Sex Ed for Adults

Depending on where and when you grew up, as a teenager you may have gotten a moderate amount of sex-related education, you may have had a clunky demonstration of rolling a condom over a banana, or you may have been taught that abstinence is all you need to know.

Once you became sexually active, you picked things up as you went along. But, how much do you actually know about sexual and reproductive health? Perhaps a periodic sex ed refresher for adults is a good thing.

A Question of Consent

The #MeToo era had made it very clear that our society has not effectively established in the collective consciousness what consent is. Somehow we seem to have strayed into the territory of a victim needing to prove they did not consent. I'm not sure how that got all turned around backward, but consent is not implicit unless it's actively taken retracted; consent only exists where it is freely given. Drunk people who can barely walk are not in a position to freely give consent. No consent, pants stay on. Should be simple, right?

Let's talk anal.

The vagina is made to be very stretchy; after all, it has to squeeze babies out. It also produces natural lubrication to keep things slip sliding along. If you think of what's passing through the rectum, it's far smaller than a baby, and so it makes sense that the tissue isn't as stretchy. It's also not producing the same sort of lubrication that the vagina is.

All of this means that during anal receptive sex, there is a high possibility of small tears occurring in the rectal mucosa, which is a great portal of entry for pathogens like HIV. Because anal receptive sex is a high risk sex act, it's particularly important to use condoms. Whether it's anal or vaginal sex, the receiving partner is always the higher risk side of the equation compared to the penetrating partner.

Emergency Contraception

First, let's get some myths out of the way when it comes to emergency contraception. It's not an abortion pill. It's also not harmful to the body. It's safe to be taken multiple times. There are probably better options to address ongoing contraceptive needs, but that doesn't mean that emergency contraceptive options are harmful.

Emergency contraceptive pills, either progestin only or combined progestin and estrogen, are most effective when taken within 72 hours of unprotected sex. They may continue to have some effectiveness, decreasing over time, up until around 120 hours following sex, although this varies depending on where a woman is in her menstrual cycle.

Ulipristal (brand name Ella) is another form of emergency contraceptive pill. It should be taken as soon as possible, up to 120 hours following unprotected sex. It may be less effective in women with a body mass index (BMI) greater than 30 because of how the medication acts in the body. After using Ella, it's recommended to use a barrier method until the next period.

Copper (non-hormonal) IUDs (intrauterine devices) act as emergency contraception when inserted within five days of unprotected sex. Once inserted they provide highly effective contraception on an ongoing basis.

Infectious Beasties

Chlamydia is often asymptomatic in both males and females. Left untreated, though, it can lead to pelvic inflammatory disease in women, which can negatively impact fertility. Gonorrhea and chlamydia often occur together. Females are often asymptomatic for gonorrhea, but if you think a sex partner could be infected, you need to get yourself tested and treated.

Herpes Simplex Virus type 1 causes cold sores and anal lesions, and type 2 causes genital lesions. It can be infectious to a partner even when the infected individual isn't having any symptoms.

Many sexually transmitted infections compromise the integrity of genital tissues, and this facilitates the transmission of HIV.

The HPV-Cancer Link

Human papilloma virus (HPV) infection is very common. It can cause genital warts, but in many people it can lie dormant doing its own thing, right up until it gives you cancer. Those of us in the pre-HPV vaccine era have a high likelihood of having HPV. I probably do, and quite possibly you do as well. It's a major risk factor for cervical and anal cancers, and it's the reason why it's recommended that women have regular pap smears.

Pap smears used to be recommended on a yearly basis, but that time frame has stretched out now. There are a couple of reasons for this. One is that cancerous changes are slow to develop. Another reason is that precancerous changes in cells often don't end up turning into cancer, so yearly screenings may yield results that aren't actually as concerning as they might appear.

Take control of your health.

Well, that's today's sex ed for adults lesson. The more you know, the better the position you're in to take control of your own sexual health. If uncertainty or embarrassment stop you from accessing effective reproductive health care, you're the one that ends up losing out. Your health care providers will absolutely have seen or heard far funkier things then whatever you can throw at them. If you're having sexual health problems, take the genitals by the horns and go get checked out.