Sexual Health

Whether or not you choose to have sex and regardless of the types of sex you may choose to have or who you have it with, it is worth making yourself aware of the risks so you can make informed choices for yourself and support friends who may seek your advice.

Below is some basic information and also information omitted from a lot of sexual health guides, but it is still very abridged. If you have any symptoms or concerns about your health you should consult your GP or visit a GUM clinic – what’s written here is to raise awareness and not to be taken as medical advice!

STIs

Getting an STI isn’t shameful or uncommon, but it’s still best avoided. Not all STIs have symptoms that show but some can become very nasty if left untreated so you should learn how to avoid them and get tested if you think you may be at risk.

While it’s true that different activities carry different risks, no sexual act is free from the chance of getting an STI. If you are sexually active, it’s probably worth getting tested on a relatively frequent basis even if you think you’re at a low risk of having an STI, and don’t be scared to talk to your partner(s) about it – it’s just common sense.

Different people mean different things by ‘sex’, which can be difficult to define. Whether or not you’re at risk of contracting or transmitting an STI, and how to protect yourself, depends on exactly what kind of sexual activity you are practising.

Types of sex

Fingering (anal or vaginal)

Fingering carries a much lower STI risk than other forms of sex, but it can still transmit STIs. Bacterial infections like Chlamydia and gonorrhoea can be easily transmitted if you get semen or vaginal fluid on your hands, and warts and herpes can also be spread by skin-to-skin contact. Protective gloves can be worn if you are worried about this

Oral

Oral sex is any sex where the mouth comes into contact with the penis, anus or vagina. All STIs can be transmitted through oral sex. The risk of HIV infection is low and mainly associated with getting semen or vaginal fluids that carry the virus in your mouth, which can then get into your bloodstream through small cuts, abrasions or ulcers.

Using a dental dam or condom will minimise the risk, and you should avoid unprotected oral sex if you have a cold sore (see herpes)

Penetrative sex (anal or vaginal)

Condoms and femidoms are the best way to prevent STI transmission from penetrative sex. This advice applies whatever type of penetrative sex you’re having – other insertibles , like sex toys, can carry STIs as well. You should also be wary of cross-contamination between the vagina and anus.

If you’re using sexual aids or sex toys it’s important to keep them clean, for which you can buy specialist sex toy cleaner.

The risk of STI transmission is higher for anal sex as the lining of the anus is thin and easily damaged, but all penetrative sex can be made less risky by being gentler, using plenty of lube (make sure it’s water-based if you’re using latex condoms – see the next section) and preparation to relax the muscles.

STIs can be transmitted by pre-come and can be transmitted whether or not the vagina or anus is fully penetrated and whether or not ejaculation occurs

Types of protection

Three common forms of protection are dental dams, condoms and Femidoms. These are known as barrier methods.

Talk to a member of your college’s welfare team (such as the welfare officer, women’s rep or LGBT+ officer) for advice on where to get protection – they may well provide them for free. Latex-free and vegan-friendly alternatives are available from other sources.

Dental Dams

These are rectangles of latex that are put over the genitals during anal or vaginal oral sex. They come in a variety of flavours.

If you’re using a latex dental dam, beware of oil based products like lipstick and some lubes, as they can deteriorate the material.

Condoms

Condoms can generally be used on anything that is being inserted (e.g. toys) and come in flavours for oral sex.

Femidoms

These are like condoms, but are inserted into the vagina instead of being put onto something.  They have some advantages:

  • They can be inserted up to 8 hours before sex
  • They can be used with a range of sizes of insertibles/phalluses
  • They are something that the person receiving can wear

Some people use Femidoms anally, although there are no studies into how reliable they are during anal sex. For advice on using Femidoms, read the instructions that come with them or look online.

Lube

Using lube during sex can help reduce the risk of STI transmission by reducing damage to genitals (e.g. tears in the anal lining) and preventing condoms from slipping off or tearing.

Using the right lube is important:

  • Oil-based lubes and products (e.g. Vaseline, body lotion or lipstick) can deteriorate latex and so shouldn’t be used with latex forms of protection. Water-based lube should be used instead
  • Silicone-based lube can be latex-safe but tends to damage sex toys and make them more likely to transmit infections due to changes in the surface

If in doubt, read the bottle.

Using protection properly is important for minimising the risk of STIs:

  • Store it in a cool place (not the pocket of your jeans)
  • Use things that have the European CE or Kite mark and that are in date
  • Do not use a barrier more than once

If you’re using a condom…

  •  Use a condom that’s the right size
  • If you’re using a condom on a penis, pinch the tip as you roll it down. This excludes air so the ejaculate has somewhere to go. If you accidentally try to put a condom on the wrong way up, throw it away so you don’t risk transferring the pre-come. Afterwards, the penis should be withdrawn while still erect and the condom held on to its base as this is done
  • Do not use two condoms at once! The friction actually increases the risk of the condoms splitting

It is important to remember that no form of protection will 100% guarantee you don’t get an STI and that some STIs can be passed by skin-to-skin transmission, so sexual health checks are still important.

Some common STIs

Lots of information is available online about the symptoms of different STIs and how they can be transmitted. The following are included because there may be something you don’t know about them that you probably ought to…

Chlamydia

Chlamydia is the most common STI, and most people who have it don’t have any symptoms. If left untreated it can cause pelvic inflammatory disease, long-term health problems and infertility

Genital warts and HPV

Genital warts are the second most common STI in England after Chlamydia. Warts are spread by skin-to-skin contact and are caused by a virus called human papilloma virus. Warts can be removed by freezing, application of a cream, or occasionally by surgery. Getting rid of the warts doesn’t itself get rid of the virus (HPV) which causes them, but your immune system will get rid of most strains of the virus over a period of months.  If you have warts in your genital area these can easily bleed when having sex and this can increase the risk of passing on other sexually transmitted infections, so it’s important to have warts treated.

You may know that some strains of HPV are associated with cervical, anal and oral cancer. Young women in the UK are vaccinated against these strains (usually in year 8 at school), however there are many other strains which don’t cause cancer but which do cause warts – the vaccine will not protect you against those! If you’ve missed the vaccine for any reason (you might, for example, have missed it if you are a student from outside the UK, an older student, transgender or a cisgender –that means not transgender – man) you might like to talk to your college nurse or GP about the possibility of being vaccinated against HPV, and the associated costs.

Herpes

Herpes is caused by a virus called Herpes Simplex which comes in two forms Herpes Simplex 1 and Herpes Simplex 2. Herpes causes painful blisters and sores which can be around your mouth (oral herpes or cold sores) or in your genital area (genital herpes). The virus is transmitted through skin-to-skin contact and is very easy to transmit through sex. When you are first infected with Herpes you may also have flu-like symptoms and feel generally unwell.  Once you’ve been infected with herpes the virus doesn’t go away, and the cold sores can come back from time to time – often if you feel run down, have another infection, or have been exposed to lots of UV light – these ‘recurrences’ tend to get more infrequent as time goes on. You can get an ’over-the-counter’ cream called zovirax to treat oral cold sores, but this is not recommended for genital herpes as it can irritate the vagina , penis or rectum. Many people with herpes have no visible symptoms, but can still pass the virus on.

HIV/AIDs

HIV or ‘Human Immunodeficiency Virus’ is a virus which can be transmitted through unprotected penetrative sex. The main risk is from vaginal sex and anal sex, but there is a small risk of HIV being transmitted if you get semen or vaginal fluids in your mouth.   Infectious HIV can be found in four body fluids – blood, semen, vaginal fluids and breast milk –  so the virus can be spread through unprotected sex, sharing needles or needlestick injuries and from parent to baby. All blood and products in the UK are screened for HIV so you don’t need to worry about acquiring HIV through medical procedures, and saliva does not contain infectious HIV so you can’t contract HIV from kissing or sharing mugs!

Almost all HIV diagnosed in the UK (over 97%) is acquired through unprotected sex. Anyone who is pregnant in the UK is offered an HIV test, and if you know you’ve got the virus you can reduce the risk of transmission by taking anti-viral drugs during pregnancy and avoiding breast-feeding. In some cases birth via caesarean section may also be recommended.

You can live for years or decades with HIV and feel completely well, but if you are not diagnosed and treated the virus will gradually weaken your immune system so that you are vulnerable to a range of infections which you would normally be able to fight off. ‘AIDS’ – Acquired Immune Deficiency Syndrome – is a list of these conditions.

The only way of knowing whether you have HIV is to have an HIV test: if you are having a sexual health check-up or are worried about HIV you should think about having an HIV test. Tests are completely free and confidential. It can take up to three months after the point at which you have been exposed to HIV for the test to work (sometimes referred to as the ‘window period’) though in most cases results are valid after about six weeks. If you have any worries it’s always useful to make an appointment and discuss these issues at a sexual health clinic or with your GP. You can also go to DHIVERSE for general support and information.

If you go to a GUM clinic or A&E within 72 hours of being exposed to HIV – from any source, not necessarily from having sex, even if you go to a GUM clinic – you may be offered PEP (Post-Exposure Prophylaxis), a four week course of anti-HIV medication. PEP reduces the risk of infection with HIV but has side effects, is not 100% effective and doesn’t work against all strains of HIV. Not all areas of England offer PEP and GPs cannot usually prescribe it. See the NHS website for more information www.nhs.uk

Although there is still no cure for HIV, treatments have improved enormously so there is a real advantage in knowing if you are infected! Unfortunately around a quarter of new HIV diagnoses in the UK are ‘late diagnoses’ which means that you are diagnosed after the best time to start on treatment.

If you are living with HIV and would like support, advice or information you may wish to contact DHIVERSE, the HIV and sexual health charity, at www.dhiverse.org.uk

Getting Tested

Getting tested is really important as some STIs (such as HIV) can have very different outcomes depending on when they are detected. www.sexualhealthcambs.nhs.uk is a really useful website that will let you see when different Cambridge clinics have appointments and book one. GUM clinics are confidential and free to everyone – home and international students – and you will not be asked for any form of ID. You can even give a fake name if you want to.

Getting tested is less scary than many people fear. You will be asked about your sexual history and from that you can get advice on what you may be at risk of and which tests it’s a good idea for you to do. Tests include swabs of the vagina, cervix, urethra, anus or throat; blood and urine samples and internal examinations. All tests are optional and you can choose to have some and not others, or to try to give a sample and stop if you’re uncomfortable. Clinics will be used to this and won’t judge you.

How often you choose to get tested is a personal choice based on your own analysis of the risks, but getting regular checks or getting checked before sleeping with a new sexual partner is generally considered to be good practice. It is however important to bear in mind that some STIs do not show up on tests for up to three months after exposure, in particular HIV.

Contraception

Barrier methods for STIs will almost always prevent conception, but many people choose to supplement or substitute these.

There are lots of forms of contraception. Some common forms include the pill (combined or progestogen only), the implant, IUDs (intrauterine devices), the contraceptive injection and the contraceptive patch. Lots of information and advice is available online (the nhs website may be a good place to look) and you can always consult your GP. Family planning services are free to everyone, including international students.

Since the pill is so well known, there are some myths about it: long-term (or short-term) use of the contraceptive pill has not been shown to have an effect on a person’s fertility or weight. Going on the pill is over 99% effective at preventing pregnancy when done correctly and can help with painful periods, but there can be side effects – like changes to your mood – and you can get pregnant if you take a pill at the wrong time, throw one up or have severe diarrhoea. Families planning clinics and GPs will be happy to discuss any problems or questions you might have when on or considering the pill.

Awareness is also really important at preventing pregnancy. It is important to remember that pre-come can contain sperm, sperm can swim, and there is always a transfer risk with pre-come or ejaculate. Withdrawing before ejaculating won’t necessarily prevent pregnancy and even if you’re having a type of sex which shouldn’t get someone pregnant (such as anal sex) you need to be careful not to let sperm get near the entrance to the vagina. Since sperm can survive for up to seven days inside the body, it is possible for someone to get pregnant from having sex at any time, including during their period.

Also note that hormone replacement therapy does not eliminate the risk of getting pregnant or impregnating someone else, even if you’ve been taking hormones for a long time. If you are taking hormones and think you may be pregnant you should see your GP immediately as there are risks.

There are two types of emergency contraception: the morning after pill and IUDs. These count as contraceptives and not abortion methods because they are designed to prevent the egg implanting in the womb. Neither is 100% effective, but IUDs have <1% failure rate. Both methods work better the sooner you take them (within 3 days for the pill and 5 days for IUDs). You can get a list of emergency contraception services near you here http://www.nhs.uk/Conditions/contraception-guide/Pages/emergency-contraception.aspx

Abortion

You can get an abortion up to 24 weeks into a pregnancy and later in exceptional circumstances. If you decide to get an abortion, you may want to consider getting one sooner rather than later to reduce the physical and potentially mental effects on yourself. Your parents will not be informed without your permission (even if you are under 16, your doctor does not have to tell your parents as long as they think you are capable of deciding for yourself, but will encourage you to involve an adult).

To get an abortion you need to be referred, but you should not be refused. If you don’t want to ask your regular doctor you can go to a contraception or sexual health service clinic, and you can ask for your GP not to be informed.

Having a baby and having an abortion can both have large psychological effects, and you may wish to use the university counselling service before or after deciding. Most abortion services also offer counselling.

www.counselling.cam.ac.uk

Some trans-specific information

There is useful information for everybody in the sections on STIs and contraception, but three things you should know that may be more likely to affect trans people are:

  • Sexual aids can transmit STIs and should be kept clean and changed for new partners or used with condoms or Femidoms
  • Care should be taken to avoid sperm transfer from ejaculate or pre-come, even if you are having a type of sex that doesn’t involve vaginal penetration with a penis
  • Hormone replacement therapy, while it can make you less fertile, does not work perfectly as contraception and will absolutely not protect you from STIs!

If you experience dysphoria or have other issues with your body it can be tempting to take more risks when having sex, but remember that ignoring something doesn’t make it go away. Getting tested may be daunting, but you can choose which tests to have done and look online or ask around to find which clinics have reputations for being especially trans-friendly.

If you are having sex with someone who is trans (or otherwise!) and you are unsure of what they are comfortable with, you should ask. Everyone is different and you shouldn’t assume that they won’t like something any more than you should assume that they will.

For more information, talk to someone with a welfare role like the LGBT+ Trans Rep lgbt-trans@cusu.cam.ac.uk or the LGBT+ Welfare Rep lgbt-welfare@cusu.cam.ac.uk. There are also lots of good resources online.

Consent

Consent in sex shouldn’t be understood to be about not saying no, but to be about saying yes. Consent is not something that happens before you begin having sex and is then fixed: a person can withdraw consent at any point. Even if you’ve been flirting, gone home with someone, engaged in foreplay or started having sex, you are never obliged to do something you don’t want to, and nor is anyone else.

The ability to have an open dialogue with someone you intend to sleep with is really important. Remember that other people may have different boundaries to you and ideas of what they enjoy, and try to be aware of and confident in voicing your own boundaries and preferences. You should also be aware that what someone wants to do can change: try not to be offended if your partner stops liking something, or feel like if you’ve done something before you have to do it again.

If, for any reason, you find yourself in a situation you’re uncomfortable with, you may wish to consider talking to friends or a welfare officer about it.

If you’ve been sexually assaulted or think that you may have been there is help available. You may wish to report it to the police, and in this case should consider preserving medical evidence. If you think you may want to report it at a later date, you can freeze evidence like clothes or a toothbrush you used after the assault. You may also choose not to report it. Support services will not insist that you do. Whatever you decide, you should consider getting medical help in case you’ve contracted an STI or are pregnant. Sources of support include Cambridge Rape Crisis (a helpline for women, with local knowledge) www.cambridgerapecrisis.co.uk, Survivors UK (a support service for men) http://www.survivorsuk.org/ and the university counselling service www.counselling.cam.ac.uk

Not wanting to have sex and not experiencing sexual attraction

Experiencing sexual attraction to another person, experiencing romantic attraction to another person, experiencing sexual urges, enjoying sex or masturbation and choosing to engage in sex or masturbation are all different things and are not dependent on each other. It is neither abnormal nor uncommon to experience some or none of the above, and your sexual and romantic orientations (who – if anyone – you want to have sex with and who – if anyone – you want to date) do not have to align.

If you or a partner find that you do not experience either sexual attraction, sexual urges, or both, you may wish to find out more about the asexual and aromantic or ‘ace’ community. Here in Cambridge you can sign up to the asexual and aromanticism mailing list, or contact our ace rep at lgbt-ace@cusu.cam.ac.uk. We also now have a secret (invite only) ace-specific Facebook group for access please contact the rep. In addition, AVEN (www.asexuality.org) is a great resource with lots of information on asexual relationships and the ace community.

Even if you do experience sexual attraction and urges, having a different sex drive to a partner is really common. It’s something you have to negotiate between yourselves and neither person is in the wrong.

Further information

For medical information, consult your GP or another medical professional. GUM clinics are free to everyone and do not require ID.

Lots of medical information can be found on the NHS website http://www.nhs.uk

Colleges have welfare provision in the form of tutors, nurses, counsellors and welfare, women’s and LGBT+ officers. Look at your college website to see what support is available at your college.

At a university level, the student advice service (which includes the sabbatical officers) the counselling service and autonomous campaigns (such as The Women’s Campaign, The LGBT+ Campaign, CUSU international and The Disabled Students’ Campaign) can provide advice and support

http://www.studentadvice.cam.ac.uk/

www.counselling.cam.ac.uk

http://www.cusu.cam.ac.uk/campaigns/

All statistics taken from the NHS website.