What Nobody Taught You About STIs, According to a Gynecologist
Few women are comfortable asking even a good friend, “I have some funny-looking bumps on my vulva—have you ever had genital warts?”
Information is empowering, so to help you protect your health, I’ll tell you four truths about sexually transmitted infections (STIs).
An STI screen doesn’t test for everything.
There are dozens of STIs, and it’s not possible or practical to test for all of them. Also, screening recommendations vary by age, symptoms, and risk factors. And no, screening for STIs is not automatic when you go to your doctor, nor is it part of a Pap test.
You need to request it (simply say, “I’d like a screen for sexually transmitted infections today”). Mention any symptoms, exposures, or concerns you have, and tell them if you’d like an oral or a rectal swab in addition to vaginal testing. (Trust me: Your doctor will not be shocked.)
You won’t necessarily know if you have one.
One would think that with an infection, there would be some kind of symptom—a fever, vaginal discharge, pain, a new sore, or bleeding. But the majority of STIs cause no symptoms in the very early stages, so at that point there’s no way to know whether you have one without your being screened. Even if there is a symptom of an STI, it may be transient and go unnoticed.
Older women are at risk.
In fact, STI rates are rising rapidly in adults at midlife and beyond. It’s not as if chlamydia asks to see proof of age before taking up residence! In addition, many postmenopausal women have vaginal and vulvar tissue that’s thin and easier to infect than the tissue of younger women.
Even when they have the best of intentions, a condom isn’t always part of the sexual playbook for couples over 40. Some older men can’t maintain an erection with a condom, and as contraception often is no longer a concern, many women may not consider it a serious issue when a man doesn’t want to condom up.
My advice: Have an assortment of male condoms on hand, and use them.
Women can give each other STIs.
Any sexual activity, including oral sex (genital or anal) and penetrative sex with toys, is fair game for STI transmission. So women who have sex with women and self-identify as lesbian, nonbinary, trans, queer, or another sexual orientation are also at risk for infection. Sexual transmission between women has been reported for vaginal infections such as trichomoniasis and bacterial vaginosis. Oral, anal, or vaginal transmission of HPV, genital herpes, hepatitis B, syphilis, and chlamydia is also a reality.
❗Two reminders
Women who use a condom 100% of the time are not 100% protected, since many STIs are spread via skin contact, not just via semen. That’s a real argument for regular screening.
If you’re diagnosed with an STI, it’s important to inform all your current or recent sexual partners so they can get tested. Even if the person is a jerk you never intend to see again, consider the next woman they might sleep with—and do her a favor.
This article originally appeared in the March 2021 issue of Prevention.
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