Does period sex increase the risk of getting an STD?

Blood stain on a tissue
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Question: Does period sex increase the risk of getting an STD?

Recently, a friend of mine wrote to me to ask me about period sex. She wanted to know if it's true that menstrual blood increases the risk of getting an STD. The short answer is yes. However, the reasons why period sex increases risk are both fascinating and varied.

Fun fact: Catholics are more likely than many other groups to have period sex. This may be because of church prohibitions on using contraceptives.

Answer:  Yes... but it's not quite clear why. 

Not all STDs are transmitted the same way. The link with period blood is probably clearest for the blood-borne diseases such as HIV. This virus is, after all, found in the blood. During menstruation there is a lot more blood to which a woman's sexual partner may be exposed. That's true even if they are practicing safer sex.

In fact, there is a small, if controversial, body of research suggesting just what you'd expect. Sex during menstruation may increase the risk of heterosexual HIV transmission. That also seems to be true if there are other blood exposures during sex. What may be more surprising is that there is also some evidence that sex during menstruation is associated with an increased risk of other sexually transmitted diseases.

Why would STD risk increase during period sex for STDs that are not transmitted through blood? Well, there are several theoretical reasons:

  1. The amount of the pathogen varies with the menstrual cycle.
    This explanation is plausible, but not proven. In at least one study, the amount of shedding of cytomegalovirus (CMV), but not herpes, has been shown to vary cyclically. However, the maximum shedding time was during the luteal phase. It was not during menstruation.
  1. Blood flow acts as a carrier for viruses and other pathogens.
    Physiologic changes during menstruation could  increase a woman's susceptibility to infection. Additionally, menstrual blood could enhance bacterial growth.
  2. A woman's cervix is more open during her period. Therefore, she may be more susceptible to upper cervical and uterine infections.
    There is conflicting data on whether ascending infections and pelvic inflammatory disease (PID) are associated with sex during or near the time of menstruation. The link may be more folk wisdom than scientific fact. It is, however, worth mentioning an alternative explanation for why ascending infections might be more common in the week after menstruation . It could be that existing infections are be more likely to ascend into the uterus and become symptomatic PID during menstruation. That might be true even if the sexual act that caused the infection occurred at another time.
  3. Women who have period sex are likely to have more sex and more sexual partners. This increases their risk in a way that has nothing to do with menstruation.
    There is some research that suggests that women who have sex during their period are at increased risk of STDs other than HIV. However, there is also data showing that women who have sex during their periods are simply more sexually active. They have more sex and more sexual partners than women who choose to abstain from sex during menstruation. This could mean that it's not having period sex that increases the women's STD risk. Instead, women who have sex during their periods may be at higher risk in general.
  1. Exposure to menstrual blood causes skin irritation and inflammation. This might increase susceptibility to infection.
    Menstrual blood can be an irritant for some people. Skin irritation can increase susceptibility to various STD infections. Put these two things together, and you have another hypothesis for risk. In fact, there is data that women may be more susceptible to vulvar skin irritation during their periods.
  2. Menstrual blood can also dilute the effects of both natural and artificial lubrication.
    This could increase the risk of tearing and other types of skin damage. that affect STD risk.

    A Word from Verywell

    In the end, the data on period sex and STD risk isn't all that clear. Self-reported data does suggest that period sex is associated with an increased risk of STDs. However, more rigorous studies have not found as clear-cut results. Personally, I'm not convinced that anyone is ever going to put the time and effort into doing the research. Still, if they did, it might well turn out that the association between STDs and period sex is more about the type of people who have sex during menstruation than the absolute risk of having sex while a woman is bleeding.

    That said, if you're going to have sex during menstruation, take precautions. Doing so is certainly not safer than having sex during other times of your menstrual cycle,. That means it's still a good idea to use condoms and take other safer sex precautions such as using appropriate lubrication.. You might also want to take precautions to keep from getting blood stains on your mattress. Those things are crazy expensive to clean.


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