Ask Dr. LauraColumns

Ask Dr. Laura: Gettin’ Kinky and PrEP

Share with your friends










Submit

Dear Dr. Laura,

My girlfriend and I have been together for five years. I recently was thinking about exploring some kinky things, but I’m afraid of bringing it up in the wrong way. How should I go about this?

Dear Kinky Canoodler,

Congrats on your relationship! Sticking it out for that long is an awesome achievement. You’re probably feeling like you know everything about each other at this point, right? So introducing something totally new can seem daunting and scary. You might feel like you don’t want to rock the boat at this point, but you are still hankering for something more. So let’s get some communication ideas rolling!

I get this question quite often, and whatever the flavor of kink or exploration is on the table, there is always concern about vulnerability. First of all, let’s address that kink is a wide variety of things. It can be everything from bondage to sensory play to torture and masochism. A very wide range! Fetishes are also often lumped into the term “kink,” and that can be everything from feet to feces…literally. So the very first step is to figuring out what you are thinking of when it comes to introducing kink into your relationship.

A lot of the feminist porn sites I mention in my previous column can give you some visuals on what that might look like. There are also sites solely dedicated to all things kink, such as kink.com and fetlife.com. Do some looking around and then make a YES/NO/MAYBE list (there are many good templates online). I do this with every new partner I have, whether they are vanilla or any flavor of kink. It really helps you understand both what you really desire from that person and what your partner is craving as well, plus the boundaries within that framework.

Now that you know what you want, educate yourself. What are the risks and benefits of these practices? What will you need to do to ensure safety and consent? Do this before bringing it up with your partner so that you are fully informed and aware of what you are presenting and so that you can answer any questions she may have.

Okay, so now how to discuss what you have come up with. Begin by discussing the idea of adding things to your regular sexual routine. Even if everything has been going amazingly, you might find that your partner has been wanting to add things, too. Make a quiet time and place to introduce the topic, maybe over a romantic dinner at home or when you are snuggled up before bed. Then ask them to make their own YES/NO/MAYBE list without seeing yours first. This takes the pressure off having to make them align. Lastly, share what you both wrote without any expectations. Find what overlaps and go for trying those things first. If you both have a “maybe” that is the same, do more research on those activities to feel them out (pun intended). Any NOs must, and I repeat must, be fully respected. Do not try to convince or manipulate your partner to making something into a maybe. As time passes and you go down your list, you may want to revisit and make a new list and discover your likes and dislikes more closely align or not. Either way you have grown in understanding and appreciating each other, and that means everything.

In Sex Positivity,

Dr. Laura

Dear Dr. Laura,

I am a gay man, and I keep hearing about the medicine PrEP. Is it as safe as a condom? Thanks.

Dear Pleasantly PrEPed,

Yay for the word being spread about PrEP! I love to know that folks are getting the word out about positive sexual health practices. PrEP is still pretty new on the market, so some people know a lot about it, while others are just learning. Let’s help you get informed!

PrEP stands for Pre-Exposure Prophylaxis, and it is a combination of HIV medications that help prevent the transmission of HIV. This means that if you take it when you are testing negative for HIV, you will have a drastically reduced risk of catching the virus from a positive partner. The first number of both national and international trials on PrEP showed an essentially 100 percent protection for transmission. For reasons that should be beyond obvious, this was both revolutionary and incredible! Everyone got super excited, and a new era of hope for reducing new cases of HIV was ushered forth.

Now for a little bit of a reality check. While there was an almost complete protection rate in those first studies, this only occurred in participants who took the medication EXACTLY as directed. That means if you miss a pill, the risk goes back up. Lots of people forget where their keys are and what meetings they have scheduled on a daily basis, so even with incredibly important things like a daily medication, it is only natural to miss a few here and there (just ask people who take a daily birth control pill). The second big issue that came with PrEP was that many people took it IN PLACE of using condoms. This is a major problem for two big reasons. First, as I just said, nothing is 100 percent effective. While those first few studies saw results that seemed miraculous, more recent research is showing the possibility of PrEP-resistant HIV strands which may lower its effectiveness over time. Secondly, condoms protect against a myriad of other STDs. When PrEP became more popular, so did increase cases of STDs like syphilis. This is likely because people who feel relieved at their lower risk of HIV have forgotten that they still need to be safeguarded against all the other bacteria and viruses that are roaming around out there.

PrEP is an incredible creation of modern science and medicine. It has surely helped tons of people stay HIV negative and have more relaxed intimate interactions with their HIV-positive people they love. Anything that helps people relax and stay healthy in bed and in love gets a big thumbs-up from me. Just remember that condoms are still key to safe intercourse of any kind and that consent and communication are always essential to a mind-blowing sex life!

In Sex Positivity,

Dr. Laura

iPrEX: Grant RM, Lama JR, Anderson PL, et al; iPrEx Study Team. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010;363(27):2587-99.

TDF2: Thigpen MC, Kebaabetswe PM, Paxton LA, et al; TDF2 Study

Group. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 2012;367(5):423-34.

Partners PrEP: Baeten JM, Donnell D, Ndase P, et al; Partners PrEP Study Team. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 2012;367(5):399-410.

Bangkok Tenofovir Study: Choopanya K, Martin M, Suntharasamai P, et al; Bangkok Tenofovir Study Group. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2013;381(9883):2083-90.

Comments

comments

Share with your friends










Submit

Laura McGuire

Dr. Laura McGuire is certified as a sexuality educator through the American Association of Sexuality Educators Counselors and Therapists.
Tags
Show More

Related Articles