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

Tuesday, September 18, 2012

Ask the IBWMW Doctor in Residence, plus boringish tech update

IBWMW's Doctor in Residence. (Artist's representation)
1. The new IBWMW Doctor in Residence is in and ready to take your questions!

"If you have doctory questions about women's health/body issues, I've got detailed answers for most health-related and emotional stuff. I focused on that for years before switching to more alternative medicine. So nothing shocks me. "--The IBWMW Doctor in Residence.

So, yes, submit questions to  And please don't worry if you have super-embarrassing questions about monkeys living in your wang or a possibly haunted left boob or whatever because our doctor is completely cool and non-judgey. I mean, she says "doctory," which is a good sign in a medical professional.

Two things to know:
--I'm keeping our Doctor in Residence's daytime identity anonymous because she is, as she puts it, is "hopefully mostly respectable to even all the conservative whoevers in my city."
-- Obviously, none of this is a replacement for individual medical advice so check with your doctor before starting or replacing any current treatment plan.

2.  Boringish Tech Update

In the process of switching my domain from unwieldy to snazzier url, I fucked all sorts of things up, most of which I barely understand.

In the midst of all the craptastrophy, I sent a test post out for the email subscribers and got the surprise gift of hearing from a bunch of readers around the world (Hungary! Thailand!) who have, before this, uttered nary a word. It was lovely to hear from you all and, please, pipe up more often. I've been completely fascinated by the open and honest comments on What would your ideal sex life look like? and would love to hear more.

As for whether the tech problems are solved....hell if I know. I thought they were, then the subscription service went rogue last night and emailed everyone some random old post. Please let me know if something seems amiss. Same goes for you lovely Kindle subscribers--I'm sorry to report that I tried to "fix" that too.

3. The Takeaways
--Technology is kind of a jerk.
--New Doctor in Residence! Ask her anything!
--If you were hoping to be the IBWMW Ambassador to Venezuela, sorry but, due to his charming letter, Ivan pretty much has the position locked up.


Thursday, September 6, 2012

The Best Comment Ever

I Was a Grade School Nudist ran on Jezebel last month. It was the top story of the day, like it was breaking, headline news. So, not only did I share my shameful secret, I shared the living fuck out of it. Here it is, if you're so inclined: Jezebel--I Was A Grade School Nudist.

There were lots of Jezebel-y comments ranging from thoughtful to completely nitpicky, i.e. this one chick:

"I hope you got permission from your friend to go skinny dipping in their pool. It's one thing to be a nudist at home or the camp site but to do that at someone else's house seems disrespectful," she typed in what I'm quite sure was a nasally high-pitched manner, as she mentally congratulated herself for her rigid rule of always asking friends' permission to skinny dip in their pools.

I read the comment to my pool-having friend--whose name is Heather--and she said, "Jeez! It wasn't like you were sitting naked on my couch eating Cheetos." Which I was most certainly not doing. Primarily because I dislike Cheetos. And having their orange powder dusting my boobs seemed like an undesirable outcome as well. Whatever. The point is: I CAN skinny dip in the pool. Heather said so. Nyah!

Last weekend, despite my admission of pool nudity*, I was again dogsitting for Heather (see above: "nyah") and briefly considered forcing my husband to sit naked-and-Cheeto-eating on her couch so I could take a picture and give it to Heather. It didn't happen because the last dregs of my Appropriateness Filter kicked in and I dimly realized that it was the kind of joke that, if she didn't think it was funny, she would REALLY not think it was funny. Also, I'd have to go to the store and purchase Cheetos and that sounded like a lot of work.

Anyway lots of comments on Jezebel, blah blah blah, but my very very favorite one was one right here on the blog from gentle reader Anonymous:

My wife always forces me to relive my nude childhood when we have guests. I still haven't met another adult who has at least admitted that they went/were dragged to a nudist colony.

My parents still have a yellowed nudie park newsletter where I medalled in the nudie olympics, my totally retracted junk on display after winning a swimming race. Takes me back. 

God, I absolutely LOVE that this photo exists. Surely it must be the Most Embarrassing Photo Ever! Do you have something worse? Well, do you? Bring it on!

I will leave you for now.  Coming next:  Reader Mail.


(photo source)

* If I'm dogsitting at your house, I will go naked in your pool. We may as well get that straight now.