Myth #5- Virgins can't have STDs

Ah, the devil is in the details, right? And didn't we have a President teach us that it depends how you define SEX? So...many youth today intend to maintain their virginity until marriage, and even wear wedding-style rings promoting their abstinence. However, many of those same youth believe that oral (and even anal) sex do not "count" towards virginity. In the last few months, I've made it a point to ask the groups of adolescents that I've been speaking to whether or not these two types of intimacy impact your virginity. I would estimate 95% have agreed that oral sex does NOT count, but only around 30% think that anal sex does not count.
Where does this leave us? This trend points out that when you are deciding whether or not to be physically intimate with someone, their self-described status of "virgin" is not necessarily a guarantee that they are disease-free. Every sexually transmitted disease except for trichomonas can be passed via oral or anal sex. Oh, and by the way, remember not everyone is honest...
As an aside, I am not intending to belittle the promise rings. I absolutely respect and admire the youth who are comfortable in their religious views and choose to respect their bodies and their faith in this manner.
BOTTOM LINE:"Virginity" does not equal disease-free. Ask more questions!

Myth #4- Condoms ="SAFE SEX"

Okay, we're on a roll. Myth #4 is that CONDOMS=SAFE SEX. Condoms absolutely DECREASE greatly your risk of both pregnancy and sexually transmitted infections, especially for the STDs transmitted via body fluids- gonorrhea, chlamydia, HIV and trichomonas. However, condoms can only cover ONE area- I don't think I need to spell out which one. Diseases that can be transmitted outside that area, by direct skin-to-skin contact, can still be spread despite proper condom use. Which diseases are these? Herpes, HPV (the wart virus), syphilis, and pubic lice (crabs).
Also, because there is a roughly 10% failure rate of condoms through breakage, there is still a chance (1 in 10) of being exposed to potential disease. Not to mention that in real life studies, condom failure rates are more like 20%, because they are simply not used consistently.
So what to do? GET TESTED-both you and your partner. Know that really SAFE SEX means both partners are tested and known to be free of disease.
BOTTOM LINE: Condoms are very helpful in decreasing disease transmission, but don't be fooled that simply using condoms guarantees "SAFE SEX".

Myth #3 Herpes Algebra

Same cookie, different crumble...Myth #3 is that you can only spread herpes when there are visible blisters. WRONG!

The herpes virus can be spread whether or not there are any visible sores. So, if parter A gets cold sores (meaning the blisters from herpes that occur outside the mouth, usually on or near the lips), he or she can pass this infection to partner B by kissing or oral-genital contact. Partner B could then develop oral or genital herpes, depending upon the site of contact. If, however, partner B already gets cold sores, then he/she will not get a new case of herpes (assuming both parties have herpes simplex type 1, which can be confirmed with a blood test.)

Confused? Let me say it differently. Once you have one type of herpes, you will not get that same type of herpes in a different spot on your body. You may, however, get a different type. The common example is that if you have cold sores, which are most often herpes simplex virus (HSV) type 1, you are still susceptible to getting genital herpes from HSV type 2.

The important point here, though, is that although herpes is thought to be most contagious immediately before, during and after blisters are present, the LACK of blisters (in between outbreaks) does NOT equal NOT contagious. A great reference book for herpes if you have further questions is: The Good News about the Bad News by Terri Warren.

BOTTOM LINE: Herpes is ALWAYS potentially contagious, whether or not you see blisters.
PS. Jump forward to the $7 Million Herpes Case!

STD AWARENESS MONTH! Myth #2 Tough cookies...

April is STD Awareness month, so I plan to blog about the common myths and misperceptions about sexually transmitted diseases. Myth #1 was addressed on April Fool's Day- STDs do NOT come from toilet seats.

Myth #2- Oral sex doesn't "count". Believe me, when it comes to passing disease, "ORAL" counts BIG time! I can't tell you how often I hear patients cry "But that's impossible, I haven't had sex yet!" when I diagnose them with genital herpes. Herpes is not the only disease you can pass via oral sex, but it certainly is the most common one that I see in my practice. In fact, trichomonas is the only sexually transmitted infection that is NOT passed via oral-genital contact.

So, realize that while oral sex by itself may not put you at risk for pregnancy, it absolutely carries with it the risk of infection.

BOTTOM LINE: Oral sex can and often DOES transmit infection- especially herpes.

Don't be April's FOOL! STD Myth #1

Toilet seats are the REAL cause of our STD (sexually transmitted disease) epidemic, right? APRIL FOOLS!!

Let me be perfectly clear- you can NOT catch sexually transmitted infections from a toilet seat! All that time our moms spent teaching us to either precariously hover over the seat or carefully plaster the seat with pieces of toilet paper was a waste. The majority of STDs are simply not that hearty! They die as soon as the fluid around them dries up. And "crabs" (pubic lice) can't grip on to the seat, so they slide off.

STDs are transmitted through SEX- oral, anal, and "old-fashioned" traditional sex. They require either a break in the skin or penetration through the mucus membranes. When you sit on a toilet seat, it's the back of your thighs. So, unless you've got cuts/scrapes there, you should be home free. Certainly, I wipe off a WET toilet seat with the handy toilet paper so I'm climbing on to a dry throne.

BOTTOM LINE: Don't be FOOLED into thinking you catch STDs from public toilets! Worry about who you kiss, not where you sit.

PS. It's a NEW MONTH, so change those air filters! (see 2/1/10 post)

100 Questions and Answers about Anorexia

As a family physician, mother, and Girl Scout leader, I am always
excited to find new tools to help our youth. 100 Questions & Answers
about Anorexia Nervosa fits the bill in all categories. Dr.
Shepphird's book is a practical, informative, accurate and thorough
resource appropriate not only for medical providers, but for patients,
family members and friends of anyone suffering from anorexia.

From the obvious but important first question, "What IS anorexia
nervosa?" to the deeper probing "My daughter recently said she just
wants to lose 'a little weight' in order to feel better about herself.
Should I be concerned?" these hundred questions tackle virtually every
aspect of an overwhelmingly prevalent disease.

Perhaps what sets Dr. Shepphird's book apart the most is her
powerful integration of personal comments in every section from two
successful women who have battled anorexia. Lynn was a world-class
athlete whose victories masked her eating disorders until her poor
health ultimately ended her competitive career. Sarah is a young
college student who began her struggles with anorexia in eighth grade.
Although (or perhaps I should say instead - not surprisingly,) Sarah
excelled in dance, school, and the social scene as she strove for
perfection across the board. Her slippery slope into eating disorders
began with the "success" of losing just three pounds. These stories
truly engage the reader. In fact, my teenage daughter found herself
skipping "the other parts" and simply reading all these stories
interspersed among the Q&A.

The statistics surrounding anorexia are staggering. Anorexia has the
highest premature death rate of any mental illness and it occurs most
often in our teenagers. We're fighting societal messages that you can
never be too thin, and that skinny equals success. Adult leaders
unaware of accurate eating disorder information can easily
inadvertently worsen the self-image of their teens, especially in
weight- focused sports or mirror-surrounded dance studios.
BOTTOM LINE: Coaches, teachers, scout leaders, clinicians and parents can all benefit from
reading 100 Questions and Answers about Anorexia.

Is a TATTOO for you?

From Angelina to Jesse, tattoos are in the news. The popularity of tattoos has soared in the last decade. I'd estimate in my suburban Austin practice that somewhere between 50-75% of my patients under the age of fifty sport a tattoo somewhere on their body. Many are discreet- a simple musical note above the ankle, or a heart or butterfly tucked away in a typically clothing covered area. The twenty-somethings often prefer what is jokingly referred to as the "tramp stamp," which is the tattoo centered in the back, peeking out above their low cut jeans and thongs. Another favorite spot for women is the back of the neck, only revealed when they wear their hair "up".
Some people take their tattoos to the extreme, including full body art work that literally takes decades to complete.
What is my medical advice regarding tattoos? Well, I've seen a few nasty skin infections in fresh tattoos that end up leaving the owner with a very disappointing outcome, but with proper skin care (and antiseptic technique during its creation) most tattoos are relatively safe. But please note that I say relatively! Why? Because any time you are dealing with breaking the barrier of the skin, there can be transmission of infection. For example, though it is uncommon, we do know that there are cases of hepatitis C that have been transmitted from tattoos. Make sure the tattoo artist is not only using clean needles, but fresh ink as well!
My motherly advice includes the suggestion that you pick a location on your body that is not always visible. Neck, hand, forearms and lower leg tattoos may clash with business attire in a future job interview, and "perky" young body parts do not always stay quite so...young. I'd advise trying a few long lasting, but non-permanent tattoos (henna) before making the life-long commitment of a "real" tattoo. Remember, there is reason that you see so many ads for laser tattoo removal!
BOTTOM LINE: Single, professionally-crafted tattoos pose little (but not NO) true medical risks, and need to be considered a permanent choice (translation, do not make this an impulsive, perhaps alcohol-enhanced decision!)