OK to talk sex­ual health with M.D.

Prince Albert Daily Herald - - OPINION - DR. KEITH ROACH

DEAR DR. ROACH: What are the chances of pick­ing up a dis­ease if I en­gage in ho­mo­sex­ual sex? What are the types of dis­eases I might en­counter and their con­se­quences? I don’t think you have ever dis­cussed the med­i­cal im­pli­ca­tions of this im­por­tant sub­ject. Has it be­come taboo in the med­i­cal pro­fes­sion? -- D.A.

AN­SWER: Many peo­ple feel un­com­fort­able dis­cussing sex­ual-health is­sues with their med­i­cal provider, but you are right that it is im­por­tant to talk about. While the fre­quen­cies of sex­u­ally trans­mit­ted in­fec­tions vary with dif­fer­ent types of en­coun­ters (male with male, male with fe­male, fe­male with fe­male), it still is pos­si­ble to ac­quire any of the sex­u­ally trans­mit­ted in­fec­tions through dif­fer­ent kinds of in­ti­mate ac­tiv­i­ties.

Par­tic­u­larly for men who have sex with men, HIV re­mains the big­gest con­cern, be­cause the con­se­quences are so im­por­tant. HIV has be­come a chronic dis­ease with proper treat­ment, but it still has dra­matic ef­fects on over­all health and on the like­li­hood of de­vel­op­ing in­fec­tion and can­cer. Thus, pre­ven­tion re­mains crit­i­cal, and talk­ing about it ahead of time is very im­por­tant. You can pro­tect your­self from HIV by choos­ing your sex­ual part­ner care­fully (I rec­om­mend that both part­ners be tested ahead of time when pos­si­ble), by us­ing con­doms, and, in some cases, by us­ing med­i­ca­tion to pre­vent trans­mis­sion (called pre-ex­po­sure pro­phy­laxis, or PrEP).

Al­co­hol and drugs can pre­dis­pose peo­ple to make un­wise de­ci­sions, such as hav­ing un­pro­tected sex, so don’t make de­ci­sions while in­tox­i­cated.

The same advice is ap­pro­pri­ate to re­duce risk of the other STIs as well, such as syphilis (which is mak­ing a dra­matic and re­gret­table come­back in some parts of the coun­try), gon­or­rhea and chlamy­dia, and less-com­mon in­fec­tions such as LGV (lym­phogran­u­loma venereum). Gen­i­tal her­pes sim­plex virus in­fec­tions are com­mon with both het­ero­sex­ual and same-sex en­coun­ters. Two STIs, hepatitis B and HPV, can be pre­vented very ef­fec­tively with vac­ci­na­tion. All peo­ple con­sid­er­ing a new sex­ual en­counter should be tested for im­mu­nity to hepatitis B and vac­ci­nated if not im­mune. HPV vac­cine should be given to any­one in the ap­pro­pri­ate age group (9 to 26 for women, 9 to 21 for men, but it’s par­tic­u­larly im­por­tant for trans­gen­der adults, or for men who have sex with men, up to age 26).

Al­though these dis­eases can be treated, pre­ven­tion is best. Her­pes and HIV can­not be cured. Reg­u­lar test­ing is ap­pro­pri­ate for peo­ple with on­go­ing sex­ual ac­tiv­ity.

There are many good sources for more in­for­ma­tion. One place to start is the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, at tinyurl.com/STI­facts, but your med­i­cal provider can give you more per­sonal rec­om­men­da­tions.

DEAR DR. ROACH: My med­i­cal doc­tor has rec­om­mended that I see a rheuma­tol­o­gist. I al­ready see a neu­rol­o­gist. Can you ex­plain the dif­fer­ence be­tween these two spe­cial­ties? -- K.B.P.

AN­SWER: “Rheum” is a wa­tery sub­stance; rheuma­tism, or what we would now call arthri­tis, was thought to be due to an ex­cess of wa­tery hu­mor. A rheuma­tol­o­gist is an ex­pert in con­nec­tive tis­sues of the body, es­pe­cially the joints. A rheuma­tol­o­gist must first com­plete an in­ter­nal medicine res­i­dency be­fore a fel­low­ship in rheuma­tol­ogy.

A neu­rol­o­gist is an ex­pert in the ner­vous sys­tem of the body, both the cen­tral ner­vous sys­tem (brain and spinal cord) as well as the pe­riph­eral ner­vous sys­tem.

There are some con­di­tions where both a rheuma­tol­o­gist and a neu­rol­o­gist can pro­vide valu­able in­sights. Sev­eral come to mind: Lyme dis­ease is one; sys­temic lu­pus ery­the­mato­sus is another.

DEAR ABBY: Last year I had a baby with one of my col­lege pro­fes­sors. He left me 10 days be­fore our daugh­ter was born and has never met her. I chased him through fam­ily court, and he gives me the bare min­i­mum in state-or­dered sup­port.

Re­cently, I spot­ted him ad­ver­tis­ing him­self on a dat­ing web­site as a lov­ing man and de­scrib­ing how he loves his first daugh­ter with no men­tion of ours (he has two other chil­dren, a girl and a boy).

How do I move past this? A part of me is an­gry for her, but I’m also an­gry for my­self. I’m in ther­apy, but see­ing him on a dat­ing web­site de­scrib­ing him­self as a good per­son, when in truth he’s a so­ciopath, has re­opened wounds I thought had closed months ago. -- OPEN WOUNDS

DEAR OPEN WOUNDS: Thank you for writ­ing to me, but this is a ques­tion you should be ad­dress­ing with your psy­chother­a­pist. Some­times it takes mul­ti­ple doses of “medicine” to cure an ail­ment, but the longer you al­low this man to oc­cupy real es­tate in your head, the harder it will be for you to get on with your life. Call your ther­a­pist.

DEAR ABBY: I love my fi­ance with all my heart. We have good friends and fam­ily. The prob­lem is, my fi­ance loves to talk. He talks A LOT.

I’ve known this since I met him, but be­cause I don’t talk much, it doesn’t bother me. I like lis­ten­ing to his sto­ries.

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