https://www.listennotes.com/e/32df5e8c99f84ed7b454dac355c5d692

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Vaginas are really similar to people. Some people fall apart when a small stress happens to them. Some people can have like all these terrible things happen and they're just like cool and calm and vaginas are like that too. Some people's vaginas are super resilient. Like they, you know, like people douche with all kinds of chemicals and stuff, but their vagina doesn't cause them any problems. Or they use lots of different kinds of lubes, you know, they're having their period, like so many things can actually throw off vaginal pH, including, or, you know, people have semen inside of them. If like their partner comes inside of them, that can throw a vaginal pH. So for some people, you can throw anything at their vagina and nothing happens.

Have you ever felt like the moment someone mentions SDIs, the conversation just stops? Like we can talk about literally everything else when it comes to our health, our workouts, our diets, our skincare routines, but the second SDIs come up, it's crickets. And here's what's wild. Most of what we think we know about SDIs is just wrong. We have been fed so much fear and misinformation that we're walking around thinking herpes is a life sentence or that getting an SDI means something tale about who we are as people. But what if I told you that the person who knows their status and is managing it is actually safer to sleep with than someone who's never been tested or won't even talk about it? What if the shame and stigma around SDIs is doing way more damage than the infections themselves? Well, in today's episode, we're breaking down the myths, the misinformation, and the unnecessary shame with Dr. Ina Park. She's a physician, a professor at UCSF, and the author of Strange Bedfellows: Inventors in the Science History and Surprising Secrets of STDs. Dr. Park is on a mission to make STI conversations as normal as talking about the weather. And honestly, after this conversation, you just might feel the same way. So if you've ever wondered about HPV, herpes, or just want to finally understand what is actually going on with sexual health right now and wellness, this episode is going to change everything. Let's dive in. Welcome Dr. Ina Park to the show.

I'm excited to be here.

Congratulations on your book. We get so many questions from our listeners about SEDs and STIs and HPV and herpes and all the things. And your new book, Strange Bedfellows: Adventures in the Science, History, and Surprising Secrets of STDs. I was thrilled when we got introduced. I'm like, we have to get her on the show. So tell me about yourself and then why you decided to write this book.

So I've been in the sort of sexual health space, you know, since my college days. And I started off as a peer educator at UC Berkeley, and I would, you know, traipse around to, like, fraternity houses and dorms with, like, a dildo and a basket of condoms and do my live demos. And, and it was actually something that I did actually as a peer educator was also dressed up as a giant condom and do these live demos in front of, like, a hundred people at Sproul Hall in Berkeley. I wrote about that for my medical school admissions essay, believe it or not, and they let me in anyway at UCLA. So I love it. You know, once I got there, I actually became much more interested in HPV. I actually got HPV as my first STI that I'm aware of and got more interested in studying it because I knew of its link to cervical cancer and anal cancer and understood that cancers of the genital tract are still kind of taboo. So I actually got more into the research area and HPV. So now I've been in this , you know, space now moving out of sexual health specifically and more into STI research. And I consult now for the CDC. And then I'm a, an associate professor.

At the School of Medicine over at UCSF. Okay.

You are the person.

And then tell us about the story about writing the book about your son. Yeah. Could you just tell that story? Because I, at first I think we're like kindred spirits. We have so many similarities in our, like you carrying around the dildos and the places I bring dildos to, you can't believe.

But yeah, I would love to, yeah. If you could just share the story about your, your aha moment that this has to be a book. I've been in the field for like eight years and all I saw every year were that STIs were getting worse. And I was thinking to myself, Emily, what can I do? I don't want to change the way people have sex and I can't go into everyone's bedroom and say, wait, wait, like let me put a barrier on, you know, before you do anything. And so what I might be able to do is actually work on reducing the stigma around these. And a way to do that is maybe to start writing about it and increase the conversation around the topic. And if I could do it through humor and storytelling, maybe I could turn people more towards the topic and fascination and wonder instead of what we are right now is, you know, this sort of fear-based mentality. You say STI and the first reaction is like, Ooh, and oh my God, I don't want that or I'm afraid of that. And the things that we're afraid of, we run away from. So I would never have written a book at that time, Emily, worst timing ever. But my son actually got hit by a car. So for the parents out there, he's fine in the hospital. We were in the ICU because he had a skull fracture and he broke his leg. And the neurosurgeon came by and said, you know, How old are you? What's your name? Let's make sure his mental status is okay. And my son answered those questions and then he said, wait a minute. Have you ever had herpes? Because if you have, I want you to ask my mom about it. She knows everything. So his whole team, he's dying. The whole team is laughing. And so then my son during the hospital stay asked the orthopedic surgeon if he'd ever had syphilis. He asked the chaplain whether or not he'd ever had chlamydia. So I just looked at him and I said, this kid is like taking a sexual history on every single person he meets and he's totally fine with it. And so maybe I could do something with this book that could get people just a little bit more comfortable talking about the topic. If I can get my seven year old comfortable about it, maybe I could.

Get other people along as well. It's such a good story when I was reading, I'm glad your son's okay. But in reading that story, I just, it's true though. It just made me think, this is the moment. I understand it. Why you needed to write this book because it is a stigma. People think, oh, I get herpes. It's like a death sentence. I can never have sex again. It's going to be this. horrible thing. And you reminded me of this story when my niece was eight visiting me in San Francisco. I was going through grad school and I had like 300, literally sex books on the shelf. And she stayed with me overnight. And then in the morning, I dropped her off. She went back to them. She said, Mommy, why does every book on Aunt M's shelf have the word sex in the title? And then she started reading the titles like, Connolly Lingus. Like, like, lesbian, asking all these questions that my sister-in-law was not ready to ask. I was not ready to answer yet. Okay. So why is there such a stigma, do you think? It's like all this misinformation.

I mean, we hear this every single day. We do. And I think part of it is the fact that we don't have, like, I'm just going to take herpes. Let's pick on herpes for a second, because I think it's the most stigmatized of the infections. And I think it's because we don't have great medication yet that completely reduces your risk of transmitting to a partner. The medicines we have are good. Like they reduce the risk by about half. But for some people, when people disclose an STI diagnosis, that that becomes a deal breaker in the relationship, which I feel like is really unfortunate and really silly because we know that, you know, something like herpes, it really just affects the skin. It's not going to cause, like, infertility. It's not going to cause any, like, long-term health problems. But there is still this stigma surrounding the topic because people are afraid to disclose. And when you disclose and get rejected, then that just augments your fear and the feelings of stigma even more. So it's like this really bad perpetuating cycle that I am hoping with you to try to break and get people more like, you know, normalizing it and understanding that we all get STIs.

We do. We all get STIs. So what is the most common then is HPV, right?

Absolutely, yes, by far. And what I tell people, like in my field, we always say HPV is the common cold of the genitals. every single person gets it. It's like a normal consequence of being a sexually active person. So I don't even want people to think about it really as an STI anymore. It's just something that happens when you have sex. It's just that we know that there are risks obviously with HPV if left unchecked, you know, for cervical cancer, anal cancer, and throat cancer. So it's not like I want people to ignore it. I want everyone to go out and get vaccinated if they're, you know, 45 or under. But it's really a normal consequence of being a sexually active human being. So let's just accept it.

You can't even really prevent it anyway.

You can get the vaccine. You can get the vaccine, but you know what? And sometimes patients have come to me and they're like, oh my God, though, I am perfect with condoms. Like, I never do anything without a barrier. And I have HPV. And I said, yes, like HPV is like glitter. Emily, like, it just goes everywhere. And you can only, you can't wear full body latex. I mean, you could, but, you know, and that's kind of kinky if you're into that. If you're into that, right. If you're into that, but, but you know what I'm talking about, like you can't cover everything and HPV literally goes everywhere. Like if you have it in the cervix, it can easily go into the anus because fluids go in there and people stick fingers in places and whatnot. So I really want people to think about it as like, I'm going to.

Get it and it's unavoidable. We asked our Instagram, I mean, we knew you were coming on and we asked them for their questions.

So here's just the questions that just came in. Does HPV ever go away? so I think the easier answer is to say yes. I mean, for most people, like 80 to 90% of people who actually get an HPV infection will clear it after two years. So that would be like, if you tested positive for HPV and then you tested yourself serially, like every three months, after two years, almost everybody has cleared the HPV. So every once in a while, I will say there is a person who They don't have sex for 20 years and then maybe something happens to their immune system. They get HIV, they get cancer, and they have to go on chemo or they get an organ transplant. Their immune system gets knocked out and sometimes the HPV comes back, but that is very unusual. And really for the most part, what we tell people is once you get rid of it, it's gone. Doesn't mean you can't get reinfected with, you know, there's over 200 types now actually classified, believe it or not.

So can a guy still go down to me if I had tested HPV exposure but no symptoms?

Yes, I think I know what she means. So maybe her HPV test was positive, like she got a cervical cancer screening test or something, and her HPV is positive. Yes, and I hope he goes down on you, please. Absolutely. What I would say is that for folks who are, you know, under 45, go get vaccinated because then you just don't have to have any stress about this. If she happens to be HPV positive, and he goes down on her and he gets HPV in his throat, most likely it's not going to do anything. But we know from Michael Douglas, for example, that in rare circumstances, people do go on to get cancer. So I don't tell people who test HPV positive because the tests that we have usually just tell you you have one of 14 types. They don't even tell you what type you have. So I just generally tell people keep going with your sex life. If you do have a pre-cancer though on your cervix, It's good for your partner if you have a stable partner to wear barriers because it actually helps your body clear it if you're not ping-ponging the infection back and forth. Okay.

So what about the cancers though? If we wanna talk about the cancers and anal cancer and how, you know, we have a lot of people like Michael Douglas and Marcia Cross, who just, they've come out talking about this.

So what do we need to know? You know, as I mentioned, like everybody for the most part clears HPV, but then there are those few people who have a persistent HPV infection. And if it's with one of those types, like the really bad actors, which are like type 16 and 18, which.

Are, by the way, both of them. They said the bad actors, like they're bad actors. Oh, no, they're great actors. They're great actors. They're like, great actors.

I'm like, what don't you like about Michael Douglas? No, they're both great actors. These HPV types are the bad actors. And both of them are covered by the vaccine. But if you get one of those and it just sits there for years and years, it slowly starts to cause a pre-cancer, and then if left unchecked, that can cause cancer. So Marsha Cross is one of the few people, I'm sure that there have been other people who've had anal cancer who, you know, are celebrities, but she's been so great at coming out and being vocal and open about it because there is some taboo, you know what I mean, around genital and anal cancers. And she's like this enthusiastic anal cheerleader, and it's amazing. I, you know, I love that she's doing that. I think it's helping destigmatize HPV in general.

Absolutely. So How likely is it that you can get an STI through oral sex?

I came of age in the HIV/AIDS era, and we always thought about oral sex as safer sex, right? And it is from an HIV perspective. You know, it's really unlikely to get HIV through oral sex, and I would say basically near impossible. But things like syphilis, gonorrhea, chlamydia, to some extent, can absolutely be contracted through oral sex. And herpes, HSV, and you absolutely can get HPV easily in the throat as well. So oral sex is really only safer from an HIV standpoint. And for everything else, it's absolutely possible to give and, you know, receive oral sex and get an STI that way.

How can we prevent that, though? What do we look for if someone's.

Not having an outbreak? Like, for, for, for, how do we.

Not, like, people always say to me, I'm like, well, the safest thing you could do. Yeah, let's just say for herpes. Yeah. Or HS. When we say, we should, maybe we should also blame when you say HSV, people just might know it was herpes, but there's HSV one and two.

So HSV two or herpes simplex virus two is the one that causes the genital herpes recurrences when for people who are living with HSV, you know, who are getting outbreaks from time to time that's caused by that virus. And then of course, like there's so many people out there who've had a cold sore on their mouth, right? And that's caused by HSV one. And if you go down on somebody, like when you're about to have a cold sore outbreak or if you have a cold sore, then you can pass that HSV-1 to your partner's genitals or anus, you know, depending on what you're into sexually. So and then that person could have an outbreak of that HSV-1 in their genitals. But the good thing about HSV-1 is that most of the time people have one outbreak and then it doesn't usually bother them again. So if you're going to get one type, people prefer to get HSV-1 because it usually does not end up causing recurrent problems. Right.

So it's the HSV-2 that is causing recurrent problems. People could have both, too, right?

You could have HSV-1 and HSV-2. You can have both, yes. Yep. You can absolutely have both. But one of the things I talk about in the book, there's like the scene where I kiss my son on the mouth and I'm like, oh, I hope you get oral herpes from me because it'll hopefully be in the best interest of your penis later in life, which is that people who've already been exposed to HSV-1, if they get exposed to HSV-2, they're way less likely to have a recognized outbreak with a lot of pain or whatever. If people don't have any antibodies to any herpes simplex virus, when they first go out and start having sex, if they get exposed, you can have a really crazy severe outbreak. And I've seen that. Of course you're going to recover if that's happening to you right now as you're listening, you're absolutely going to recover. But people that don't have any antibodies tend to have a more severe response.

Well, I love that part of your book because again, I can so picture you like in San Francisco, I think said you're in Noe Valley, which is where we live. And you're like, yeah, the moms with their hand sanitizer and the kid runs up and they're washing their hands and you were just like, come kiss me on the mouth. Like, you were germaphobic. So going back to herpes HSV right now, you wrote this book because you really want everyone to be able to talk about STDs, STIs like your son did at seven years old without shame, asking the doctor if he's had chlamydia. and that's what I want. My mission is to get people to talk about sex like they're talking about the weather. And I know you do this very well in your book, Strange Bedfellows, but how do we get people to realize that if you have herpes, you can.

Still have a healthy sex life? Well, it's really hard. And I want to, like, identify and empathize with your listeners who are living with HSV, who are feeling like, oh, my God, am I gonna be able to have pleasure and joy in my sex life again? I mean, I'm here to tell you because I've seen people from the minute they've gotten diagnosed. And I've seen people who've been living with it for 20 years, and it totally, it gets better. That's number one. It absolutely gets better. Your outbreaks become less and less frequent. And then you also develop your little mini TED talk that you have to get, you know, that you give to partners to disclose. Also, I think we're gonna keep working on medications as well as there's a bunch of work on vaccines for people who are actually living with herpes. There are people who are working on therapeutic vaccines to actually, even after you have the virus, to help reduce the number of outbreaks and reduce your shedding. So I think eventually we're going to get to a place where we just say, it's just another skin infection. It's just like HPV. It's really not a big deal. We're not quite there yet, Emily. And it's because we don't have good enough medication so that someone can, you know, say to their partner, I have no risk of transmitting this to you.

Right. Even with a daily suppressant, you still could transfer it, right? Yes.

I mean, it's very, you know, the thing is, let's think about this. Like after someone gets HSV-2 and they're living with it for a couple of years, they're really only shedding any virus on like 10% of the days out of the year. And then if you take the suppressants every day, you're reducing your risk of transmitting by half. So, you know, the risk of you actually catching HSV from somebody who knows their status and is taking their meds every day is actually really not very high. The person you're going to get HSV from is the person who doesn't know their status and is just like having sex willy-nilly right? So it's really the people that know their status that you want to sleep with those people because they are doing something to control it and everybody else doesn't have any idea and they're walking around clueless.

Oh, God, it's such, I hadn't even heard it flipped that way, but you're absolutely right. If you are on top of it, and you know that you could surprise, you know, because then also if you have it, you know when you're going to get an outbreak or you can kind of feel it and you're going to stop it and you're like, but right, otherwise, then somebody's like, they may be their carrier, right? And that whole notion of someone being a carrier and never knowing that they have it.

I got DM'd today on Twitter by somebody who got infected by somebody who was completely asymptomatic and just didn't know their status. And so now, of course, the person that got infected is having severe and recurrent outbreaks. And then there's people walking around who have HSV-2 who never have an outbreak and never have any problems. So it's the same thing I say about HIV too, Emily. When someone knows their HIV status and they're taking their meds every day, that is not the person you're going to get HIV from. You're going to get HIV from the person who doesn't know their status and has really high levels of virus around. So that's the thing that's so weird about about HSV2 is that the people who actually are on top of it and dealing with it are probably not going to be that likely to transmit it.

I want everybody to hear this right now because what is what is the percentage right now of people who do it? I know that you say in your book, Strange Bedfellows, that the number is dropping from people who are contracting HSV2. But in general, would you say what, because I think that's the one that people are most worried about.

Yeah, I mean, at the height of it all, it was one in five Americans had HSV-2, and now it's about one in eight. But if we think about how big our country is, that's still a ton of people. It's like 50 million people have it. I mean, barriers are helpful, but again, like HSV, especially, you can get outbreaks around the anal area, you can get outbreaks on your vulva. You know, you can't cover those with a barrier. So I say when people are going out and having sex, they just need to understand that comes with the territory and it could happen. And if somebody discloses their status to you, you know, say thank you for telling me. And in your mind, I want you to hear our voices saying, this person is on top of it and I'm not likely actually to get HSV from them. Yeah, exactly.

Oh, God, I just want that to be a meme or so I want you to make a video. I want you to send that to everybody because I hear it all the time. So here's some questions. So someone else said, if I was diagnosed with herpes 16 years ago and haven't had an outbreak in eight years, how contagious is it?

I mean, I think her risk of transmission is really low. I mean, if she really wants to do a great insurance policy, because the thing is, the issue is it's like the shedding happens and it's sort of imperceptible. You know, it's like when animals shed, no one has any idea it's happening silently. All you see is the hair on the ground, right? and it's the same thing with viral shedding. No idea that it's happening. So even though she hasn't had an outbreak for eight years, they're probably, you know, a handful of days out of the year that she is shedding. If she wants to, like, put a super strong, like, insurance policy on it, other than saying, I haven't had anything for eight years, she could take suppression every day.

And then, then again, she's really unlikely to transmit it. Okay. And then can I get herpes from.

Someone who has no symptoms? Absolutely. Most people do. That's the time most people actually get herpes because people who are, you know, not jerks, when they have an outbreak, avoid sleeping with people if they know they're not jerks.

What if both people have HSV? Like, is it better, like if you have HSV too and your partner has it?

Yeah, no biggie.

Then you're just going back and forth, right?

Yeah. I mean, you can't get it again. So once you have it, if you get exposed again, you already have the antibodies in your blood. I mean, it's a question I get asked a lot is, well, What if they give me like with HIV there are, you know, slightly different variations in types, but people with HSV the thought is like if this person has my partner has it and I have it, they're not going to be able to give me a second type of herpes and it's not going to worsen the outbreaks or the frequency that I already have.

Okay, that's good to know. And then, okay, maybe you have some I've talked about this in the show, but how do you tell a partner you are HSV positive without killing the mood?

Yeah, I mean, I would say that conversation should be had when clothes are still on and not when like someone's about to go down on you.

You know what I mean?

It's probably not the moment. The timing is really important with that. Like I think if you've already like gotten hot and heavy and you're already like halfway nude or whatever, that's a really hard time. Cause it's, you know, it requires thinking and calculation on the part of the other person, you know, which is why some people just don't do it, Emily.

Yeah, exactly. I say outside the bedroom when you know you're going to have sex with someone, when you know that you are going to, behand. Hey, let's talk about our status.

Yeah.

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And I think everyone thinks when they first get diagnosed, they think that Every partner is going to freak out. And I just have to tell you, it's been really interesting, like talking to people who are living with herpes. Some people just kind of shrug and say, okay, like it's not like some people really don't think it's a big deal. And then some people do need to like know a lot more. And I've actually talked to couples who are like thinking about having sex and like one of them wants, you know, some reassurance and, you know, to talk to me before they actually go for it. And, So it's just, you know, people think my sex life is over and every partner is going to freak out.

And it's not true.

Right.

Not at all. I think your book Strange Bedfellows is changing the stigma. You've already changed the stigma. So how about warts?

Yeah.

You have a whole book chapter on warts, warts and all. And we have a question that says how to get creative when a sexual.

Partner has general warts. So should we just talk about warts for a minute? You know, warts are caused by HPV six and 11. Those are also in the vaccine, by the way. So if you get the vaccine, you're very unlikely to get warts. And the good thing, the silver lining about getting warts is that those types of HPV will not cause cancer. They never cause cancer. What I tell people who are like actively having an outbreak of warts is like, tell your partner if it's on your penis, like wear a barrier. You know what I mean? You don't have to stop having sex altogether because you happen to have a wart. But I think when you know that you actively have HPV there and that those warts shed a ton of virus, it's a good idea to, you know, tell partners what's going on. But you don't absolutely have to stop doing it. And if someone like were to go down on you and notice that there's a wart there, this has definitely happened to folks that I know. HPV might go into your throat, but that's not going to cause any kind of cancer at all.

It's not going to cause any problems. Okay. So how do we know though? Like, what are you looking for? If you're like, well, maybe they don't know, but you see a bump, how.

Would you explain what people should look for? Do you have any like tips of the trade? They can look just like little bumps and they can look like little cauliflowers or broccolis, you know what I mean, on a stalk. Sorry to use a food analogy around words, but sometimes people don't like to know that they're being examined by their partner. You know what I mean? So you gotta be kind of stealth about it if you're gonna like do a quick warts check on the person before you do anything with them. But yeah, sometimes they just look like little bumps, but most of the time they have a little texture to them, like little tiny bumps or areas that look kind of rough, like a little cauliflower. Okay.

What has surprised you because you were already working in this field for so long.

Already.

So did anything surprise you? Because you go really into depth. I mean, you get into HIV, you get into or it's like we said, pubic hair, which we'll get into in a minute. Was there anything that, you know, when you write the book and you sit down and do it, what was some new insights that? Yeah.

One of the things that I thought was so fascinating was about the bachelor, believe it or not. So I don't know if you taught you probably haven't talked about the bachelor. No, but I want to talk a little bit. Tell me. Yeah. One thing I thought was super interesting was they actually screen all the potential bachelorettes. for HSV-2 and they use this test that is really inaccurate. And if you actually screen positive on that test, they don't let you participate on the show. Some, you know, producer like comes up to you and says, by the way, you have herpes and like, you can't be on the show. And the problem is, is that these tests that we actually have, they have these like different levels of positive. So there's low positive and high positive. If you have a low positive test, It's accurate like 50% of the time. 50% of them are false positives. So they're being these women are being told that they have a lifelong potentially STI and the test is wrong. So what I said in that chapter was like, ladies go get a confirmation and then go back and get that rose, you know, because. Right. We are like denying people the ability to have true love on TV because of this test that's giving false positive results.

And most of the tests are right. The herpes tests or the HSV tests are there's not a lot of great tests unless you have an outbreak.

Right? If you're having an outbreak, the tests are amazing. They're really similar to the tests that we're using for COVID. So they're these PCR tests, like the ones that use a crime scene. So they amplify genetic material. They're super accurate. So if you have anything wrong with your genitals and they swab it and they say it's HSV, you can believe that. But these blood tests are terrible and we need to have better ones. Now a lot of the labs are actually offering a confirmation test if that first test is positive, just like we do for HIV, you know what I mean? Like you run one test and then you run a second test to make sure that it's accurate. For a long time though, many labs just did one test and we were giving out lots of false positive results.

Oh my God, really? Everyone go get tested again. This is another public service announcement. Poor rejected bachelorettes. Maybe it was doing them a favor though. I know, who knows. But also, let's talk about your chapter on pubic hair. Bushwacked. Because it is a trend I always think, oh, is the bush going to come back? Because it seems like this has been going on since like the early aughts.

Yep.

Exactly. I remember hearing about Brazilian waxing and I went and did it. I got into it and now maybe it's coming back a little bit. Can we just talk about the purpose.

Of pubic hair and how it relates to STIs? For this chapter, I had just like, I started thinking about it because I just noticed like, oh my God, I haven't seen pubic hair in such a long time. Like all my patients decided pubic hair was the enemy. and I don't know why that was. And then I said, I wonder what this might be doing in terms of possibly creating risk of STIs because sometimes when you wax or shave, you can cause a little trauma to the skin. And I actually had a patient who came in, he had a little wart, a couple little warts, they got frozen off. And then of course, like he thought he was going to have sex that night on a date, so he shaved super fast and dry. And then he came back and the HPV had gotten into all those little micro traumas and he had like 50 warts after that. So I was like, okay, what is going on here? So, yeah, I mean, you know, I'm not saying that people care. I just said like, I'm like, oh, this poor guy. I mean, total nightmare. And he didn't even get laid.

Was it even worth it? Oh my God.

It was not worth it. So yeah, so the thing is, I don't know that pubic care serves a purpose other than maybe it provides like a little bit of reduction of the friction, right, that you might get when you're rubbing just skin against to skin. But I do have to say, like after having my first and last Brazilian for this book, I had tons of tiny little areas that were bleeding and little micro tears or whatever that are entry points for viruses, especially like herpes or HPV. So it's just something for people to be aware of. Like, I don't actually tell people not to take off their hair. I say you do you, but if you're gonna shave, which a lot of people do, because, you know, like a Brazilian requires like an appointment and like dealing, right? But if you're going to shave, the Pubic Hair researchers that I interview here say, do it in the morning if you think you're going to go out that night. So give your skin that six to seven hours to start healing before you expose yourself to someone else's skin.

Good advice. We get a lot of questions about this. What do I do about the bumps and how do I take care of it? What are the best practices that you've learned?

The thing that I do talk about, because he studied this as well, is that men who have sex with men also are not just shaving the front, but they're also often shaving the anal area. more likely to get injuries as well because it's hard to, like, the gymnastics is complicated.

How do you do exactly? Right? How do you get your leg over that? It's not easy. Oh my gosh.

It's not easy. But yeah, so anyways, I do, like, there are a couple studies in there that we talk about. I always, you know, talk about a study through a story, if possible, but that people who are taking it all off, like, you know, 12 or more times a year, they're more likely, it looks like, to get STIs and it's probably related to the trauma or maybe they're also just having more sex. And that's why they're taking off all their hair all the time.

Yeah, exactly. Well, let's talk about, speaking of having lots of sex, let's talk about that notion that people think that the more sex partners you have and you get an STD that it means something about you, that it says something about you and how true is that? Yeah.

Emily, this goes back to what we were taught, I think, when we were growing up, that, like, STDs are sort of some punishment or something for doing something wrong. Right. There's that whole mentality that we have and. I tell a story in this chapter about two patients that I saw, and one had had 25 partners in three months. He was a gay man and he was mostly having really short relationships. Some of them were just like one time only, some of them are just like, you know, a couple weeks. And then I had another person who I saw who only had two partners, but he was going back and forth and having sex with one. And then in a short time, you know, he was driving back and forth from Las Vegas to California, having sex with another one, going back and having sex with so he was having concurrent relationships that were overlapping. And the person who only had two partners had like four STIs in the course of a very short course of time. And then the person who had 25 partners had nothing. And so really the absolute number of people is not what actually increases your risk of STIs. Like of course, 25 is probably higher risk than one, but My point is, is that if you are in a network of people where there's really just not that much, you know, infection or people are like super on top of it and testing regularly, you're just not that likely to get an STI even with lots of sex partners.

Yeah. So what does increase your risk? Is there anything you could say this will increase your risk of STIs?

Yes. If your partner has other partners at the same time that they're having sex with you. So if you know or you suspect if you have a negotiated, like non-monogamous relationship, an open relationship, it's, you know, that's all good. But sometimes the relationship is open on one end and the other person, you know, has not agreed to it. So if you think that that's going on, that's a situation where you might catch something because having the relationships that overlap where people are going back and forth between partners, that is actually much higher risk than somebody who has partners and then stops and then goes to another partner. has a relationship stops and goes to the next partner, especially if you test in between. So, yeah, if your partner is other partners, you need to be more on top of it in terms of getting STI testing regularly.

That also reminds you of a question about vaginas. What about people who get repeated like bacterial vaginosis or they get a lot of UTIs or bladder infections? Can you talk about why some vulva owners might be at risk of having more than others. And then the second part of that question, I don't, because I have so many questions. The second part of the question I'm going to forget to ask is about this notion that if you get an STD or an STI, it's because your partner cheated and that might not be the case.

Yeah.

So, but let's cover, let's talk about.

Vaginas for a minute. Yes, let's talk about vaginas. So, like, I have a whole chapter on the vaginal microbiome and we talk about BV and it's called the Garden of Good and Evil. And what I talk about there is that vaginas are really similar to people. Some people fall apart when a small stress happens to them. Some people can have like all these terrible things happen and they're just like cool and calm and vaginas are like that too. Some people's vaginas are super resilient. Like they, you know, like people douche with all kinds of chemicals and stuff, but their vagina doesn't cause them any problems. Or they use lots of different kinds of loops, you know, they're having their period. Like so many things can actually throw off vaginal pH. including or, you know, people have semen inside of them if like their partner comes inside of them, that can throw a vaginal pH. So for some people, you can throw anything at their vagina and nothing happens. But other people, literally every single time they get their period and that blood, which is a higher pH than the pH of the vagina, every single time they get their period, they get BV. I mean, so literally some people's vaginas are on the edge. and people learn that about themselves after a while. They're like, you know what? You're gonna throw me off the edge. You need to wear a condom, you know, until I know that I wanna go there. Because some people deal, you know, which you may have heard from listeners, like with chronic problems or recurrent problems with their vagina because they get thrown off balance so easily. But I wanna tell folks that there is a really cool medication that looks really promising. And it was just published in the New England Journal of Medicine, which is a super prominent healthcare journal, But it's called lactin V and it's based on lactobacillus, which is the bacteria that we actually want in our vaginas all the time. Because when it's there, your pH is okay and it helps you handle like insults to the environment. You know what I mean? If you have lots of lactobacillus around, when your lactobacillus die off, that's when you start getting, you know, things like the odor and the discharge of BV.

Is it a daily pill or a.

Pill that you take?

It's going to be a suppository. Okay. So it's like a recurring suppository that.

You just to make sure that you have the right. Okay. That's so interesting. So there are things coming, you know what I mean, that are going to help. Because right now, right now what we do is we give people antibiotics, right? And that helps. We give something called Flagyl or whatever, and then some people get a yeast infection after they take that, then they're like vaginas in another spiral of badness.

You know, it's really, it's, I wish we had more. Is there any commonalities between the vaginas that happen to get more infections or you guys are just like luck of the draw, how you were born, your DNA? Like what makes a certain vagina more susceptible to infection and other ones not so much.

I don't have like a common pattern or like, I wish I could say there was something in diet that you could control to make your vagina more resilient. I mean, I will say that we know that semen really throws things off. So if you have a delicate vagina, semen will just make things go crazy. Douching, we know, can make it worse. So there's ways you can make it worse, but I don't have a great way to make your vagina more resilient. Right. If I did that, that would be awesome. Oh my God.

Could you imagine?

No.

Because I know, for example, when I would have new sex partners, I usually would get something. Not every time, but if it was new semen, it was new. Yeah, that's right.

It's like a whole new microbiome. You know, like we know that you have a microbiome in the vagina of bacteria that normally live there. And then when people are together for a long time, then people share, you know what I mean? Bacteria, right? With each other and it's all good. When you get a new person, the inside of the penis and the outside of the penis have their own bacteria. And sometimes your body's like, whoa, what the heck is this? You know, and you have to get used to that person. And then for a while, things can feel maybe not frankly, you know, like into the BV realm, but things can feel a little off or you're like, this is not my normal state. And then sometimes, you know, you will equilibrate and get back to, you know, your normal.

And urinary tract infections and BV, they don't They're not going to go away, right? Like you have to get them treated. Don't they just kind of stay with.

You for a while? Well, so like a UTI, a UTI, some people, you know, that whole sort of thing about flushing it out with water, cranberry juice or whatever, you can, if you have an early UTI and you just hit it super hard with the fluids, you can, you know, it doesn't always become like a full-blown infection with BV. Same thing, if things start to get out of whack and let's say then you don't get exposed to that semen, and things can die down before it fully, you know, becomes malodorous and with lots of discharge. You know, if you've already gotten to that point where you're like, wow, I have a lot of discharge and things do not smell right, usually you need to take something to get it back on track.

And then sometimes you just don't know either.

Right.

You're sometimes you don't know if you have BV or you don't know it. And so that's why I always say if you're with a vulva, your partner is as a vulva and you notice that it's changed. Yes. There's an odor or something. Yes. I think that we're also nervous to say something, but I think saying I care about you and I've noticed that there's been a change. you might want to go to your gynecologist and get checked out.

That's a beautiful way. Yeah, that's a totally beautiful way to say it. That's like not shaming at all to the person as opposed to, you know, I have had people who are like cis women who their partner has complained, you know what I mean? Like the way they framed it was like, this doesn't smell right. Or like they just made them feel bad about it, you know what I mean? And you can say it just to say like, Hey, this is different.

Exactly.

Yeah. Just, just be honest.

Be loving and be loving. Be like, I care about you and this is an easy. awful. I want to continue to go down on you. I want to continue to test you. Something's off.

Yeah, that's beautiful. I love it.

Yes. Thank you. Okay, so maybe we'll get into another an email question we have. This is from Sophie and she has, this is a longer one. And she says, I've been dating my boyfriend for a year. We first got together, he disclosed he has genital herpes. He was diagnosed a year before we got together, has had two outbreaks, both at the same time of the year. Each year he hasn't taken antiviral medication yet, but we've talked about him getting a prescription for Valtrex so he can avoid a third outbreak. Right. since we're approaching that time of year again. Not sure if that is even how outbreaks work. We always wear condoms, but I'm curious, if he starts taking Valtrex, what is the risk of transmission if we have sex without condoms? Since we've gotten much closer, our relationship has gotten stronger and more intimate, and I've been craving no condom sex. And if we wanted to get pregnant one day, how would we do that?

Yeah, I mean, so if he starts taking Valtrex, like, you know, at least five days before they're going to have condomless sex, then that's the best he's going to do in terms-- or, you know, he can start a week before or two weeks before if he wants to, but at least five days before would be great in order to prevent an outbreak from happening or to reduce-- like if he's going to have some shedding, then it will reduce the amount of virus that's shedding, so reduce the chance that she's going to catch it. Like, I can't give you an exact percentage. Okay. Because the thing is, is that I know he had an outbreak that first year and that second year he might not have an outbreak at all this year. Yeah, because the first two years with genital herpes are the worst and some people actually don't ever have outbreaks after those first couple of years. So I think it's nice if we know you're coming up on that time as an insurance policy, it's an awesome idea to take the Valtrex daily. It has very little side effects. I've had patients who've taken it for 10 years every day. So, you know, and it's really not a problem in terms of, you know, causing any health issues. So I think it's a good idea and then I they should go for it.

Okay. This is from Anonymous 26 in Miami. How do I tell my boyfriend who's got a cold sore that I don't want him to go down on me until it's gone just in case he could spread it? I don't want to hurt his feelings because he loves going down on me, and I love it too. Oh, just be honest with them and just say, okay, let's go back to your book. Strange bedfellows. I'm a park. Let's not have any shame in this. Let's not make it so awkward. I think you just say, I am concerned. It is. Scientifically proven that if you have a cold sore on your mouth, I could get it on my vagina. So let's just wait a week.

Yeah. And the way to frame it, I think, which is nice is to say, I love having you go down on me. It is so great. And I know from listening to Emily and Ina talk on Sex with Emily, this could potentially give me a cold sore or a sore on my vulva, and I don't really want to go there. So let's just wait a week. Or she might already have antibodies to HSV-1. So she could also, I mean, the tests are not great, as we know, but if she goes and she gets a high positive result, because they can draw your blood and test you for those antibodies. If she already has those antibodies, then he can go down on her and she's not going to have a problem because she's already been exposed. You know, there's a lot of people carrying around the antibodies for cold sores as well, Emily, and they don't realize it.

So, I'm so glad you're here with me. You're going to have to come back because we've got so many questions.

We haven't scratched the surface. We literally haven't. I want to just share like a tiny bit of advice that I give at the end because people are like, oh my God, how can I avoid getting STIs? And so my advice is you can't avoid getting STI. I mean, you can, like you can wear barriers, you can do that, but if you're going to be a sexual person, you're probably going to get an STI. And so my advice in the end of the book, I tried to come up with like seven words, like Michael Pollan's book. He says eat food, not too much and mostly plants.

Right?

So I was like, I'm gonna do the same thing. I said, have sex, not too much, and then I failed. So what I came up with my seven words were have sex with people that you like. Another way to say this is like, don't have sex with jerks. Don't have sex with assholes. You know what I mean? And that's because it doesn't protect you from getting an STI if you have sex with people that you find something redeeming about. But if an STI enters the picture, you're less likely to have a ton of regret. Like when people say, like, I slept with this person. I don't remember anything because I was so drunk or so high. I don't remember their name. Or, I don't even like this person, but I just slept with them because I was lonely or whatever. And then STI enters the picture. That's when I've noticed that there's a lot more regret. And so I can only protect you from regret and minimize regret. So that's what I'm about here. Like, maximize pleasure, minimize regret.

That's what we can do. So interesting. I would say, I would say have sex with people who are kind. Yes, that's perfect.

Yes, have sex with kind people.

Right.

You know, life is too short to have sex with somebody who you're like, this is not a nice person and they don't really care about me and the sex isn't even that good. You know what I mean? You don't need that person. You need to find somebody else.

Exactly. Ina Park, thank you so much for being here. I'm going to ask you the five quickie questions we asked all our guests and then we're going to let people know how they can find you. Okay. What is your biggest turn on?

Ooh. My biggest turn on, you know, I just my life, I have two kids and like my life is so busy. Like there's no romance. So like, you know, like my husband like buys me flowers or like does something super nice for me. Like suddenly I'm like, oh my God, I feel aroused. Like that's it's so weird. Like someone does something nice for me and that is what does it for me. It's not like if he, you know, if he takes off his, you were like to take off his pants and have an erection or whatever, I'd be like, yeah. But if you like you said, oh, I cleaned out your car.

I'm like, wow, suddenly my clothes are coming off.

You know what I mean?

Right, biggest turn off.

Oh, I don't like it if someone like sort of approaches me aggressively. Like if we haven't like had some sort of agreement that we're having a little bit more of an like aggressive play type of thing. I feel like I get intimidated or I want to retreat when someone sort of comes at me too forcefully or with too much energy.

What makes good sex?

Communication about like how it's going, you know, like Move it over here or whatever, do this. Like, I think keeping communication going in the act actually makes it great. Because otherwise you're like, oh, it's not totally working for me, but you're afraid to say something. You know what I mean? And I think those really satisfying times are when everybody's getting what they want.

Something you would tell your younger self about sex and relationships?

Oh, my gosh. I would have said, have more sex with more people. I had this sort of fear you know, before I became sort of more knowledgeable about stuff, like, I really limited my number of partners. So I was afraid to get, you know, HIV. I grew up in that time, right? I was afraid to get HIV. I was afraid to get STIs. And now I would go back and tell myself, oh, my God, definitely sleep with that person. Oh, and sleep with that person, too.

And do that threesome and do that. Like, I just turned down a lot of fun opportunities because I was too scared. Yeah. I grew up at that time, too.

Where it was just, it was a lot scarier. Yeah. What's the number one thing you wish everyone knew about sex? well, it's in the book, right? Just that we're all gonna have it. It's totally normal and wonderful and a joyful part of life. And STIs sort of are part of the game and the cost of doing business in the sexual marketplace. Let's get used to them because we're gonna be living with them for as long as we're having sex. I like it.

Thank you so much, Ida. How can people find you?

Get on Instagram, @inaParkMD. And I'm just gonna be posting some short videos that talk just about like little educational videos talking about some of.

The things we're talking about here. But we will tag you on this and then we will follow you share your videos.

Absolutely.

Okay, great. Thank you for your book, Strange Bedfellows.

They can find your book wherever they buy books. Yes, exactly. Wherever books are sold. Yeah. Amazon, Barnes & Noble, bookshop.org, IndieBound, like.

Every book outlet has it. So go ahead and check it out. Thanks. Well, thank you for making STDs entertaining and insightful and less scary. Your book really does that, and it's a great read. And I think it's really going to help level it so people realize they can still have a healthy, happy life and sex life, even if they get an STI or an STD.

Exactly. And we're all gonna get one.

We're all gonna get one. It's all fine. We're all good. Just have sex with kind people.

Yes, exactly.

Thank you, Ina. Appreciate you.

Thank you, Emily.

That's it for today's episode. Thanks so much for listening to Sex with Emily. If you love the show, Please like, subscribe and leave a review wherever you get your podcast. And hey, share this with a friend or partner. It just might spark something. You can find me on Instagram, YouTube, Facebook, TikTok, and X. It's all @sexwithemily. And I've been told I give really good email. So sign up at sexwithemily.com for free guides, articles, and more ways to prioritize your pleasure. Have a question about sex, dating our relationships, call my hotline 559-Talk-Sex that's 559-825-5739 or leave a message at sexwithemily.com/ask and hey was it good for you email me anytime at feedback@sexwithemily.com I'd love to hear what you're thinking.