[Question #6994] HIV Risk - Mutual Masturbation

8 months ago

Dear Doctors:

I have come here a few times over the last couple of years with questions about no/low risk situations. I appreciate your expertise and patience. I've come to realize that I have a legitimate phobia or obsessiveness surrounding HIV. I am embarrassed by the problem but I have started to meet with a therapist to discuss the underlying fear. In the meantime, your reasoned and science-based answers often provide help in the overall context of addressing the phobia.

I'm a 46-year-old heterosexual male living in the Midwest United States. In the last 2.5 years, I've only had actual sex with one woman but that relationship ended a while back. Having grown up in the late 80's and early 90's, the general fear surrounding the HIV message has never really left my mind. It has always been my habit for both partners to be tested when beginning a long-term relationship.

I do not have unprotected sex without both partners knowing current status; however, there have been a few occasions during the last year or so where I have engaged in mutual masturbation. Unfortunately, even that behavior has started to cause too much anxiety and has triggered a testing pattern (as well as ruined a number of developing relationships). This is what has primarily prompted me to seek therapy since the obsession is now officially affecting my ability to develop a normal relationship.

I recently had a situation where I was engaged in deep kissing with a new partner. I was fully clothed but wearing shorts. My partner was wearing a long dress without underwear on. I did not place my hand in her genital region, but my bare thigh was between her legs and pressed against her genitals. At the time, I was suffering from a sunburn on my leg. The burn was not blistered but was red and swollen.

Of course, I have just enough knowledge to be dangerous but I recall reading somewhere that inflammation of the skin can be an infection risk? So my two questions:

1. Would the sunburn on my thigh

8 months ago

Sorry... looks like my computer froze up at the end of my description. My two questions:

1. Would the sunburn on my thigh represent any type of infection risk given the contact with my partner's genitals?

2. Is still your advice that the only practical risk of HIV infection is unprotected vaginal or anal sex?

Thanks for your patience. It is really hell to live with this type of anxiety and I feel for everyone else who comes to this forum with the same issue.

H. Hunter Handsfield, MD

8 months ago

Welcome back to the forum. I see that by chance your four previous questions were answered by Dr. Hook. You got me this time, but you won't hear anything materially different. I scanned your previous threads and agree with everything he said.

And this really is a repeat of many of the same questions. You learned in those discussions that sexual transmission of HIV is extraordinarily rare unless there is penetrating vaginal or anal sex. In other words, the answer to question no. 2 is yes. For sure you are not at risk through mutual; masturbation. There has been no research on whether sunburn would increase the risk of exposure through a massage, but surely not: there is absolutely no reason to be concerned this could have elevated the risk. I'll also assure you (again?) that kissing is risk free; and will repeat what Dr. Hook said about the chance your masseuse had HIV is low. But even if she did, this event should not be generating any worry. I don't recommend HIV testing.

The problem with anxiety and obsessions -- and although I'm not a psychologist, I think it's fair to classify your inflated HIV fears as an obsession -- is that they are impervious to facts and science. It seems plain that having this additional response, i.e. telling you what you already know intellectually but not emotionally, isn't going to do anything more than give you temporary respite. I hope you'll be reassured by these comments and your concerns will decline, but it won't be anywhere near permanent. And it sounds like these issues are significantly interfering with your life. You know where this is going: you're not going to get beyond this without professional counseling. Be assured I suggest it from compassion, not criticism.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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H. Hunter Handsfield, MD

8 months ago

When I first replied, there was a typo, now corrected. "...the answer to question no. 2 [not 1] is correct." You probably understood, but being certain no misunderstanding.---

8 months ago

Thank you so much for your reply. I do realize that this has become an anxiety-drive obsession and I'm currently seeing a therapist. Your response does help to put things in perspective and hopefully the therapy sessions will get to the bottom of the issue. For those of us who came of age during the time when the virus was so prominent in the media, and effective treatments did not really exist, I think the fear just became embedded in our behavior. For me, however, it has gradually progressed beyond just the idea of unprotected sex to include non-penetrative contact like I've described. I do realize this is unhealthy psychologically so I appreciate your candor and expertise.

H. Hunter Handsfield, MD

8 months ago

Thanks for the thanks. I do hope you'll discuss all this with your therapist. And maybe it will help a little to know you're not alone in such anxieties. James Curran MD, dean of the Rollins School of Public Health at Emory University and former head of CDC's Division of HIV/AIDS Prevention, had an insightful perspective during a lecture a few years ago. He pointed out that we Baby Boomers are the only generation in human history to come of sexual age without serious risk of a deadly STI. Until the 1950s it was syphilis, which killed people by the millions before penicillin was developed. Then there was little risk of dying of a sexually transmitted infection, and that lack of fear helped fuel the sexual revolution of the 1960s-70s. Then HIV/AIDS came along in the 1980s.---

8 months ago

I think I have one question left so would like to use it for reassurance... I know this sunburn thing seems ridiculous (to me as well) but I just read that immune cells are brought to the skin's surface as a result of a sunburn, which is what causes the redness and inflammation. If these are the same cells targeted by HIV, what is it that keeps the virus from attaching to those cells and entering the bloodstream? I understand with a mucous membrane that the infected cells may pass more easily into the bloodstream, but what would keep the same types of cells present on the surface of "dry" skin from doing the same thing?

This is day 16 from my "exposure" and no fever, rash or sore throat but definitely plenty of stomach upset during this time. Can I be encouraged that I've not had ARS symptoms at this point?

Thank you so much for your patience.

H. Hunter Handsfield, MD

8 months ago

Inflammatory cells susceptible to HIV not on the surface of the skin but rather deep. I suppose absence of symptoms can be viewed as slightly reassuring. The source of your encouragement that you don't have HIV should be the science and the science based reassurance you have had.

That concludes this thread. Please note the forum does not permit repeated questions on the same topic or exposure. This being your fifth, with identical opinions and advice each time, it must be your last. Future new questions about obviously low risk events known to be risk free, and your resulting axieties about HIV may be deleted without comment and without refund of the posting fee. This policy is based on compassion, not criticism, and is designed to reduce temptations to keep paying for questions with obvious answers. In addition, our experience is that continued answers to anxiety-driven questions simply prolong those anxieties, when a better option is usually to seek professional counseling. Finally, such questions have little educational value for other users, one of the forum's main purposes. Thank you for your understanding.

I hope this and the other discussion have been hellpful. Hang in with that counseling!

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