Ask the Experts About LGBT Health
Q: Let's get tested TOGETHER BEFORE we have sex, for A VARIETY of STDs.
How widespread is this strategy? "Let's get tested TOGETHER BEFORE we have sex, for A VARIETY of STDs."
Do sexual health checkups reduce ambiguity and can they be like anything else POTENTIAL sex partners do together?
A: Response from Dr. Makadon
Hello,
This is a fine idea and widely practiced. When a couple is monogamous and they decide to change their behaviors with each other, say by not using condoms for anal sex, it's called "negotiated safety." There are times when this strategy doesn't work. When one partner puts himself at risk without telling the other partner, this practice has failed.
Another, broader phenomenon is that many "unsafe" sexual encounters happen among partners who don't know each other very well and/or during the heat of passion and/or while under the influence of alcohol or drugs. I routinely see people in practice who have multiple anonymous sex partners every week. Waiting a six week window after any possible exposure to an HIV/STD test, and then waiting 2 weeks for all the results to come back is not something some people are ever going to do.
In a perfectly safe world everyone would always wear their seat belts, they would eat healthy food and they would get the right amount of exercise to optimize their health. The world isn't perfect and sexual desire is fueled by raw instinct. So, ascribing a perfectly logical framework to how people connect sexually is always only going to work for a percentage of the population.
I think a more common strategy when people meet and find a connection is to employ safer-sex practices at the beginning. Once a significant relationship appears likely, it is very common at Fenway at least, for the people involved to get a complete sexual health checkup and proceed from there. When negotiated safety comes into play eg.: not using condoms anymore, it's important to make sure there is dialog, that the window period has been addressed and that each person feels comfortable discussing sex, the potential for slip-ups and other possibilities that might not be apparent during the excitement which accompanies a new relationship. Again, this strategy only works in terms of maintaining safety if both partners don't put themselves at risk outside the relationship. It's a very personal decision, and one people can only make for themselves.
Thanks for writing and best wishes,
Harvey Makadon, MD
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Forum Experts
 Harvey J. Makadon, MD is Clinical Professor of Medicine at Harvard Medical School and Director of Education and Training at The Fenway Institute at Fenway Health in Boston. He is a member of the Division of General Medicine at Beth Israel Deaconess Medical Center and is the lead editor of The Fenway Guide to LGBT Health, published by the American College of Physicians in 2007. He has long been involved in developing both educational and clinical programs to serve gay, lesbian, bisexual and transgender populations.  Patricia Raney, MD, is a staff physician at Fenway Health in Boston, Massachusetts. She is a graduate of the University of Massachusetts Medical School and is Board Certified in Family Medicine. Her clinical interests include women's health and wellness, primary care, preventive care and the health concerns of lesbians, bisexual women and transgender people. On a more personal note, she is an avid stone carver. |
