A conversation with my good friend who works at Planned Parenthood, sporadically texting over a 24-hour period:
Joe: So what does an STI check entail?
Friend: An STI test can look a few different ways.
It can involve peeing into a cup or getting blood drawn, depending on
the STIs you’re testing for. Either way, the sample gets sent away, and
you should get your results in a week or two. Folks with penises used to
have to get a q-tip swab in their urethra (the hole you pee out of)
which was VERY painful so we make sure people know that’s not how it’s
done anymore haha.
J: Jesus Christ, I didn’t know about the q-tip
thing. Thank you for switching it up, Planned Parenthood. I promised my
nurse today that I wouldn’t faint at the blood draw, but I would not
have been able to make the same promise during a penis penetration.
And hey, what’s up with the switch from "STD" to "STI"? I guess I first learned of the switch on
Degrassi.
F: Hahaha well done,
Degrassi! I didn’t
know they mentioned that. I joke that STDs are rebranding, but the heart
of it is that "disease" isn’t the most accurate term for them. "Disease" sends the message that it’s a terrible thing that someone is
stuck with forever, when in reality, most STIs are curable (and all are
treatable). They really are more infections—able to be cleared up with
the appropriate medication. Plus, "disease" holds a ton of stigma and
we know STIs are super common. Removing the word disease also aims to
reduce some of the shame and stigma.
J: I’m glad you mentioned the stigma. We both know
getting an STI is nothing to be ashamed of, but I can imagine a decent
amount of people feel otherwise. I was pleasantly surprised, then, how
non-judgmental everyone was at PP. Even my... socially unconventional(?)
answers to the questions they asked were met with a shrug.
F: Yeah I think folks in public health have seen and
heard a ton. But at PP we try really hard to be open, affirming, and
nonjudgmental in our care. So I’m glad they were good to you!
J: How often should you get a check-up? Does it depend on how much sex you’re having?
F: Typically we recommend folks get tested every six
months or so if they’re sexually active. If someone’s style is more the
monogamous route, then we’d recommend getting tested between each new
relationship. I know some folks that go get tested with their new
partner before getting into the sexy stuff and folks in committed
monogamous relationships who get tested yearly at their physical. So
really it’s about finding a routine that works for you. Going every day
might be excessive.
J: I know this may be more playing therapist than
clinician, but: Could getting an STI check ever come off as a lack of
faith your partner’s fidelity? When you’re in a relationship, I mean,
and have been for a while.
F: I think that’s one of several barriers people
face in getting tested, for sure! We mentioned stigma before and I think
that, paired with the way we were taught sexuality education sets us up
in a bad way when it comes to getting tested. I know at least my sex ed
taught me that STDs happened to people "who had too much sex and got
what they deserved" #catholicschool. We never learned to approach
getting tested as just another routine healthcare practice to be mindful
of. My sex ed also never taught me about healthy relationships or open
communication, so we aren’t equipped always to broach the topic of
sexual health with a partner. It can feel vulnerable and scary and
definitely like a lack of trust. There are lots of ways to bring it up
and no one way is perfect, but making sure a partner knows you want to
get tested to make sure you both remain safe and healthy is one way to
start it.
That’s more my musings than clinical facts, but getting tested while
in a monogamous relationship is definitely an opportunity to practice
honest and tricky communication.
J: In your experience working with the youth at PP,
just how bad is the sex ed situation with today’s teens? Do they even
know what an STI is? Or is it better than I suspect, and you’re just
filling in some blanks for them?
F: It depends on your state’s laws. A lot of states
fund abstinence-only education ("just don’t have sex"), which studies
show is ineffective, at best. In TN, we’re working under a law called
the "Gateway Sexual Activity" law. It makes it illegal to teach about
any behavior that could be considered a "gateway to sex." It’s
incredibly vague and teachers are nervous to get sued, so they teach
info that varies teacher to teacher. I’ve had students who never learned
reproductive anatomy, who only saw stigmatizing, shamey pictures of
STIs (which is SO unhelpful because the most common symptom of all STIs
is no symptom at all), and who learned that being anything but straight
was wrong. It’s illegal to have a condom on public school property. BUT
I’ve also encountered teachers who have made it their mission to find
ways to get young folks the info they deserve. It’s a particular brand
of harmful here, but unfortunately it’s no worse that many other states
in the US.
J: That’s fucking wild. I just wish legislatures
would, I dunno, look at some fucking data every once in a while to see
what’s effective instead doing this draconian bullshit and harming kids.
But maybe I’m digressing...
It probably varies on the context of your sexual encounters, but if
you had to ballpark it, how likely is someone to get an STI in his/her
lifetime? Or is that, like, not even an answerable question?
F: The statistic in the US is that 1 in 2 sexually active adults will get an STI by age 25.
J: I guess we’ll find out which side of the coin I fall come next week.
F: Which is to say folks should get tested because
STIs are super common, but also the notion that people are "dirty" or "nasty" if they have an STI is inaccurate—lots of people get them!
People you know! So stop shaming people because it’s not nice and keeps
people from feeling empowered to get tested or communicate openly with a
partner.
J: Okay, so I know it’s possible to get an STI from
oral sex, but the likelihood of getting one that way is lower than
vaginal intercourse. Nevertheless, I’ve heard it recommended that you
should wear a condom during oral as well. Is there any point that one
could feel okay about saying "it’s worth taking that small risk"? Or
would even considering it betray your duties as a professional?
[
later] The more I think about
that question, the more pointless it sounds. If your message is that 1)
be safe and try to prevent STIs, 2) but if you get one, don’t be
ashamed, just get it treated, all good!, then trying to determine if
getting a blowjob is worth the price of an STI seems pretty flippant in
that context.
F: Hahah no no, i think it’s a fair question! In a
perfect world, people would use condoms/dental dams during oral sex.
While all STIs are treatable, unfortunately there is stigma in on our
world currently and having to tell future partners about an STI is
something most folks would like to avoid having to do if they can. It’s a
slightly lower transmission rate, but as
Degrassi has shown us,
folks can definitely contract STIs in the mucous membranes in their
throats and mouths. But if someone has previously hated using condoms at
all and has only recently started using condoms during vaginal or anal
sex, from a harm reduction standpoint, maybe we take a breath before
really focusing on protection during oral sex. Everyone’s on their
journey and you have to work with them to see "how can we be a bit safer
from STIs than we are now?" When teaching, I try to avoid those nuances
and highlight that oral, anal, and vaginal sex can transmit STIs, so how
can we lower that risk?
J: Honestly, it sounds like you know what you’re
talking about, and I think those Nashville teens are damn lucky to have
you. Tell me this—it’s probably enough of a struggle to get people in
general to be safe and prevent infection; is there any room for
sex-positive talk as well in the conversation? (Meaning the general
conversation I guess, not your specific conversations with teens, which
may be hamstrung by laws or guidelines) Like, is there time to impress
upon people that sex itself is good, or should the focus simply on SAFE
sex being good? If that makes sense.
F: Yeah! We are sex positive, for sure (to the
extent we’re allowed to be—people are just WAITING for an opportunity
to say PP is "encouraging" youth to have sex). Sex can and should be an
enjoyable experience for everyone who is involved in it! We don’t ever
tell anyone how they should feel or act about sexual behavior, because
everyone brings such different life experience to their sexuality.
Trauma is real, but so is enjoyment! We create a space so everyone can
feel as safe as possible digging into these questions, learning the info
they can then integrate with their personal values and life. When
talking about STIs, we highlight that everyone can be more free to be in
the moment and enjoy themselves if they take steps to prevent STIs or
pregnancy on the front end. Striking the balance between trauma informed
and sex positive is so important.
J: Sex really
is awesome. Okay, so we’ve alluded a
couple times to lawmakers come down unfairly on Planned Parenthood and
other sex ed professionals. Today (as I was informed by a PP worker
during my visit), the Senate is voting on the bullshit health law that,
if passed, will have dire effects on PP, which in my opinion is a
fucking integral part of the community. So my final question is, what
can we do to help?!
F: It’s true! The bill they’re proposing would
defund us. Many PPs receive Title X money, which helps them provide
family planning services (B.C., STI testing, cancer screenings, etc) at
low cost for people. Taking that money away would keep folks from
accessing what is potentially life-saving care. People often think
"defunding PP = defunding abortion," but under a national thing called the
Hyde Amendment, legally no federal dollars can go to abortion
services. So we need people to call their Senators ASAP! People should
be able to choose to access their healthcare wherever they want,
regardless of their income or zip code. The sooner people can call, the
better.
Thanks to my friend for her fucking awesome insights and wise words! Very appreciative. You heard her, folks. Get those STI screenings. Donate to Planned Parenthood here. Talk to your congressmen. And watch as much Degrassi as you can!
Love,
Joey