The Medical Minute: The importance of candid conversations about sex

April 23, 2003

by John Repke, M.D., F.A.C.O.G.
Chair of obstetrics and gynecology
Penn State Milton S. Hershey Medical Center/Penn State College of Medicine

Today the majority of women in the United States, especially women between the ages of 15 and 45, look to their obstetrician-gynecologists for their primary health information. For that reason, women's health physicians and their patients need to be open and honest about the risks women face when it comes to sexually transmitted diseases (STDs). Issues related to sexuality and STDs are major components of women's health evaluations. Women and their doctors need to treat such issues accordingly.

All sexually active women are potentially at risk of acquiring an STD, regardless of their age or sexual orientation. Understanding how to minimize the risk of acquiring an STD is critical to the health of the public, as well as to the health of the individual.

What many women may not realize is the extent of the spectrum of STDs. In the past, the majority of STDs were thought to be treatable. More often than not, they were seen as annoyances, but not life threatening. Today we know that STDs are not always treatable, and may be lethal.

STDs include illnesses that are both cliché and obscure. While many women have at least heard of Chlamydia, Gonorrhea, Syphilis and crab lice (Phthirus Pubis), the list includes a host of diseases not so readily recognizable, such as: Chancroid, Cytomegalovirus, Granuloma Inguinale, Lymphogranuloma Venereum, Molluscum Contagiosum, Trichomonas Vaginalis and the Human Papilloma Virus (HPV). Hepatitis B and C, Herpes Simplex Virus (HSV), and Human Immunodeficiency Virus (HIV) also remain serious health threats for sexually active women.

This is only a partial list of diseases that may be transmitted sexually and many of them produce no symptoms. Immunization, when possible (as in the case of Hepatitis B) may reduce the risk of infection. However, education is key.

The obstetrician-gynecologist, in his or her assessment of the patient, must ask specific questions about sexual practices and sexual orientation. In addition, other risk factors for acquiring STDs should be identified, including multiple sexual partners, drug use, a history of STDs or a history of having had prior genital sores or ulcerations, a history of a sexual partners who has had an STD (even if the patient has not been diagnosed previously as being infected), and participation in the "sex industry" or any activity in which money was exchanged for sexual activity. Failure to have frank doctor-patient conversations about STDs can have serious consequences, many of which can't be cured by a simple shot of penicillin.

Herpes Simplex Virus (HSV)
Herpes simplex virus (HSV) exists in more than 50 million adults in the United States. Herpes is not curable, and may, if transmitted to a fetus, result in newborn brain damage or death. It is frequently asymptomatic yet the individual may still infect a sexual partner.

Human Papillomavirus (HPV)
More than five million cases of Human Papillomavirus (HPV) are diagnosed each year in the United States. HPV is most likely the principle cause of cervical cancer. Like HSV and HIV, HPV may be asymptomatic while still being infectious.

HIV and AIDS
The Human Immunodeficiency Virus, as we all know, remains a lethal disease, despite significant advances in controlling and delaying disease progression. As progress has been made against the disease, overall safe sex practices, driven by a healthy fear of contracting HIV/AIDS, have waned. The message that HIV is still a threat cannot be lost of sexually active women.

What can you do?
As patients and providers, candid discussions must occur. Equally candid discussions with sexual partners should occur to minimize the likelihood of transmission. Women should ask their doctors direct questions about their risk of exposure and safe practices to prevent contracting STDs.

Health care workers are also at risk for some of the above diseases, as they may be transmitted in blood, blood products or other body fluids to which health care workers may be exposed and for this reason hospital and health care facilities have adopted a system of "universal precautions" to protect workers and patients.

The most effective way to avoid infection with an STD is to never be exposed. Sexual abstinence, mutually monogamous relationships, and condom use when initiating a new sexual relationship can all be effective strategies for STD prevention. Your OB/GYN provider can assist greatly in this fight to prevent STDs, and patient education materials on STDs may be received from The American College of Obstetricians and Gynecologists at www.acog.org.

As is the case with most preventable diseases, knowledge is power when it comes to STD — but education begins with communication.

(Media Contacts)

Last Updated March 20, 2009