Looking at STIs with regard to fertility and childbearing from the perspective of a sexual health and labor delivery nurse.
What do your sexual habits have to do with your fertility?
Well, regardless of whether you’ve got a uterus or a penis, it can actually have a lot to do with it.
When we think about baby-making, our minds jump to the traditional storyline of a young heterosexual couple that falls in love, gets married, becomes financially stable, stops taking birth control (or has it removed), and then expects to become pregnant right away. In reality, most couples do not become pregnant right away; in fact, an estimated 12-15% of couples in the US struggle with infertility. Infertility can be described as the inability of a reproductive-aged person to become pregnant after 12 months of purposefully unprotected sex with the intention of conceiving.
Infertility can be caused by a number of different factors. Although some couples, whether they end up conceiving or not, never find out what the cause of their infertility troubles were, it is estimated that in heterosexual couples, one third of causes are related to the partner with the womb, one third are related to the partner with the testes, and one third of causes are an issue of both, combined . Causes of infertility can be related to lifestyle, underlying health conditions, hormonal imbalances and more, but can you believe that one of the top causes of infertility can be caused by scarring of the genital tract?! Various studies done on infertile couples found that 12-30% of folks struggling with infertility had an undiagnosed chlamydia infection! [3a, 3b] While we hear more about it in the fallopian tubes, it can also occur in the vas deferens.
Scarring of the Reproductive Tract
STIs such as Gonorrhea and Chlamydia are bacterial infections that are transmitted through vaginal, oral, and anal sexual contact. Common side effects of chlamydia are abnormal discharge from any of the orifices you have sex with (vagina, penis, anus, throat), genital pain or pain with urination. Gonorrhea can look similar but there may also be pain in the testicles or difficulty urinating. The thing about these infections is that they don’t always produce symptoms, and you may never know you have them unless you get tested. You definitely won’t be able to scout these infections out by looking at the genitals of a potential partner! Once contracted, these bacteria sit in your reproductive tract and cause damage to the cells that line it, which over time starts to create scar tissue. This scar tissue can build up and block the fallopian tubes or vas deferens, making it difficult for sperm to travel out of a penis or up to an egg for fertilization within the fallopian tube. No fertilization = no baby.
Not only can STIs affect fertility, they can have an effect on childbearing as well.
STIs such as HSV (herpes simplex virus), HPV (human papillomavirus), and HIV (human immunodeficiency virus) are all viruses and therefore can’t be cured with simple treatment of antibiotics. Medicine has come a long way with different treatments to help manage these infections, but there are no true cures for them yet. While these viruses don’t have as much of an effect on ability to become pregnant, they do have negative implications for other aspects associated with childbearing.
HSV (herpes simplex virus)
It is recommended for those with an active HSV outbreak at the time of delivery to deliver via caesarean section instead of vaginally due to the potential risk of transmitting the virus to the infant during a vaginal birth . While there is nothing wrong with having a C-section, it does carry a lot more risk and recovery time than a vaginal delivery. At least attempting a vaginal delivery is generally desired by both the mother and the medical team.
HPV (human papillomavirus)
HPV is a tricky one because it’s very contagious and most of the time there are no signs or symptoms to know you have it. There are about 40 different strains of the virus; the lower risk ones (type 6 and 11) are the ones that cause genital warts and should actually be the least of your worries. There are about 15 higher risk types and these are the ones that are responsible for causing cancer of the cervix, vulva, vagina, and penis. Routine pap tests (every 3 years) are recommended for all humans with a cervix starting at age 25. During a pap test, a q-tip like swab is used to wipe the cervix to check for abnormal or cancerous cells that are caused by HPV. Fertility and childbearing start to come into the picture when someone is found to have abnormal cells on their cervix which require intervention. Interventions for abnormal cells can vary from monitoring more closely through more frequent screening, all the way to having parts of the cervix removed for biopsy or to remove cancerous tissue. If caught early, outcomes are generally positive for the patient; however, these invasive procedures can create scar tissue on the cervix, making it hard for it to dilate enough to be able to have a vaginal delivery. In some cases, the cervix will not dilate at all, meaning the mother would need to have a caesarian section. Additionally, interventions such as a LEEP (loop electrosurgical excision procedure) or Cone biopsy can cause preterm labor [5a, 5b].
HIV (human immunodeficiency virus)
There are very few true contraindications to breastfeeding an infant, even a mother who is using illicit drugs is still encouraged to breastfeed. However, HIV is one of the true contraindications to breastfeeding , as the virus is transmittable through breast milk. Since breastfeeding is a great way to combat postpartum depression, this can set a new mother up for challenges and issues related to guilt and shame.
Now that you’re probably freaked out about ever having sex again, let’s talk about some ways you can protect yourself! Anyone who is sexually active is at risk for all types of STIs, so the best thing you can do is practice risk management and harm reduction. The best methods to prevent yourself from getting an STI is obviously to use condoms and limit your number of sexual partners. These things may not suit everybody’s lifestyle, so luckily there are many other things you can do to reduce your risk. Did you know things like quitting smoking , avoiding the use of spermicide (nonoxynol-9) , and not removing your pubic hair  can decrease your risk for contracting an STI? Yep you heard that right, the government of Canada has stated that spermicide and condoms that contain it actually increase your chances of contracting an STI or HIV. Also, keep in mind that an untreated STI will put you at risk for more STIs, so it’s best to get tested between each partner. If that’s not possible for you, try to get tested as routinely as you can and if you have a cervix, stay up to date on your pap tests every three years.
Whether fertility or childbearing are on your radar at this point in your life or not, take measures to protect yourself and stay healthy so that no door is closed for you if the day comes when you or the love of your life want to conceive!
Header image illustrated by Leonor Carvalho