Dr. Andrea and The Cases of Post-Vasectomy Sex Pain + The Ellusive Zoloft Orgasm

Welcome to today's installment of Ask Dr. Andrea.  Dr. Andrea is the IBWMW Doctor-at-Large, which is a good thing because the blog spends WAY too much time googling various "symptoms."

Dr. Andrea is a total bad-ass--not only because she's an osteopath at the Center for Sustainable Medicine, with specialties in women's/sexual health, nutrition and Ayurveda--but because she takes time out of her busy schedule (which I imagine involves lots of yoga and kale juice) to answer our questions.*

Dear Dr. Andrea:

I have been a reader of IBWMW for a few years. My husband and I have been together for almost 10 years – married for 6. I am 28. He is 31. He had a vasectomy in 2011. 

Our sex life is different than most (at least I think so). We are only having sex once or twice a month. I wish it was more frequent. When we do have sex I am satisfied – always able to have at least one orgasm and we try just about every position. No complaints about the actual sex.

Since his vasectomy he has slowly admitted to me that he has a lot of pain after sex. He understood it was a risk at the time of surgery. This pain has impacted our sex life in that I don’t feel he enjoys sex as I would like him to. I know that after he knows when I’m “done” he anticipates the pain and is not as hard. I think his inner monologue is something like this: “Ok. She is satisfied. Oh shit! This will be painful!”  I feel badly for him that he does not enjoy things as I do. I am extremely open to discussion but he is a bit more private when verbalizing his sexual needs.

Is there anything we can do to decrease pain? Is there something we can try to help accept the sensation of pain? Meditation? Icing? Breathing? Any insight would be very much appreciated.
--Anoymous
 

Dear Anonymous- 

First off let me express my condolences- this is a tough situation. Any time sex causes pain instead of pleasure can be really difficult physically and psychologically for both partners. 

The first thing I would suggest is going to a really good Urologist- perhaps whoever did his vasectomy if he had a good rapport with the doctor. Ordinarily I would love to suggest holistic or alternative things, but post-surgery several things can happen that need to be evaluated, especially since some of them can be treated so that the pain goes away entirely. 

In the meantime, here is what is likely happening--the sperm have to go somewhere when the vas deferens is cut, so sometimes they build up in the epididymis or in the surrounding tissue and cause chronic pain. If it's happening only during sex or upon ejaculation, it could be partially a positional issue from the muscles around the testicles tensing up right before ejaculation and then the extra pressure of some sperm being released and backing up in the tube (or leaking out and irritating surrounding tissue). 

Some urologists suggest trying ibuprofen, but that would likely work best for the chronic (meaning pain all the time) version. Although it's definitely worth a try. Take the suggested dose an hour or so prior to having sex (assuming you have no allergy to ibuprofen, no stomach bleeding or irritation problems, no high blood pressure, and no kidney issues, etc... of course!) and see if it helps. 

Surgery-wise, they can go back in and clean it up, or remove the epididymis of the side that's most painful, or remove any granulomas or scar tissue that have formed that might be causing positional/ejaculation pain. 

Also, reversal of the vasectomy almost always ends the pain if it's due to one of the above issues. But that requires some definite verbalization of what you're each needing and wanting as a form of birth control and how it affects your sex life. I always try to promote positive thinking in sticky situations--perhaps this issue will help open up the dialogue between the two of you and create more pleasure on both sides. Good luck, let me know how it goes and what works!

 --Dr. Andrea

*******

Dear Dr. Andrea:

I take 150 mg of Zoloft daily and experience the common side effect of having a harder time reaching orgasm.  I'm sure the 3 or 4 drinks I may have also had don't help.  Is there anything I can do to speed up the orgasm (for my wife's benefit, not so much mine) other than not drink?  What if I also smoke a little pot the same evening, how does that impact my issue?  Would it help if I skipped my daily Zoloft dose on the days I think I'm getting lucky?  Thanks.
 A.K.

Dr. Andrea on the Safety of Oral Sex and the Comfort of Anal Sex. For other kinds of sex, you're just gonna have to wing it.

Doing this? You're on your own.

Welcome, possibly troubled Gentle Reader, to today's installment of Ask Dr. Andrea. For you new subscribers (thank you!!!), Dr. Andrea is the IBWMW Doctor-at-Large, which is a good thing because the blog is a bit of a hypochondriac.

Dr. Andrea is a total bad-ass--an osteopath at the Center for Sustainable Medicine, with specialties in women's/sexual health, nutrition and Ayurveda--and I can still scarcely believe this, she's still willing to take our questions.*

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HPV is in the news as causing throat cancer in Hollywood stars. Is it a danger to a, say, 57-year-old het? And if they can immunize kids against it, can they immunize adults? Oh, and if they can, why aren’t they offering it? Cost? Liability? We’re already doomed?

Dr. Andrea: Throat cancer is a danger to anyone who's ever had oral sex, including having had a penis in his or her mouth (especially one without a condom on it.). The reason HPV (the kind that, say, likes living on penises) loves the back of the throat, is that there are tonsils there ( = lots of folds and crevices to hide in) and the back of the tongue also has lots of bumps and stuff stuck to it (bad breath bacteria, adenoid/tonsil-like blobs, etc. yum. :/ ) that make for a lovely spot for HVP to stick.

As for immunizing adults- sort of. The vaccine seems to work well for females up to age 25 and males up to age 21. The thing is, once you've been exposed to the viruses, the vaccine we have doesn't seem to do much so it's recommended to be given before the first sexual encounter for best prevention. I wouldn't say we're doomed exactly, but prevention does seem to be our best (only?) weapon at the moment. That and decreasing risk by having fewer number of partners (the risk tends to go up the more you've had), not also having HIV, and using protection (although condoms aren't 100% especially if the skin that has the virus in it is outside the condom). The good news is, despite throat malignancies in general being pretty terrible, spread seems to be slightly rarer with HPV types, and treatment seems to be working as well as it can be expected to, with the usual gnarly side effects, but still not as bad as possible. Sorry for a not Mary-Sunshine answer, but you did ask about throat cancer. :/ [see also: this NYT article]

We are exploring open arrangements. What STIs are men at risk for when performing oral sex on women? (I'm as open to precautions as anyone, but sorry, dental dams are like I'm having oral sex with a love doll. And that I can do at home, alone. I mean, if I did that kind of stuff. )

The simple answer is: all of them. I guess I'm not being very Mary-Sunshine on this one either.  The reality is that beyond monogamy, things get statistically way more risky. I would suggest choosing partners and weighing risks of this idea carefully, discussing it again with your main partner at regular intervals to make sure you're both ok with it, and have full testing done on everyone before you are physically intimate with each new partner. And of course, do a thorough visual inspection of each partner before intercourse. [IBWMW note: I am immaturely picturing one of those miner's caps with a halogen light for said visual inspection.] Complicated, yes, but this is the world we're in- it's not just HIV, HSV, gonorrhea and chlamydia, but even bugs like syphilis are making a huge world tour comeback. Be safe out there!

****

My husband and I are interested in trying anal sex, but our attempts so far have been much too painful even with copious amounts of lubricant. Fingers are fine, and a tapered dildo smaller than my husband's penis, but any attempts with his penis are excruciating. I've not found any advice that was specific enough to help, just generalities about 'relaxing.' Any ideas?

Honestly, for some people, anal sex is not pleasurable. But it sounds like you've done a great job of trying various versions of it, easing yourself into it, and being creative, so what is the motivation for this if it's not an workable progression that is fun for you both? If the smaller items are pleasurable for you, it could simply be a size issue, which could be worked on (using increasingly larger sizes for a few weeks) along with relaxing breathing exercises to remind your body you are safe and shut down the sympathetics that may be causing reflexive tightening. (p.s. that can work for mild cases of vaginismus or size differences also. Think SLOW- slowly increase dimensions, use very slow movements). Just take it easy as you don't want to stretch yourself permanently or tear anything- pain may be an indicator that that's about to happen.

Aside from general cleaning preparation and lubricant, generally that suffices if it is going to be a pleasure-inducing activity. That said, this next part isn't directed at you necessarily, but in general, the psychological aspects of anal sex can be more pronounced than with vaginal sex (especially for women, in my experience with patients), which can be related to, yes, 'relaxing,' but also deeper sorts of things like vulnerability in general, and letting go completely of control and security to trusting the other partner. My suspicion in this case is that this is a size issue, but looking at your motivations and desire to do it in the first place (when it's excruciatingly painful) might be helpful too- there are many many things to try other than anal sex if it's not doing it for you.
 
Let me know if you figure out a way to make it happen and it's great--I'd love to hear about that for future patients!

-Dr. Andrea 

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Say 'thank you' to Dr. Andrea everybody!  And remember, send questions in a comment below, an email or using the (fully operational!) contact form in the right margin.

Btw, the anal sex question reminded me of a time Sandra and I were pervishly browsing the "sex" section at a book store and saw a book called something like "Anal Sex, Volume 2."  I wish we would have looked inside it because it was a HUGE book. They must have been doing lots of padding to come up with that much anal sex info, perhaps adding pages and pages of anal sex word searches or something.

Now, I am not an anal sex expert (though I am, as I like to brag, an Anal Bleaching Expert) but it seems to me that there is not *that* much to know about the topic. Surely not two volumes worth? Perhaps an anal sex pamphlet could've done the trick. Or, fuck, maybe even just an informative haiku. Which I have thoughtfully provided here. Clip n' save to consult in times of need. 

Anal Sex, A Haiku

Want some anal sex?
Here's what to know: Use lots of 
Lube and go real slow. 

xoxoxo
jill

*(Note: This is NOT a substitute for individual medical advice or care. So if Dr. Andrea tells you to stick a rusty tin can up your butt or something, check with your doctor first. Go on, check with them. I dare you.)

(photo courtesy of my beloved Lady Cheeky)

This is only a test

Wish I was here

Fuck, I miss you all. Working to make money blows.  I don't recommend it at all.

Anyway, a few wee things.

1.  Dr. Andrea is in. Now, I am quite sure that every one of you aren't completely free of embarrassing health issues, sexual problems, genital questions and such. This is a chance to get your question answered by a real doctor, for FREE and anonymously (except for all of us, you know, reading about your itchy wiener or whatever). Man--or chick--up and send your question to: jillhamilton001@gmail.com or test out the snazzy new contact form at lower right and let me know if it works.

2.  Expert Predict Sexbots Will Be Part of Our Lives by 2050 is my latest article in DAME magazine. Go on over and give it some love if you will. Worst thing I discovered: Some sexbots are available for RENT.

3.  Some lady sent me this comment/unsolicited advice on Facebook: "Please try to use 'polyandrous' instead of 'slutty'. Thank you."  It was the preemptive "thank you" that got me, as though I'd be heeding her advice. 

4.  Naomi Wolf is now following me on Twitter. Squee.

5.  I was happy to see that some of you bought the aforementioned Naomi Wolf's book  Vagina: A New Biography via the Amazon link at right. Will love to hear what you think. (My 11 year old saw me reading it--as my daughter, this is her cross to bear--and goes, "Hey, what's that book about? VAGINAS?")

6. Someone also used the Amazon link to purchase "Cottonelle Ultra Comfort Care Toilet Paper, Mega Roll Economy Plus Pack, 27 Count," which means that in that person's brain there is now a tiny, tenuous neurological link between the blog and their mega/plus/ultra toilet paper needs. I am tentatively happy about this.

7.  And speaking of overly dramatic toileting-related product adjectives, my current favorite is Fresh Step Extreme Odor Control Scoopable Clumping Cat Litter.

No more Purina Hot Pockets cat food for you, little kitty

I am not a package designer but, really, trained professionals sat in on probably countless long meetings and not one person thought it was a bad idea to mark up the package with the words "EXTREME URINE & FECES"? In big-ass red letters? We are plenty crass in this country, but I think "odor control" would've worked just fine.

8. 8, 8, I forgot what 8 was for.

9.  Don't forget about your Dr. Andrea question...

xoxox
jill

(gorgeous photo from Lady Cheeky,)

Dr. Andrea and The Case of the Night Wank

Welcome, possibly troubled Gentle Reader, to today's installment of Ask Dr. Andrea. For you new subscribers (thank you!!!), Dr. Andrea is our Doctor-at-Large with specialities in women's/sexual health, nutrition and Ayurveda. If you have an entertainingly embarrassing problem, or--why not!--even a regular ol' boring one, man up and email it to jillhamilton001@gmail.com. And don't worry, you can be completely anonymous so no one needs to be knowing about your personal business. Except in a broad general sense. (Note: This is NOT a substitute for individual medical advice or care. So if Dr. Andrea tells you to stick a rusty tin can up your butt or something, check with your doctor first. Go on, check with them. I dare you.)

A few months ago, I noticed my partner was masturbating in his sleep. I've been aware of it happening a handful of times since then. It doesn't really bother me, but he thinks it's weird. He wanted to know more about how he's doing it, but since it's dark and I'm usually half asleep when it happens, I'm pretty useless. I suggested he film himself sleeping, then we could get some creepy Paranormal Activity action all up in here. He didn't really like the idea. Anyway, so far I haven't been able to collect much data on it for him although it did happen last night and I had my back against his left side so I knew he was using his right hand. He thought that was weird because he always uses his left hand (when he's awake). He started breathing hard for a bit, but then calmed down and then I woke him up. He doesn't think he's ever finished from this. 

Anyway, we were just wondering if there are any known causes, cures, or magical potions.

Anonymous 

Dr. Andrea:  First, this is not unheard of and is likely not harmful.

If he's really concerned, my doctor-like inclination is to suggest a sleep study with a sleep disorder specialist, since these activities might indicate that his sleep structure is not quite normal for some reason (normal being a rather arbitrary word here- very few of my patients have totally 'normal' sleep).

But honestly this doesn't sound like a problem big enough to warrant all that. It sounds like an interesting combination of a sleepwalking-style sleep movement disorder (there's even a movie about it! http://www.imdb.com/title/tt2077851/ ), and normal tumescence and ejaculation during sleep (the phrase 'wet dream' makes me gag).

There is actually a name for this type of activity: "sexsomnia"!! I know, right? It does sound a bit funny, but that means there are enough cases for researchers to have given it a label. The technical definition is initiating sex while asleep, but I imagine it would pertain to your partner's activities as well. If it indicates that he's not sleeping enough or deeply enough for true rest, then it might be a problem. The things that I'd ask are whether he feels rested when he wakes in the morning (jumping out of bed vs hitting snooze multiple times), and whether there has been a change in your sex life linked to when this started. 

If sleep structure is indeed an issue, and he'd like to stop, it may be he needs more 'quality' rest- the body wants to be asleep between 10pm and (at least) 5am. In Chinese medicine, there's a proverb that says "every hour of sleep before midnight is actually worth 2 hours of sleep." Making sure he's getting adequate exercise and eating a healthy diet (plant-based, not too much processed food) can be helpful too, as those affect sleep disorders in general.

You're welcome to email me directly and give me more details if you'd like!

******

If you wish the Wisdom of Dr. Andrea, bring the customary two chickens and goat to her mountaintop lair, or just pop your question into an email.

xoxoxo

jill

(Photo: Alfred Cheney, Muriel Gray, 1920)

Dr. Andrea and the Mystery of the Possibly Missing Clit*

Ahoy.

Welcome, troubled friends, to the third installment of Ask Doctor Andrea. Dr. Andrea is our groovy IBWMW Doctor-at-Large with specialties in women's/sexual health, nutrition, and Ayurveda. If you have an entertainingly embarrassing problem, or hell, just a regular old boring one, man up and email it on in. (Note: This is not a substitute for individual medical advice or care. So if Dr. Andrea tells you to stick a rusty tin can up your butt or something, check with your doctor first.)

*******
I have been married for 35 years and I have seen my wife have four orgasms in that time. The first one was on our 25th anniversary vacation. She says she has very little desire for sex. But we make love once or twice a week and she says she enjoys it to a degree (the touching, skin-on-skin, closeness, cuddling, etc.). 

We have had ups and downs in the relationship but overall do pretty well together.  We have seen counselors to keep the relationship healthy and we have talked about her lack of desire and lack of orgasms.  The conclusion is that she just has a low libido and is “wired” with a low sex drive.  That’s just how she is, physically and personality-wise, so I am trying to accept that (as one might accept a physical disability in a partner). 

Still, there are some paths we have not explored thoroughly.  To get to the point, what is a "normal" clitoris? I know where it is supposed to be, but will an aroused woman have a little button or bump or something external that a man can feel there (with finger or tongue or whatever)? Because I have never felt anything more than a slight swelling at the top of my wife's genitals. I suspect that may a contributor to her lack of responsiveness.

I have only been intimate with my wife, so I have nothing to use as a comparison.  But when I read erotica: “He rolled my swollen clit between his fingers” or self help books (Satisfaction, K. Cattrall & M. Levinson): “The clitoris responds quickly when his tongue draws circles on its surface.”

Surface?  Circles?  Swollen?  Sounds like their should be a little button or nub or something.  In all my years of going down there, there is nothing “sticking out” or swollen or anything but concave cleft between her labia minor. My wife says she can feel her clit, but I certainly cannot. I have heard there are medical conditions where the clit never "descends" or stays under the clitoral hood. She could have a general sensation there but nothing I can detect externally.  How common is that?

She is also very sensitive in that area.  When I rub it to try to stimulate her, after a minute or so, she pushes me away, complaining I am “rubbing her raw,” even if we are using a lot of lubricant.  I have talked to her about this over the years, and although I try to be very gentle about it, it's a difficult subject to discuss, as she takes it as me criticizing her, or saying something is wrong with her. Well, four orgasms in 35 years, it sounds like something is not right. But she says she has asked her OBGYN and she says she's "normal" physically.

I just wonder if this could be related to her difficulty in enjoying sex.

******

Dr. Andrea: First of all, thank you for asking! It shows you are willing to find new information to be more aware of what's going on and try to change a situation that isn't as fulfilling as it could be. Kudos.

I have to say I have several questions before I answer as best I can with limited information- it's odd to do it over the internet and not in person so I can see the expressions/body language/energy of both people.

That said, here is my response:

It's probably not her anatomy. Everyone's clitoris is different- and the thing is, it's a tiny area with a fantastically dense amount of nerve endings, and since she's 'super sensitive in that area,' you have noticed 'swelling,' and there's no history of female circumcision (RIGHT?!?), she's likely perfect. Most don't actually 'pop out.' It's not a penis, and there's a reason it was so 'mysterious' for much of western medical history (cultural patriarchal issues aside for the moment). When did you start trying to find her clitoris? Atrophy does occur in women as they age, and the entire area can flatten and thin out, especially if sex is infrequent (or unsatisfying- the positive hormonal and anatomical response is important in keeping the tissue functioning), so the anatomy may have changed slightly since you married. Is she peri- during- or post-menopausal? Changing hormonal balance could also affect her perception, lubrication, enjoyment, and communication, depending on how it's going for her.

Point two about anatomy- the female body has about a billion potential erogenous zones. Let that sink in. Think about a billion. Yes, the clitoris is a magical thing. But imagine this: take all the nerve endings in your penis, all of them, and shrink the physical size of skin area down to smaller than your pinky finger tip, then poke/prod/itch/tap/lick only that tiny area for more than a second or two = overwhelm and irritation = forget it. Especially if it's never been successful before. Not fun so much. 

Dr. Andrea will Not be fazed. Questions about itchy privates and Sylvia Plath references? No problem, sister.

Dr. Andrea explaining a metaphor in The Bell Jar

Welcome to the second installment of Ask Dr. Andrea, our new IBWMW Doctor-at-Large. Dr. Andrea is an open-minded, completely cool doctor with specialties in women's/sexual health, sustainable medicine, Ayurveda, nutrition, yoga and such. She'll be answering your questions, eh, about every month or so, so if you have a burning issue--perhaps literally like our suffering friend below--email it to jillhamilton001@gmail.com.

***

I have three questions:

1.  I have a very itchy part of the entrance to my vagina that usually lasts a few days each month.  I don't think it is a yeast infection, as there is no discharge or smell, and I was prescribed Diflucan which did nothing to ease the itching.  The natural lubricant from my vagina seems to make the itching worse after masturbating, or after sex.  My doctor did not seem very worried about it, and prescribed Clobetasol Propionate, which I use liberally every time I get itchy and it solves the problem.  However, do you have other patients that have this?  The spot is located right on the entrance to the vagina at the back part of the "rim" and the spot is approximately the size of a nickel.  Oh, and scratching at it with toilet paper makes it itch even worse.

2. Perhaps this is related to the first question.  I have pain every time I have intercourse.  It is not bad, maybe a 3 on a scale of 1 - 10.  The pain is during the first penetration, even if I'm lubricated and have already orgasmed.  After that, I can be penetrated several times with no pain.  Is my vagina just highly sensitive?  

3. This question is just purely out of curiosity. In the book "The Bell Jar", the main character starts to bleed uncontrollably the first time she has sex. She goes to the emergency room and the doctor says something like "this happens to one in a thousand girls", or something like that.  What is it that happened to her? Or did the author just make this up?  I have always wondered...

Dr. Andrea: Ok, so, all the info and things you've tried narrowed the answer down a bit, so thanks!

There are several things that could be going on, so it's difficult to figure out without at least an exam, and sometimes even a biopsy is required for definitive diagnosis. The first question sounds to be a version of "vulvar vestibulitis syndrome" (assuming yeast is truly ruled out by symptom type as well as ineffectiveness of the usual treatment, and that steroid cream helped). Various dermatological issues in that area that seem likely are as follows: lichen planus or sclerosis, lichen simplex chronicus, HPV related irritation, HSV (atypical presentation), psoriasis or seborrheic dermatitis, tinia (ringworm), pemphigus, or erythema multiforme. Hormone cycles can affect all of the above, as well as diet and contact with fabrics and soaps/lotions (and of course yeast or bacterial infection would make symptoms worse). So, I would suggest a couple things right off to see if they help:  make sure your diet is low in processed flours and sugar, wear natural fabrics like cotton for underwear to wick away sweat and allow airflow, and use soaps and detergents without dyes or perfumes (preferably natural instead of petroleum sources).

As for the second question, yes, it definitely could be related, and yes, it sounds like your vagina is sensitive! That can be a good thing- but it requires a bit of patience and care to work with. It sounds most like something called vulvodynia (or dyspareunia, although that usually refers to the entire sex act being painful). In your case this might be due to a muscle spasm that won't relax until it's rather forced to. There are several ways to approach this. The first is giving yourself more time and having your partner both take it easy during first penetration, as well as massaging the vulvar area (from the entrance in/up about 2 inches) well beforehand. Fear of it can make it worse, so taking time away from sex to do your own massage will help too. One way to do this is by doing a daily massage before your shower with warmed sesame or almond oil (put the oil in a flip-top and warm it with a few changes of hot tap water in a larger container), liberally massaging everywhere. And yes, inside! Not necessarily with sexual intent... think self-love, rather than self-loooove. The good thing about the self-massage (other than that you'll never need lotion again) is that the oil is antibacterial and antifungal as well as lubricating and moisturizing, so it can kill several birds with one stone. Not that I advocate killing birds. You get the idea. There are also physical therapists that help with vaginal

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