The New Sex Rules

If the last round of sex education you received was back in middle school, you're probably due for a refresher course. When it comes to the latest sex-related information — think contraception, risk of sexually transmitted infections regardless of your age, you'll find that the modern sexual landscape is quite different than it was even five years ago, says Dr. Robin Sawyer, author of Sexpertise: Real Answers to Real Questions About Sex. Need to brush up on your modern sex knowledge? Below, Dr. Sawyer fills you in on what you need to know about sex — right now.

Q: Let's cut to the chase: Is there an easy way to ask someone how many partners he or she has had?

A: If you're trying to determine your relative risk for a sexually transmitted infection (STI), a more effective question might be, "Do you always use condoms when you have sex?” Think about it: a person who uses a condom 100 percent of the time with 30 partners might be a safer sexual risk than someone who has had as few as three partners but only occasionally used condoms.

Q: Which STIs are on the rise these days and which aren't as prevalent as they have been in the past?

A: Chlamydia has become one of the most common STIs in young adults, with an estimated three million new cases a year in the U.S. It is so common in young women that by the age of 30, about half of all sexually active women have been infected with Chlamydia. Chlamydia can be transmitted through vaginal, anal or oral intercourse, so for those of you folks continuing to convince yourselves that oral sex is perfectly safe, you'd better pay attention! The vast majority of women have no symptoms for this infection, and even about 50 percent of men can be asymptomatic. If a woman has symptoms, she is likely to experience burning during urination and pain during intercourse. Men tend to experience a rather watery discharge and also will experience discomfort urinating. Those signals should send you to the doctor.

Human papilloma virus (HPV) is also quite prevalent today. Many different strains of HPV exist, including some that are believed to be the cause of cervical cancer. Fortunately, in 2006, the FDA approved Gardasil, a vaccination that can protect young women from specific strains of HPV that seem to cause the majority of cervical cancer.

Q: What are today's best methods of contraception and the prevention of STIs?

A: The best methods of contraception are those which are most effective at actually preventing pregnancy, and are usually the easiest to use — the Pill or the Depo Provera shot, both of which are used by women. The once-every-12-weeks shot is the most effective as the user can't do anything to mess up, like forgetting to take a pill. Despite several different available contraceptive methods, the vast majority of the 18-to-30 year-old age group confines its use to the Pill and/or condoms.

Don't forget, the hormonal methods (Pill, Depo Provera) provide absolutely no protection against sexually transmitted diseases, so using a condom is always a great idea no matter what, as it will help protect you against STIs.

Q: Emergency Contraception Pills (ECPs) are relatively new. How do they actually work, and why are they so controversial?

A: The most common type of ECP is Plan B, a progestin-only pill that received FDA approval as an over-the-counter (OTC) medication in 2006. Most experts believe that ECPs work by interfering with the fertilization and implantation of an egg and not by causing any type of abortion. Obviously, a constituency exists that disagrees and considers this method of contraception to be the same as an abortion, hence the controversy. Despite two expert scientific panels basically stating that ECP was safer than an aspirin, the FDA, under pressure from the White House, initially refused to allow OTC status for this drug. Even after OTC status was provided, it came with a huge caveat — it's only available to women over 18 years of age.

Q: Is it safe to use drugs like Viagra recreationally to increase the enjoyment of sex?

A: Only in your dreams — literally! If you take Viagra and you think it increases your libido and sex is much better, then congratulations, but your response had nothing to do with the drug. Viagra is intended for use by men experiencing problems with erectile dysfunction and is not intended for improving the romping, recreational sex of 20- and 30-somethings! There is no question that perfectly healthy young men are using Viagra in the belief that sex will be better/stronger/longer/more intense — you fill in the blank. In the club scene, some men are combining Viagra with other drugs like ecstasy. Ultimately, it's a good prescription for a heart attack. In a world where we always seem to be seeking bigger, better, more of everything — sex appears to be no different with recreational use of Viagra offering the irresistible but false promise of greater satisfaction. Consider yourself warned, and proceed accordingly!