April is STI Awareness Month-Kayla Matteo, Des Moines University Student Doctor

My high school sex ed class can be summed up as playing “toss the testicle” with rubber body organs. Sexual health was an awkward topic that my well-meaning health teacher seamlessly avoided — in hindsight, many would have had a difficult time rallying a class of 15-year-olds who could barely keep it together at any mention of “vagina.” One would assume that my college education would make up for the experience of only learning how to throw a curveball with a rubber testicle, but I never fully received that knowledge. Sure, we had some optional talks at the club fair's Planned Parenthood booth, but many other college students and I moved through our teenage and early adult years without foundational knowledge about sex, and the reality of the not-so-fun additions to sex: sexually transmitted infections. 

Now I find myself here in medical school, finally learning the hard facts of STI prevention that I never fully picked up in all my 20 years of education. April is STI Awareness Month, and I am determined to ensure that knowledge about STIs and how to prevent them CANNOT only be reserved for medical students. Adolescents need to be armed with such knowledge to protect themselves and others, and have confidence in advocating for their own bodies and health when the time comes. So here are some common facts and myths about STIs that I wish I knew back then during health class, and what we need others to know now.

·        Fact vs myth: Syphilis is an STI that was only prominent during the 1400s-early 1900s.

o   MYTH: In fact, right here in Iowa, there has been a huge rise in syphilis cases based on data from 20211. So how do we protect ourselves from contracting syphilis? The only way to protect yourself from syphilis is to use condoms to prevent contact with sores. However, some syphilis sores are not fully covered by condoms, and syphilis can be contracted by contacting these sores 2. The best thing to do is use condoms, and stay aware! If you’re unsure where to get condoms, don’t feel comfortable buying them, or cannot afford them, here is a condom locator that shows places to get free condoms!

·        Fact vs myth: There is a cure for syphilis.

o   FACT: A single injection of Penicillin G can cure the earlier stages of syphilis2. If you need to be treated for syphilis, wait until the sores are completely healed before having sex again, and tell your partner so they can get treatment too! 

·        Fact vs myth: You can give someone genital herpes if you perform oral sex on them with an active cold sore.

o   FACT: Oral herpes is usually caused by HSV-1 and genital herpes is usually caused by HSV-2. While these two strains of herpes prefer to hang out in different locations, they can sometimes change teams when exposed to the other location. If someone performs oral sex while having an active cold sore (aka an HSV-1 infection), it is possible for HSV-1 to pop up on the genitals. If someone has an active HSV-2 infection on the genitals, it is possible for HSV-2 to show up around the mouth 3,4.

·        Fact vs myth: You can only give someone genital herpes with an active, symptomatic infection.

o   MYTH: People can still spread herpes infections without any symptoms due to “viral shedding.” In fact, most people are infected with herpes during this asymptomatic shedding period5. Therefore, it is extremely important to keep barrier methods like condoms and dental dams in your back pocket (or wallet, whichever you prefer)!

·        Fact vs myth: If you don’t have any symptoms, you don’t have an STI.

o   MYTH: There are several STIs that can be asymptomatic, so it’s important to get tested when you are sexually active. Untreated STIs can cause infertility, chronic health problems, and more. Here are some of the most common asymptomatic STIs and possible health risks if they are left untreated, and how to prevent them 6,7.

1. STI: HPV (Human Papillomavirus)

Risks If Untreated- Cervical cancer (and others)

How to Prevent If Sexually Active-

• GET VACCINATED!

• Routine cervical cancer screening 

• Condoms

• Monogamy

• Getting tested before and after each new partner

2. STI: Chlamydia & Gonorrhea

Risks If Untreated- Pelvic Inflammatory Disease (scarring of fallopian tubes), which can lead to infertility

How to Prevent If Sexually Active-

• Condoms

• Monogamy

• Getting tested before and after each new partner

3. STI: Trichomoniasis  

Risks if Untreated: Increased risk of getting other STIs and HIV

How to Prevent if SexuallyActive:

Condoms

Monogamy

Getting tested before and after each new partner

4. STI: Herpes

Risks if Untreated: Spreading to sexual partners

How to Prevent if Sexually Active:

• Condoms

• Monogamy

• Getting tested before and after each new partner

*Keep in mind that while condoms are the most effective form of STI prevention other than abstinence, they are not 100% protective. Even though the risks are low, you could be doing everything right and still might contract an STI.

        Fact vs Myth: Having a sexual relationship is not possible if I contract an STI.

o   MYTH: There is a ton of shame and stigma associated with contracting an STI, which can often make people feel like sex in the future is out of the question. However, not only are STIs quite common, most of them are extremely manageable. For example, chlamydia, gonorrhea, and syphilis can be treated with a course of antibiotics. Herpes and HIV may be incurable, but their infectiousness can be significantly lowered with antiviral medications. It may be difficult to tell your partner about your STI status, but letting your partner know before you have sex allows both of you to make informed choices about having sex. Open and honest communication creates a safe environment for you and your partner to decide how to proceed8.

Talking about STIs can often be uncomfortable, but arming yourself with the knowledge early on can make all the difference when it comes to prevention. To learn more about STIs and how to prevent them, chat with a trusted healthcare provider — they’ve got your back.

Sources

1.  Iowa Public Health Tracking Portal, Syphilis Data, 2021. https://tracking.idph.iowa.gov/Health/Sexually-Transmitted-Diseases/Syphilis-Data

2. Center for Disease Control and Prevention. Syphilis & MSM Fact Sheet, 2022. https://www.cdc.gov/std/syphilis/stdfact-msm-syphilis.htm#:~:text=Using%20latex%20condoms%20the%20right,sores%20can%20still%20transmit%20syphilis

3. Center for Disease Control and Prevention. Genital Herpes Fact Sheet, 2022. https://www.cdc.gov/std/herpes/stdfact-herpes.htm#:~:text=Yes.,are%20due%20to%20HSV%2D1

4. Planned Parenthood. Oral & Genital Herpes. https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/herpes

5. Mount Sinai Health Library. Herpes simplex. https://www.mountsinai.org/health-library/report/herpes-simplex#:~:text=Genital%20herpes%20is%20contagious%20from,not%20present%20(asymptomatic%20shedding)

6. Michael Cackovic, MD. Ohio State University Wexner Medical Center. STIs you can have with no symptoms, 2019. https://wexnermedical.osu.edu/blog/stis-without-symptoms

7. Center for Disease Control and Prevention. Sexually Transmitted Infections Fact Sheets. https://www.cdc.gov/std/healthcomm/fact_sheets.htm

8. Center for Disease Control and Prevention. STI Awareness Week: Conversation Tips, 2022. https://www.cdc.gov/std/saw/pbyt/conversation.htm

I Believe Comprehensive Sex Ed Would Have Prevented My Emotionally Abusive Relationship, Here's How..

Sex Ed class is about so much more than working to prevent STIs and unintended pregnancies. Or at least it should be about more than that… If you are among the lucky ones, you may have received some information about birth control methods beyond condoms or abstinence, and maybe even a chance to put in anonymous questions at the end of class for your teacher to answer, in an honest way- hopefully.

I got none of this. I received abstinence-only education as my sex ed, and boy did that lead to some problems. Problems that I thought most certainly had to be unique to me and my life, but as I grew up I came to realize there were so many other people who had faced similar problems due to their lack of sex education. Problems like unhealthy or abusive relationships, sexual assault, depression and much more.

The thing about comprehensive sex education is, yes it talks about STIs and unintended pregnancy prevention, but it also tends to talk about consent, setting boundaries, ways to communicate your boundaries, identifying the difference between healthy and unhealthy relationships and even the warning signs that a relationship is or could become abusive. All these things work to prevent dating violence, abuse, sexual assault and even depression. A deeper level to all of this is talking about sexual orientation and gender identity as well. Also identifying gender stereotypes, which ties into that topic, can lead to violence in relationships. Nobody talks about or even realizes how the gender stereotypes that society has come up with, often are the main culprit in dating violence.

Let’s take this very real example from my own past relationship into consideration. I was in a heterosexual relationship, which is where gender stereotypes thrive might I add, and one day I can’t remember how the conversation got started but it turned into a conversation about who “wears the pants in the relationship”. I am joking said I assumed I did, but my argument only came from a sense that I made most decisions in the relationship when it came to meals for supper and date night activities. My sarcastic statement was met with a very serious face telling me that “he was superior and I was inferior”. I chuckled at this because I could only imagine that he was being sarcastic now too, but no matter how many times I asked if he was only joking, the answer remained the same, “I am superior.” He never wavered and to this day I still don’t know if he truly thought that or not.

Seeing it typed out in front of me, I can see now how obvious of a red flag that interaction was, and how he must have really felt the need to fit his gender stereotype that men are dominant and women are to be submissive.

But at the time of interaction, I found myself questioning if I was viewed as his equal, the way a healthy relationship should be. With that, I also find myself wondering if other couples even realize that a relationship should be viewed as equal and that no one person in the relationship is superior, no matter if one person makes more money or cooks more meals, or takes better care of the kids. To maintain a healthy relationship, it must be viewed as an equal partnership. I only realized this after I began my work as a sex educator though, who knows if I ever would have made it out of that relationship with this knowledge?

There are so many other examples I could pull from this relationship to show how truly unhealthy it was. From the belittling tone of voice used to talk to me, the constant comments about my bodily imperfections, the name callings, using my worst fears against me t win arguments, the objects that would be thrown or broken during these disagreements and so much more. All of these actions I chose to write off. I told myself that relationships take work and can be hard, that I just need to put in the effort to make it work because that’s what I thought I was supposed to do. So much of what I thought a relationship was supposed to be like came from social media, TV, and my own parent’s relationship at home. I had no idea that all of these sources were pure examples of what a healthy relationship should look like. Without the knowledge, I received becoming a sexual health educator, I would never have been able to identify the unhealthy relationship I was in and the warning signs of abuse that I faced weekly.

I ended that relationship with a clearer idea of what I wanted my next relationship to be and look like. I now know that in a healthy relationship, there’s honest and open communication, where both people listen to the other and hear out what they have to say. There’s no one telling you they don’t care about what you have to say or tell you that your opinion doesn’t matter. I learned from sex education that in a healthy relationship, you are a team, equals, and no one is above the other getting to boss them around. I also learned that frequently arguing or throwing/breaking things during an argument is a warning sign of abuse. I often wonder what may have happened in the relationship if I had allowed it to continue. I found myself frustrated that I didn’t have the information sooner. I felt like if I had learned about all of this in middle school or high school, it would have saved me from all the emotional and mental abuse that I went through in the relationship. I desperately wanted to go back in time and find a younger me and teach her everything that I had learned. But I can’t do that. All I can do now is try my best to educate teens about healthy relationships in hopes that others don’t have relatable experiences.

A final note, I want to add is I also came to recognize my own imperfections in this relationship. I acted, at times, in ways that I am not proud of. I think with the proper education I could have learned how to better treat my partner and how to better react in certain situations. Teens and young adults are expected to learn and figure out relationships all on their own life experience but why not give them a head start in figuring it out and talk to them at a young age about consent, boundaries, bodily autonomy, kind words and what a healthy relationship should be like. Thank you~Greta.

Holy Moly…It’s Let’s Talk Month!

By Sydni Loney, Program Assistant

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What is ‘Let’s Talk Month?’, you ask?

Let’s Talk Month is an annual educational campaign coordinated by Advocates For Youth (AFY), a national non-profit focused on helping adolescents make informed and healthy decisions about their sexual health. According to AFY, “Let's Talk Month is an opportunity for community agencies, religious institutions, businesses, schools, media, parent groups and health providers to plan programs and activities which encourage parent/child communication about sexuality.”

Each October, our efforts are channeled into helping folks find ways to begin these conversations. Pause, let’s say that again; conversations. A one-time talk is great, but all of the topics encompassed in sexuality can’t be discussed in a single sit-down. Plus, learning new information often takes repetition. AKA, talking OVER and OVER again about the same information. And while it may feel overwhelming or uncomfortable for both of you, research shows that young people prefer to learn this information from their parents/caregivers. Not the internet. Not MTV. Not their friends. YOU.

So when and where do you even begin?! Just like we encourage education to begin early in the schools, we encourage discussions to begin early at home as well. If you have a preschooler or elementary student:

• Introduce the concept of bodily autonomy. Help them learn to take care of their own body rather than doing everything for them. Don’t force them to sit on Santa’s lap or hug a relative if they don’t want to; teach them that they control their body and what happens to it.

• Introduce consent. Model asking before tickling or hugging, and stop when they say “stop!” even if they are giggling. Teach them to ask you before tickling or climbing all over you.

• Use correct terms for anatomy. Don’t refer to their body parts as a “ding-dong” or “cookie”; this will teach them that their body parts are nothing to be ashamed of. It can also help them if they ever experience sexual violence, because they will know the correct way to describe what happened to them.

If you’re past the little years and have a middle-/high-schooler:

• Ask about what they are learning in school. Many students begin receiving sex education of some kind in middle or high school, so ask them about what they are learning. Use open-ended questions, not questions they can mumble a “yes” or “no” to.

• Don’t be afraid to bring up topics like birth control and STD testing. It may sound horrifying, but many students don’t receive reliable information about these thing from anywhere else. If you don’t know all the details yourself, look them up or find resources you can pass off to your teen.

• Talk about relationships. If you notice that they or their friends have begun dating relationships, ask them questions about it. You can also use TV shows, movies, or song lyrics to begin these conversations. 1 in 3 teens will experience dating violence at some point. Help curb their risk but talking openly and freely about what’s healthy and what’s not.

• Find the right time. Avoid scenarios that might feel confrontational. Any anything with constant direct eye-contact might be a bit much for both of you. Instead, use the drive to an extracurricular or sitting on the couch during a movie to bring up these topics. The more comfortable you can make it, the more your teen will open up.

• Learn when to let it go. Teens can be moody, and sometimes they simply won’t be receptive to the conversation. As long as they aren’t in any danger, sometimes it’s best to just let things go for the moment. Make sure they have resources available for if/when they are ready to talk.

You can learn more about Let’s Talk Month and find additional resources at here.