustrates the recipients as much as it sometimes frustrates me to get the same e-mail over and over again. That answer is this. There are many possible STD symptoms - sores, discharge, itching, pain - but some STDs have no symptoms at all. Therefore the only way to know if you have an STD is to get screened, and sometimes you have to wait up to several months before those screening tests will be effective.

Still, by the time Independence Day rolls along, you should be just about ready to embrace your freedom...

The Politics of Contraception

Fri, 17 Feb 2012 09:01:59 +0000

Since the religious right and the Republican party think that limiting access to contraception is a good idea and abortion is a bad idea, their goal is clearly to increase the teen birth rate. I don't know why they think that limiting young women's educational and professional attainment is a good idea, or enjoy upping the rates of poor pregnancy outcomes that are associated with teenage motherhood, but they should be pleased to know that their strategy is working! Last week, the Archives of Pediatrics and Adolescent Medicine published a paper which showed that the teen birth rate is, in fact, substantially higher in conservative and more religious states. Isn't it wonderful when policies do exactly what politicians want them to?

Top 10 Reasons To Support Comprehensive Sex Education

Sex is not all about intercourse

Wed, 15 Feb 2012 09:46:25 +0000

I loved this recent comic from Girls with Slingshots, which not only brings up the wide variety of practices that constitute safe sex but reminds readers that sex isn't just about intercourse. As one character puts it, "if oral and fingering are things only lesbians do, then I feel really bad for you straight people."

Of course, straight people do engage in oral sex and fingering. What they don't often do is engage in them safely, because these activities are often thought of as the prelude to "real sex" rather than as sexual acts themselves. Bad choice. Oral sex has risks for both partners, and fingering can also spread STDs. (If you never want to feel clean again, research HPV transmission by fomite. The list of pathogens that can thrive under your fingernails is disturbing.)

Anyway, I just want to say "Kudos!" to Danielle Corsetto, the author of Girls With Slingshots, who is doing a great job educating her readers about safe sex. I should head over and apologize for getting a bit lecture-y when she posted a footnote saying that STDs are now called STIs because scientists want to be P.C.*

_{*Oh, and all of you people who sent me the comic? I subscribe to the GWS RSS feed, so I'd already seen it... but I did appreciate the thought!}

Scary Bacteria!

Mon, 13 Feb 2012 09:52:09 +0000

I would like to stop posting news items about antibiotic resistant gonorrhea. I really would. If I could stop posting about gonorrhea, then it would mean that it wasn't appearing in the news anymore, and I could have some hope that we wouldn't see completely untreatable cases of this common bacterial STD in my lifetime. That would be nice.

Unfortunately, the news continues to be pessimistic. An article on the subject in the February 7th issue of the New England Journal of Medicine, opened with the phrase "It's time to sound the alarm," and I have to agree. There are more than 600,000 cases of gonorrhea reported every year - making it the second most common notifiable disease. It disproportionately affects the poor and other vulnerable populations. And now? The resistance to the last line of defense - third generation cephalosporins - is growing. The prevalence of strains with a reduced susceptibility to these drugs is more than 10 times what it was in 2006.

The bottom line is that we have to focus on effective treatment, while it's still available, and prevention - for when it's not. In other words, when individuals come in with gonorrhea, doctors have to give them an injection of ceftriaxone (along with a dose of azithromycin to cover any coexisting infections), convince them to bring any recent partners in for treat, and drive home how important it is to do a better job of practicing safe sex in the future. Maybe one day there will be other preventative options, like a vaccine, but probably not before we run out of reliable cures.

Faulty Reasoning

Fri, 10 Feb 2012 09:22:16 +0000

I was recently sent this article, which states that baby boomers are getting more STDs now than people of the same age were 10 years ago. There's only one problem. The assumption underlying the article, which reports the number of diagnoses instead of the incidence rate, is that there were the same number of people in the age groups in question during both years. But was that actually the case? Let's do a bit of investigating.

According to the U.S. census, there were almost 20 million more people in the 45-64 year old age group in 2010 than there were in 2000. There were also slightly more than 5 million additional adults aged 65 and older. Those statistics reflect an increase in population size of 31 percent and 15 percent respectively. Going back to those absolute numbers from the first article, the proportional rise in the number of STDs did in fact well exceed the change in population size; however, there was no way to know that from the data that was presented.

If we had assumed the population had stayed the same size, the article would have shown a syphilis rate for 45-64 year olds in 2010 that was 2.8 times the rate seen in 2000. With the adjusted population size, that difference was barely 2.2. It's a relatively minor difference in this particular example, but that wouldn't always be the case. There's a good reason why people compare incidence rates and not numbers of cases when they're looking across years and populations. Lots of things can change.

A disturbing possibility...

Wed, 08 Feb 2012 09:44:02 +0000

For years, one of the bright lights in HIV research has been how effective antiretroviral therapy is at helping women who want children reduce the risk of passing HIV on to their infants. However, a study recently published in the Cleft Palate--Craniofacial Journal suggests that the process isn't entirely risk free and doctors may want to be a bit more cautious in their choice of which antiretroviral drugs to use. Several HIV drugs - including efavirenz, lamivudine, abacavir sulfate/lamivudine/zidovudine, and nelfinavir - have been associated with a significantly increased risk of cleft palate and other birth defects. Although the type of study performed did not make it possible for the researchers to establish whether the medications caused the birth defects, it did suggest that there needs to be a lot more research done in this area. In the meantime, doctors might want to focus on some of the drugs with a somewhat lower risk of associated birth defects.

New Standards for Sex Education

Mon, 06 Feb 2012 09:37:49 +0000

Last week was a good week for sex education. A coalition of health education groups proposed a set of new national standards for sex education curricula, and I got a sneak peek at the Center for Family Life Education's new two volume set of sex education lessons - "Teaching Safer Sex." I'll post a full review of the books once they're out, but I bring them up now because it was interesting to read them in conjunction with the new recommendations*. They gave me some great ideas for how to teach about some of the more difficult topics included in the standards.

The standards, by the way, are brilliant. They cover everything from reproductive anatomy to gender identity to school-based bullying and relationship violence. There are also sections on body image and an enormous focus on identifying medically accurate information. I hope that school districts adopt them wholesale. I doubt they will, but a believer in comprehensive sex education can dream...

I recommend that anyone interested in sex education download the proposed standards from the link above, but in case you're curious, some highlights include (paraphrased):

By the end of second grade, students should be able to use the proper names for body parts, talk about different behavior expectations for boys and girls, describe some different family structures, explain what bullying and teasing are and why they're wrong, and know how to identify and report inappropriate touching.
By the end of fifth grade, they should be able to: identify and explain the functions of the organs of the male and female reproductive tract, understand the changes that happen during puberty, identify medically accurate resources about puberty and hygiene, talk about how culture influences body image, and define sexual orientation.
By the end of eighth grade, they should be able to talk respectfully about individuals with different gender identities and sexual orientations, explain the risks and benefits of various contraceptive options including abstinence and condoms, and analyze the impact of social media on friendships and other forms of relationship.
By the end of twelfth grade, they should be able to analyze individual responsibility for getting STD tested and talking about STDs with partners, demonstrate respect for boundaries around intimacy and sexuality, and demonstrate ways to respond when someone is being bullied or harassed.

Now that's what I mean when I talk about comprehensive sex education. It isn't just about naming body parts and identifying contraceptive options. It's about helping young people build the skills they need to form healthy relationships in all areas of their life.

*Disclaimer - I was sent a free electronic review copy of Teaching Safer Sex. No other compensation was received

Self HPV Testing

Fri, 03 Feb 2012 09:08:53 +0000

I love self-sampling tests. I used the technique during my thesis research, and I think that allowing women to do their own vaginal and cervical samples removes a big barrier for invasive STD testing and Pap smears by making the experience more private and less embarrassing. However although I was excited to see recent research reports about the sensitivity of self-testing for HPV in the Jan 23 issue of the Journal of the National Cancer Institute, I do want to remind people that this is not going to be the solution for everyone.

While non-invasive HPV testing is a great way to identify women who are HPV negative and have an extremely low risk of cervical cancer, the difference between HPV testing and the Pap smear is that a positive HPV test on its own doesn't necessarily mean anything. Women may be HPV infected transiently and never have any cervical changes. Therefore, this type of testing has to be done with caution. Both doctors and women will need to be well educated about what a positive result does and doesn't mean.

Oral HPV in Men

Wed, 01 Feb 2012 09:08:02 +0000

Data about the growing problem of oral HPV continues to accumulate. First there were the studies showing that HPV related oral and throat cancers were quickly outpacing those caused by cigarettes. Now there's data suggesting that, in the U.S., approximately 4 percent of women and 10 percent of men are orally infected with HPV.

The study, published online first in JAMA on 1/26/12, was performed on a representative national sample of Americans as part of the National Health and Nutrition Examination Survey (NHANES). In the study of over 5000 participants, researchers found that both high- and low- risk forms of HPV were quite common in the US population. HPV infection risk increased with age until the early 60s, with two peaks in 30-34 and 60-54 year olds, and other independent risk factors for HPV included being male as opposed to female, being sexually active, having more sex partners, and smoking. Interestingly, neither race nor education level was associated with oral HPV risk, although both are associated with STD risk more generally. This may be because common safe sex precautions are ineffective at preventing oral HPV infection.

On which note, it's worth making a point of the fact that oral HPV infections were associated with sexual activity whether or not the participants had practiced oral sex. Although there may be some reporting bias involved, this strongly suggests that oral HPV can also be transmitted through other sexual activities, such as deep kissing.