America is in the middle of a silent-but-huge sexually transmitted infection (STI) epidemic. HIV/AIDS transmission rates seem to be on the decline, but chlamydia, gonorrhea, and syphilis are surging across the nation. According to recent Centers for Disease Control and Prevention (CDC) data, in 2017, Americans contracted about 1.7 million new cases of gonorrhea. That’s 100,000 more than in 2016, itself a record-breaking year for infections, and about twice as many as in 2010.
They contracted over 555,000 new cases of gonorrhea, again 100,000 more than in 2016 and a spike up of over two-thirds since 2013. And they contracted over 30,000 new cases of syphilis, 2,600 more than in 2016 and four times as many cases as were reported in 2000. And those are just a fraction of the 20 million new STIs contracted in America every year—that we are able to detect. All told, experts agree half of all Americans will likely contract an STI by the time they hit age 25.
No one knows for sure why STI rates are spiking. Some argue we’re just getting better at detecting infections. Some worry innovations in HIV prevention have made people lax about protection in general, as other STIs seem less serious. (In truth, chlamydia and gonorrhea can sit, symptomless, in one’s system for quite some time, and cause major health issues down the line. Gonorrhea is also increasingly resistant to standard antibacterial treatments, making it seriously troubling.)
But most accounts of America’s STI landscape point towards the reality that, as a culture, we deprioritize, underfund, and just generally suck at sex education. We aren’t great at personal conversations about sex either. And we stigmatize issues of sexual health, assuming anyone who suffers a sexual ailment has done something irresponsible.
This lack of education and open conversation goes a long ways to explaining many troubling gaps in the average American’s sexual health knowledge, which may help to spread infections and diseases. Like awareness of the risk of asymptomatic STIs, of STI transmission through oral sex, and of catching some diseases, like herpes, through skin-to-skin contact that a condom or dental dam might not cover. This stigmatization may explain why so many people who contract an STI don’t tell their partners or seek timely treatment. Both factors may explain why so few people get tested regularly—and why nearly half of the population has apparently never been tested.
However, at least a few groups in America are extremely competent and proactive when it comes to managing their sexual health. That, of course, typically includes people like medical experts and sexual health educators. It also includes sex workers, like porn stars.
Porn performers are not flawless when it comes to sexual health. Despite industry protocols, like requirements that stars test for STIs every 14 days, many will suffer infections from time to time. There are even periodic HIV scares in the industry. Still, performers depend on their sexual health to make a living and therefore, says star Kiki Daire, “have to take extra care of our bodies.” They are forced to speak openly and often about sexual health with their colleagues and their doctors. And they take more preventative measures, as performer Larkin Love points out, than much of the general population. It is also worth noting, says porn star Brenna Sparks, that “in the rare event a performer in the industry shows the slightest evidence of a disease, all production comes to a complete halt until everything is contained,” keeping risks relatively low.
“I have always taken sexual health seriously,” says star Kimmie KaBoom. “But I have learned that the adult industry is probably the most aware and safest when it comes to overall sexual health.” In some cases, particularly knowledgeable and long-working performers may even arguably (and sadly) have more practical knowledge about sexual health than some doctors.
The tools and tactics adult performers use to stay clean and healthy aren’t just relevant to their profession, either. Again, they are not perfect, and not everything they have to say will be relevant to every reader. But their insights on sexual health management are a strong guidepost for anyone, especially those who are sexually active with multiple partners, on how to protect themselves and others. Below, several performers share their thoughts with VICE about how people in the general public can stay sexually healthy, happy, and safe.
What do you see as the biggest mistakes the general public makes about sexual health?
Riley Reyes : [Most people] only go [to a doctor] if they have symptoms or think they caught something. You can get an STI, even from someone you trust, and even from oral. Many STIs can be asymptomatic. Most infections are spread by people who don't know they have them. [Also,] a lot of people are willing to have unprotected sex without doing their due diligence. Just loving or trusting someone is not a good reason to have unprotected sex.
Larkin Love The number of people I know in 2018 who say that they don't want to get tested because they're afraid of knowing the results is horrifying.
Brenna Sparks Not getting tested and not wearing protection. Also, poor hygiene. Your poor hygiene could actually lead to your partner getting a UTI, even if you don't have one. So keep that in mind and be considerate. Males should make sure they keep their [penises] clean. Females need to keep up with cleaning their vagina. Uncircumcised males need to make sure urine or semen is washed immediately. Sex toys need to be kept clean [too], as they are responsible for many issues as well like UTIs.
Why do you think it is so hard for so many people to tackle sexual health issues?
Kiki Daire: [Because our culture treats] sex and our genitals as something dirty, not to be spoken about. [That] leads to a lot of health issues. Not to mention [the] lack of education [among] our youth. We aren't taught from a young age that sex is natural, healthy, and as such needs to be talked about. Testing isn't something that is normal to most people sadly.
Riley Reyes: There is still a lot of shame and stigma attached to STIs. Like they can only be contracted by someone who is dirty or immoral. Anyone who is sexually active can get sick. It's just like getting strep throat, or any other contagious infection. These things can happen. And if you go to a doctor, you can get treated.
Kimmie KaBoom People don't have an open line of communication with their partners.
What has working in the adult industry taught you about protecting your sexual health that you didn’t know before you entered it, or might not have learned otherwise?
Kiki Daire: Oh my goodness… I learned pretty much everything I know [about sexual health] from being a sex worker, out of necessity.
Brenna Sparks: The importance of maintaining your health, for your sake and others. To get tested often when you’re engaging sexually with anyone, even a long-time partner. There are many ways of contracting diseases. [Being] with someone for a while does not mean anything.
Lola Fae : I've learned that I can speak up for myself! I knew this before. Porn just reinforced this. If I'm sick, I can deny sex. I should, and will, deny sex when I am ill.
Riley Reyes: I have learned more about my vaginal flora than I ever would have otherwise. I've figured out the balance of my body, and how to maintain my pH so that my natural microbiome doesn't suffer. With this many partners, and this much sex, it's vital to stave off yeast infections and bacterial vaginosis.
Larkin Love:Bacterial vaginosis is a very real thing. It can even be caused if your body doesn't like a particular lube, condom, or partner. Anything that changes your vaginal pH.
What do you think people outside of the industry could learn from the way porn performers talk about, or otherwise tackle, their sexual health?
Larkin Love: The biggest thing to learn is to actually talk. Don't bury your head in the sand and assume that it will just go away.
Brenna Sparks: Promote the discussion [of sexual health with partners] in a casual manner. The topic doesn’t need to be about fear. [It] can be all-around interesting.
Johnny Goodluck : You need to set an incredible amount of importance to this [issue.] And you just have to get over the discomfort. It’s hard to talk to anyone about sexual health, even for performers! But it's so crucial to keeping yourself healthy, and people you engage with safe! You also have to communicate with your partner about your status, and theirs. If you care enough to have sex, why wouldn't you care enough to know if you, or they, are safe for sex?
Lola Fae: [Be] honest and blunt when speaking with doctors. Be as descriptive as you can be.
Larkin Love: There is nothing you can say to a health professional that they won't have experienced. It's not like they're going to punch you in the crotch. Your partner might. But they won't.
What, at a bare minimum, do you think people need to do to maintain their sexual health?
Brenna Sparks Testing twice a month is not in most people’s cards. But once every few months would suffice. Don’t sit there and think you’re doing yourself or everyone else a favor by sitting quiet. If you have concerns about anything, get checked out. Talk with a doctor. Be honest and detailed with them about your lifestyle. If you’ve been irresponsible, admit it. We make mistakes. We all are misguided about some subjects. Don’t let it get to you. At worst, the doctor will give you a small lecture on safety.
Kimmie KaBoom: It's really important to be tested when having your annual check up. More often if you are highly sexual active.
Johnny Goodluck: [Get] tested after every partner. The first time you get with someone, you should know that you are clean and safe to have sex, [and] they are clean and safe to have sex.
Lola Fae: Getting tested every three months, or every new partner. I always make a partner get tested before engaging in any sexual activity. If you meet someone who is unwilling to get tested, they aren't worth your sexual health! Use condoms if you absolutely must have sex with someone not tested. Pay attention to the way your body feels. Notice anything that comes out that may be abnormal. Women, watch your discharge, mucus, and your excretions. Men, watch your excretions, mucus, and please use an antiseptic soap before having sex if you have sex with multiple partners. Antiseptic soap will help kill bacteria that may affect your partners vaginal or anal biome. And pee before and after sex.
Riley Reyes: If you don't want to use barriers, you both need to get tested to assure you won't unknowingly spread an infection. You could even go together to the clinic. Make a date out of it.
Some doctors can be judgmental or ill informed about certain sexual lifestyles, though, especially those that involve multiple partners or non-normative activities. How do you find a doctor who will respect, rather than shame you for, your sexual habits?
Riley Reyes: Unfortunately, a lot of stigma comes from medical professionals. Performers often have to hide our profession from our doctor in order to get proper, nonjudgmental medical care.
Kiki Daire: [Many performers] tend to go to doctors that are OK with what we do and understand we need a different kind of care. My advice to the wider world would be to always look for people, from friends to health providers, [whose values] align with your values.
Brenna Sparks: [Take] great care in selecting a doctor when possible, instead of just going to any random one.
Lola Fae: If the doctor makes you feel shame in any way, walk out and refuse to pay that mother fluffer. Because they are not doing their job correctly. A good doctor will make you feel supported, inform you of how to solve the problem, and patiently answer your questions.
What else do you think people should keep in mind about managing their sexual health?
Johnny Goodluck: There is nothing more important than knowing you are free of disease. This will help your confidence in bed. Your partner [will] appreciate and respect your discipline. [And] it's not the end of the world if you contract something.
Lola Fae: Performers and civilians alike feel bad when diagnosed with an illness. We all need to do our part of being understanding, helpful, and resourceful. We must all take part in the education of ourselves and others to keep sex safe. I want to encourage people to open the doors to taboo conversations.
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