Are You Playing Sexual Roulette?

We know the risks, but few of us practise safe sex all the time. Here's what you need to know

What You Need To Know About Safe Sex

Photo by iStockphoto

It was her fourth date with a promising new man, but Chloe*, 34, wasn’t planning on sealing the deal quite yet. “I was trying to wait, but he came over and it just happened,” recalls the Toronto-based digital media editor. “I remember thinking afterwards, Oh, we shouldn’t have done that.” She was on the pill, so although she had a pack of condoms in her nightstand, the couple didn’t use one. “He seemed like a nice guy,” she says. “I could have stopped him, but I didn’t. And after that, we got serious pretty quickly and I thought, Well, now we’re a couple and I’m on the pill and he’s healthy, so let’s keep doing it this way.”

If this story line sounds all too familiar, you’re not alone: In a new survey on sexual health, more than half of the respondents admitted to occasionally skipping condoms in a casual or non-exclusive relationship, while less than a quarter wait until both parties have been tested for sexually transmitted infections (STIs) before tossing the Trojans. “We are the queens of denial when it comes to notions of passion and romance,” says Lucia O’Sullivan, a psychology professor at the University of New Brunswick in Fredericton who has done extensive research on sexual risk-taking.

While there are no official statistics on just how many Canadian women are having unprotected sex, the massive U.S. National Survey of Sexual Health and Behavior released last year found that condoms are used for only one in four acts of vaginal sex—a figure that closely mirrors those found in FLARE’s own survey, as well as O’Sullivan’s research. “Pretty much universally you’ll find that a small majority report using condoms,” she says, “but relatively few do so consistently.” And attitudes about safe sex seem to be getting increasingly lax, according to a recent study done to mark World Contraception Day: In the U.S. (Canadians were not surveyed), the number of sexually active young people (ages 18–24) who have had unprotected sex with a new partner rose from 38 percent in 2009 to 53 percent in 2011. The most common reasons given for skipping contraception: not having it available in the heat of the moment; a partner’s preference to forgo it; and alcohol-fuelled forgetfulness.

At the same time, certain STIs are spreading faster than the latest YouTube video gone viral. While HIV infection rates have stayed relatively flat, cases of chlamydia—the most common STI in Canada—jumped by 80 percent between 1999 and 2008, with women more than twice as likely as men to report infection. Over the same period, infection rates for gonorrhea rose by 116 percent, with rates for women ages 30–39 jumping by a whopping 287 percent. (There has also been a dramatic uptick in syphilis in the past decade, but six and a half times more men than women report infection.) Actual numbers for all STIs are likely even higher, since many people have no clue they’re infected, says Dr. Howard Njoo, director general of the Centre for Communicable Diseases and Infection Control at the Public Health Agency of Canada.

What’s worse, many STIs can have serious effects on our reproductive health if left undetected. Yet in our survey, less than one-quarter of women said they get tested regularly for STIs (aside from Pap smears, which screen for abnormal cervical cells caused by HPV), and few of us talk openly with our partners, doctors or even friends about our sexual health. “We consider STIs the most shameful things possible, yet we get infections—like colds and warts—from other people all the time,” says O’Sullivan. To protect ourselves, we have to get the frank facts. Here’s what you need to know.

While it’s easy to assume there’s a connection between skyrocketing STI rates and the hookup culture glorified on shows such as Jersey Shore or Gossip Girl, none of the experts we interviewed would pin Canada’s current chlamydia and gonorrhea epidemic on how sex is portrayed in television and movies. Instead, many chalk it up to safe sex fatigue.

“Fifteen years ago, there was much more concern about HIV,” says Stephanie Mitelman, a sexual health educator and instructor at Concordia University in Montreal. “Now there’s much more complacency.” Dr. Mark Yudin, a staff obstetrician and gynecologist at St. Michael’s Hospital in Toronto, agrees: “The safe sex message was so strong for so long that I think people got bored with it.” What’s more, HIV treatments have radically improved over the past 15 years. “These days, someone with HIV can lead a long, healthy and productive life,” he says. “That’s fantastic news, but I think it’s caused people to let down their guard a little.”

This complacency may actually be contagious. “Generally, if you think your friends are engaging in something, ultimately your chances of doing it are higher,” says O’Sullivan. Indeed, FLARE survey takers who believed their friends were having unprotected sex were 72 percent more likely to have it themselves. You don’t even have to be right about what others are doing—you can still be swayed by your misconceptions.

But while we may not be losing a lot of sleep over the risks of infections, getting knocked up is another story. “[That] would be worse than getting an STI,” says Chloe. (She remains both STI- and pregnancy-free.) “Disease is still [taking] the back seat to pregnancy,” confirms O’Sullivan. “Unfortunately a lot of people think, Well, I’m on the pill, so I don’t need condoms anymore. And that’s where things get messy.”

For Amy*, a 33-year-old office administrator in Toronto, messy came in the form of chlamydia. “When I was younger, I was really promiscuous,” she says. “A lot of it had to do with drinking—I wasn’t making very good decisions.” (That’s another common scenario: 43 percent of FLARE survey takers who have had unprotected sex say that alcohol influenced their decision.) Amy, who was on the pill for most of this time, never felt confident enough to push the issue of condoms, and she was diagnosed with chlamydia following an annual physical.

“It absolutely devastated me. I felt dirty,” says Amy, who didn’t experience any symptoms before her diagnosis. “I had been sleeping with several people, none of whom really cared about me. So it was a huge wake-up call.” (It’s crucial to note that STI testing is not necessarily included as part of an annual physical; see our “Speak Up to Get Screened” sidebar, page 74, for details.) A round of antibiotics got rid of the infection, but the stigma associated with having an STI stuck around. “I went back and told the people I had been with, which was awful because they probably thought it was me who passed it to them,” she says. “I didn’t have sex for a while after that.”

These days she’s much more diligent about carrying condoms and making guys use them, but Amy admits that it can be a problem when it impairs her partner’s performance. “In my current relationship, half the time he’ll go soft after a few minutes [in a condom], which is annoying for me and for him,” she says. “So we’ve had unprotected sex because of that.”

“Non-use is really a couple dynamic,” stresses O’Sullivan. “A lot of women don’t like condoms either.” Accordingly, 40 percent of FLARE survey respondents say the fact that they hate how condoms feel is their biggest barrier to using them. But perhaps the number one motivator behind the decision to go bare is a misplaced sense of trust in our partner—either by accepting his word that he’s clean and monogamous, or never bringing it up in the first place.

That was the case for Brooke, a 32-year-old customer service representative. “I slept with my friends, people I had known for years, and I didn’t have one-night stands,” she says. “I thought that made me safe.” Instead, she was diagnosed with HIV when she was newly married and 11 weeks pregnant. (Screening is standard for pregnant women.) She’s still not certain who infected her—her husband remains HIV-negative—and gave birth to a healthy baby boy last summer. But breaking the news of her diagnosis to her parents was hellish, and the meds she must take for the rest of her life made her sick for much of her pregnancy.

Instead of feeling sorry for herself, though, she’s furious that she wasn’t tested for HIV sooner. “I don’t think [doctors] give enough information to young women about how real the risks are of any disease,” she says. “If we’re not told, then we’re in the dark.” She’s also on a mission to encourage more infected women to speak up about their status, and would like to see a female celebrity come out as HIV-positive. “Someone famous has to have it,” says Brooke, who is writing a memoir about her experience. “If you sit there and shut up, how will other women know to wear condoms and get tested?”

Never mind a celebrity spokeswoman; it would be a start to see movies like No Strings Attached or Friends with Benefits make more than a passing reference to safer sex. Many of us in real-life casual relationships aren’t talking about this stuff either: While more than half of the women in our survey say they’ve had a “friends with benefits”-style arrangement at some point in their lives, only 30 percent make it a policy to always ask a new partner about their bedroom history.

And even in the rare occasion that STIs are portrayed on TV or in movies, the story is usually about HIV—even though we’re statistically way more likely to catch chlamydia, gonorrhea or HPV.

“I think we should worry about all STIs, because they all have their problems,” says Dr. Yudin. “But chlamydia is the most common STI in Canada by far, and many times it can be asymptomatic, which is something women need to think about.”

Left untreated, chlamydia and gonorrhea (both infections of the cervix) can rise to the uterus, the fallopian tubes and even the ovaries, leading to pelvic inflammatory disease (PID). Aside from being incredibly painful, PID can cause infertility and ectopic pregnancy, serious complications that “maybe aren’t as much on the radar screen in the right here and right now,” says Dr. Yudin.

Though its infection rates aren’t tracked by the Public Health Agency of Canada, HPV is also incredibly prevalent. Some strains of the virus don’t come with symptoms, while others can lead to genital warts or, in rare cases, certain types of cancer such as cancer of the cervix. (More than 40 strains of HPV can be transmitted through sexual contact, even with condom use.) And though HPV vaccinations such as Gardasil are marketed toward girls and young women, Dr. Andrea Lobo of Planned Parenthood Toronto stresses it’s not too late for older women to take advantage. Gardasil, which protects against four types of HPV, is now approved for girls and women ages 9–45 in Canada.

While most STIs are curable—or, in the case of incurable viral infections such as HPV, herpes or HIV, manageable—it’s crucial to get tested regularly: at least once a year if you’re monogamous, and more often if you’re not. A good rule of thumb? Get screened before hooking up with someone new. Above all, remember that a sexually transmitted infection can happen to anyone and shouldn’t be a source of shame. “That’s one of the main reasons people won’t do the necessary homework to ensure they’re healthy,” says O’Sullivan. “If we could remove some of that stigma, it would serve us very well.”

*Name has been changed