[Question #389] risk evaluation

105 months ago

Hello doctors,

my question is a more theoretical one. I’m a 29 year old caucasian female living in Europe and I’ve been in a relationship with my boyfriend (31, caucasian) for about 4 months. I knew from the beginning that he liked rough sex (I do too) and that he would like to do more of a BDSM practices like whipping, spanking me with a wooden stick, dog play etc., but we didn’t do it because I didn’t want to. But recently he told me he really wants to do more BDSM stuff because he likes inflicting pain and humiliating his partner and he was hoping that after we would get into a serious relationship I would eventually agreed with those practices. I got mad and broke up with him because even though I like rough sex, I’m not a masochist.

But now when I started to think about the relationship, I started to feel nervous about the possibility of him having an HIV. It’s probably just guilt and shock about the fact that I got into a relationship with someone like that, but I can’t get it out of my head. He told me that his former girlfriends were always into quite rough (for my taste) BDSM like really rough whipping and rod-spanking and bondage and that when he was at university he experimented even with practices like needle play and electro play. At the same time, he’s not promiscuous, he always did it with girls he knew and most of them were steady girlfriends, I think except for university years he was always in a long-term relationship. All his girlfriends were educated, university graduates, normal-looking girls. He is a PhD candidate, very successful in his job and quite rich. He’s very responsible and reliable and very concerned about his health and hygiene and I have the impression he’s on the guard when it comes to Std‘s. We were talking about getting married and having children in the future, but apparently he wants that with someone who wants to be submissive in the relationship.

I know it’s my decision to get tested, but I was wondering if you could give me your risk evaluation, for example if there is any statistic on HIV in dominant/submissive couples.

Btw. we only had unprotected sex about 4 times and I didn’t have any ARS symptoms afterwards.

Thank you so much for your time and help.

H. Hunter Handsfield, MD

105 months ago

Welcome to ASHA's Ask the Expert forum. Thank you for your question.

To my knowledge, there are no data to suggest that heterosexual men (or women) who are into BDSM are more likely to be HIV infected. I can imagine a theoretical reason why the risk might be slightly higher, to the extent that traumatic sexual practices, with bleeding, could raise the chance of transmission. But even if so, the increased risk would have to be trivial compared to the more basic risks: men having sex with men, injection drug use with shared equipment, and so on. Further, from your description, your partner has a very low risk sexual profile in regard to his past sexual practices and preferences in partners.

Further, in the very unlikely chance he had HIV, the average transmission risk for vaginal intercourse, male to female, averages somewhere around 1 in a thousand per exposure. So even if he were infected, the odds are very strongly in your favor. But since you are concerned, I certainly endorse the idea that you be tested for HIV. The expected negative results probably will be more reassuring than any response based on probility and statistics. Once 4 or more weeks have passed since your last unprotected exposure, the standard 4th generation ("duo", "combo") blood tests -- which are the normal day-to-day tests in most areas of western Europe -- will be conclusive.

I hope this has helped. Best wishes and happy new year--

HHH, MD

---