Hot Summer?
Are you heading into a hedonistic summer? The possibility of pregnancy or STIs can make sexual encounters risky. There are a few important methods of decreasing risk after an unprotected encounter.
Most of you know about the “morning-after pill”. In the old days, this was a high dose of estrogen and progesterone given within 72 hours of unprotected sex. Now we have Plan B and other similar medications which are a single dose of progesterone and have a much better side effect profile. This works best when taken ASAP after intercourse, and I recommend picking up a package at the pharmacy (no prescription required) to keep in your bedside table so that you’re not stuck in the lineup at the 24-hour pharmacy at midnight.
This medication works 87% of the time, not great, but better than nothing after an oops. The other very important information about Plan B is that it works by delaying ovulation, so you are vulnerable to pregnancy later in your cycle than usual. Do not rely on birth control apps or other calendar methods of birth control for a month or two after using Emergency Contraception. It’s also less effective with BMI over 25.
The most effective method of emergency contraception is a copper intrauterine device (IUD), inserted by a doctor within 7 days of unprotected intercourse. This lowers the risk of pregnancy by 99.9%. It’s challenging to get an IUD on a tight time restriction, and your local Public Health Sexual Health Clinic is likely your best bet for accessing this method.
Another option is Ulipristal (Brand name Ella) which is effective for up to 5 days for people of all sizes. You’ll need a prescription, but your family doctor or the new private virtual services would both be good resources to access this.
What about STI prevention after exposure? For chlamydia and gonorrhoea, we simply recommend testing about 2 weeks after the sexual exposure. If you had unprotected sex with a person who is at high risk for HIV, you may consider taking Post Exposure Prophylaxis (PEP). In Ontario, high-risk populations include:
Gay, bisexual and other men who have sex with men, including trans men,
People who inject drugs,
Men and women from parts of Africa and the Caribbean where HIV is endemic,
Indigenous Peoples, and
Women, including trans women, who are sexual partners or drug-using partners of people with HIV
PEP means taking HIV medicines every day for 28 days. It must be started within 72 hours after a possible exposure to HIV. The sooner PEP is started after possible HIV exposure, the better.
If you get through unprotected sex unscathed, it’s time to consider prevention.
For STIs: Get your HPV vaccination - people of all genders and of all ages who are sexually active can consider the vaccine, which prevents cancer of the throat, cervix and anus. Check with your doctor to make sure you are vaccinated against Hepatitis B. Use a condom every time.
For HIV: If you are at high risk, consider Pre-Exposure Prophylaxis (PrEP). This is a pill that you take every day to prevent HIV and it is 99% effective. In Ontario this is recommended for: 1) people with an HIV positive partner who is not adequately responding to treatment, 2) men who have sex with men (or transgender women) without condoms AND have tested positive for other STIs, and 3) injection drug users who share needles. In the US it is recommended for any person of any gender who doesn’t use condoms with new partners or has had an STI in the last 6 months. It is worth connecting with a PrEP provider to discuss the pros and cons of treatment. There are lots of online options including Felix. Use a condom every time.
For Pregnancy: Start a long-acting reversible contraceptive (LARC) like IUD, depo-provera or Nexplanon, or get a vasectomy. The New York Times calculated 10-year pregnancy risk with condom use and concluded that 86 of 100 people will get pregnant using this method.