WOMEN'S SEXUAL HEALTH

HIV AND SEX

CAN I STILL HAVE SEX?

Yes. Sex can be enjoyed just as much after HIV diagnosis as it was before, with either long- or short-term partners.

SAFE SEX

Safe sex means recognising that there are a variety of types of sex and partners. Whether you identify as a woman, a trans woman (pre- or post-op), non-binary or don’t identify, the best way to protect yourself and your partner against HIV and other STIs is to:

• use a condom (internal or external) for vaginal or anal sex
• use a water-based lube with the condom
• use a condom or dental dam (a latex square placed over the genitals or anus) for oral sex

WHAT CAN I DO TO PROTECT OTHERS FROM HIV?

For it to be as safe as possible for your partner to not wear a condom, the following provisions are essential:

• If you haven’t started HIV treatment you should make sure male partners wear condoms during sex
• You take combination HIV medication as prescribed
• You have had an undetectable HIV viral load for at least six months
• Both you and your partner are free from other STIs

SHOULD HE WEAR A CONDOM?

If the provisions listed are followed, it is you and your partner’s choice to decide whether to use condoms.

WHAT ARE THE BENEFITS OF USING A CONDOM?

Condoms are the best way to protect you and your male partner from unwanted pregnancy, HIV and other sexually transmitted infections (STIs). This includes bacterial infections like gonorrhoea or viruses such as herpes.

When both partners have HIV, it is still important to use a condom because:

• Your partner may have a resistant strain of HIV that your HIV medication does not protect you against
• There are two types of HIV which are found within different communities: HIV ‘type 1’ and ‘type 2’. Although type 2 is rare, it is important to check that you both have the same type

SHOULD I TELL MY PARTNER?

There are many benefits in talking about your diagnosis:

• You and your partner can make informed choices about sexual activities
• Being open and honest can do wonders to promote better emotional health
• Often, the reactions from those who you tell can be more positive than you may have thought. This can open up your support network
• There may be a legal requirement in your country to disclose your status
• One thing you (and they) may not realise is that if you’re on effective treatment and have an undetectable viral load, the likelihood of you passing on HIV to others is significantly reduced
• If you are newly diagnosed, you may wish to advise recent sexual partners to take an HIV test

Are there any negatives?

It is helpful to think about the different reactions partners may have hearing about your HIV diagnosis:

• Hopefully your partner will be supportive but it's always possible that they may react negatively
• They may not be aware that if you are on effective HIV treatment and your HIV viral load is undetectable, the likelihood of you passing on HIV to others is significantly reduced

If your situation is particularly difficult and you are concerned about domestic problems or violence, you should ask your healthcare team if there is any specialist guidance or support available to help you make your decision or manage negative reactions.

CONSIDERATIONS FOR TRANSGENDER WOMEN

Whether you have had lower surgery or not, the best way to protect yourself and your partner against STIs and HIV is to:

• use a condom (internal* or external) for vaginal or anal sex
• use a water-based lubricant with the condom
• use a condom or dental dam (a latex square placed over the genitals or anus) for oral sex

If you have undergone lower surgery, there are some considerations to keep in mind to protect both yourself and your partner from STIs and HIV:

• If your vagina was made using skin from your colon (known as an intestinal implant or colovaginoplasty) you may be more at risk of contracting some STIs, such as chlamydia and gonorrhea, as intestinal skin is a mucus membrane and some STIs can penetrate it more easily. Therefore, during sexual activity you should always use a condom for vaginal, anal, and oral sex, and a dental dam* (a latex square placed over the genitals or anus) for oral sex.
• If your vagina was created using penile and testicular skin, although it is less vulnerable to STIs, if the skin tears you are still at risk of contracting an STI. Therefore, using a water-based lubricant with a condom or dental dam can help reduce your risk of contracting an STI.

If you are undergoing surgery to create your vagina using penile and testicular skin, it is important to fully treat any warts you may have, and ensure they are fully cleared before your surgery as these can continue to grow inside your vagina.

*Please use a condom that is right for you. Not all transgender women can use internal condoms.

RECOMMENDATION FOR SEXUAL HEALTH SCREENING

The recommendation on how frequently you have a sexual health screening is dependent on the number of people you have sex with. If you have casual sex, it is recommended you get checked at least every six months, and if you have lots of sexual partners it is recommended you get checked at least every three months. If you have one sexual partner it is recommended that you have a sexual health screening at least once every year. However, if you or your partner has been at risk of contracting an STI or HIV, or show any symptoms that could be an STI (i.e. inflammation, discharge, sores) it is recommended you and your partner visit a clinic to have a sexual health check as soon as possible, and avoid having any type of sex until you have a clear test result.

SHOULD I TELL MY PARTNER?

There are many benefits in talking about your diagnosis:

• You and your partner can make informed choices about sexual activities
• Being open and honest can do wonders to promote better emotional health
• Often, the reactions from those who you tell can be more positive than you may have thought. This can open up your support network
• There may be a legal requirement in your country to disclose your status
• One thing you (and they) may not realise is that if you’re on effective treatment and have an undetectable viral load, the likelihood of you passing on HIV to others is significantly reduced
• If you are newly diagnosed, you may wish to advise recent sexual partners to take an HIV test

Are there any negatives?

It is helpful to think about the different reactions partners may have hearing about your HIV diagnosis:

• Hopefully your partner will be supportive but it's always possible that they may react negatively
• They may not be aware that if you are on effective HIV treatment and your HIV viral load is undetectable, the likelihood of you passing on HIV to others is significantly reduced

If your situation is particularly difficult and you are concerned about domestic problems or violence, you should ask your healthcare team if there is any specialist guidance or support available to help you make your decision or manage negative reactions.

CAN HIV AFFECT MY SEX DRIVE?

Possibly, but sex drive changes are common amongst people with or without HIV for reasons entirely unrelated to HIV. It is also more common to happen as you age.

It doesn’t affect everyone’s sex drive, however, HIV can increase the likelihood of a low libido in the following ways:

• Vaginal dryness or thrush, pain or severe pre-menstrual syndrome (PMS)
• An HIV diagnosis can often be stressful; stress can have an impact on sex drive and ability to relax during sex
• Early menopause (the end of your menstrual cycle). This is as a result of abnormal production of the female hormones progesterone and oestrogen. Oestrogen and testosterone levels fall significantly during and after the menopause, and can cause a reduction in sexual desire. Visit the menopause page for more information

If you are concerned about changes to your sex drive, discomfort during sex or any other sexual problem, speak to your healthcare team for advice.