Wednesday, September 26, 2012

Something "Dodgy" Down There: Dr. Andrea on Herpes and Unreliable Dick

Doctor, is this normal?
Welcome to the first installment of Ask Dr. Andrea, the new IBWMW Doctor.* Dr. Andrea is a down-to-earth, open-minded, completely cool doctor with specialties in women's/sexual health, sustainable medicine, Ayurveda, nutrition, yoga and such. She also uses terms like "morning wood," which I like, though I can't say why, exactly. For more info on Dr. Andrea, do have a look at her web site.

Please welcome Dr. Andrea as she tackles her first two questions:

I am a 30something year old woman in an open marriage with a husband and a boyfriend, no other partners for me. My husband and I practice safe intercourse with other partners, but oral sex is unprotected. Both men get cold sores occasionally, I have never had one. To make a long story short, my boyfriend gave me herpes of some kind via oral sex. He had a cold sore, which he says he has been getting since childhood. Three weeks later, I had an outbreak (which at the time I thought was the world's worst yeast infection, but after the second outbreak two weeks later--not nearly as bad--I realized what was going on). I've never had anything dodgy down there except the standard yeast and urinary tract infections, so I was pretty upset.  Anyway, I went and got the blood test... It came back as HSV-1 4.7 and HSV-2 3.33--both positive. Sooooo, I was super-double bummed out, because it is my understanding that HSV-2 is a MUCH bigger deal than HSV-1. Anyway, a little googling gave me some hope: a value less than 3.5 gives some realistic chance that its a false positive. Google tells me I should go get a Western Blot to confirm HSV-2, which I plan to do right after I get some health insurance (I went to Planned Parenthood and tried to explain all this but they were befuddled by my question, and claimed the Western Blot is only for HIV, which did not inspire confidence, and I left).  

So my questions are: 1) Could he have given me both types of HSV?  2) How big a deal is this if it is HSV1 and the HSV2 was a false positive?  What do I have to disclose to future partners?  IME, once you disclose crotch rot of any kind, no matter what your excuses, nobody is interested in fucking you. I can't blame them, but if my chance of passing it along without symptoms is like .00001%, then that matters in what I decide to do. Obviously if it is HSV2, I have some problems, because my husband doesn't have it (to our knowledge) and I probably shouldn't be sleeping around if I know I do. I can't envision myself having condom protected sex with my husband for the next 50 years. Neither man has had any lab work done.

Thanks for your opinion!   

Dr. Andrea: Thanks for writing in! Let me answer the questions piece by piece:

1. Yes he could have--so could your husband actually--from either oral or any other type of genital contact from themselves (perhaps they've carried the virus forever and didn't know, or had sex with someone recently who had a lesion or was an asymptomatic shedder) [***Oh and an important note for ALL readers: condoms only protect the shaft from touching your skin and mucosa directly but many many herpes outbreak locations are nowhere near the genitalia and are often just on the outside for females so those bits definitely have contact with the partner's skin (for example: labia majora, inner thighs, buttocks and cleft area, top of pubic bone, and of course, in or around the mouth/tongue/nose area)]. Both types of HSV can be asymptomatic, and there are VAST numbers of people that test positive WITH viral shedding but NO symptoms (shedding means the virus is in the skin and sheds bits of itself that if they touch another person may get into their skin and nerves and make themselves at home)... and since they have no idea they pass it on and on and on...

2. With all the oral/regular flip flopping that goes on in our beds, at this point in history it really doesn't seem to matter whether you have HSV1 or HSV2 in normal situations--both can occur in both places. HSV1 seems much worse from a doctor standpoint since it can cause lethal encephalopathy (brain inflammation) especially in people with weakened immune systems, and babies or old people, with lasting damage to the brain. The thing is, most of us are exposed to HSV1 when we're babies since 70+% of humans have the virus and it rarely causes issues in healthy people, unless under stress a 'cold sore' pops up, which might be unattractive, but doesn't seem to freak everyone out quite as much as HSV2. HSV2 can cause a viral meningitis (usually with the first outbreak only) that is usually just a seriously awful headache, neck stiffness, and high fever, but rarely causes any lasting damage. Somewhere around 35% of people may have HSV2 now, although the estimates are all over the place since blood testing catches many people that have been exposed but have fought it off and don't have shedding, OR shed without symptoms, and those that have symptoms often don't seek treatment or tell anyone out of embarrassment etc...

Now for the 3rd question/issue... your chance of passing it without symptoms is low, yes, but larger than 0.00001%. Partially because you shed before and after the lesions are present, so it's hard to know 100%. The risk goes down if you take daily suppressive medication, but still isn't zero. So, yes, you DO need to tell partners. And I would suggest both men and you having total lab work done (including G/C/Chlamydia, syphilis, HCV- much more deadly than HSV, and HIV of course) so you all know where you stand and can make educated decisions about further open-relationship involvements (which means new partners in ya'll's group need to be told--and should really be tested also). I personally think all new partners should do lab work in the interest of honesty and knowledge of risk, especially since not everyone wants to disclose every indiscretion they've ever had and lord knows people like to say things they WISH were true but aren't, especially with touchy subjects like this...

That all said... HSV is NOT the end of the world. It isn't 'crotch rot' per se, in that it doesn't smell bad or cause infertility (that we know of) or for things to fall off (some infections do!). It can be painful, annoying, and it can be embarrassing to discuss. But just like with the 'protection/birth control' discussion, talking about this stuff is NECESSARY and if we're all adults here, we should be able to say the word herpes out loud if we're going to be getting naked with each other anyway. Honestly, SOOOOOO many people have this stuff, it needs to be understood and the shame lifted so we can all protect ourselves better. Two people with different versions of the virus can re-infect each other over and over too, so even if both people have it, daily suppressive therapy (or at the very very least herbal suppression (unproven) and immune system optimization are needed) is the best idea.

Now, for the sensitive part. It may seem upon being diagnosed with this, that the fun free sexual world is over. People can and do end up feeling dirty, perhaps violated if the partner didn't tell them
(or even know themselves), and unattractive (especially during a painful outbreak). The thing is, this is all illusion really--like I've said, this stuff is everywhere and lots of people don't even KNOW they are spreading it. The safety thing is rather an illusion for most people. Many people (up to 1 of 3!) have HSV2, but how many people do you know that advertise it? Even before having sex? Not many. In my experience, if someone loves you, they will still want to have lots of sex with you, especially if you are honest with them, and take precautions (like taking daily medication and refraining from sex (but not from playing, using toys, etc!) when you have tingling or a visible lesion), they know you love them and want to protect them, and very likely the risk will be acceptable. In the instance that they become infected, again, it's not the end of the world for an otherwise healthy person, and they can take the same steps you do to protect themselves and you. That said, perhaps discussions around this may sift out what's really important to each person in a relationship, and upend illusions. I wish you all the peace and love possible moving forward.

It's all about honesty, and in the reality we live in now- relationships should all be as open and honest as possible, no matter how many partners you chose to have--but every partner should have the whole story.

I have been married for 36 years. The past 10 years of my marriage have been “sexless.” Once I decided to quit trying to fix my wife and decided to fix myself, everything fell into place and now I am having an affair with a married woman who finds herself in a similar situation.  

Here is my medical question. I’m 61 years old.  When I had sex regularly, ten years ago, my dick was working quite well. Then, I had my long dry spell of just solo sex. Going into this affair, I thought everything was still working well.  But when it came to performing for others again, I discovered that my dick is not reliable partner it had been. To remedy this situation, I ordered Levitra from a Canadian pharmacy and am expecting it will be here in time for my next tryst. I plan to experiment with half of a 10 mg pill to see what happens. I do NOT want to end up in an emergency room with a erection that has lasted more than 4 hours.  That would require “lots of explaining” to my wife.

Does the IBWMW Doctor concur with this approach?

Dr. Andrea:  This may not be the answer you'd prefer, but most of ED in healthy people is psychological. If you have diabetes or heart disease (or are at risk for them--ED can be a FIRST symptom--please ask your doctor), then circulation and nerve responses can be slow, irregular, or unsustainable. However, if you are healthy, if solo sex works for you, and if you have early morning tumescence (=morning wood), this is likely not a physical issue. To answer your question though, trying a small amount of the pill is an ok idea, although a small dose (unless you are a small person) may not work at all--other than the placebo effect (which does work 30% of the time anyway).

I'd like to answer the last question though, which is whether I concur with this approach. I answered the above as a doctor with years of experience. I'll answer this as a doctor who is also a counselor and believes honesty (at the very least with yourself--but with partners in the instance of sexual contact and possible disease spread--see question one!) and personal growth are two of the most important parts of relationships and life in general. I don't concur with the approach because I don't know the answers to the following questions: Why was your marriage sexless after so many years and why are you still married if that's very important to you? What is the purpose of marriage in your mind, and if you are uncomfortable with the idea of your wife finding out, why is that? I think if there isn't a physical problem here (since I've had male patients who are healthy able to have fulfilling sex well into their 80s or even 90s in some cases), then finding the answers to those questions, as well as delving into whether you are truly invested in the current affair (and are free of guilt or worry about your wife), will be the keys to solving your issue and perhaps finding that your body is a reliable partner once again.

Have a question for Dr. Andrea? Send it in. (Note: This is not a substitute for individual medical advice or care. Check with your doctor before starting or replacing any current treatment plan. Submitted questions may be edited for clarity.)

* When I previously called Dr. Andrea our Doctor-in-Residence, I meant it in the sense of in a "writer in residence" (i.e. "an accomplished writer with a temporary residential post at an academic institution for the purposes of sharing insights.") Dr. Andrea is not a resident per the medical definition ("a stage of graduate medical training")--but an accomplished doctor who will be dropping by IBWMW answering our embarrassing questions just because she thinks it's the right thing to do. Have I mentioned how much I love Dr. Andrea?

Click here to learn more about Dr. Andrea.

photo: Atelier Manasse

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