Sexually Transmitted Diseases, Practical Tips and Lessons
Expert associate of the Dobra Družba Union, Dr. med. Anita, shares some friendly advice.
Introduction: Beyond the Basics
Goodness, what new can we even say on this topic? The birds are probably already chirping that you need to use condoms to protect against HIV and hepatitis, and if we stick to that, we're safe. What else is there to say – can we reinvent the wheel here? Let this actually sound like reinventing the wheel, but it's always and everywhere important. The fact is that most laypeople really don't know any other diseases besides HIV and hepatitis, which the birds are already chirping about. They know little about other, less known diseases – but it is precisely these that are much more common than the two mentioned above (which are best known because they are among the most severe forms of STDs). Some are visible at first glance, some are not, so a person and their genitals look completely flawless and healthy. And the fact is that condoms are only effective if they don't break. Well, let's start there.
How to prevent condoms from breaking during sex work?
The instructions for condoms say that when putting it on, you should be careful to squeeze all the air out of the reservoir for semen at the end of the condom before rolling it down the penis. Well, in my experience, condoms usually don't break because there's too much air or too much pressure from sperm in the reservoir, but because of friction, because everything is too dry, it rubs dry during penetration and tears. So – although lubricant is basically intended more for anal sex (because the butt doesn't lubricate itself), be aware that in commercial sex (where it rarely happens that you're really attracted to the client and will be sufficiently lubricated from start to finish), lubricant is a mandatory part of the equipment to prevent condoms from breaking. Saliva and your natural moisture may be sufficient at the beginning of intercourse, but this by no means means that it will slide and glide enough throughout the entire act. Not just before intercourse, add it during as well, as soon as you feel that it has started to 'chafe and rub' your vagina. If you don't do this, there is a risk that the condom will break. Keep lubricant within reach, it should be such that it's not a problem to squeeze it out the moment you feel you need to add it (the tube or bottle should always be full enough to get it out without a problem). The easiest way to add it is when you change positions, so you don't interrupt the action itself, but nicely incorporate the addition of lubricant – quickly squeeze it onto your hand, rub a little on the penis, wipe what's left on your hand on your pussy, and you can continue having sex normally without having to interrupt the action or search for lubricant. Just licking is not enough, it will be too dry again very quickly. Be careful not to use any massage oil or cream that is not intended for this purpose instead of lubricant – it can damage the condom. During doggy-style sex, feel every now and then to see if the condom is still on. Some clients are such rascals that they secretly take it off or unroll it during sex, even pushing it inside you so deep that it's a problem to get it out. You can feel discreetly so that the client thinks you're teasing them, but you're actually checking if everything is as it should be. Clients are really cunning, as even friendly ones you wouldn't think of can do something like that. Some clients might also comment, why do you need lubricant if you're having vaginal sex, not anal. You can calmly reply with a smile, just in case, so it doesn't break. Don't pay attention to such remarks – it's commendable that you're looking out for the safety of both. And of course, be careful not to damage the condom with your nails when putting it on, especially if you have long ones. Nails can stretch it so much during application that it becomes more susceptible to breaking. If you follow this, you can greatly reduce the chance of condoms breaking and thus the transmission of STDs. In case it does happen that it breaks – just don't panic, not every other person is infected. If there was an ejaculation and you're not on contraception, you have three days to go to the pharmacy for a postcoital pill, which you can get without a prescription, so you don't have to worry about pregnancy. Just don't worry, don't stress your psyche and think positively – but still monitor your body and if you get a strange smell or discharge, burning urination, or notice changes on your genitals, go get tested.
What about oral sex (fellatio)?
Under oral sex, I will count all options – blowjobs, cunnilingus, and rimming (for hetero, homo, and trans sex workers). Whether you will perform oral sex with or without a condom is a matter of personal decision, but we know well that clients much prefer oral sex without a condom (except for a few fearful ones who want oral sex with a condom themselves). Oral sex with a condom can be more pleasant if you use flavored condoms, only the reservoir will tickle you during deep throat. As for oral sex without a condom, based on my own experience, I can say that it is a very safe form of sex. In thirteen years, I have not gotten anything through oral sex without a condom, and nothing was ever found during STD tests or throat swabs. If you are not decided, it's better to do it with protection. However, I always followed these safety measures – I received the client in a well-lit room (if someone wanted, I dimmed it later for a more romantic atmosphere), but it was important for me to see the penis at the beginning, to assess hygiene, that it was nicely washed everywhere, including under the foreskin. If hygiene was lacking (smegma), I immediately sent them back to the shower. You really don't have to put filth in your mouth and don't be embarrassed to send a dirty person back to the shower (some even need help with washing because they don't know how themselves – no joke). It can be embarrassing for them, at most. I look at the penis and of course their butt, if they want me to do anything with it, well in the light, as genital herpes and genital warts are visible.
Herpes and Warts
Herpes are blisters, similar to cold sores on the lips, while genital warts can be flat, bumps, or triangles (pyramids) and in several colors (pink, brownish, skin-colored). All of this can be present on the penis, around the anus, or on the testicles. Don't confuse this with a birthmark or a mole. It has happened to me that I judged too quickly and told a client he had a wart, when in fact it was either a mole or a circumcised foreskin that looked like a wart. And his dick went limp. Birthmarks and raised moles are soft, while genital warts are hard, rough, a little cracked – that's how you distinguish them from a birthmark. Some men (gay prostitutes will notice this more) have so many around their anus that it looks quite florid, but they don't even know it themselves, because they don't look at their own anus (you can only see your own anus or pussy from below well with a mirror). In such cases, I definitely tell the client – I judge for myself whether we perform the service and tell them only at the end, I reassure them a bit, tell them not to worry, that it's all solvable at the doctor's and I emphasize that they should come when the matter is sorted. If the matter is so extensive that it's already disgusting, of course, I don't accept them, but I explain it nicely. And clients are grateful to me that they went to get it sorted and came back next time without warts. With warts, a condom doesn't help much, as HPV (human papillomavirus), which causes them, is transmitted by touch. From experience, I can say that vaccination against the HPV virus, which is both against genital warts and against cervical cancer (both are caused by the HPV virus, but different subtypes of the virus), really helped me. The vaccine is not cheap – years ago it was 400 euros for three installments (because you receive three doses of injections). But I can say that it was a very useful 400 euros spent – I never got any infection.
And ejaculation in the mouth?
I don't do it because I strictly watch my health, and I'm only turned on by the sperm of men who attract me. Just like ejaculation in the mouth, pre-ejaculate can also be risky – those are the drops that come out of the dick even before the main ejaculation. If you know you have a sore in your mouth (ulcer, canker sore, you bit yourself, have diseased teeth or gums) I definitely advise against ejaculation in the mouth, in this case, it is also better to do oral sex with a condom because of pre-ejaculate. Even if you don't have any mucosal injury that you know of, you can have micro-injuries when food scratches you (say, a bread crust). A friend who shoots porn told me that they were taught there that it is riskier to spit out sperm than to swallow it directly. If you spit it out, you roll it around your mouth and mucosa more, so there is a greater chance of potential infection than if you swallow it directly and quickly and the stomach acid directly fries the viruses. Let everyone judge for themselves what attitude they have towards a client's sperm and how much they 'fear' it. My view on this is that oral sex without a condom is not problematic if the man is neat, clean, and I don't notice any visible changes on the penis (as described above), but I don't do ejaculation in the mouth professionally. I also want oral sex with a condom if there is too much pre-ejaculate. If someone complains and wants more, it can be explained elegantly with a single sentence – I only do what falls within the scope of SAFE sex!
Beyond the Obvious
Well, we've covered the basics from a practical point of view and upgraded the classic standard 'use condoms, and you're safe' a bit. As I already mentioned, some STDs are visible at first glance (described above), but some are not. And for PRIVATE sexual relations, far too many people (including sex workers who strictly use protection at work, but have different standards for private sex) judge a sexual partner by impression, whether they look neat and healthy, and on this basis have sex without a condom. Laypeople think that if someone is emaciated, unkempt, with bad teeth – they are risky. But someone who is of normal appearance, neat, clean, nicely dressed, fragrant, shaved – 'you can see they take care of themselves,' they look healthy! How much does such a judgment about someone's health actually hold? Well, here I must disappoint you right away – those of you for whom it is 'normal to have private sex without a condom if someone looks neat and healthy.' No, it's not just about 'innocent bacteria that cause burning urination and you get rid of them with Sumamed' (more on these bacteria later), in this way you can also get those most severe diseases that even laypeople are afraid of. What I am about to tell you is by no means taken from surveys or statistics, but I myself had the opportunity to experience and get to know the scenes and people from 'marginal groups' from the inside, how they function and think.
The Bareback Fetish
Many gays and bisexuals have a fetish called BareBack, abbreviated as fetish BB, which means a fetish for sex without a condom (in translation without a bag or without a rubber). They also put the abbreviation BB in ads when they look for sex on the net. I once had a bisexual boyfriend with whom I went to gay-bisex parties and after-parties and I had the opportunity to get to know the backstage of such scenes. What is surprising and perhaps difficult for an 'ordinary' person to understand about the BB fetish is that for them it is NOT about irresponsibility, nor about intentionally transmitting diseases – but they are all (those who consider themselves BareBack) very well informed about HIV and everything related to it! And they go into BareBack sex completely voluntarily, they take the risk that even if they get HIV, they will get pills anyway, which they will take for the rest of their lives, while looking and functioning completely normally. When you are on HIV pills, you are not contagious and cannot transmit the virus (because you only have the HIV virus in your lymph nodes, not in your blood and sperm), of course, if you take them regularly and correctly, which not everyone does, especially not when there are parties and after-parties. Thus, HIV-positive people on pills continue to live a normal, decent life and can peacefully continue to indulge in pleasures without a condom. All this theory would work nicely if it only appeared among gays. The problem arises from the fact that bisexuals are also involved here – those who are 'handsome, neat, nicely dressed, fragrant' – some look quite manly and a person would never dream that they are bisexual – THEY LOOK COMPLETELY HEALTHY. And you can run into such a 'cute macho bisexual,' who fits in well with ordinary people, where he acts completely straight, anywhere, even in completely 'normal' places – in a bar, gym, library... You like him and you give it to him without a condom and you don't even think about it because he looks 'healthy and neat.' AIDS IS NOT EXOTIC – AIDS AND HIV-POSITIVE GOOD-LOOKING GUYS ARE ALL AROUND US, IN A 'NORMAL' ENVIRONMENT. Statistics say that such HIV-positive bisexual guys who like the BareBack fetish are usually around 30 years old, athletic build, and tattooed – these are the 'cute bisexuals' who are like time bombs for innocent women who would never even dream of this. I compared this description with the real situation, and there were some like that. One of them also had a slightly sunken cheekbone on his face, which, as written in certain sources, is supposed to be a sign of an HIV pill user (which is of course not a rule). Bisexuals are the so-called 'bridge population' – a population that forms a bridge between marginal risk groups (gays) and the population of 'ordinary' people (read: girls and women who have no idea what's going on). I have served you the behind-the-scenes truth. But no panic – use your head, and a condom ON your head (the lower one, of course).
More Common Ailments
Let's move on, now that we've dealt with the 'more serious' matters, to more common ailments. Not all bacteria fall under STDs, 'ordinary' bacteria can also cause trouble. The first thing to pay attention to – most girls in the business use so-called menstrual sponges (soft tampons) for work during their period, which are intended for sex on those days. Use the sponge for only one day, then throw it away and use a new one the next day! Even if you take it out and rinse it after each client, know that a breeding ground for bacteria begins to form in and on the moist sponge – even if it is rinsed. This can lead to an infection in the vagina and an unpleasant odor. Throw the sponge away before bacteria can grow on it, and use a new one. You don't need a new one for every client. Have it in only when you're working, not for too many hours at a time. And throw it away in the evening. Have you ever had a burning (or stinging) sensation during urination? Have you ever had a strange smell and/or discharge from your pussy? Yes, all of this is caused by bacteria. This is an area that the lay public is less familiar with, as most people, as I mentioned, only know about HIV and hepatitis. Bacteria – of various kinds, some unpleasant only because of the smell, others more risky in terms of later complications if you don't react to them and ignore the above-mentioned symptoms.
Chlamydia
The most noteworthy is chlamydia. As many as twenty percent of the NORMAL population has it – so not people from risk groups at all, but completely ordinary people – so every fifth person. In men, it almost always burns a little during urination, in women sometimes too, but in as many as 80 percent of cases, if a woman gets it, the infection is asymptomatic, which is the worst – you have it, but you don't know you have it. Long-term untreated chlamydia destroys you from the inside, the inflammation causes your reproductive organs to stick together, making you infertile. And not only that, if you don't know you have it, it can progress from the reproductive organs into the blood, deposit in the vessel walls, increasing plaque – thus increasing the risk of stroke and heart attack. It is by no means innocent – because it is so hidden, but with such long-term consequences. Therefore, I really warmly recommend that when you get preventively tested for STDs, you don't just give blood, but also swabs (cervix and urethra) and urine – that is, you get tested completely. HIV, hepatitis, and syphilis can be seen from the blood, various bacteria from swabs, and the parasite Trichomonas vaginalis from urine (this is the one that makes it said 'that the pussy stinks of fish'). You get tested with a referral at an infectious or dermatological clinic.
Urinary Issues and Hygiene
Burning urination should always be taken seriously, even if it burns just a little and not every day, as besides chlamydia, there are also some other bacteria – the point is that there is a risk with some of them that the inflammation progresses to the reproductive organs, glues your fallopian tubes together, and causes infertility. These bacteria are completely easily solvable with antibiotics, if only we act in time. Every unpleasant smell and every burning urination does not yet mean an STD. During slightly perverse sexual games, some intestinal bacteria can escape into the urethra – this is not an STD, but the most common intestinal bacterium Escherichia Coli, which can cause problems down there. Anything (dick, dildo, fingers...) that moves or rubs in a way that goes from the anal direction towards the vaginal can carry this bacterium, it's not even necessary for it to have been inside the anus. There is a very practical preventive tip for this – if you have played in any of these ways, especially if you have switched holes – be sure to pee immediately after sex! This flushes the potential intestinal bacterium out of the urethra before it manages to anchor and attach to the wall of the urethra. There will be no problems. An unpleasant vaginal odor can also be just a consequence of bacteria multiplying too much and disrupting the natural pH balance – this is called bacterial vaginosis. This is also not an STD, but bacteria that we introduce with fingers or unwashed vibrators, dildos. It has been proven that Borax vaginal suppositories from the pharmacy without a prescription help with this. I notice this in that before using Borax, my pussy is fresh and odorless for only a short time after showering, but after use, it is fresh and odorless all day after showering. And when you go to sleep at night with a suppository (this is not in the instructions), be sure to put on a pad so you don't have everything pasty and sticky when the suppository melts and flows out. If it itches and you have a whitish, lumpy discharge, fungi have multiplied too much – for these, there are also Canesten vaginal suppositories and ointment without a prescription at the pharmacy.
Conclusion
White discharge is a normal and common phenomenon, use vaginal suppositories only if there is really too much of it and it is accompanied by an unpleasant odor. In my experience, just intimate soaps with lactacid are not enough to regulate the odor, as the vaginal flora needs to be regulated from the inside – as I mentioned, with vaginal suppositories (I affectionately named them 'pussy-lettes'). That's all for today. I hope I have helped you and revealed something new to you. Dr. med. Anita