In the Bedroom: Are You at Risk?

For today's sexually active women, there are a lot of creepy diseases out there, and unprotected sex is one way to welcome them (albeit, unwittingly) into your life. Condoms suddenly make sense.

Many women wonder just how many diseases are are out. Unfortunately it's a pretty long list, and symptoms can be a tip off to a gynecologist that a patient has contracted a sexually transmitted disease (STD).

Pain can indicate a bacterial infection (such as gonorrhea) or the virus, herpes. A rash or painless lesion might indicate syphilis. A vaginal discharge could be anything from a simple yeast infection to any of several STDs. Warts, fevers, burning with urination, even sore joints can implicate STDs.

Your doctor will want to know how long have the symptoms been going on? Could it be that you had symptoms before the actual sexual episode? If so, then maybe your partner is the one at risk. Since herpes can affect the eyes, hepatitis can be sexually acquired, joints can swell painfully from gonorrhea, and lice can be unknown to the patient, a physical exam should be a careful head-to-toe appraisal without exception.

Swollen lymph nodes can accompany herpes or any other inflammatory STD. Herpes can also cause fever, but so can gonorrhea and other pelvic inflammatory diseases.

Tenderness over the liver area can indicate hepatitis contracted from a sexual partner, but it can also indicate a type of generalized peritonitis caused by infections in the tubes (fallopian tubes). One of the most sensitive indicators of a sexually acquired pelvic infection is tenderness during the actual pelvic exam. At Charity Hospital where I trained, the doctors used to call it the "Chandelier Sign," meaning that when such a finding occurred, the patient reached for the chandelier (or hit the roof, in other vernacular) because of the discomfort the exam caused.

A "wet prep" is a smear of vaginal secretions to rule out sexually acquired bacterial infections or trichomonas (a flimsy living organism that can cause burning and itching). Laboratory evaluations include a Pap smear to rule out presence of the Human Papilloma Virus (HPV), which can cause genital warts or, worse, precancerous changes at the mouth of the womb (cervix). Vaginal cultures can check for gonorrhea, herpes, and chlamydia (often a silent cause of future infertility). And blood work can check for HIV (the cause of AIDS), syphilis, and hepatitis.

Except for hepatitis and AIDS, which can both be fatal, all of the other illnesses have excellent medications and procedures to eliminate them. An STD can cause such potentially damaging results to a women's reproductive potential, as well as literally cause an explosion of infection throughout a community because of it's pyramid effect, that most physicians recommend treatment even for possible exposure from casual sex. There are so many things out there and a comprehensive check can be so expensive, that it's simpler to reassess one's sexual habits and institute safeguards to eliminate these worries from an already busy life. Condoms are not the end-all barriers against everything. Lice are not prevented. Even herpes and warts can spread to other areas of contact not covered by the condom. But the real killers like hepatitis and AIDS, and the reproductive cripplers of gonorrhea and chlamydia are much less likely with condoms. Only abstinence gives a guarantee (now there's a thought!).