Feature

Sex/steria

James, a 30-year-old PR account exec, isn’t taking any chances. Though he’s not abstaining from sex, James does all he can to decrease his risk while he plays the field. His precautions have become the stuff of legend among those who have been invited up to his Murray Hill duplex. “I always wear a condom, even during foreplay,” he says with evangelical zeal. “And I use plastic wrap as an oral dam when giving head. I’ve had some who really don’t like it at all, but most say it was 90 percent as good.” James also won’t receive oral sex without barrier protection; he puts on a condom and then adjourns to the shower to wash off the taste. “A lot of women don’t like condoms,” he says. “Tough. Neither do I. However, the next morning, I can feel relaxed and can go about my life. I mean, the genetic urge to get ‘wet’ is always there. But two hours of enjoyment never outweigh weeks of worry, trips to the doctor, and potentially lifelong issues.”

Like Lindsey, James’s STD obsession has led him to mistake a common malady for a social disease. When he was 23, he became convinced that his first bladder infection was really the result of a night when he was not quite so vigilant. He submitted to a battery of STD tests, some of them painful. “Ever since then,” he says, “if a girl will go down on me without a condom, say, on a first date, I know that in all likelihood she did that with someone else the night before.”

Not content to worry only about STDs, James makes a habit of using three, preferably four, methods of contraception simultaneously. “I’ll use a condom, she’ll be on the Pill, and I’ll pull out, too. Of course, getting someone pregnant would be a nightmare. The condom box claims a 98 percent rate of effectiveness; when I pull out, I take care of the other 2 percent.”

Sex is a numbers game for safe-sex obsessives, but in terms of numbers, the obsession may be spreading even faster than the diseases. Calls to the CDC’s National STD and AIDS Hotline rose from about 650,000 in 2001 to 777,266 in 2003—an increase of over 19 percent. Catherine Wild, a health-communication specialist who has been answering hotline queries for the past six years, says that herpes and HPV calls are the ones coming in fast and furious—this despite an overall 17 percent decrease in the rate of genital-herpes infection since the early nineties.

“In light of people realizing that condoms aren’t totally effective at preventing the transmission of herpes and HPV because the condom doesn’t cover the whole genital area, we get people asking how much of their body they should cover in Saran Wrap,” Wild says. “People also test obsessively. They may have been at risk for something two years ago, but still test every month, even if they haven’t had a partner since. Obviously they come up negative. It’s an anxiety disorder. We can’t help beyond explaining the process. We suggest they consider seeing a mental-health professional.”

Robert Salant, a clinical associate professor of urology at NYU Medical Center and a physician at Midtown Urologic Associates, has seen these obsessives in his practice. He notes a 35 percent increase in self-referred patients in the past two years: “More and more frequently, my patients come in for evaluation for a potential STD armed with pages of Internet articles or already ‘self-diagnosed.’ Sometimes they are right, and sometimes they are wrong.”

While Salant suggests that the advantages of increased public awareness outweigh the disadvantages of unfiltered information, he has witnessed the consequences of Internet-spawned STD paranoia. “I have definitely had the occasion when a patient came to me convinced he had HPV, yet there was absolutely no objective evidence of infection,” he says. “One young man had seen six physicians prior to visiting with me. He was upset that the previous six had missed the HPV diagnosis. He was even more upset when I examined him and found no evidence of disease. I often wonder how many more doctors he visited before he finally believed he was fine.”

In Dr. Bregman’s experience, this kind of STD paranoia is an almost exclusively heterosexual phenomenon. He rarely sees it in his gay patients, despite the fact that HIV infection is again on the rise in that community. His straight patients, however, particularly the men, mirror those of Dr. Salant’s. “There is an increase in patient requests for STD testing to a level that is not always medically justified,” he says. “And some continue to believe they have a disease when good testing—accurate 99 out of a hundred times—tells them they don’t.”

While these doctors understand their patients’ STD concerns, they don’t think their fear is warranted. “There is some research suggesting that the herpes virus may not be completely contained by the use of condoms,” admits Salant. “But a larger body of literature suggests that latex condoms do indeed prevent the transmission. I rarely, if ever, recommend abstinence as a primary method to combat the spread of STDs.”

Most safe-sex obsessives take extreme measures because they are afraid of catching an STD, but 32-year-old Richard has given up sex because he is afraid of spreading one. Eighteen months ago, he was diagnosed with genital warts. “It was maddening,” Richard explains. “I’d have the warts lasered off, and because of the scars the procedure leaves, I was out of commission for weeks on end.” The doctor told him that after three wart-free months, he could safely dive back into the dating pool—with condoms, of course. But soon after starting a new relationship, the warts would return. HPV outbreaks have been linked to stress, and Richard was under plenty of it. “I’d get overcome with the guilt and shame of not telling them about my past health issues that I thought were history,” he says. “I’d just have to make up an excuse and end the relationship and then start the cycle all over again.”

After leaving four confused girls in his wake, Richard decided abstinence would be simpler, and safer. “The problem is not going without sex but explaining not taking girls home. It’s actually aphrodisiacal when you are sexually aloof with an attractive girl, but a couple of them have spread rumors about me being gay. I think this might be a good time to join the Peace Corps.”

According to sex therapist Jean Moné, Richard’s decision is not all that unusual. “People are starving themselves sexually and sometimes need an excuse to do that. Germs and disease can provide that excuse,” she explains. “It’s a sexual anorexia. People can go into this high-risk Orange Alert mind-set of ‘I don’t want to take risks; I don’t want to have sex at all.’ Being intimate is when we take off the mask and show our true selves to the other person, warts and all.” Moné’s use of the phrase is deliberate. “Warts can be burned off. Other stuff you can take antibiotics for. With herpes, most people only get a few outbreaks a year. If you can be responsible with it, well, there are a lot worse things.”

This kind of rationalization is no comfort to safe-sex obsessives. “Try explaining you only have a few outbreaks a year to an attractive female who doesn’t have herpes,” says James, his face turning red. “Second date? I think not. Even if she accepted it, long-term sex would always need to be with a condom. Even with daily medication, it’s a fact that it can still spread at the beginning of an outbreak without visible symptoms.”

James’s diligent use of condoms and plastic wrap is one thing, but isn’t abstaining entirely a disproportionate reaction to the risk? Isn’t it unhealthy to forgo one of life’s most basic needs and greatest pleasures in pursuit of health? At the suggestion that giving up sex for fear of disease was like giving up eating for fear of food poisoning, Lindsey’s expression sours. She is unconvinced. “There’s no shame in getting food poisoning from sushi, but goddamned genital warts? I mean, how do I tell my mom about that?”