You may be thinking about what it means to be involved in a sexual relationship. It’s normal to think about sex and have sexual feelings; however, there are many things that are important to think about before you decide to have sex, including whether this is what you want and whether this is the right time in your life. You should never feel pressured to have sex.
Deciding to have a sexual relationship is a BIG deal for everyone because of the possible risks of pregnancy and getting a sexually transmitted infection. Sexually transmitted infections (STIs) are the same as sexually transmitted “diseases” (STDs) and are passed from person to person during sexual contact. STIs include: chlamydia, gonorrhea, hepatitis B, herpes, HIV/AIDS, human papillomavirus (HPV), Molluscum contagiosum, pubic lice (“crabs”), scabies, syphilis, trichomoniasis and pelvic inflammatory disease (PID). Anyone who has had sexual contact can get an STI. Men and women of all ages, regions, ethnic backgrounds, and economic levels can get STIs. This is especially true if you are a solid organ donor recipient.
What does the immune system do?
The immune system’s #1 job is to attack foreign invaders in the body. When the immune system thinks that cells or tissue (such as germs) are not a normal part of the body, it works to cause inflammation. Symptoms of inflammation include fever, swelling, pain, and redness.
After a solid organ transplant, the immune system is suppressed with medicine such as Prograf (immunosuppression) so that the immune system does not notice the transplanted organ as being different from other cells in the body. When the immune system is weakened, it doesn’t attack the new organ, but it is also less effective in attacking infections in the body. Common infections can be worse than usual because the immune system can’t respond as strongly to fight off the infection.
Let’s talk about sex…
Sexual contact includes any sexual act with another person involving contact with the vulva, clitoris, vagina, anus, penis and testicles. Sexually transmitted infections (STIs) are spread mainly through person to person by contact with or without intercourse (penetration). Anyone who has sexual contact with another person is at risk of getting a sexually transmitted infection (STI). This includes different-sex couples and same-sex couples. STIs do not discriminate. Anyone who has sexual contact and/or sexual intercourse can get an STI. In fact the only way to be 100% protected against sexually transmitted infections and pregnancy is to practice “abstinence” which means to “abstain” or not have sex.
If you are a SOT recipient and are sexually active or planning to be, you can reduce your risks of STIs by using a barrier method (condoms and/or dental dams) EVERY time you have sex.
Safer sex means using a “barrier method” of protection such as male condoms, female condoms, and dental dams (for mouth to genital/anal contact). Barrier methods prevent direct oral, anal and genital contact, and the passing of body fluids (blood, semen, and vaginal fluids) from one person to another. Barrier methods provide protection against most sexually transmitted infections but not all. For example, HPV (human papillomavirus) can be spread from skin to skin contact around the genital area, not covered by condoms. It’s important to always use a barrier method of protection with all sexual contact and to protect yourself by getting immunized with the human papillomavirus (HPV) vaccine which protects against the most common cancer causing strains of HPV. Everyone over the age of 9 years should receive the HPV vaccine especially before becoming sexually active.
Pregnancy can cause serious health risks for some SOT recipients.
Some transplant medications such as mycophenolate mofetil (CellCept®) are associated with miscarriage and significant birth defects. Females taking mycophenolate mofetil must also use a birth control method in addition to a barrier method of protection. Talk to your medical/transplant team about whether or not pregnancy is safe for you.
Frequently Asked Questions about Sexual Health (FAQs)
Can I have pleasurable sex?
Whether you are a SOT recipient or not, you can have pleasurable sex. It’s important to be able to talk to your partner and communicate what feels good.
Can you get STIs from oral or anal sex?
Absolutely! Anyone can get an STI in any area of the body where there is sexual contact. This includes the mouth and throat, penis, vagina, and rectal area.
What are the symptoms of an STI?
Symptoms vary depending on the type of sexually transmitted infection. Some STIs have no symptoms (asymptomatic). Symptoms can include a different type of discharge than usual from the penis or vagina, genital sores, pain or itching of the vagina or penis, lower abdominal pain, pain or burning with urination, pain during sex, swollen lymph nodes (glands), and flu-like illness.
How can I know if my partner has an STI?
You may not be able to tell if your partner has an STI because a person can be contagious before they have symptoms or they may not have any symptoms at all. However, if you or your sexual partner(s) have symptoms of an STI, do NOT have any kind of sexual activity (including oral sex) until you and/or your partner get checked and treated by your medical/transplant team. It’s very important to tell your medical team/transplant team if you are having oral sex so that you can get screened for any possible oral or throat infections. It’s also important to let your providers know if you are having anal sex so that you can get screened for any possible infections.
Can vaccinations protect me from getting STIs?
Yes. Some sexually transmitted infections can be prevented through vaccination such as human papillomavirus (HPV) and hepatitis B. It is especially important that immunosuppressed SOT recipients get vaccinated before going on immunosuppressive medicine, if possible, because STIs, such as HPV, can cause cancers of the skin and genital regions.
What should I do if I think I have an STI?
If you have any symptoms of an STI (sores, rashes, or discharge from the genital area), any unexplained problems, or you think you may have been exposed to an STI (even if you don’t have symptoms), see your primary care provider right away to get tested.
- You can’t test or diagnose yourself with an STI. Only a health care provider can do that. Most STIs can be treated, and the earlier you get treatment, the better. More serious problems can develop if you wait. Whenever possible, treatment is given in a single dose, but sometimes you’ll need to take medication longer.
- If you are diagnosed with an STI, call your transplant team and let them know what you are being treated for and the name and dose of the medicine you are taking.
What should I do if my partner or a past partner tells me that he/she has an STI?
Ask your partner the name of the STI and what medication was taken. Tell your medical/transplant team right away so that you can get tested and treated.
Are all STIs curable?
No. Some STIs such as herpes or HIV, stay with a person forever. These infections can be controlled with medications but cannot be cured. Other STIs such as chlamydia and gonorrhea can be cured but it’s important to be treated right away to avoid complications and fertility problems later.
Do I need to change condoms or dams between body sites?
YES. Dental dams should not be used in more than one body area (change between vagina and anus). Condoms should also be changed between body areas (change between anal and vaginal sex).
Is anal sex safe for immunosuppressed people?
Both men and women are more likely to get an STI and acquire HIV with anal sex. Anal sex can cause more tissue damage than vaginal or oral sex so it can put an immunosuppressed patient at an increased risk of infection. The anus lacks natural lubrication so it is important to use a water based lubricant (such as KY Jelly®) and to use a condom every time you have anal or any other type of sex. If you prefer to have anal sex, you should avoid having it when your white blood cells are low (neutropenia). Wait until your white blood count is in the normal range.
How can I use sex toys safely?
Sex toys should be thoroughly cleaned after each use to prevent the spread of STIs. Follow the directions that come with the sex toy for proper cleaning. Use condoms or dental dams when using sex toys. Remember to change the condom/dental dam if you change body sites such as using the sex toy in the anus and then in the vagina.
Where can I buy condoms?
Condoms are sold online, at most grocery and convenient stores and pharmacies. You don’t need a prescription to buy condoms. Free condoms may be available in your medical provider’s office.
Where can I buy dental dams?
Dental dams are sold online and in stores that sell sex products. You don’t need a prescription to buy dental dams.
What if I can’t find dental dams?
Non-lubricated condoms can easily be made into a substitute dental dam. Using scissors, carefully cut off the elastic band part of the condom and the tip, and then cut it length-wise. Now you have a rectangular piece of latex (or polyurethane if you are latex sensitive) that can be stretched and used just like a dental dam. It’s important to remember that germs such as HPV can be transmitted by oral sex and are linked to cancers of the mouth. This is why using barrier methods of protection and being fully immunized are so important.
Where can I get birth control?
Birth control is usually prescribed by your primary care provider (PCP) or gynecologist. It’s important to talk with your medical/transplant team about your sexual activity so that the best birth control method can be prescribed for you.
What is STI screening?
STI screening means testing your blood or body fluid for a sexually transmitted infection. Screening tests include blood tests, urine tests, and swabs (Q-Tips) from an infected body part or sore. Blood tests require a quick needle stick. Urine tests and swabs are painless.
Do I need a Pap test?
If you are sexually active, you’ll need to have a Pap test. Pap tests help detect pre-cancerous/cancerous lesions of the cervix (inside of the vagina) that are most often caused by STIs. In general, women should have their first Pap test at 21 years of age. Women who are immunosuppressed and sexually active, may need a Pap test earlier. Let your medical/transplant team know when you become sexually active so they can help you schedule your first Pap test with the appropriate health care provider. After you have your first Pap test, ask your provider how frequently you’ll need to have it repeated.
Where can I get tested for STIs?
You can be tested for STIs at your primary care provider’s office or at special clinics for STI testing.
How are STIs diagnosed?
A specific test (swab, urine or blood) is sent to a laboratory to check on whether you have an infection then notifies your medical team of the results.
Are STI tests always accurate?
No test for any STI is 100% accurate but STI testing is very accurate most of the time.
Can an STI be more serious because I am immunosuppressed?
Yes. Some STIs may go unnoticed because of the immunosuppression taken to prevent organ rejection. Infections can be more serious if they are not diagnosed right away.
If I have already had an STI, can I get it again?
Yes. You can get the same STI again – especially if you have sex without a condom and/or dental dam. You can also have more than one STI at a time.
Can I get pregnant from anal sex?
It is unlikely but it can happen if semen from the anus leaks in to the vagina.
What is meant by “screening”?
Screening for STIs means “getting tested” because you are sexually active and could be exposed to STIs. Screening can detect an STI before there are symptoms.
What about confidentiality? I don’t want my parents to know that I’m having sex.
What you tell your medical/ transplant team about your sexual behavior is confidential. By law, your medical providers cannot talk about this information to anyone else unless he/she seriously believes there is danger to you or others, or that you are not able to make safe decisions on your own. This means your parents, teachers, partners, or friends can’t find out any information from any of your medical providers or transplant team about anything including if you are having sex. Although we do our best to keep your information private, there is a chance your health insurance company or pharmacy may send information to your home. You may find it helpful to talk to your parents about your health and your worries.
If you are or plan to become sexually active, you should:
- Understand the possible risks and benefits that are involved before becoming sexually active.
- Always tell your medical providers (including your transplant team) if you are sexually active so that you are given important and necessary information to stay healthy.
- Use a barrier method of protection (condoms/dental dams) 100% of the time. You need to make sure that you use a new latex condom (or dental dam) correctly every time you have oral, anal, or vaginal sex. Change condoms in between different types of sexual activity such as from anal to vaginal sex. If you are allergic to latex, use polyurethane male or female condoms. Do not use lamb skin condoms or plastic wrap for sexual intercourse.
- Use a water-based lubricant with condoms (such as KY Jelly®). The lubricant will keep the condom from breaking. Never use lubricants that contain oil or fat, such as petroleum jelly or cooking oil. These products weaken latex and can cause the condom to break.
- Do NOT have sexual contact with anyone who has signs of an STI (sores, blisters, rashes, or discharge from the mouth/genital area).
- Get tested for STI’s and encourage your partner to be tested too before you have sexual contact. You should do this with each new sexual partner.
- Limiting the number of sexual partners may decrease your risk of getting an STI. The more sexual partners you have, the greater your risk of being exposed to an STI.