Learning begins in bed

Dear Readers, June is here, and gay pride is in the air for a lot of reasons. I hope that you are finding the atmosphere conducive to healthy bodies, healthy minds, and healthy relationships. The letters in this column cover a variety of topics, and a few answers contain the suggestion that the writer see her physician or gynecologist. There is a lot of information that gets passed along when the patient and the doctor are face to face, information that is lacking when I am responding to a letter. I realize that, for some of you, it is very hard physically or financially or emotionally to see a physician with some of the issues you bring to me. Nonetheless, my advice and suggestions should not be viewed as the ultimate medical advice for those who write with medical concerns. I offer honest opinions and back them up with facts and experience, but I do hope that those whose issues indicate the need for medical attention will try to get it. And not just on the Internet! Keep the letters coming. As many of you know, I am not prompt, but I will write back! Best regards, and stay healthy, Susan Ball, M.D.

Send your questions to Dr. Ball at:DrBall@advocate.com

To start off, I wanted to include part of a letter that I received in response to my last column. I really appreciated the thoughtful response and hope that you will too: Many thanks to the "cunning linguist"!Regarding your response to the woman whose partner did not want to perform oral sex on her, I agree with you that her use of the term "eating me out" was really tacky and might be contributing to her girlfriend's reticence to try oral sex. But I think you shortchanged her in the advice department. With your permission, I'd like to offer what I've learned from my own experience and from some therapists and sex-positive books. First of all, as women, we get such negative messages about our genitalia from our culture from the time we are little girls--like being told we smell bad or not to touch ourselves "down there"--that it sometimes takes a conscious effort to embrace and enjoy giving oral sex to another woman at first. My life partner, whom I've been with for five years, came out later in life and had never been with a female lover previously. As you might imagine, the idea of performing oral sex was daunting to her at first. I tried to be sensitive and patient with her in this regard--the one thing you should never do is pressure someone into something they don't feel like doing or it will be a turnoff to them for sure! Talk about how she feels and why it's scary for her. A lot of women (myself included at first) are afraid they will find the scent of a woman's natural vaginal secretions off-putting. It really helps to take a shower together before having oral sex. You can even do it in the shower, bath, or hot tub the first few times. That's a great way to get used to the enjoyment of the sensations you feel with your tongue and lips. Later you can adjust to her scent and taste when it does not seem so daunting. I'm happy to say that my life partner now enjoys performing oral sex as much as receiving it--and it's hot for both of us. --A formerly skittish, now confident, cunning linguistHere are some new letters:Thank you for your informative and respectful columns and advice. I have a question that I am sure has been asked previously, but I have been unable to find a suitable answer. I am a 25-year-old lesbian with only a fair amount of sexual experience. I have slept with only two women, and I have only recently begun to feel really comfortable with sex. For example, I now feel like I know what I am doing well enough to feel secure in sexual situations. Anyway, to the question: Without any outside help, I have reached orgasm masturbating. A few times I did with the women I dated, though I was not very physically attracted to either of them. With my vibrator, however, I enjoy fabulous orgasms, and during 99% of these I ejaculate. While I did see the episode of Sex and the City where Sam's girlfriend ejaculated, I am neither familiar with the normalcy or frequency of female ejaculation nor the physiological process behind it. Furthermore, I have been dating a woman now for a bit, but we have not had sex yet, and now I am wondering what might result if ejaculation is a feature of my orgasms. If so, would the absence of it mean that I did not come?--C Dear C: Well, not all women ejaculate--and most don't ejaculate all the time when they have orgasms--so if you don't ejaculate, it doesn't mean you didn't have an orgasm, but you should be able to determine this without my help. Sometimes women ejaculate but don't have their full orgasm. Other times it is the reverse. Female ejaculation is certainly much less common than it is in men, for whom ejaculation is endemic to the process of orgasm. Female ejaculation is not well understood, but clearly some women experience a lot of it whereas others do not. This doesn't mean one has a better orgasm than the other. I hope that this is helpful to you. Have fun!I saw your column on Advocate.com and was wondering if you could help me. I am an abstinent lesbian and have been for a few years now. I want to wait for "the one." I masturbate occasionally to make up for it. My problem is, frequently after I masturbate I get these horrible cramps. I also get them if I'm really stressed or nervous. I have gone to several doctors, and they can't seem to find anything wrong. I'm tired of living with this pain and would be grateful for any help you can give. --M Dear M: Thank you for your letter. I asked my GYN consultant about your problem. She said that it sounds like muscle spasms and suggested you try taking a nonsteroidal anti-inflammatory agent (like Motrin or Advil or ibuprofen) a little while before you engage in this activity. I think that you will find it helpful. You can also do some deep-breathing exercises that will improve the blood flow and oxygenation to those cramping muscles. Good luck!Hello. I am a 31-year-old female. I have had cold sores since early childhood. Recently, my partner has been diagnosed with shingles. Her rash is on her pelvic area. We have never been intimate while I have had a breakout. Is there any possibility that my cold sores contributed to her shingles? --T Dear T: Cold sores are caused by herpes simplex virus (HSV) I or II. Generally, oral herpes is caused by strain II and genital herpes by strain I. Shingles is caused by Varicella zoster virus, which is in the herpes virus family but is not simplex. If your girlfriend's outbreak has been cultured and is definitely Varicella zoster, then it is not at all related to your cold sores. On rare occasions, HSV can cause an abscess-like lesion (herpetic whitlow), but this doesn't look like shingles, and the two aren't confused. Outbreaks of shingles come from latent chicken pox infection and can occur when people are immunosuppressed, as may occur when they have the flu or diabetes or in cases of HIV infection or chemotherapy regimens. Sometimes shingles is a totally random event, just popping out of nowhere. People with shingles need to stay away from pregnant women or anyone who hasn't had chicken pox or been vaccinated against it. Having said that, it is important to know that your herpes infection can be transmitted even when you do not have an outbreak. Most cases are. So while you did not cause the shingles, it's important to be aware that you can still potentially transmit herpes. I hope this is helpful for you. Good luck!I had anal warts removed in March. I have never had anal sex in my life! I am in the process of starting a new relationship. I will tell her I have HPV, but what kind of risk am I putting her in? I have had a follow-up--no warts at all. So, what are her chances of getting the virus? --T

Dear T: HPV is very easily transmitted, and warts are just one manifestation of it. Many types of HPV have no symptoms at all. So not having warts doesn't mean you don't have HPV. The warts (also known as condyloma) can be treated; the HPV usually clears up on its own within 12-24 months. Many people have anal condyloma without having had anal intercourse. Just contact (hands, penises, toys) can do it. The most important thing is to get a PAP test to make sure you don't have the kind of HPV that can lead to cervical cancer. There are over 80 different kinds of HPV, and most are totally without symptoms, but a few cause warts, as you know, and a few cause changes in the cervical tissue that can lead to cancer. Bottom line: It is very hard not to spread HPV, but in most cases the transmission goes entirely unnoticed. Getting regular check-ups is an important way to keep track of the rare instances in which HPV does cause problems. Good luck! My girlfriend and I are seniors in high school, and neither of us have ever had sex with anyone but each other. We are still in the closet as a couple because of parental problems, so, of course, an STD would especially suck right now. We've tried to find answers and can't ask anyone else. If we are completely clean, can we develop any disease from oral sex? We know that vaginal fluids can lead to hepatitis, but is that only if you are infected? --A Dear A: I hope that your relationship is going well. There are very few infections that you would need to be concerned about if both of you have only ever had sex with each other. You need not worry about things like HIV or gonorrhea or syphilis. But you are right that hepatitis B and C are both potentially transmitted through sex (usually with blood-to-blood contact or in the presence of some kind of vaginal sore). But if neither of you has hepatitis, then you cannot give it or receive it from each other. Herpes simplex can be transmitted if one of you has a cold sore or fever blister and you have unprotected oral sex with your girlfriend. If neither of you has ever had an oral lesion, then you will not transmit it. But if you have, there is a low but not insignificant risk that you could give your herpes infection to your girlfriend, even in the absence of a sore (this is called asymptomatic viral shedding). The only way to absolutely protect against STDs is to consistently use protection. This is not always convenient, but that is the reality. The bummer about herpes is that most people who have it don't even know it because they never knew they had an outbreak. I won't say not to worry about it, but if you are careful not to have sex or kiss a lot if one of you has an oral lesion, then the chance of transmission is less.