Vocal Health: helping the transgender community find their voice.

Literally.

One of the primary ways people express their gender is through their voice. Which is why it can be incredibly frustrating when you’ve transitioned but your voice hasn’t caught up. And while estrogen-based hormones don’t have an impact on your vocal chords, working with a vocal coach can feminize the tone and timbre of your voice.

We know that ‘trying on’ and ‘testing out’ a new voice will initially feel a bit strange (probably a lot like acting). But over time, your new voice will become second nature.

Voice plays a vital role

Voice features such as pitch, voice quality and inflection can signal a person’s gender to others. Which is why for so many transgender women, voice is one of the most crucial and often unguided aspects of transition, especially because oestrogen therapy cannot feminise the voice in trans women.

If you Google Male to Female Voice training, your search results will be flooded with “How To’s” and YouTube tutorials.

While these instruction videos might work for one person, there’s no guarantee they’ll work for another. In addition, medical experts warn that the voice is a muscle, and it can get injured or strained if not used properly. There’s also a risk that you pinch your voice without realizing because no one is there to guide and correct you.

Recent advances in voice therapy is making significant strides in helping to empower transgender women through their voice. Feminine-sounding voices are generally perceived as higher pitched, slightly breathier and with more varied inflection than masculine-sounding voices.

Voice therapy retrains the voice by retraining the brain and focuses on five parts of speech: pitch, intonation, volume, articulation and resonance.

The training also focuses on helping to feminize body language, facial expressions, and mannerisms.

The bottom line

Some people want to change how their speaking voice sounds as part of their gender expression. Others do not. It is your choice. For many, finding their voice is about so much more than just the way they sound and are perceived by others, it forms a vital piece of their identity. But, for those undergoing vocal training, it is critical to take your time and not push yourself too hard.

Remember you’re using muscles in a new way, which means they’re bound to get sore. Just as you can’t run a marathon on your first day of practice, you won’t be able to learn and perfect a female voice overnight. The most important thing is to look after yourself and your vocal chords!

Drink plenty of water, avoid overexertion, avoid raising your voice, rest your voice when tired, and allow adequate time to warmup and warm-down your voice.

Remember, patience is a virtue! “Rivers know this: there is no hurry. We shall get there some day.” ― A.A. Milne, Winnie-the-Pooh.

November is Trans Awareness month on our QWC sexual health calendar. In this series of articles we will aim to assist you in better undertanding the issues facing the Trans community.

Essential tips for tucking, strapping & packing

Whether it’s tucking, strapping or packing, we all have our own philosophies when it comes to our bodies that help us not only create our desired body shape but contribute to making us feel whole.  And with so many new products coming onto the market, it’s becoming even easier to express ourselves in a painless, comfortable, safe, and in many cases, a fashion-forward way.

The most important thing is to learn to love your body and embrace being your unique self. As Oscar Wilde famously put it – “Be yourself; everyone else is already taken”.  For many of us tucking, binding and packing is a huge part of our daily realities. But, like with everything in life, there are risks involved if not done properly. We outline key tips to keep in mind to ensure you stay safe (and away from the ER) when tucking, strapping and packing.

1. Chest Binding

Binding for so many is an absolute non-negotiable.  But, while chest binding can significantly improve mental health and anxiety, it can cause negative side effects. A 2016 study that examined 2 outcomes among people who bind found only 2.8% of individuals out of 1800 had rare and severe outcomes like rib fractures. This reinforces the fact that binding is not inherently harmful if the right precautions are taken.

Safe ways to bind include:

• Take a break every couple hours. Prolonged binding could cause adverse side effects including breast, back and chest pain, skin irritation, or fungal infections. The golden rule is to try to give yourself a break every 8 to 12 hours. Make sure you also avoid exercising and sleeping in your binder.
• Find the right fit. Wearing binders that are too tight will not only restrict your breathing but can cause tissue and muscle damage. Bodies change over time, especially if you’re on hormones. Make sure you wear a binder that fits your body comfortably and correctly and change the size when you need to. Trust us, you don’t want to be out somewhere and not be able to breathe!!
• Bind properly. Commercial binders, sports bras, strategic layering, and bandages, are the safest ways to bind. Do NOT bind your chest with duct tape or plastic wrap as this can damage your skin.
• Be careful how you wash it. Hand wash and air dry your binder regularly (Every few days). Make sure you don’t put your binder in the tumble drier as there’s a very high chance it’ll shrink.

2. Tucking

As with binding, tucking (no matter how you choose to tuck) needs to be done safely and comfortably to ensure no adverse and damaging side effects. Risks associated with improper tucking include skin irritation and discomfort, UTIs, dehydration, infections, and bladder and kidney damage.

Safe ways to tuck include:

• Don’t tuck for too long. Tucking for too long can lead to testicular discomfort and pain. As with chest binding, we recommend taking regular breaks from tucking.
• Be mindful of the tape you choose. Not all tape is skin safe to use, especially when it comes to sensitive skin. It’s therefore super important to choose the right adhesive to avoid chafing and skin irritation. We recommend testing a small area before full application. It’s also a good idea to shave the area where the tape will be used, so there’s no irritation or pain when the tape is removed.
• Keep it clean. The increased moisture caused by tucking can cause skin irritation, rashes, and infections. Make sure you keep the area dry and clean. Consider applying anti-fungal powder or creams to prevent odours and infections.

3. Packing

While packing comes with far fewer health risks than binding and tucking, a small percentage of people do report some negative side-effects from wearing certain prosthetics.

Safe ways to pack include:

• Be careful if you have allergies. If you’re allergic, be extra careful to check ingredients carefully when purchasing a prosthesis. We recommend purchasing silicone because it is non-allergenic and non-porous. Silicone is also much easier to clean.
• Store your packer carefully. You obviously want your packer to retain its shape which means storing it carefully as opposed to throwing it into a cupboard or into the bottom of your bedside drawer.
• Watch out for the adhesive. Be careful of the ingredients contained in the adhesives used to hold the packer in place. This is directly applied to the skin and can cause significant skin irritation, especially if you’re allergic.

The bottom line

Binding, tucking and packing are vital for so many for a variety of reasons.  Just make sure you do it as safely as possible to mitigate any potential health risks and side effects. So, what are you waiting for? Get outside and rock the look that makes you feel whole and happy. With a little tuck here or a little packing there, you do YOU! Above all, feel comfortable, be safe and take care.

HIV

Testing

Human immunodeficiency virus (HIV) testing determines whether you are infected with HIV. HIV is a virus that weakens your immune system and can lead to acquired immunodeficiency syndrome (AIDS).

HIV tests can check for antibodies that your immune system produces in reaction to the HIV infection. AN HIV antibody test is only accurate three months after exposure, because this is how long it takes your body to produce enough antibodies for it to show up in a test. Other HIV tests look for evidence of the virus in the body. Recently developed tests can produce results in minutes.

HIV testing is the only way to know for sure if you have HIV, and knowing your status means you can keep yourself and your sexual partners healthy. In addition, being diagnosed early gives you a better chance of living a long and healthy life, while allowing you to take control of your health.

 You should have an HIV test if you:

• have had unprotected sex
• have had multiple sex partners
• have recently been diagnosed with another STI
• have shared needles or other injecting equipment
• are worried about HIV and want to put your mind at ease

 If you are sexually active, it’s good to get into the habit of regularly testing for HIV.

 HIV Positive Medical Support

If your result is positive or ‘reactive’, you will need to give a blood sample to have your results confirmed.

For most people, receiving a positive diagnosis can be a shocking and emotional experience – this is completely normal. Your doctor is there to support you and to answer any questions that you have.

If you do have HIV, being diagnosed at an early stage will allow you access to treatment, allowing you to live a longer and healthier life. You can start taking antiretroviral drugs immediately, which will reduce the amount of HIV in your body and protect your immune system from damage. And with the correct treatment and care, those living with HIV can expect to live as long as the average person. Reducing the levels of HIV in your body also make it less likely that you will pass HIV in to your partner. In fact some people will find that the virus becomes undetectable in their system with treatment – this means that the HIV does not show up in normal blood tests.

Although there is no cure for HIV/AIDS, treatments have come a long way and provide an improved and extended quality of life for most, meaning a near normal life expectancy. Remember that HIV is now a manageable illness – the earlier you begin treatment, the healthier you can stay, while also preventing the onset of AIDS.

 How to get your Pep Prescription

 Post-exposure prophylaxis, or PEP, is an emergency treatment for HIV, to be taken after possible exposure to HIV to prevent infection. It’s a short four-week course of antiretroviral drugs that can stop HIV infection if taken properly. PEP is most effective at preventing HIV infection if you take it within 24 hours of exposure. The most important thing is to make sure you take PEP within the 72-hour window. It’s important to get tested after using PEP, to make sure the treatment was successful. You should test 3 months after potential exposure, and again 6 months after.

PEP is not taken if you already have HIV, or as a regular form of HIV prevention. If you face a prolonged risk of HIV, for example if your partner is living with HIV or if you regularly have sex without a condom with multiple partners, PrEP is a better choice for you.

PEP is only is available from doctors or the emergency department of a hospital. The Queer Wellness Centre will be able to prescribe Pep should you require it.

STIs

Common STIs

1. Hepatitis C

Hepatitis C is a viral infection that causes liver inflammation, which can lead to serious liver damage including cirrhosis, liver cancer, and liver failure. The hepatitis C virus (HCV) spreads when blood contaminated with the virus enters the bloodstream of an uninfected person.
Transmission can be caused by sharing needles, syringes, toothbrushes and more. Hepatitis C can also be acquired through sexual intercourse.

Hepatitis C can go undiagnosed for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease. Soon after getting infected, some people may get flu-like symptoms, nausea, or abdominal pain. Other signs and symptoms include:

• Fever
• Fatigue
• Dark-coloured urine
• Poor appetite
• Abdominal pain
• Nausea, vomiting or diarrhea
• Jaundice (yellow discoloration of the skin and eyes
• Joint pain

Risk factors

• Your risk of hepatitis C infection is increased if you:
• Have ever injected or inhaled illicit drugs
• Have HIV
• Are a health care worker who may have contact with blood
• Received a blood transfusion or organ transplant before 1992
• Were born to a person with a hepatitis C infection
• Have sex with an infected partner
• Received a piercing or tattoo in an unclean environment using unsterile equipment

Prevention

Unfortunately, there is no vaccine that you can get to prevent infection from the hepatitis C virus. However, there are precautions you can take to protect yourself:

• Do not share needles, syringes, or body piercing and tattooing equipment. Always use fresh sterile needles.Practice safe sex. Avoid engaging in unprotected sex with multiple partners. If you’re having sex with more than one partner, use latex condoms correctly and every time.
• Only use approved lubricants like water or silicone-based lube with condoms. Oil based lubricants can damage condoms and cause them to break.
• Sex toys should not be shared with multiple partners, and you should always put a condom over sex toys that are inserted. Sex toys should be washed before and after use.
• Don’t share personal care items such as razors, toothbrushes, cuticle scissors, or nail clippers.
• It’s also possible for hepatitis C to spread through accidental contact with an infected person’s blood. You should wear disposable gloves if you need to give someone first-aid treatment, or before cleaning contaminated surfaces.

Get Tested for Hepatitis C and Know Your Status

If you suspect that you’ve been exposed to the virus at some point, talk to your doctor about getting tested, even if you don’t have any symptoms.
Hepatitis C is diagnosed by blood tests. There are two types of tests to confirm hepatitis C infection: antibody test and hepatitis C PCR test. An HCV antibody test is used for initial tests, and if positive, an HCV RNA test is used to confirm the presence of the hepatitis virus itself.
If you have been diagnosed with HIV, you should have a hepatitis C test at least once a year.

Treatment of Hepatitis C

Hepatitis C can be treated and cured. Improved treatments are available which are highly effective at clearing the virus from your body, thus avoiding ongoing symptoms and liver damage from cirrhosis, liver cancer, and liver failure.
People who have had hepatitis C should investigate minimising further damage to their liver from alcohol and drug use.
Even if you are cured of hepatitis C, it is possible to be reinfected should you come into contact with the virus again. Unlike with hepatitis A and hepatitis B, you cannot develop immunity to the hepatitis C virus.
In order to access HCV treatment, it is necessary to see your doctor to discuss treatment options. The sooner you are diagnosed, the sooner you can get treated, and you have a better chance of being cured with early treatment.

I already have Hepatitis C

Hepatitis C is a contagious and serious liver disease. There’s no vaccine to protect against the virus, but with the right safety measures, you can prevent spreading the infection to others. If you do become infected, starting treatment can improve your liver health and lessen the likelihood of spreading the virus to others.
If you are living with hepatitis C and you cut yourself or have some other skin wound, cover it with sterile, waterproof dressing – be careful not to get blood on anything. Always wear a condom and use a water-based lube during sex. Make sure to dispose of soiled care items like bandages in a sealed bag.

2. Chlamydia

Chlamydia is one of the most common sexually transmitted infections you can get. It is caused by bacteria called Chlamydia trachomatis and it can infect both men and women in equal measure across all age groups. Women can get chlamydia in the cervix, rectum, or throat. Men can get chlamydia in the urethra (inside the penis), rectum, or throat. You may not know you have chlamydia because many people never develop any signs or symptoms, but chlamydia isn’t difficult to treat once you know you have it. If left untreated, however, it can lead to more-serious health problems, including infertility in both men and women, pelvic inflammatory disease, and ectopic pregnancy. Untreated chlamydia may also increase your chances of getting or giving HIV/AIDS.

Symptoms of chlamydia

Early-stage Chlamydia infections rarely cause any symptoms. When signs do start to occur it is usually a few weeks after exposure to the infection. Signs and symptoms of a chlamydia infection can include:

Women:

• Painful urination
• Vaginal discharge
• Lower abdominal pain
• A burning sensation when urinating
• Pain during intercourse
• Bleeding between periods and after sex in women
• Swelling in the vagina or around the anus
• Nausea or fever

Men:

• Discharge from the penis (pus, watery, or milky discharge)
• Testicular pain and swelling in one or both testicles
• Pain in the lower abdomen
• A burning sensation when urinating
• Burning or itching around the opening of the penis

Chlamydia can also infect the rectum causing rectal pain, discharge or bleeding.
It’s also possible to acquire chlamydial eye infections (conjunctivitis) through contact with infected secretions.
Both men and women can also develop reactive arthritis because of a chlamydia infection – this is a type of arthritis that happens as a “reaction” to an infection in the body.

How do you get chlamydia?

Chlamydia is most commonly spread during oral, vaginal, or anal sex with someone who has the infection. It’s also possible for a mother to spread chlamydia to her child during delivery, causing pneumonia or a serious eye infection in her new-born. Chlamydia can also cause premature birth.
If you’ve had chlamydia and were treated in the past, you can get re-infected if you have unprotected sex with someone who has it.

Risk factors

Chlamydia is more common in young people. You are more likely to get it if you don’t consistently use a condom, or if you have multiple partners.

Factors that increase your risk of a chlamydia infection include:

• Being sexually active before age 25
• Multiple sex partners within a short period of time
• Not using a condom consistently
• History of prior sexually transmitted infection
• Men who have sex with men

How is chlamydia diagnosed?

Lab tests are used to diagnose chlamydia. Your doctor may ask you to provide a urine sample. For women doctors may use a cotton swab to get a sample from your vagina to test for chlamydia.

Who should be tested for chlamydia?

You should go to your doctor for a test if you have symptoms of chlamydia, or if you have a partner who has a sexually transmitted disease. Those at higher risk should get checked for chlamydia every year.

Treatment of chlamydia

Treatment of chlamydia is very important as it can lead to serious long term health consequences. Antibiotics are effective in treating chlamydia and will cure the infection. You may get a one-time dose of antibiotics, or you may need to take medicine every day for 7 days. Antibiotics however cannot repair any permanent damage that the disease has caused.
To prevent spreading chlamydia, you should not have sex until the infection has cleared up.
Repeat infections are common, so you should get tested again approximately three months after treatment.
Depending on the test used to diagnose chlamydia, a person may also be treated for gonorrhoea because these two bacteria often occur together

3. Gonorrhoea

Gonorrhoea is a very common sexually transmitted infection caused by bacteria that can infect both men and women, and was commonly known as ‘the clap’. It can cause infections in the genitals, rectum, and throat. In females, gonorrhoea can also infect the cervix. You can get gonorrhoea by having vaginal, anal, or oral sex with someone who has gonorrhoea.

Abstaining from sex or always using a condom when you have sex, and being in a mutually monogamous relationship are the best ways to prevent sexually transmitted infections such as gonorrhoea.

Symptoms of Gonorrhoea

Both men and women with gonorrhoea often have no symptoms at all, or symptoms might be mistaken for a bladder infection.

Symptoms in men can include:

• A burning sensation when urinating
• A white, yellow, or green discharge from the penis
• Painful or swollen testicles

Symptoms in women can include:

• Painful or burning sensation when urinating
• Increased vaginal discharge
• Vaginal bleeding between periods

Rectal infections can involve discharge, anal itching, soreness, bleeding, and painful bowel movements.

You should be examined by your doctor if you notice any of these symptoms.

Risk Factors for Gonorrhoea

Any sexually active person can get gonorrhoea through unprotected vaginal, anal, or oral sex. Other factors that can increase your risk include:

• Having a new sex partner, a sex partner who has other partners, or by having multiple sex partners
• Sharing sex toys without washing them and covering with a new condom each time they are used
• Having had gonorrhoea or another sexually transmitted infection

If you are a sexually active man who is gay, bisexual, or who has sex with men, you should be tested for gonorrhoea every year.
Annual screening is recommended for sexually active women younger than 25, or older women with risk factors such as new or multiple sex partners, a sex partner with other partners, or a sex partner who has a sexually transmitted infection.
Having gonorrhoea makes you more susceptible to infection with HIV, and subsequently AIDS. If you have HIV and also have gonorrhoea, your viral load will increase, making you more likely to pass on HIV if you have sex without a condom, even if you are taking antiretrovirals.

Prevention of Gonorrhoea

To prevent gonorrhoea you should:

• Use a condom if you have sex, including anal sex, oral sex or vaginal sex.
• Use male and female condoms, dental dams and latex gloves.
• Stay in a monogamous relationship in which neither partner has sex with anyone else.
• Before you have sex, you and your partner should get tested and share your results with each other.
• Don’t have sex with someone who appears to have a sexually transmitted infection e.g. burning during urination or a genital rash or sore.

How is Gonorrhoea diagnosed?

A simple urine test or a swab taken by your doctor will show whether or not you have gonorrhoea.
If you have had oral or anal sex, swabs may be used to collect samples from your throat or rectum. In some cases, a swab may be used to collect a sample from a man’s urethra (urine canal) or a woman’s cervix.

Treatment of Gonorrhoea

Gonorrhoea can be cured with the right treatment, but though medication will stop the infection, it will not undo any permanent damage caused by the disease. You should always wait seven days after finishing all medications before having sex. If you’ve had gonorrhoea in the past, you can still get infected again if you have unprotected sex with a person who has gonorrhoea.
Untreated gonorrhoea can cause serious and permanent health problems in both men and women and can lead to permanent infertility in both. In rare cases, untreated gonorrhoea can spread to your blood or joints – this condition can be life-threatening.

4. Syphilis

Syphilis is a sexually transmitted infection (STI) caused by bacteria that causes infected sores, blisters or ulcers on your genitals, anus, or mouth.

The bacteria enter your body through minor cuts or abrasions in your skin or mucous membranes. It’s normally contracted through vaginal, anal, or oral sex without a condom, or by sharing sex toys with someone who has the infection. You can also contract syphilis by having direct contact with an infected sore or rash (such as during kissing) – even if you don’t have sex.

Syphilis is also contracted by sharing needles with someone who has syphilis. It’s possible for syphilis to be passed from mother to unborn child during pregnancy, if the infection is left untreated.

After the initial infection, the syphilis bacteria can remain dormant in your body for decades before becoming active again.

Early syphilis can be cured, but without treatment syphilis can severely damage your heart, brain or other organs, and can be life-threatening.

Symptoms of Syphilis

Many people with syphilis won’t present with symptoms for years. Once it begins to show it develops in three stages, and symptoms vary with each stage.

1. The first stage is known as primary syphilis, and is a small painless sore called a chancre (shang-kur) which usually develops about three weeks after exposure. This can occur on the penis or vagina, in the mouth or around the anus. The sore usually heals within two to six weeks and may go unnoticed as it may be painless or hidden in the vagina or rectum. Glands near the site if the sore (in the neck, groin or armpit) may get bigger. If the infection is not treated, it will move to the second stage.
2. Secondary syphilis usually occurs a few weeks after the sore disappears. You may now get a rash on your body that begins of your trunk, but can spread to the palms of your hands, or on the soles of your feet. The rash is usually not itchy and can be accompanied by wart like sores or skin growths in your mouth or genital area. You might feel ill with a fever or headache, and experience muscle aches, weight loss, a sore throat, and swollen lymph nodes.
   These symptoms may disappear within a few weeks, or repeatedly come and go.
   The infections then enter a period known as the latent (hidden) stage where people do not experience any symptoms. This latent stage can last for years.
3. The third stage known as tertiary syphilis the disease may damage your heat, brain, nerves, eyes, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection. The infection is usually detected by this point.

Neurosyphilis: At any stage, syphilis can spread and cause damage to the brain and nervous system (neurosyphilis) and the eye (ocular syphilis). Such damage can include stroke, meningitis, dementia, and impotence in men.

Risk factors for Syphilis

You face an increased risk of acquiring syphilis if you:

• Engage in unprotected oral, anal or vaginal sex
• Have sex with multiple partners, or your partner has multiple partners
• Are a man who has sex with men
• Are infected with HIV

Prevention of Syphilis

The only guaranteed way to avoid syphilis is to avoid any sexual contact with an infected person. Otherwise it is best to be in a monogamous relationship with someone you know who does not have the illness.

Condoms can reduce your risk of contracting syphilis, but only if the condom covers the syphilis sores – this will not work if the sores are in your mouth.

Diagnosis of Syphilis

Your doctor can examine your genital area, mouth and throat, and check for rashes or growths. If you have sores, a swab will be taken. Blood tests will be used to confirm the presence of antibodies that the boy produces in reaction to the infection.
If you have nervous system complication from syphilis, you may have a procedure called a lumbar puncture (or spinal tap) to collect a sample of cerebrospinal fluid.

If you have syphilis you should be tested for other sexually transmitted infections.

Treatment for Syphilis

When diagnosed and treated in its early stages, syphilis is relatively easy to cure. The preferred treatment at all three stages is penicillin. If you are allergic to penicillin alternative antibiotics will be prescribed.

Treatment can help prevent future damage but can’t repair or reverse damage that’s already occurred.

Once cured, syphilis doesn’t recur on its own. However, you can become reinfected if you have contact with someone’s syphilis sore.

You will need to have regular blood tests for at least a year after treatment, to ensure that the infection has cleared. Avoid having sex until you have finished your treatment, the sores have healed, and your doctor says you can.

Without treatment, syphilis can lead to damage throughout your body and even death. It also increases the risk of HIV infection and, for women, can cause problems during pregnancy including a drastically increased risk of miscarriage, or your new-born’s death within a few days after birth.

5. Herpes, Genital & anal warts, crab

Herpes

Genital herpes is a sexually transmitted infection which causes infected sores, blisters, ulcers and cuts in both men and women. It is caused by the herpes simplex virus (HSV) which can be passed on even if the person does not have any symptoms. Sexual contact is the primary way that the virus spreads.

After the initial infection, the virus will lie dormant in your body and can reoccur many times a year, for many years.

Genital herpes can cause pain, itching and sores/ulcers in your genital area until the infection clears. During an initial outbreak of genital herpes, you may experience flu-like symptoms such as swollen lymph nodes in your groin, headache, muscle aches, and fever. You can spread the infection on yourself by touching an infected sore and then touching another area of your body. Sores can develop on the buttocks and thighs, urethra, anus and mouth. Women can also develop sores in or on the vaginal area, external genitals, and cervix. Men can also develop sores in on the penis or scrotum.

Genital herpes is caused by HSV-2. The virus spreads through skin-to-skin contact. It is very common and highly contagious, whether or not you have an open sore.

There’s no cure for genital herpes, but medication can help to relieve symptoms, and reduce the risk of infecting others. Condoms also can help prevent the spread of a genital herpes infection.

Genital & Anal Warts

Genital warts are caused by the sexually transmitted human papilloma virus (HPV), of which there are over 100 strains, and are usually found around the penis, vagina, and anus. They can be passed on through sexual intercourse without a condom, or via sharing sex toys without appropriately washing them.

Genital warts are often diagnosed by appearance, and are most often small, raised, painless growths that resemble cauliflowers. They are rarely painful and not likely to bleed or pus.

A few types of genital HPV have been linked to anal and cervical cancer. Samples can be taken of these cells to be tested for the cancer-causing HPV strains.

The HPV virus that causes genital warts cannot be cured, though the warts themselves can be treated and gotten rid of. Treatment is administered by applying a cream or chemicals to the warts, or by freezing them off.

If you have genital warts you can expect to have repeat outbreaks throughout your lifetime.

Genital warts are passed on from someone who has the virus through oral, anal, or vaginal sex without a condom or dental dam, or even through close genital contact.

Vaccines are available to protect girls against certain types of HPV that can cause genital warts – but you need to have this vaccine before you start having sex. The vaccine is not a guarantee that you will not contract HPV in the future, but certainly goes a long way towards preventing it.

If you have genital warts you should be tested for other STIs.

Pubic Lice / Crabs

Pubic lice, also known as crabs, are tiny parasitic insects found in your genital area or other areas with coarse body hair. They are a different type of lice from head lice and receive their nickname because their bodies resemble miniscule crabs.

The most common way to acquire pubic lice is through sexual intercourse, or close bodily contact with someone who has public lice. They cannot be prevented from spreading during sex, even with the use of condoms. You may also acquire pubic lice from contaminated sheets, blankets, towels or clothes.

To prevent an infestation, you would need to avoid sexual or other close contact with, or sharing bedding or clothes with someone who has lice.

Pubic lice feed on your blood, and their bites can cause severe itching, which can lead to inflammation and irritation caused by scratching, which in turn can lead to an infection such as impetigo. Eye infections, such as conjunctivitis, and eye inflammation, can sometimes develop if your eyelashes have been infested with pubic lice.

The lice lay their eggs in sacs that stick to hair. Pubic lice don’t carry other diseases or sexually transmitted infections.

Treatment includes applying over-the-counter creams and lotions that kill the parasites and their eggs, which is available from pharmacies. Most often, the whole body will need to be treated, and treatment usually has to be repeated after a few days. At the same time all clothes and bedding should be washed in hot water.

6. Hepatitis A & B

Hepatitis A

Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus and is usually passed on through faecal matter via contaminated food and water but is also a sexually transmitted infection. It mainly causes inflammation of the liver – which is when your liver becomes swollen and painful.

Hepatitis A can be prevented by washing your hands frequently, being careful where you eat and drink, and by practising safe sex including using male and female condoms, dental dams, and latex gloves. You should never share sex toys with someone who has the virus. You can also be infected by sharing contaminated needles and syringes.

Vaccines are available for people at high risk.

Usually hepatitis A is not serious, and it generally only lasts around 10 to 14 days, and then clears up on its own. Signs and symptoms can include fatigue, nausea or vomiting, abdominal pain by your liver, loss of appetite, and jaundice.  

You’re at increased risk of hepatitis A if you have any type of sexual contact with someone who has hepatitis A.

Your doctor can carry out a simple blood test which will show if you have hepatitis A. It is important to be tested to make sure you do not have something more serious like hepatitis B or C. But unlike other types of viral hepatitis, hepatitis A does not cause long-term liver damage, and it does not become chronic.

 Hepatitis B

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV), which can cause liver failure, liver cancer, or cirrhosis – leading to death.

The virus is passed from person to person through blood, semen or other body fluids. You may contract HBV if you have unprotected sexual intercourse with someone who is infected or share sex toys. The virus can spread if the person’s blood, saliva, semen or vaginal secretions enter your body. HBV is also easily spread through needles and syringes. It does not spread by sneezing or coughing.

There is a vaccine available to prevent hepatitis B, but there is no cure for the illness. Infected people should take precautions to prevent spreading the virus to others.

Symptoms generally occur a few months after infection and can include:

• Abdominal pain
• Dark urine
• Fever
• Joint pain
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue
• Yellowing of your skin and the whites of your eyes (jaundice)

Your risk of HBV increases if you:

• Have unprotected sex with multiple sex partners
• Share needles or syringes
• Are a man who has sex with other men

Hepatitis B can be prevented by practising safer sex including using male and female condoms, dental dams and latex gloves, and never sharing needles or syringes.

You should contact your doctor immediately if you’ve been exposed to hepatitis B as preventative medication may reduce your risk of infection if you receive treatment within 24 hours.

 Getting tested for STIs

If you’ve had unprotected sex, or you’re worried about a sexually transmitted infection, get tested as soon as possible – even if you don’t have any symptoms.

Otherwise you should make an appointment with a doctor when you become sexually active, and before you start having sex with a new partner.

Sexually transmitted infections (STIs) are generally acquired by sexual contact with an infected person. The bacteria or viruses may pass from one person to another in blood, semen, or vaginal and other bodily fluids. STIs can be caused by:

• Bacteria (gonorrhoea, syphilis, chlamydia)
• Parasites (trichomoniasis)
• Viruses (HPV, genital herpes, HIV)

If left untreated, STIs, can cause severe health problems, including infertility, cancer, blindness and organ damage.

STIs do not always cause symptoms and can be contracted from someone who may appear to be perfectly healthy. Because of this STIs can often go unnoticed until complications occur, or a partner is diagnosed. Visible symptoms can include:

• Sores or bumps on the penis, genitals or in the oral or rectal area
• Painful/burning urination
• Strange discharge from the penis
• Unusual or odd-smelling vaginal discharge
• Unusual vaginal bleeding
• Pain during sex
• Swollen lymph nodes
• Lower abdominal pain or in the genital areas
• Flu-like symptoms like fever, body aches, swollen glands, and feeling tired

STI symptoms can come and go over time, but that doesn’t mean the STI is gone.

STI testing may include urine tests, blood tests, swabs, and physical exams. There are a number of different STIs, and the test type will depend on which STI you are being tested for. Most STIs can be tested for using urine or blood samples. Your doctor can order urine or blood tests to check for chlamydia, gonorrhoea, hepatitis, herpes, HIV and syphilis.

If you are a sexually active adult, you should get tested every 3 to 12 months, depending on your level of sexual activity.

 Treatment of STIs

If you have an untreated STI it can cause a range of mild to severe health complications and create other health conditions.

STIs caused by bacteria are easier to treat than viral infections, which can be managed but not necessarily cured. Treatment for STIs usually consists of one of the following:

• Antibiotics are used to cure many sexually transmitted bacteria and parasitic infections including gonorrhoea, syphilis, chlamydia and trichomoniasis. Typically, you’ll be treated for gonorrhoea and chlamydia at the same time because the two infections often appear together.

Once you start a course of antibiotics it is important to complete the course. It’s also important to abstain from sex until seven days after you’ve completed antibiotic treatment and any sores have healed.

• Antiviral drugs. If you have herpes or HIV, you’ll be prescribed an antiviral drug. Antiviral drugs will reduce the number of herpes recurrences if you take daily suppressive therapy, but you will still be contagious.

Antiviral drugs can keep HIV infection in check for many years and even reduce your virus count so low that it can hardly be detected, but you will still have the virus and can still transmit it.

 Prevention of spreading STIs

There are several ways in which you can avoid or reduce your risk of spreading STIs. These include:

• Abstinence – the surest way to prevent spreading an STI is to abstain from having sex completely.
• Avoid sexual intercourse with new partners until you and your partner(s) have been tested for STIs.
• Get vaccinated early before exposure e.g. hepatitis.
• Use condoms and dental dams consistently and correctly. Never use oil-based lubricants with a latex condom or dental dam.
• Wash sex toys thoroughly after each use and do not share sex toys outside of your relationship with your partner.

 Risk factors for STIs

Anyone who is having sex is at risk of contracting a sexually transmitted infection. Factors that can increases that risk include:

• Unprotected sex (vaginal or anal penetration) with an infected partner who isn’t wearing a condom significantly increases the risk of getting an STI.
• Unprotected oral sex with an infected partner.
• Sexual intercourse with multiple partners. No judgement here. We’re just giving you the facts.
• A history of STIs – having one STI makes it easier for another to take hold.
• Injecting drugs – sharing needles or syringes spreads serious infections such as hepatitis and HIV.

1. Your Gay Arse: from top to bottom

Your sexual health is very important. Gay, bisexual and MSM need to stay on top of their health and protect themselves throughout their lives. There are a number of precautions you can take to prevent contracting a sexually transmitted infection, and if you are concerned you can easily take tests to find out your status.

All sexually active gay and bisexual men should be tested regularly for STDs, including HIV, Syphilis, Hepatitis B, Hepatitis C, Chlamydia, and Gonorrhoea.

If you have had sex with someone you don’t know well, or have casual sex with multiple partners, you should be screened more often for STDs and may benefit from getting tested for HIV more frequently.

It is important to have an open conversation with your doctor about getting vaccinations for Hepatitis A and B, and HPV – there are a number of vaccines that can help to protect your health.

You can do many things to protect your sexual health. For example, you can learn about how STIs are spread and how you can reduce your chances of getting an STI. Have open and honest conversations with your partners about your risk of being infected with an STI. You can also talk to your doctor about PrEP, which may be appropriate if you have many partners.

2. These are such a pain in the arse: Fissures, warts and rectal STIs

1. Fissures

An anal fissure is a small cut or tear in the thin moist tissue that lines the anus, and in the case of men who have sex with men, is most often caused by anal penetration. An anal fissure can also occur when you pass hard or large stools during a bowel movement. The condition generally causes severe pain and bleeding, and you can also experience spasms in the ring of muscle at the end of your anus (anal sphincter). The fissure can be deep enough to expose the muscle tissue underneath.
Symptoms of an anal fissure can include:

• A visible crack or tear in the skin around the anus
• Pain, sometimes severe, during bowel movements that may last several hours
• Pain after bowel movements that can last up to several hours
• Bright red blood on the stool or toilet paper after a bowel movement
• Burning or itching in the anal area
• A small lump or skin tag on the skin near the anal fissure

Anal intercourse puts you at a much higher risk of developing fissures. Repetitive injury to the area can prevent the anal fissure from healing, and if the condition last longer than eight weeks it may need further treatment.

An unhealed fissure may require medications or surgery to reduce the pain and to repair or remove the fissure. Otherwise, the most common treatments include dietary fibre and stool softeners, as well as applying topical pain relievers to the affected area. Taking a sitz bath to relax the anal muscles, relieve irritation, and increase blood flow to the anorectal area can also help.
Once you have experienced an anal fissure, you may be prone to getting them more often.

A doctor can usually diagnose an anal fissure by examining the area around the anus. They may sometimes need to perform a rectal exam to confirm the diagnosis, and will use an instrument called an anoscope to make it easier to see the tear. An anoscope is a thin tube that allows doctors to inspect the anal canal.

2. Anal Warts

Anal warts are caused by the human papilloma virus (HPV), one of the most common sexually transmitted infections (STI). The warts primarily affect the area inside and around the anus, but may also develop on the skin of the genital area. Anal warts first appear as small bumps or growths, and generally don’t cause discomfort or pain – they may itch or bleed as they grow larger though. They often develop a cauliflower-like appearance as they grow, or when several warts are clustered together.

HPV spreads from one person to another by direct contact with the mouth, anus, penis, or vagina of a person with HPV, even if warts are not visible. Sexual intercourse is not necessary to spread the infection as it can be transmitted by skin-to-skin contact.

You are at greater risk of contracting anal warts if you have unprotected anal sex with multiple partners.

A doctor can diagnose anal warts by visual examination. An anoscope may be used internally to look for warts inside the anus. Topical prescription treatments may be used for anal warts that are located outside the anus. Other medications or cryotherapy (freezing) to treat anal warts may be applied by your doctor.

3. Rectal STIs

Anal itching can be a symptom of a sexually transmitted infection, and is often an indication of anal herpes, gonorrhoea, anal warts, and pubic lice.
Anal herpes is caused by a virus known as the herpes simplex virus (HSV). Herpes can be spread by sexual contact with someone infected by the virus, especially if they have an active outbreak of herpes sores on their skin. Reddish sores and whitish blisters that appear when you’re having an outbreak can be itchy and ooze discharge or pus.

3. Douching and Enemas: Understanding the ins and outs 

Rectal douching (or anal douching or enemas) involves rinsing the rectum to clean it in preparation for anal sex.

Douching is usually performed with plain water using an instrument of some sort to push the water into the rectum, and then expelling it to rinse out. While generally harmless, it should be noted that douching should not be performed too often – too frequent or improper anal douching can lead to constipation, irritation in the lining of the rectum (which can increase risk for HIV/STD), or damage to the rectal walls.

Over the counter douches designed for women should not be used in your rectum. Also do not put any chemicals like soap inside yourself. What you use and how often you do it matters.

4. Preparing the ‘hole’ thing for anal sex

When it comes to having mutual pleasurable and safe anal sex, it’s important to know how to be prepared. In addition to cleansing and douching (as above), the paraphernalia we use can play a big part. But did you know the absolute importance of using a water-based lubricant (and not an oil based one) in conjunction with latex condoms? In case not, this is vital for condom safety!

While we are on the subject of condoms, always wear a condom and use a water-based lubricant. Sex toys should be treated the same for that matter, and always washed thoroughly after use. The wisest decision is to use a fresh condom on sex toys every time they are used.

Fingering, rimming and fisting can all bring great pleasure, but usually with the aid of a lubricant. You should again use a water-based lubricant and avoid chemicals that can irritate and damage the anus, which in turn increases the risk of infections and tears/bleeding. Sores or lesions make it easier for STIs such as Hepatitis and HIV to enter the body. And if you’re living with HIV, your viral load is likely to increase because your immune system is weaker – this will make you more likely to pass on HIV if you have sex without a condom. So your choice of lubricant may be a lot more important than you think.

5. Avoiding Anal Cancer

5.1 What is Anal Cancer

Anal cancer is predominantly caused by chronic or persistent human papillomavirus (HPV) infection. HPV, which chiefly spreads through direct skin-to-skin contact, is the most common sexually transmitted infection across the globe.

According to research, oncogenic high-risk HPV can be detected in 80% to 90% of anal cancers, placing anal cancer second only to cervical cancer in the strength of its association with HPV infection. Anal HPV infection among gay men is common and if it remains undetected or not adequately treated, it may lead to anal cancer. Likewise, HPV infection is also responsible for causing cervical, vaginal, vulvar, and penile cancers.

Furthermore, according to research, age-specific anal pre-cancer management, including post-treatment HPV vaccination, can potentially lead to an 80 percent decrease in lifetime risk of anal cancer and anal cancer mortality among gay men.

 5.2 How to Avoid Anal Cancer

If anal cancer is typically preceded by persistent HPV infection that often leads to pre-cancer, what can be done about it? Vaccinate against HPV! The best form of prevention for anal cancer is the vaccination against HPV infection. HPV vaccination is recommended for males 13 to 27 years old. It’s important to know that vaccination at older ages is not as effective in lowering cancer risk. Speak to your doctor immediately to get an HPV vaccination.

6. Anoscopy & Anal Cytology

What is an Anascopy?

An anoscopy is like a pap smear for the anus to detect anal cancer. Using a small tubular instrument called an anoscope which is inserter a few inches into the anus a doctor can evaluate problems of the anal canal. An anoscopy can also be used to diagnose haemorrhoids and anal fissures which are tears in the lining of the anus. It is also used in the treatment of warts produced by HPV. Screening for anal cancer in gay men is inadequate, but the Queer Wellness Centre is aiming to turn that around with Africa’s first anoscopy and anal cytology unit.

What is Anal Cytology?

Anal cytology is a screening test that collects cells from the anal canal to determine if you have anal cancer or are at risk of getting it. Like the cervix, you can detect cancer at any early stage, when it’s still treatable, via a sampling of cells.

The Anascopy Procedure

The anal Pap test is quick and painless. Your doctor will insert a swab that looks like a long Q-tip into your anus to collect a sample of cells to be sent to a pathologist in a lab. The pathologist then views these cells under a microscope to determine if they are normal, dysplastic (precancerous) or cancerous. This is a highly effective screening tool for the anal canal.

What is PrEP

PrEP (Pre-exposure prophylaxis) is a course of HIV drugs taken by HIV-negative people to protect them against HIV infection. Taking PrEP properly virtually eliminates the risk of getting HIV.
It works by taking a dual combination of antiretrovirals (ARVs) in order to decrease the chance of acquiring HIV infection if exposed to it during intercourse. In South Africa, these ARVs are commonly known as Truvada, Tenemine and Adco-Emetevir.
PrEP is not meant to be taken for life, but rather at times when a person feels they might of at risk of contracting HIV. You will need to take PrEP for 7 days before you are protected, and then every day for as long as you want protection.
*It is important to note that PrEP is not the same as PEP (Post-exposure prophylaxis), which is an emergency treatment taken after possible exposure to the HIV virus.

How does PrEP prevent HIV?

The combination of drugs in the PrEP antiretrovirals stop the virus from replicating in your body. So if for example you are exposed to HIV during intercourse, there should be enough levels of the drugs present to prevent you from getting an HIV infection.

How effective is PrEP?

As long as PrEP is used correctly it will effectively eliminate your risk of becoming infected with HIV. Global results have shown that PrEP reduces the risk of contracting HIV by up to 99%

How to get a PrEP prescription

To get a script for PrEP you will need to visit your GP. At this appointment you can expect your doctor to review your medical history, perform a physical examination, as well as order certain tests. This is to ensure you do not have a currently undiagnosed HIV infection, as well as checking the health of your kidneys and urine.
QWC has GPs who can assist with a medical history review and provide PrEP scripts in indiscriminatory environment.

Medical Check Ups required while on PrEP

It is very important to attend regular check-ups with your GP every three to six months while taking PrEP.
This will ensure you are not experiencing any side effects, and more importantly that your kidneys remain in good health. In rare cases PrEP can affect kidney functions. If you are taking PrEP and experience any side effects, tell your GP immediately.
Your doctor will also order HIV tests at each of your follow up appointments to make sure you have not contracted the infection.

Who can take PrEP?

PrEP is for people who are HIV-negative and believe they are more at risk of contracting an HIV infection. PrEP can be used by men and women of any sexual orientation.

Avoiding STIs while on PrEP

While PrEP protects you from HIV, it does not give you any protection from other sexually transmitted infections (STIs). This means you are at risk of catching a different STI. A condom is still the best way to prevent other STIs such as chlamydia, gonorrhoea, and hepatitis C.
If you notice any genital symptoms while taking PrEP such as an itch or discharge, you should consult your GP to undergo screening for potential infections.

Using PrEP with other medication

Before commencing with PrEP it is important to disclose all medications you are taking with your doctor so they can be made aware of any potential interactions between medications.

How much will PrEP cost

In South Africa, PrEP is available only by prescription, and has to be paid for privately. A prescription for PrEP costs approximately R365 a month for Truvada. The generic can be claimed through some medical aids schemes with chronic benefits packages.