If you know Jen Gunter, M.D.’s name from anywhere, it’s likely from listening to her set the record straight on everything from the dubious claims of Gwyneth Paltrow’s controversial media brand, Goop, to whatever medical advice is making the rounds on Twitter. So we were hardly surprised to find out that the author of the (excellently titled) new book, “The Vagina Bible,” is a fountain of truth for all things women’s health-related, including safe sex. Whether it’s about the most underrated forms of protection or how to have sometimes awkward conversations with someone you’re far from having the DTR with, Gutner doesn’t hold back.
Dr Gunter, first of all, what are the top things you see college-age and 20-something women lacking knowledge of in terms of STIs?
I’d like to address the emotional stuff, because that’s never talked about. Let’s talk about anxiety related to HPV. The shame seems to really be burdened uniquely on women, who are also the ones who are tested regularly for STIs. I think many young women don’t realize that young male partners aren’t going to be regularly tested.
Is that just based on their habits?
Those are the screening guidelines. The guidelines are really for women under 24 to be screened annually for chlamydia if they’re sexually active and then to start pap smears at 21, which would tip off, in many cases, if they have an HPV infection. Women think, well, because my doctor tests me every year for chlamydia, this guy I’m going to be with is tested, too. But young men who are 21 or 22 don’t really have any reason to go to the doctor. It’s not something that’s built into their routine because it’s not in the screening guidelines. [Ed note: The United States Preventive Services Task Force says, ‘The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men.”]
That’s really interesting. I didn’t know that, I guess because I’ve always been tested.
Right, if you were always tested, you’d kind of think automatically, dudes are, too. Having these conversations are important, and if the subject is shameful, how can you even have a conversation?
A lot of people know you for myth-busting around Goop and its many, many claims. What are some myths you’d like to correct around STIs?
People need to realize that anybody can get an STI. It is not in any way a reflection of your character. It’s no more shameful to catch an STI than it is to catch influenza from shaking somebody’s hand.
Another myth is that it requires penile insertion or ejaculation to get an STD or STI. That’s not the case. Many STIs can be transmitted by oral sex and anal sex as well. There are some theories that chlamydia, because of the way it’s transmitted, may even just be transmitted through close contact with secretions. I mean, definitely intimate contact. But still, a lot of close rubbing and almost insertional, half-insertional activities are definitely a risk as well.
And this isn’t a myth, per say, but it bothers me that sometimes people don’t get screened out of fear — they’re afraid of getting a positive result. I can understand that, but we can always help you better if you’re screened sooner.
It’s 2019 and there’s a least some research being done around STIs. Are there any surprising findings or things that have changed the conversation you’ve seen come to light recently?
We unfortunately know less about STI transmission in women who partner with women. I was really surprised to find a study that showed that the rates of chlamydia for women 24 and under who partner with women are the same as for women who partner with men. This is super important because you want everyone to know you should be screened if you’re sexually active, no matter who you’re sexually active with.
That said, talking about STIs and STDs is easier when you’re in an exclusive relationship or have at least DTRed. What do you advise in more casual relationships, whether they be hookups, friends with benefits, or just pretty new?
Good sex is about communication, really, so if you can’t talk to this person about keeping both of you safe, what does that say about how compatible you might be sexually? It’s really funny. People can have sex a lot more than they can talk about it. They’re not embarrassed to take their clothes off and to do the deed, but they’re embarrassed to talk about it with their clothes.
You’ve got to advocate for yourself. The more you have the conversation, the easier it is. Just like the very first time you went on your first Tinder date, it might have been awkward and weird, and you’re like, ugh, what do I talk about? Once you’ve gone on like 30 dates, you kind of have the script down.
Is there a form of protection that you feel is either overrated or underrated?
I would say condoms are both. They’re underrated in the sense that people don’t use them often enough. They’re overrated in that yeah, they reduce your rate of transmission, but they’re not 100%. For most infections, you’re looking at like 90 to 93%.
The one that is totally underrated is pre-exposure prophylaxis (PrEP) for HIV. We’re still seeing over 30,000 cases of seuxal HIV transmission in the U.S. every year. Every single one of those is essentially preventable with PrEP. I think that many women don’t know, especially if they partner with a man who is bisexual, that they may have an increased risk and that might be something to talk about. Or, if you’re having sex with people whose HIV status you don’t know, you might want to talk to your doctor about PrEP.
There’s this misconception that if you use Truvada [ed note: a brand of PrEP] you’re a slut or whatever. We don’t think that about people who use condoms. The best lecture I heard on PReP is to think about it like a vaccine. Just like when you get a vaccine for HPV, you have antibodies in your blood to protect you. That doesn’t mean you don’t think about condoms and other things. PReP is very similar in that as long as you take the medication every single day, the levels are in your bloodstream protecting you all the time, just like antibodies.
I suspect that most people think about PrEP as something for a gay male population. But we know that in 2016, women made up 19% of all new HIV diagnoses but only 7% of PrEP users. Does it work exactly the same way for women?
Absolutely. The problem with the PReP guidelines for women is we don’t have clear ones, like if you have this many partners, do this. That’s why it’s super important to talk with an expert in PrEP about your risk.
Finally, let’s talk about your book. Why did you write “The Vagina BIble,” and what do you hope readers get out of it?
I’m hoping my readers get information — accurate, unbiased information without clickbait and rabbit holes. It’s so easy for us to get contaminated with misinformation, especially about sex, bodies, and how they work. It happens to all of us, and sometimes the good points don’t get out there. With good information, people can make empowered decisions with their bodies.