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What Your Gynecologist Means When She Asks If You’ve Been Sexually Active

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You say you haven’t had vaginal sex, but have tried oral and manual sex. You’re safe from pregnancy, but assuming you didn’t use a barrier method for those things, you’re not totally safe from contracting a sexually transmitted infection, some of which may not show symptoms. Conditions like herpes, HPV, and trichomoniasis can be transmitted from skin-to-skin contact and touching your partner’s genitals with infected fluids on your hands (or vice versa). Being penetrated vaginally with fingers can also mess with your vagina’s pH balance, which can lead to things like bacterial vaginosis and yeast infections — not technically STIs, but a gyno’s domain nonetheless.

All that said, your doctor can’t test or treat you unless you offer a detailed, specific set of facts. Ideally, she’ll ask you lots of questions, and you’ll be as open as possible.

“Historically, the way we were taught to ask was, ‘Are you sexually active, yes or no? With men, women or both?’” says Meera Shah, chief medical officer of Planned Parenthood Hudson Peconic and fellow for Physicians for Reproductive Health. “But that’s not the way to ask anymore, because you’re not going to get all the information you need.”

Instead, Dr. Shah makes a point of getting down to brass tacks. She’ll ask, “What body parts are you using to have sex?” And: “Are you in a mutually monogamous relationship?” And: “What genders are your sexual partners?” (And then the follow-up question: “Were they assigned male/female at birth?”) She’ll ask about oral sex and anal play, about fingers and shared sex toys. A lot of doctors, she says, don’t test for extra-genital chlamydia or gonorrhea — that is, when those STIs show up in places other than a penis or vagina. Not that Dr. Shah jumps right for the throat or rectal swab: “It depends on the characteristics of the partners [the patient] is having sex with.”

This all may sound scary and invasive, but chances are you’re perfectly fine, and you’re already ahead of the game by scheduling (and even preparing for!) this exam. Overall, Dr. Shah says the key is to be “very up front” on your first visit. You don’t have much control over what the doctor will ask, but you certainly can choose to be an open book.