Sexual health

Enjoying sex safely...

This article intends to provide frank and accurate information about safer sex and to dispel common misconceptions surrounding the transmission of HIV.

There is more to sexual health than HIV and some of this information applies to preventing sexually transmitted diseases and to preventing unwanted pregnancies. Our aim at the medical centre is to PREVENT unwanted pregnancies with the distress and heartache associated with an unwanted pregnancy.

We would like to STRESS just how important it is to seek out contraceptive advice before you commit yourself sexually. AND if your contraceptive fails you (or you fail to use one) PLEASE come and see us - ring and make a confidential appointment with the nurse (9.00am - 5.00pm 483193) or use the nurses "drop in" session or St. Bartholomew's Medical Centre (same doctors 242334) for ORAL EMERGENCY CONTRACEPTION (up to 72 hours after unprotected sexual intercourse) or an Interuterine Contraceptive Device (coil) can be fitted up to 5 days after unprotected sexual intercourse.

We saw a rise in the number of students coming back from the long summer break, last September, with an unwanted pregnancy - Be prepared - equip yourselves with a supply of condoms and take them with you on holiday - we provide them free all term.

Perhaps it might help to clarify a few myths surrounding sex at university.

Everybody's going out with someone and everybody else appears to be having sex.

Not so. The truth is that it doesn't happen nearly as often as you think and be aware that in some institutions Fresher's are regarded by the more cynical "experienced" student as sitting targets. Have you heard of "f***ing a friendly fresher"? There is no rush, take your time and stop and think before you commit yourself.

If I don't say "Yes" he'll find someone else or think I'm a frigid virgin

It's your body and it's your decision whether or not to have sex at all. Noone can or should force you into doing anything you're not sure about or ready for. Rejection is better than infection and it is OK. to say NO. Our surveys show that women are asking men to wear condoms and that their needs and views are being respected. Negotiating safer sex is not always easy but being assertively positive is not the same as being aggressivly negative.

Good Timing helps: Bring it up before you are sexually aroused, the earlier the better really. I know it can be difficult - mention condoms too early and you might feel you look pushy or available. However the earlier you discuss protection the easier it is to agree on using some. A good yard stick, if you haven't agreed yet, is to discuss protection before you or your partner start undressing. It will be easier to ask about condoms then, than when you are both in danger of getting physically/emotionally carried away.

Try saying: "Your condoms or mine"; "We need to use a condom, I would never make love without one"; "I'd like you to wear a condom please - better safe than sorry". Safer sex is an expression of self worth. You are valuing yourself, and your partner enough to protect each other.

Do Condoms work?

They do "work" in that they protect you and your partner from Sexually Transmitted Infections such as HIV, Gonorrehea, Hepatitis B, women from cancer of the cervix, and help protect you from an unwanted pregnancy. It just isn't always that easy to negotiate safer sex (See above). I can tell you confidently that from a comprehensive student health questionnaire conducted here at Brookes in 1996/7 that a huge percentage of students here (both male and female) feel that they would be able to ask their sexual partner to use a condom at the crucial moment so DON'T BE SHY ask away.

The MEDICAL CENTRE on campus provides FREE CONDOMS ALL SEMESTER to help protect from sexually transmitted infections just drop in and see one of the nurses. We provide ultra strong condoms, recommended for anal sex - the lubricant is different to extra safe doesn't irritate the anal passages. Just ask the nurses. If, however, a condom does split or you are worried that you've had a leakage (or you haven't used one) the Medical Centre provides Confidential Oral Emergency Contraception within 72 hours of unprotected sexual intercourse (or an Interuterine Contraceptive Device (coil) can be fitted up to 5 days after unprotected sexual intercourse) and can help to prevent an unwanted pregnancy. Did you know that sperm leaves the end of the penis during ejaculation, at 28 miles per hour?

So what is safer sex? = loving carefully and staying healthy

What are the sort of things that interfere with safer sex negotiations?

Acting on Impulse - without thinking if either of you have adequate protection against HIV or other sexually transmitted diseases or acknowledging that you are very fertile (between 18-25 yrs you are 2-3 times more likely to become pregnant if you have unprotected sexual intercourse).

Question: A man who is HIV negative has vaginal intercourse once with a woman who is HIV positive. What are the chances of his catching the AIDS virus? Answer: between 1 in 100 and 1 in 1,000 and it is probably towards the 1 in 1,000 end. Why take the chance when you can use a condom?

Try to keep a supply of condoms - present supplies from the medical centre have an expiry date of 2005 (one is not going to be enough and having a few in stock doesn't imply that you're a rampant sex fiend). Not everyone is going to know their HIV status - Do YOU know how many partners your partner's had and their partner's had and their partner and their partner and their partner and...

try this website www.sexualhealthoxfordshire.nhs.uk

Alcohol and Drugs which include ecstasy and cannabis lower your inhibitions and affect your judgement. It is easy to forget about important issues such as contraception and protection if you've drunk alot.

Negative attitudes to carrying condoms by BOTH sexes may inhibit your use of them.Condoms come in different sizes,shapes,colours,can expand 600%, protects against cancer of the cervix and are free on campus. Not everyone is going to know their HIV status - Do YOU know how many partners your partner's had and their partner's had and their partner and their partner and their partner and... The majority of students at Brookes view the carrying of condoms positively. If you are taking the oral contraceptive pill you still need to use condoms unless you know your partner's HIV status.

Lack of experience may lead to embarrassment which may inhibit your use of condoms. Don't be shy - give them a try, putting one on can be incorporated into your loveplay and does not (necessarily) result in the loss of your erection (as some fear) and if it does (probably through inexperience) go back to your loveplay until you become aroused again.

The fear of being rejected or of being left without a partner may impair your negotiating skills. (see myth 2).

Complacency The fact that you have been going out with the same person for a few months can mean that you feel "safe" and as a result you may give up using condoms - particularly if your partner chooses to "go on the pill". However, unless you know your partner's HIV status you remain at risk. Don't forget that condoms can help to protect the woman's cervix from developing cancer. So...

Don't be put off - LOVE CAREFULLY AND STAY HEALTHY

Condoms

There are many different types of condoms on the market but actually during your stay in Oxford you can obtain safe and free condoms from:
The Medical Centre
The Alec Turnbull Clinic (Family Planning)
1st Floor, Raglan House, Between Towns Road, Cowley, Oxford OX43JH Tel: 01865 456666.
Terrence Higgins Trust, Oxfordshire
Monday - Friday 10.00am - 5.00pm. (43 Pembroke House, Oxford. tel: 01865 243389).
GUM Clinic Churchill Hospital - tel: 01865 231231

WARNING - OIL based lubricants can have a catastrophic effect on condoms... BABY OIL for example, destroys up to 95% of a condom's strength in just 15 minutes!!!! USE water based lubricants such as KY jelly it not only makes sex safer it makes penetration easier and therefore more pleasurable.

The right condom for the right sex

Trade names can be confusing. You would expect Durex ultra-safe to be the toughest and thickest, but in fact they are standard condoms for penetrative vaginal sex. Whereas the Durex ultra-strong cannot be mistaken for anything other than a thick hardy layer of latex. Of course the thicker they are the less intense the sensation, but that goes for the penis inside and not for the one receiving it. Although Durex do not explicitly state it on the packet, the Ultra-strong is most suited to anal sex. However, a condom for anal sex has been produced called Safeguard Forte and is stocked by Terrence Higgins Trust and available free.

Smooth Sex

Extra lubrication can make the difference between experiencing heaven and hell. Fortunately, there's more to manufactured lubricants than KY Jelly, which is effective if a little medical. Again, they're not easy to get hold of, but they're worth looking out for. Body Liquid Silk is a favourite with its creamy moisturising texture and comes in sachet as well as bottle form. Other include Slik and Wet Stuff.

The Gay Men's Project at Terrence Higgins Trust, Oxfordshire, stocks a selection and are free to individuals (Tel: 01865 243389).

HOW to Use a Condom

Condoms are easier to use with practice, so don't be shy have a try when you are on your own.

• Open the individual packet carefully tear (NOT with your teeth) the foil along one short side and the condom will slip out.
• Put the condom on BEFORE there is ANY CONTACT between the vaginal or anal area. A good idea is to have opened the packet just before you start making love and leave it within easy reach so that you don't need to fumble with the packaging at the crucial moment.
• Place the rolled condom on the end of the erect penis, making sure it's the right way up, and squeeze the "nipple" end to expel any air trapped inside. Use your other hand to gently unroll the condom down the whole penis.
• After intercourse, the penis should be withdrawn before it goes soft, holding the condom firmly at the base to prevent any fluid leaking
• Tie a knot in the end of the condom, wrap it in tissue and put it in a dustbin, not down the toilet.
• Use a condom after each withdrawal which is why a supply of them is important.

Only use a condom with a British Kite mark or the new European CE mark which is a safety standard. There is a higher risk of breaking with condoms that have not reached the safety standard. Some novelty condoms such as "glow in the dark" ones are not suitable for sexual intercourse. Others are only advisable for oral sex e.g. "minty" which will cause vaginal abrasions if used for intercourse.

If you don't get on with one type of condom - try another - there are condoms for those who are allergic to the spermicide such as "Durex allergy" or "Jiffy Silhouette" Durex gold for example might suit a man who finds others too tight. Femidom is the name of the condom for women.

Condoms DO NOT provide 100% protection against PREGNANCY. They offer 85% - 98% against pregnancy depending on how they are used. Do seek medical advice about other forms of contraception and unless you know your partner's HIV status ALWAYS use a condom as well as other methods of contraception.

Forgotten your Pill? What to do if you miss Pills?

If you are more than 12 hours late taking the pill - take the most recently delayed pill now, and use a condom for the next 7 days - if you have fewer than 7 pills left in the pack, then when you have finished the pack start the next pack the next day, without a break). You also need to take extra contraceptive precautions if you are on antibiotics, or if you have diarrhoea and/or vomiting. Chemists can issue an emergency packet of contraceptive pills if you've left your normal supply, accidentally, somewhere else. If you are using the oral combined contraceptive pill you need to take extra precautions i.e. a condom.

What is HIV and how do you catch it?

HIV is the virus that may lead to AIDS. It is a human virus and cannot survive without human tissue, therefore HIV can only be "caught" when you are doing certain activities e.g. having unprotected sexual intercourse.

It doesn't matter who you are it is what you do.

The virus is mainly found in four body fluids: Blood : Semen : Vaginal Fluid : Breast milk

Blood

In order for you to become infected with HIV, blood infected with HIV would have to enter your bloodstream. The most common way is through sharing needles with an infected person while using drugs or through infected blood transfusions.

Since 1986 blood transfusions in the U.K. are considered to be safe but this does not apply to nearly two thirds of the world.

It is very difficult to acquire HIV while giving first aid or playing sports. The virus needs a point of entry into the blood stream. This rarely happens in every day life e.g. during a game of rugby or hockey if a player has a bleeding wound, there is no risk to the First Aider unless he/she is also bleeding and their wounds are directly in contact. There have been no instances of HIV being passed on like this anywhere in the world. There is no risk involved in donating blood, in this country.

Semen/Vaginal fluid

Semen (often known as cum) and vaginal fluids contain large amounts of HIV in an infected person. The virus is spread during sexual intercourse i.e. the insertion of the penis into either the vagina or anus. The virus passes in through the wall of the vagina or the tip of the penis. The active male partner does not have to ejaculate as the virus may live in the fluid at the tip of the penis. A woman is more infectious during her period. Other sexually transmitted diseases that cause ulcers increase the risk.

Did you know?

• Someone with HIV may look and feel healthy for years (as long as 15 years in some cases)
• HIV is NOT spread by touching, sharing food or drink, using toilets or showers.

Informal talk on testing issues Do I really need a test? What does having a test involve? Do I have to tell the truth about the sex I've had?

Terrence Higgins Trust offers one-off and short term counselling to anyone wanting to explore issues around sex, sexuality and HIV.

You can have confidential, anonymous (you are just given a number) free HIV testing at the GUM Clinic in the Churchill : Tel 01865 231231. There is a daily walk in clinic for from 12.15 - 15.15.

Hepatitis

Hepatitis literally means inflammation of the liver. Viruses are the commonest cause of hepatitis but drugs and alcohol excess can also give rise to hepatitis. Until recently scientists had only positively identified two viruses, hepatitis A and hepatitis B. Hepatitis C, D and E have now been discovered. The different hepatitis viruses all cause a similar acute illness but there are differences in the possible long term effects. There are major differences in the way they are spread. Hepatitis is often described as either "acute" or "chronic". An acute illness is one that lasts a relatively short time and may be severe in its effects: a short, sharp illness. a chronic illness is one that persists over a long time, sometimes coming and going. (Ref. British Liver Trust)

Hepatitis B

A potentially serious liver inflammation

The virus is extremely resilient and carriers, of whom there are 300 million globally, can be asymptomatic with the result that hepatitis B can be transmitted unknowingly.

How is it Spread?

Hepatitis B is spread via sexual contact and contact with body fluids which include blood or blood products, saliva, urine and semen, menstrual and vaginal secretions, and breast milk. Ways of exchanging body fluids include sexual activity, sharing injecting needles, sharing razors, unhygenic practices when tattooing, acupuncture, electrolysis, ear piercing, dental surgery and human bites.

Main at risk groups

• sex industry workers (male and female)
• homosexual and bisexual men
• health care workers
• immigrants from or travellers to countries where Hep.B is common e.g. Far East, South East Asia, Middle East, Africa.
• morticians
• regular recipients of blood products
• people with tattoos
• those who are immunosuppressed
• first aiders
• intravenous drug users

Signs and Symptoms of acute Hepatitis B

• symptoms are those of flu with tiredness, sore throat, fatigue, cough
• loss of appetite
• nausea and vomiting
• joint and abdominal pain
• jaundice (looking yellow)
• dark urine
• pale faeces
• distaste for smoking
• erythematous rash

Incubation period

The incubation period is reported to be between 30-40 days and 160-180 days. Of those with acute Hepatitis B Virus fewer than 1% die of liver failure and the rest recover completely, although the illness is relatively prolonged. 5% of those infected become carriers. Carriers may be categorised as having the virus mildly, moderately, or severely. There are no symptoms when it is mild, fatigue is usually the main symptom when it is moderate and cirrhosis or carcinoma may develop when it is severe. Blood tests can tell if a person is a carrier of the virus and is infectious to others passing on the virus by the activities mentioned above.

Treatment

• Whilst the liver is healing it is sensible to avoid alcohol which could cause further damage.
• There is no specific treatment except rest.
• Avoiding the exchange of body fluids helps to prevent the transmission of Hepatitis B.

LOVE CAREFULLY AND STAY HEALTHY

Hepatitis C

In 1989 a new and major strain of the hepatitis virus was discovered. It is estimated that at least 2% of the world's population has the virus, with around 4 million carriers in Europe alone.

Main at risk groups

• Intravenous drug users who may have come into contact with infected blood via sharing injecting equipment. Studies have shown infection rates among injectors to be as high as 85% in Glasgow.
• Recipients of blood products who received transfusions before blood screening, which started in September 1991.
• Sexual partners of infected individuals. It is thought that although sexual transmission rates are lower than for Hepatitis B or HIV, sexual contact is a risk factor. It is not clear whether transmission occurs solely because of the sexual activity or whether some other factor is involved. (There is an increased incidence of hepatitis C infection in people who are sexually promiscuous)
• The unborn children of infected mothers.

It is possible to catch the virus unknowingly, at any time, by coming into contact (through a cut or scratch) with the blood of a carrier of the virus, possibly through sharing razors or toothbrushes or tattooing.

Signs and Symptoms

• Approximately 95% of acute infections are symptomless. 5% present with flu like symptoms: temperature, stomach pains, jaundice (looking yellow) and generally feeling ill.
• 50% or more with an acute infection will go on to develop chronic hepatitis and 10 -20% of those are likely to develop cirrhosis of the liver within 5 and 30 years.

Incubation period

The average incubation period is 30-60 days, however it could be longer before the body produces antibodies. It can have a long latent period.

A positive antibody test implies continued infection.

Testing

Testing for Hepatitis C involves confidential pre and post test counselling and is carried out by specialist health advisors, as for HIV, at the GUM Clinic, Churchill Hospital, Oxford. Tel: 01865 231231 option 3

Is it Infectious?

Someone with hepatitis C can transmit the virus through their blood. They should:

• Clean up their blood with household bleach themselves and cover the wound with a plaster. It is not necessary to take special precautions with cutlery or plates that have come into contact with saliva so long as they are properly washed.
• Avoid unprotected sex (use a condom) the route of sexual transmission is not yet fully understood.
• Not play contact sports without letting someone else know that they are a carrier, in case of injury. They should not continue to play with a cut.
• Not donate blood.
• Not share needles, razors, scissors or toothbrushes.

Treatment

• A drug called Interferon alpha has proved effective in between 27% and 41.2% of cases. Treatment is usually 3 times a week for between 2 - 6 months by injection. It has mild side effects. Once treatment is stopped, half of those treated relapse.
• It is advisable to limit the drinking of alcohol to less than 14 units for women and 21 units for men because cirrhosis seems to develop more easily in those who exceed this limit.
• There is no vaccine at present to prevent infection because the virus comes in many different forms and has the ability to transmute.

Further Information and Help

The Medical Centre's "Drop in" service and nurse's appointments service is open Monday to Friday 9.00am-5.00pm and offers confidential advice on all sexual matters. A place to talk privately about any concern you may have. They offer pregnancy testing and Emergency Contraception up to 72 hours (or 5 days if necessary) after unprotected sexual intercourse (but don't delay - the earlier you receive it, the better)

Contraceptive services are provided through the week at the Medical Centre.

Useful Websites and Telephone numbers

www.playingsafely.co.uk - 'make condoms a fun and essential part of your sex life...'

National Aids Trust - the UK's leading independent policy and campaigning charity on HIV

hygieneexpert.co.uk - 'ensuring cleanliness and good health...' includes articles on sexual health and hygiene

Brookes Medical Centre
(for advice on all sexual health issues) (01865) 483193

St. Bartholomew's Medical Centre
(same doctors) Cowley Road (01865) 242334

Alec Turnbull Clinic (Family Planning Clinic)
(01865) 456666

GUM Clinic Churchill Hospital (for free and confidential HIV testing and advice and treatment for all sexually transmitted infections)
(01865) 231231

Terrence Higgins Trust, Oxfordshire (01865) 243389

Oxford Friend (gay / lesbian befriending and counselling)
Tuesdays, Wednesdays, Fridays 7-9pm: (01865) 726893

Sexual Abuse and Rape crisis centre: (01865) 726295