[Question #5618] Risk assessment

22 months ago
Hi Doctors, thank you for the amazing work you do. This forum is so helpful and it is great to have access to expert, trustworthy information when it comes to sexual health.

I am a man and I got a massage from a woman. During the massage, she presented a handheld massager device or vibrator.  Here is an amazon link if you don't mind taking a look at the type of device. Maybe it was a different brand but very similar in design.
https://www.amazon.com/Original-Magic-Wand-Essentials-Massager/dp/B01DCHMIF2/ref=lp_3767551_1_13_s_it/144-4570145-1797842?s=hpc&ie=UTF8&qid=1562020048&sr=1-13

I asked if it was clean and she said she uses bleach to clean it. So I let her use it on me - my legs and arms and then on the surface of my penis and scrotum. After using it on me for a couple minutes,  she then proceeded to use it on herself for a couple minutes, she basically sat on it with the head of the device massaging her genitals, however, she was wearing panties. She proceeded to use it on me again - maybe about 20 seconds after it was touching her over her panties. She touched it to my penis for about 5-10 seconds and then I requested her to stop. In retrospect I wish I stated initially that I was not comfortable getting massaged by this device. I will say, the device did not look particularly wet after she used it on herself, possibly the panties prevented much of her secretions from getting on the device?

I know from this forum that hand to genital contact is totally risk free, even with use of the other person's genital secretions. Is that applicable in this situation? Or given that it is a massager with different surface material (rubbery or porous?) and high frequency vibration, is this not risk free/comparable to hand to genital contact? Is there risk for herpes, HIV or other STIs?

Thank you kindly!
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Welcome to the Forum.  Thanks for your confidence in our site.  I'll be glad to comment.  This is not an event that I would be concerned about, for a variety of reasons.  
1.  Let's start with your partner.  Statistically it is unlikely that she had an STI.  Most people do not.  This is the case even for persons who engage in commercial sex work.
2.  Second, the sex acts.  No penetration occurred and her underwear we between the mucosal surfaces of her vagina and you (or the vibrator).  STIs are not transmitted through material, even the material of sheer underwear and even if the material gets wet.
3.  Finally, the vibrator.  In addition to the factors mentioned about, while theoretically a vibrator might be used to immediately transfer genital secretions from person to person, this is not unlike mutual masturbation which, as you note is safe sex and not associated with STI risk.

Thus I see this as a no risk event and would not be worried.  I see no medical reason for concern or testing.  I hope that you feel similarly following this explanation. EWH
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22 months ago
Thank you so much, Dr. Hook, I absolutely feel similarly after getting your expert input. I really appreciate it.

Unrelated to this event, could I clarify that my understanding is correct with you, regarding periodic testing? I am of scientific background and believe my STI knowledge is good, but thought I should make sure I am on point!

1) HIV, GC/CT and syphilis periodic testing for anyone sexually active not in a committed mutually monogamous relationship even if always using condoms. Fully condom protected vaginal (and anal) sex are no risk for fluid transmitted dz like HIV and are low risk for skin to skin dz like syphilis, but recs are based on abundance of caution.

2) periodic testing recs do not apply if one restricts activity to only kissing, mutual masturbation and receiving condom protected fellatio (even if one has had >1 partner)

3) Beyond the 4 tests mentioned above,  routine/periodic tests for other infections such as herpes are not recommended unless there is a direct risk factor or symptom.

Thank you!
Edward W. Hook M.D.
Edward W. Hook M.D.
22 months ago
Straight to your follow-up questions.
1.  Correct.  while I have great confidence in the efficacy of condoms, I would recommend periodic testing out of an abundance of caution.  Further, the negative tests that are likely to occur will testing will be confidence affirming.
2.  Correct as well.  the activities you describe are safe sex and no risk for STI.
3.  Correct as well.

Take care.  EWH
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21 months ago
Apologies for straying off topic from my original question. I am willing to pay submit a new question if it is appropriate. 

If condom protection is complete during insertive sex  - i.e worn the whole time and does not break, is it still considered no risk for HIV and other infections which infect via the urethra? Condoms are not 100 percent effective because of risk of failure or user misuse.. but if actually used properly and confirmed to not fail during a particular episode, there is no route for these fluid transmitted infections to be transmitted, correct?

Thank you so much, Dr. Hook.
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
While I agree with the sense of your statement above, when research on condom efficacy is carried out, no matter how good the study, there are always a very few cases of STI which occur in persons who report perfect condom use without breakage.  The problem is that in these studies we depend on participant reports of how they used their condoms.  As an investigator in these sorts of studies, I can also tell you that we worry but cannot prove that some participants may not accurately report condom non-use (perhaps out of embarrassment) or may experience slippage of condoms which went unnoticed.  Thus, while I have great confidence in condoms, I cannot provide you with any scientific study which proves the condoms are perfect for prevention of STI acquisition.  Further, for some "lesion" diseases like herpes or syphilis, a condom may not prevent contact with an infectious lesions, thus while they absolutely markedly reduce the risk for infection, that protection is not perfect.

Having said that, I have every reason to believe that perfect condom use will provide close to perfect protection for STIs like gonorrhea, chlamydia trichomonas, NGU and HIV and a high degree of protection against syphilis, herpes and HPV.   

Sorry for the nuanced response but I want to be scientifically rigorous in my answer.  I hope that it is helpful to you. As you know, since this is my 3rd response, this will conclude this thread which will be closed shortly without additional responses.  Take care.  EWH
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