This week’s column is by guest writer, Jenny Ford.
So you’ve researched the risk profile of all your favorite sexual activities and set your preferred standards for safer sex. Do you think you are now protected from the sexually-transmitted pestilence to which your immoral lifestyle exposes you?
This is a true story. Only the names have been changed, to protect the not-so-innocent. The bottom line is – you can never be as safe in an open system as you are in a closed one.
So here we are. Lots of attractive, healthy poly adults practicing various versions of polyamory. Here is A, and his two girlfriends, B and C. They have been together for 8 and 15 years respectively, and long ago did the testing, embraced unprotected sex within the V, and practice condom use with meticulous care in any other sexual relationships. Here is X and Y, married 20 years, who just a few years ago became poly, using condoms with everyone but each other.
C meets X. Things go well. 18 months down the track, A and B begin to wonder if C and X will want to stop using condoms. B realises that her health would then be dependent on the safer sex practices of X and Y, people she has met once or twice at birthday parties. Egad!
But it gets worse.
Y meets J, who is already having unprotected sex with his girlfriend, K, as she does with her girlfriend, L. Things go well with Y and J.
Now, if Y and J want to move to unprotected sex, they need to call a conference of A, B and C, J, K and L, and X and Y, get everyone tested, agree on standards of safer sex behavior and decide how to handle notifications of any possible heightened risks.
Think that’s starting to get a little unwieldy?
Consider this – all that preparation and negotiation is only mitigating risks relating to relatively LOW transmissibility diseases – HIV, Hep C, syphilis, and so on. Granted, they are the ones more likely to kill or do permanent damage, so they are the ones on which we focus our attention. Even working with, say in this case, eight people, it should be possible to ascertain that any given infection is not already in the group, and then make sure the risk of it entering is minimised.
But it’s a completely different problem when you consider something which is more easily transmissible (albeit an irritation, not a life-threatening disease) – something like thrush (candida albicans).1
Thrush can live in digestive tracts, mouths, noses, and so on. It can be transmitted via objects such as clothing and towels, via the hands from genitals to mouth, and even, although less often, during relatively safer sexual practices such as tongue-kissing.
Even if every one of the eight people took the once-only tablet which pounds your liver but kills the candida everywhere, unless they all stopped tongue-kissing outside the group, eventually, someone would get re-infected, and it would be back to Square 1.
Whereas in a monogamous pairing, once the thrush is gone it’s gone, period. Even a polyfi group could keep themselves free of it. It’s that damn free love that comes back to bite us on the ass (or in this case, somewhere close to that vicinity).
Now I am not advocating monogamy, or even polyfidelity, as a solution to this problem. For me, dealing with regular re-infections of something irritating but not life-threatening is preferable to shutting down all my kissing friends and swearing off any external sexual partners. That’s my choice, but I’m making it with my eyes open.
I don’t kid myself that by waving the magic condom-wand over my life I make it as germ-free as a staid monogamous paired life would be.
The reason I am writing this article now is that in the above fable it would be very easy for the couple X and C, or the couple Y and J, to think about the risks and make the decisions about their fluid bonding behaviors /without even realising how many other people will be affected/ by those choices. In addition, when it comes to things which get around condoms, it’s often the case that people never even stop to think in the first place. How many people start using dental dams during oral sex when they have a cold sore, for example?
I’m embarrassed to admit that it took me being in the position of Y and having thrush /come back/ post the nuclear holocaust tablet before I actually went through the “how can I prevent this from happening again” thought process – and realised I couldn’t. Not without giving up sex (or even tongue-kissing) with anyone who won’t be thoroughly fidelitous.
And I’m a reasonably intelligent, well-educated, risk-averse, rational thinker. If I had never thought this through, I’m guessing lots of other people haven’t either.
So I am saying – think it through. Not just about HIV and Hepatitis C. Find out about herpes, thrush, genital warts, and everything else. I’m not telling you what to do with the information. I’m just saying, make sure you understand what your current practices will and won’t do to protect you, and be sure you are willing to take the consequences.
In my case, possibly because I don’t know enough about my liver, I figure I’ll just keep taking the liver-blasting tablets as required. Ask me in 20 years whether I think I made the right choice …
1Note from the Goddess of Java: We Americans call this a yeast infection colloquially.
Jenny Ford has an Honours degree in Psychology and works as a business consultant and executive coach …. by day. In her other life, she is a polyamorous, bisexual community-builder and relationships coach. She has husband, a girlfriend, a boyfriend, three children (though the teenager could count as three all on her own), and two cats. She lives in Sydney, Australia with a subset of the above family members and is currently researching how to bend space and time so she can live with ll the people she loves in all the places they want to live without leaving Sydney. Expressions of appreciation for Jenny should take the form of Lindt chocolate balls. Bonus points if they are the black 60% cocoa ones.
What They Don’t Tell You About STDs and Non-Monogamy
© 2007, Jenny Ford
Used by permission, all rights reserved
19 thoughts on “What They Don’t Tell You About STDs and Non-Monogamy”
Thrush? WTF? Never heard of it before.
Interesting- when it’s considered to be an STD in the U.S. we are told we have a yeast infection, but when a nursing mom gets it , it’s thrush ?!?
That’s the only context in which I hear the term used here…
Well, Kit, we differentiate between types of herpes, too, even thought the virus is biologically the same. It’s only where it’s presented that makes a difference when the doc writes it on the chart.
It’s bad when, say, a trusted partner goes off, breaks the agreements, and has unprotected group sex, and then brings back a scorching case of herpes that nobody gets thank god but everyone has to pay over $300 for testing and then there is draaaaama.
It’s also bad when you just pass along a bacterial vaginal infection that you didn’t know you had, or one gets passed to you and it’s just an accident and I would imagine that’s more common than the scorching herpes scenario.
Having clear agreements will *help* protect you from some factors, but nothing is a guarantee, that’s for damn sure, and one of the agreements I think that poly networks should have is frequency of testing/medical care.
Start of mild rant
So once again we have a OMGWTFBBQ! warning about (minor) STDs in poly. Yet another example of our sexual bias.
Yes, they are potentials. I’m just not quite sure they deserve all the anguish and hand-wringing we give them.
How about other diseases? Ever see the flu go around a poly community? Who warns about that? Common cold? How about athletes foot from all those showers together? Are you going to continue to take mega doses of Lamisil to kill off the possibility of fungus infections and fry your liver even worse?
How about the spread of TB on an airplane? Practice ‘safe breathing’ when flying? Why focus just on (minor) sexually-transmitted diseases when they are more dangerous non-sexually transmitted diseases out there that can be transmitted just as easily within a close social network whether they’re sexually transmitted or not? Know the death rate from flu in the US every year?
This is a perfect example of using emotional and social bias to set priorities instead of doing an actual risk analysis and ranking potential risks due to actual overall risk to the group.
End of mild rant
I agree with the concept that when you have an open poly arrangement, every time you make a connection the number of people affected usually goes up exponentially. (Not always of course)
Thrush/Yeast infection however… I have a recommendation for that.
Your body has good bacteria in it called acidophilus, and when you take that liver blasting pill, it kills this as well leaving you wide open for reinfection. I have had a yeast infection once in my life despite being exposed to it regularly for a while. My ex-girlfriend had it chronically due to a deficient immune system. The one time I did get one, I treated it myself with yogurt (has to have active bacterial culture) garlic and vinegar. They are all much nicer on your body and don’t leave you wide open for infection, ’cause they don’t kill all the bacteria in your body. And if you feel like you don’t want to go this route, I would suggest eating yogurt for a while after taking the pill to at least repopulate yourself with the good stuff.
One thing about the “liver blasting” tablets…livers regenerate pretty well. That’s why live liver transplants work. Of course, you should make sure a doctor knows how often you’ve had to take these tablets (and when the last time you needed them was) to make a sound judgment, but my non-professional understanding is that it’s nothing to worry too much about if this is a relatively infrequent occurrence.
Give me a freaking break. Candida is a NORMAL component of our bodies flora. You can’t quarantine it away. You can get an infection spontaneously when the flora gets a bit out of hand from taking antibiotics for an ear infection or simply from stress. You can give it to another person by giving them a high dose of it. But when it comes down to it, it’s just yeast.
If you have a normal immune system, it’s almost never a great issue.
Way to fearmonger.
Actually, on the Herpes front, it’s not true that location makes the diagnosis of what kind of Herpes. They are indeed two different strains, HSV-1 and HSV-2. You can get HSV-1 in your mouth and on your genitals. The same with HSV-2. While they are indeed similar, they are not the same. There are blood tests that can tell the difference between the two strains. In fact, on that front, Chicken Pox are also a form of Herpes.
I STRONGLY agree with Mary Adde, Candida is a NORMAL component of body flora, only overgrowing when conditions in the body change. Super-infections are common in people who’ve been given long-term antibiotics because it kills off the bacterial competition and allows Candida to overgrow in the bowels.
I am a ASCP registered Medical Technologists who’s worked in the field for over 7 years and has worked in Microbiology labs of several hospitals.
Candida isn’t communicated like most infections – it’s a normal component in the throat, gut, and occasional normally found in the vagina without being pathogenic.
…to think about the risks and make the decisions… /without even realising how many other people will be affected/ by those choices.
A huge amount of work has been done on the mathematics of epidemiology. What it comes down to is, the spread of communicable disease is an exponential function. If the exponent is even slightly above some critical value, transmission starts to take off like a rocket and you get a general epidemic. If the exponent is held even slightly below that value, the disease remains confined to relatively few people in small, isolated clusters — in a steady state that never takes off.
This is why having a culture of rigorous condom use and STD testing is SO IMPORTANT if polyamory is going to survive and spread. STD transmission rates really must be held below some critical exponent, and we don’t really know what it is. The crucial thing to know is that even a SMALL change in the exponent — for instance, a small change in the culture of condom use or lack thereof — can tip the balance from a low-grade steady state of occasional infections to a runaway epidemic affecting tens of millions. Or vice versa: from an epidemic back to a low-grade steady state that will affect only a few.
(My wife Sparkler was trained in biostatistics; we talk about this kind of stuff over the dinner table.)
Wow. What an unfortunate article, by an ill-informed person. I’m disappointed.
There’s some basic truth here — contagion thrives on contact, and sexually transmitted diseases are apt to be transmitted among people who have sex with various subsets of each other. (Wow, who’d have guessed?) But candida’s a very poor choice to prove the point — I have a monogamous friend who’s been afflicted with it for months, maybe years, and my wife had it when we were monogamous. And the author gets through the whole article without mentioning Human Papilloma Virus, which is very contagious — and some types seem to be enablers for cervical cancer. A good argument from the standpoint of epidemiology would omit candida and include HPV.
And a more honest argument would mention that these cautions apply also to those who practice serial monogamy and those whose “monogamous” partners are not quite honest.
To Anonymous about the mild rant:
The reason to talk about sexually-transmitted diseases is because the differences between poly and a “close social network” is…sex. Monogamous people with close social networks get the flu and common colds, etc. but they have much less risk (assuming honesty) for the other diseases mentioned here. So it makes perfect sense to talk about the *extra* exposure that poly people have over and above a “close social network.”
To John Kelly:
The problem with talking about HPVs is that a *huge* percent of the population is already infected (I’ve heard rates as high as 90%) so trying to keep it out of a poly group might only be possible by not sleeping with *anyone*. The new vaccine isn’t approved for men or for women over a certain age so that doesn’t really help everyone. And lots of people get it and their immune system kills it and all is (temporarily) well. Periodic testing for those at risk seems a smarter policy to me.
I love the mild rant by anonymous. I’m tired of all the hand-wringing. Why do we have it? It’s all due to society’s moral condemnation of sexual activity. When have you ever heard some fundie christian say “They got tb – serves them right for flying in an airplane, the sinners”. Let’s just stop talking about it so much. We only bolster that fundie nonsense.
I also love the posts by Mary Adde and Radagast97. If you want to avoid disease you should stop thinking in terms of germs anyway. The presence/absence of microbes is a very minor factor when it comes to disease causation. If I were to somehow magically learn that during the unprotected sex I just had, some Chlamydia germs swam up my urethra, I wouldn’t be the least bit worried. I take care of myself – I’m healthy as a horse – and my immune system would kick their ass. Germs are around, and they’re for the most part beneficial. To quibble with Radagast97 who writes that yeast can occasionally be normally found in the vagina without being pathogenic – I’d say that means it’s NEVER pathogenic. When you do have a so-called yeast infection, something else has gone wrong. Don’t blame the yeast. I would never damage my liver to kill yeast in my body. I think Mary Adde and Radagast97 are presuming a commensal relationship between Homo sapiens and Candida albicans, but maybe it’s symbiotic. Perhaps the yeast provide some as yet undiscovered benefit to us, like the E. coli in our guts that make vitamin K for us. Is asthma caused by having lungs? Yes and no – capiche? Germ theory of disease isn’t 100% useless, but it’s greatly exaggerated. Read For Her Own Good: 150 Years of the Expert’s Advice to Women (by Barbara Ehrenreich & Dierdre English) for a good history about how this theory rose to prominence by being good for the pecuniary needs of the medical profession.
Enjoy it with a nice piece of sourdough bread and appreciate your yeast. 🙂
Well, actually, there *is* evidence that yeast infections can be passed back and forth through sexual contact (so says the CDC). It isn’t very common, but it does happen, so women with recurrent infections are often told that their partners should also be treated to help prevent them. Likewise, BV shouldn’t be sexually transmissible, either, as it is caused by an overgrowth of bacteria normally found in the vagina. Nonetheless, there is evidence that women whose female partners have it are more likely to get it, themselves, and it is currently considered to be a sexually transmissible disease.
Pathogens don’t care what stories people tell about their sexuality. Pathogens are transmitted when the necessary conditions exist.
So-called “monogamous” people are at far higher risk than responsible poly folk, given that many people cheat and others are known to also lie.
I have some concerns about how risk anxiety becomes legitimized when its connected to sex and lifestyle.
I don’t sit down with ABC-XYZ to discuss the risks of going to the obgyn, though my doc has her (gloved) hand in a woman every 20 minutes or so (I guess from the waiting room turnover) of a working day, besides surgeries and births that happen every month. The last ambulance I was in, I noticed the gloves were food grade, with a higher fail rate then condoms for birth control.
No one is telling me not to go to the Doctors, because of the risks involved.
I always smile when a Doctor gives the little spiel about numbers of sexual partners, when they are often the biggest unknown/least discussed factors some people ever take, because what they do doesn’t fit the box of how sex is defined. (Which makes some sense as a profession goes, but little if we are just talking about fluids, and why one might go to/be at the doctors office in the first place.)
Please don’t now add it to your list of worries, I’m pointing it out, to see if it registers on the list, and if it doesn’t there maybe more power in thinking about sex with the same level of routine (as in a normal thing to do, not as in frequency) and relaxed concern.
We breath, we sometimes sneeze, and sometimes go to the doctors and sometimes have sex, and sometimes that involves others.
Educating ourselves is smart because everything we do has risks, yet I can’t help feeling that fears not (and never has been) the best motivator.
Have Fun, Play Safe, and Good Luck…