Sexuality Education

Navigating Sexual Health Conversations with Multiple Partners

Having safer sex with just one partner is one thing, but what about navigating sexual risk when there are multiple partners in play? Though there are certainly a few more moving bits and pieces to manage, with clear communication and the mutual goal of having informed consensual sex that is as safe as possible, it’s totally doable. It should be noted that transparency among everyone involved, including about STI status, is the difference between practicing non-monogamy versus cheating. This conversation is one that should happen regardless of how casual or serious the relationship is. 

There is no such thing as risk-free sex; all sex comes with at least a small risk of pregnancy and/or STIs. Communication and safer sex practices are the best way to mitigate risk, even if it can’t be completely eliminated. Here are some specific tips to help you navigate your sexual health and safety with multiple partners. 

1) Understand the full scope of risk

  • Here are some questions you should know the answers to after discussing safer sex practices with your partners

    • How many people total are involved (all your partners plus all of their partners)? 

    • Has everyone been tested recently (see tip #2)? 

    • What is the protocol following an STI diagnosis of one of your partners or one of your partners’ partners? 

    • What types of protection are being used? 

      1. Who, if anyone, is fluid bonded (having unprotected sex)?

    • Is everyone involved fully aware that not all STIs are immediately detectable, nor do they all involve visible and obvious symptoms?  

2) Get tested often

  • If you’re sleeping with other people, and especially if those people are also sleeping with multiple people, it’s a good idea to get routine STI tests. For most, it’s sufficient to get tested every 3-6 months, but if you’re worried about that being too much or too little, consider consulting a trusted medical professional who you can comfortably talk to about your sex life.

  • It is really important to remember that it takes some STIs up to three months to be detectable with testing so even if all sexual partners test negative, there is still a nonzero risk of STI transmission.  

3) Be upfront about your boundaries without shaming

  • Weighing the risk to reward ratio for sex is a personal decision so it’s possible you might not see exactly eye to eye with your partners. It’s important to assert what your boundaries are, while still being respectful of the risk they’ve chosen to take on especially since STIs are shrouded in so much stigma as it is. At the end of the day, you are at liberty to decline to have sex with someone if their sex practices seem too risky for your comfort, which is why it’s so important to have these conversations early in order to establish those boundaries on both sides. It’s possible to do so by explaining yourself and what you want without disparaging the choices someone else has made.

It can feel scary or intimidating to have these conversations and that’s okay! It might even help ease some anxiety to express that upfront. And if someone does take issue with you trying to have this kind of conversation, they’re not someone you want to be involved with anyway.

Tips for Talking With Young People About Sex

Sex can be a tricky and  uncomfortable conversation topic for  many people, especially when it comes to talking with young people. At the end of the day, the vast majority of young people will be curious about sex at some point; it’s far preferable for them to be equipped with accurate information about safer sex, boundary setting, and consent despite the associated discomfort. Furthermore, the only way anyone, adults and young people alike, can mitigate that discomfort and the taboo around sex is to open up these conversations. Sex is nothing to be ashamed of and unfortunately, in the United States, it’s often perceived as dirty and inappropriate. The reality is that it’s a fun and normal part of being human.

A foundational part of talking about sex,  like any complex subject, is to familiarize yourself with relevant terminology. Talking about sex with young people doesn’t mean you should go around talking to toddlers about explicit sex acts but there is a way to introduce the topic in a gradual, age-appropriate way that builds on itself. Starting to introduce proper terms like “penis,” “vulva,” “vagina,” “clitoris,” “buttocks,” and “nipples” even before a child is verbal is a great starting point. Though introducing these terms may feel uncomfortable, at the end of the day they’re simply names for body parts that everyone should get used to using. 

As kids get a little older, it is vital to help them get acquainted with the concepts of consent and boundaries, both within and outside a sexual context. Kids must be taught that no one has a right to their body and they have every right to say no to being touched in any way. This also works the other way, kids must be taught to respect other people’s consent and boundaries. 

It’s important to keep in mind that these days, as children are introduced to the internet earlier and earlier, they are more prone to being prematurely exposed to explicit content. This will inevitably prompt natural curiosity that the adults in their lives need to be prepared to address. 

As a young person gets closer to the onset of puberty, this is the a time to start discussing bodily changes, menstruation, and masturbation. There are plenty of books that cover these topics extensively that can be beneficial to both the child and adult in question. 

Ultimately, regular conversations with young people about sex and adjacent topics is a good way to ensure they’re equipped with the necessary information to make good decisions about their bodies and their sex lives (if and when they choose to have one).  

Having these conversations can certainly be daunting. That’s where we come in! Embrace Sexual Wellness has a program specifically aimed at helping parents and other caregivers be sex-positve role models for the children in their lives. To learn more about how you can start to feel prepared and empowered for these conversations, check out this link.

7 Contraceptive Options: An Overview

Practicing safer sex is a vital part of reproductive health and some of the best tools to support safer sex are contraceptives. There is a wide variety of types of birth control and different options suit different lifestyles best. For example, for people who want to prevent pregnancy with a low maintenance option, an implant or IUD may be a good option. Embrace Sexual Wellness has compiled an overview of contraceptive options, with information such as efficacy, pros and cons, side effects, and more. We hope this guide will aid you in figuring out which method will work best for you. Keep in mind that condoms and dental dams are the only form of contraceptive that protects against STIs and should be paired with another method to ensure the most effective protection against pregnancy and STIs. We recommend using at least two methods, one of which should protect against STIs, to ensure the maximum amount of protection.     

Note: all efficacy rates refer to perfect usage of the method and with those that require manual maintenance, human error may diminish efficacy rates

Intrauterine Devices (IUDs)

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Overview

  • Efficacy: 99% effective

  • STI Protection: Does not protect against STIs

  • How it’s used: inserted by a doctor. No manual maintenance required

  • Types

    • Copper (Paragard) 

      • How it works

        • A copper IUD is a plastic body with copper wrapped around it. Copper changes the way sperm cells move so they can’t access the egg. 

      • Benefits

        • High efficacy at preventing pregnancy 

        • Lasts up to 12 years but can be removed at any time by a doctor

        • Can be used as emergency birth control if inserted within 5 days of unprotected sex 

        • Does not need manual maintenance 

      • Drawbacks

        • Insertion can be uncomfortable

        • Initial side effects can be unpleasant but for most, should subside after the first 6-12 months 

        • Does not provide STI protection

    • Hormonal (Mirena, Kyleena, Liletta, and Skyla)

      • How it works

        • Hormonal IUDs release a small amount of progestin which mimics the hormone progesterone that bodies naturally make. These hormones both make the cervical mucus thicker to block sperm from accessing the egg and the hormones can also stop ovulation, meaning there’s no egg present to be fertilized  

      • Benefits 

        • Long-lasting

          • Mirena: up to 7 years 

          • Kyleena: up to 5 years

          • Liletta: up to 7 years

          • Skyla: up to 3 years

        • For some, lightened periods and cramps

        • Can potentially manage symptoms of endometriosis and polycystic ovarian syndrome (PCOS)

      • Drawbacks

        • Insertion can be uncomfortable

        • Initial side effects can be unpleasant but for most, should subside after the first 6-12 months 

        • Hormones may worsen or complicate pre-existing mental and reproductive health conditions

        • Does not provide STI protection 

  • How to Access It

    • IUDs have to be inserted by a doctor, most commonly an OB/GYN or a clinic like Planned Parenthood

  • Potential Side Effects 

    • Longer and heavier periods and cramps for the first 6-12 months

    • Irregular periods and spotting between periods 

  • Works Best For

    • People who want to “set and forget” their birth control.

    • People who, for whatever reason, can’t or don’t want to use hormonal birth control (copper only) 

    • People who are interested in birth control that has the potential to lighten or get rid of periods (hormonal IUDs only) 

  • Contraindications

    • Conditions that cause pain from vaginal penetration such vaginismus

    • Mental illness (not for all; case by case basis) 

    • People who want a regular, natural period


Birth Control Pills

Overview

  • Efficacy: 91% effective

  • STI Protection: Does not protect against STIs

  • How it’s used: Oral ingestion once a day at the same time

  • Types

    • Combination (estrogen and progestin)

      • How it works

        • The hormones in the pill prevent ovaries from releasing  an egg each month, thickens cervical mucus to block sperm, and thins lining of sperm to lower risk of fertilized egg implanting in the womb.

        • The last week of the pack is hormone-free to allow a period to happen. For those interested in skipping their periods, consult your healthcare professional about not taking the hormone-free week of pills.

      • Benefits 

        • Less strict time window for taking the pill, though it’s recommended to take it around the same time everyday to help stick to the routine

      • Drawbacks

        • Does not protect against STIs

    • Progestin only

      • How it works

        • The hormones in the pill prevent ovaries from releasing  an egg each month, thickens cervical mucus to block sperm, and thins lining of sperm to lower risk of fertilized egg implanting in the womb.

      • Benefits

        • For those who want to lighten or eliminate their period, hormonal birth control may help 

      • Drawbacks

        • Must be taken in the same 3 hour window every day to be effective

        • Does not protect against STIs

  • How to Access It

    • Must be prescribed by a healthcare professional 

  • Potential Side Effects 

    • Spotting or bleeding between periods

    • Sore breasts

    • Nausea

    • Headaches

    • Weight gain

  • Works Best For

    • People who can remember and stick to a scheduled daily routine

  • Contraindications

    • If you’re prone to blood clots and strokes

    • Any condition involving regular vomiting and/or diarrhea, as the pill will not work following these functions

Nexplanon Implant

Overview

  • Efficacy: 99+% effective

  • STI Protection: Does not protect against STIs

  • How it’s used: implanted in arm by a healthcare professional under local anesthetic. No manual maintenance required 

  • Type

    • Nexplanon

      • How it works

        • Releases progesterone to prevent the release of an egg each month and thickens cervical mucus to block sperm cells. 

      • Benefits

        • Long lasting (up to 5 years)

        • Highly effective

      • Drawbacks

        • Does not protect against STIs

        • Requires minor doctor’s office procedure 

  • How to Access It

    • Must be inserted into arm by healthcare professional, most commonly an OB/GYN 

  • Potential Side Effects 

    • Irregular bleeding especially in the first 6-12 months

    • Headaches

    • Breast pain 

    • Nausea

    • Temporary bruising around insertion area  

  • Works Best For

    • People who want low maintenance birth control 

    • People who can’t use estrogen-based contraception

  • Contraindications

    • If you’ve had or do have breast cancer

Depo-Provera Injections

Overview

  • Efficacy: 94%

  • STI Protection: Does not protect against STIs

  • How it’s used: Injected in a doctor’s office once every 3 months

  • Type

    • Depo-Provera

      • How it works

        • Releases progesterone which prevents ovulation, thickens cervical mucus to block sperm, and thins lining of womb to lessen likelihood of egg implantation.

      • Benefits

        • May reduce heavy, painful periods

        • Less maintenance than the pill 

      • Drawbacks

        • Ability to get pregnant may not return for up to one year after ceasing injections

        • Does not protect against STIs 

        • Medium maintenance - requires doctor’s visit every 3 months

  • How to Access It

    • Injections must be performed in a doctor’s office 

  • Potential Side Effects 

    • Changes to period

      • Bleeding more than usual

      • Spotting

      • Lack of a period

      • Nausea

      • Weight gain

      • Depression

      • Sore breasts

  • Works Best For

    • Those who cannot use estrogen-based birth control

    • Those who need a discreet method of birth control 

  • Contraindications

    • If you want to be able to get pregnant soon after ceasing birth control

    • If you struggle with mental illness (case by case basis) 

Condoms

Overview

  • Efficacy: 85% effective  

  • STI Protection: Yes, when used correctly, condoms protect against STIs 

  • How it’s used: worn on the penis to prevent sperm from entering the vaginal canal (external condom) or inserted into vaginal canal (internal condom) 

For an extensive overview of types of condoms and tips for usage, read this Embrace Sexual Wellness article

Diaphragm and Spermicide

Overview

  • Efficacy: 88% effective

  • STI Protection: No, they do not protect against STIs

  • How it’s used: the shallow, bendable cup is inserted into the vaginal canal and covers the cervix to block sperm from entering. Must be used in conjunction with spermicide 

  • Parts

    • Diaphragm

      • How it works

        • Creates physical barrier between cervix and sperm

      • Benefits

        • Non-hormonal option

        • Not as intrusive as more long term contraceptives like IUDs

        • Effective immediately after it’s inserted

        • Few side effects

      • Drawbacks

        • Less effective than other options

        • Efficacy may be affected by human error 

        • Must stay inside vaginal canal for 6 hours after sex but not more than 24 hours

        • Learning curve for inserting it 

    • Spermicide

      • How it works

        • Chemicals stop sperm movement, held in place by the diaphragm 

      • Benefits 

        • Increases efficacy of diaphragm

      • Drawbacks

        • May cause irritation and/or UTIs

        • If you have sex again after applying it, you still must apply it again 

  • How to Access It

    •  Must be prescribed by your healthcare practitioner

  • Potential Side Effects 

    • Frequent UTIs

    • Irritation from spermicide can make vaginal canal more susceptible to STIs 

  • Works Best For

    • Those who cannot use hormonal birth control 

    • Those who don’t mind a high maintenance option 

  • Contraindications

    • If you can’t commit to consistently using the diaphragm properly

    • If you’re allergic to silicone, latex, or spermicide

    • If you have vaginal abnormalities that disallow a proper fit or placement

Patch

Overview

  • Efficacy: 99% effective

  • STI Protection: Does not provide STI protection

  • How it’s used: Must be stuck to either the belly, buttocks, back, or upper outer arm (latter option for Xulane only) and replaced once a week 

  • Types

    • Xulane

      • How it works

        • The patch transdermally introduces the hormones estrogen and norelgestromin, a form of progestin, which suppress ovulation. The patch needs to be replaced every 7 days for the first three weeks of the month and no patch is worn on the last week of the month.

      • Benefits

        • Potentially may help acne and make periods lighter

        • High effectiveness

        • Only needs to be replaced once a week 

        • Possible to get pregnant immediately after ceasing use

      • Drawbacks

        • Only works effectively for those with a BMI below 30

        • Patch may be susceptible to falling off

    • Twirla

      • How it works

        • The patch transdermally introduces the hormones estrogen and levonorgestrel, a form of progestin, which suppress ovulation. The patch needs to be replaced every 7 days for the first three weeks of the month and no patch is worn on the last week of the month.  

      • Benefits 

        • Potentially may help acne and make periods lighter 

        • High effectiveness

        • Only needs to be replaced once a week

        • Possible to get pregnant immediately after ceasing use

      • Drawbacks

        • Only works effectively for those with a BMI below 30

        • Patch may be susceptible to falling off 

        • Requires manual maintenance 

  • How to Access It

    •  Must be prescribed by a healthcare professional

  • Potential Side Effects 

    • Nausea

    • Headache

    • Skin irritation around patch 

  • Works Best For

    • Those with a BMI under 30

    • Those who want a less invasive contraceptive that doesn’t require as frequent maintenance as the pill

    • Those who are not regularly submerged in water because it may compromise the adhesion of the patch

  • Contraindications

    • People with a BMI over 30

    • Smokers over the age of 35 


Vaginal Ring

Overview

  • Efficacy: 99%

  • STI Protection: The ring does not protect against STIs

  • How it’s used: The ring needs to be inserted into the vaginal canal. The NuvaRing needs to be replaced every 5 weeks while ANNOVERA lasts a full year.

  • Types

    • NuvaRing

      • How it works

        • The NuvaRing releases a continuous low dose of the hormones etonogestrel and ethinyl estradiol to prevent pregnancy 

      • Benefits

        • Has the potential to reduce acne and make periods lighter

        • High effectiveness

        • Option to skip period altogether

      • Drawbacks

        • Requires remembering to replace the ring 

        • Possible for ring to fall out 

        • Cheaper options than ANNOVERA ring

    • ANNOVERA

      • How it works

        • The ANNOVERA releases a continuous low dose of the hormones segesterone acetate and ethinyl estradiol to prevent pregnancy 

      • Benefits

        • Lasts a full year

        • Has the potential to reduce acne and make periods lighter

        • High effectiveness

        • Option to skip period altogether

      • Drawbacks

        • More expensive than NuvaRing because no generic exists currently

        • Cannot be used while breastfeeding

  • How to Access It

    •  Must be prescribed by a healthcare professional

  • Potential Side Effects 

    • Headaches

    • Nausea 

    • Sore breasts

  • Works Best For

    • Those who want total control over their birth control but don’t want the frequency of maintenance of the pill

    • Those who want a less long term hormonal option than the IUD

  • Contraindications

    • Smokers over 35

    • Breastfeeding people

It may take a few tries to find the best contraceptive method for your life. If you’re still unsure of where to start, try this Planned Parenthood quiz about what types of birth control might work for you. Make sure to consult your healthcare professional about the pros and cons of different contraceptives within the context of your life. Remember to use at least two contraceptive methods with one that protects against STIs every time you have sex. Sex can never be 100% risk-free but contraceptives greatly increase safety for everyone involved.