The Surprising Ways STIs Impact Women Differently Than Men

From remembering to take birth control to giving birth, women often assume different sexual risks and responsibilities than men. This is especially true when it comes to certain sexually transmitted infections (STIs). Women may experience higher rates or more serious long-term consequences, depending on the condition.

Sangeeta Sinha, MD, an OBGYN at StoneSprings Hospital Center in Dulles, Virginia, discusses how women and men are impacted differently by STIs, and offers essential facts about prevention.

“Male to female HIV transmission during vaginal sex is more efficient than the other way around,” says Dr. Sinha. “One reason for this is that when a woman has unprotected sex with an HIV positive man, he deposits a considerable amount of semen into her vagina.”

In the opposite case, when an HIV positive woman has sex with a man, far less infected bodily fluid is deposited into his urethra (the tube that allows urine and semen to leave his body), Sinha explains.

The vagina is also:

• Larger in surface area than the penis, so more tissue is exposed
• More delicate than the penis, and more likely to tear during sex, making extra openings for the virus to enter a woman’s bloodstream
• Exposed to the virus for a longer time period, since semen stays in the vagina for several days after sex

So, what can you do to lower your risk? 

You can reduce your odds of developing HIV by:

• Wearing condoms during anal, vaginal, and oral sex. Use a dental dam if performing oral sex on a woman. Condoms reduce HIV transmission during vaginal sex by 80 to 90 percent when they are used appropriately.
• Talking to your healthcare provider about pre-exposure prophylaxis (PrEP), a daily medication for people at especially high risk for HIV. When taken consistently, it lowers the risk of getting HIV through sex by over 90 percent. Using condoms along with PrEP offers even more protection.   

You should also get tested for HIV at least once. Get tested again if you’re diagnosed with another STI, you’ve had more than one partner since your last test, or you’ve engaged in high-risk behaviors like anal or unprotected sex outside of your relationship. 

Women are less likely than men to display gonorrhea symptoms. That frequently keeps them from receiving a prompt diagnosis. Without the proper treatment, gonorrhea puts women at risk for long-term problems like:

• Pelvic inflammatory disease (PID), a condition that can cause severe pain, especially during sex and menstruation, among other symptoms. It can also cause no symptoms at all, putting women at risk for ectopic pregnancy or infertility without warning.
• Ectopic pregnancy, or a painful pregnancy that develops in the wrong place, such as in the fallopian tubes, on the ovary or outside the uterus. An ectopic pregnancy isn’t viable and is a major cause of maternal death, especially during the first trimester.
• Infertility

Untreated gonorrhea also increases a woman’s chances of catching other serious infections like syphilis and HIV. Make an appointment with your healthcare provider if you suspect you’ve been exposed, or you’re showing gonorrhea symptoms like burning during urination, vaginal discharge, and bleeding between periods. 

Untreated STIs cause infertility for at least 24,000 women in the United States annually. “STIs like gonorrhea, chlamydia, herpes, and syphilis can cause severe pelvic infections,” says Sinha. “Infections may travel from the vagina to the cervix, and possibly to the fallopian tubes—even to the ovaries. In some cases, after those infections heal, the fallopian tubes or ovaries form scar tissue, resulting in infertility.”

This is a significant consequence of STIs, she continues, and can be potentially devastating for people. Infertility can cause depression and low self-esteem for someone who wanted to start a family.

“Unplanned pregnancy is one of the biggest consequences of unprotected sex and it, of course, affects women more than men,” says Sinha. Along with the stress, responsibility, and expenses of pregnancy, STIs can also lead to pregnancy and birth complications, such as:

• Passing an infection like HIV to the fetus or herpes to the baby
• Having a low birth-weight baby, which raises the infant’s risk of infections, developmental delays, and learning disabilities later on
• Stillbirth, or giving birth to a baby who has already passed away 

All pregnant people should be tested for STIs during their first prenatal visit, according to the CDC. Even if they test positive, prompt treatment can dramatically reduce the chance of passing on an STI. For example, treatment reduces the odds of an infant getting HIV to less than 1 in 100.

Women may experience vaginal changes with menstruation, menopause, new bath products, and more. They can also develop itching or vaginal discharge due to routine infections like yeast infections. Women may brush off STIs as one of these routine changes and may treat them incorrectly with home remedies or over-the-counter medications.    

Men, on the other hand, are more likely to seek help for symptoms like penile discharge since they’re harder to explain away. Skin changes are also more immediately visible on a penis than they are on a vagina.

In general, women see a healthcare provider more often than men. Each appointment is an opportunity to talk about safe sex and get tested for STIs.

“HIV screening, for example, can now be done in many doctor’s offices,” says Sinha. “It’s a quick blood test, you may be able to get your results right there and then you’ll know where you stand.”

But don’t assume your healthcare provider will automatically test you for HIV or any other STIs during office visits. Instead, talk about your sexual history and partners so your provider may determine which tests are right for you. 

“The bottom line is you need to use protection and know your partner’s history,” says Sinha. “Women often bear the greater burden in terms of birth control—from taking a daily pill, to implants in their arm or uterus, to the costs of those treatments. The least men can do is wear a condom.”

Interested in getting tested for STIs?

• Locate an OBGYN through Sharecare’s Find a Doctor tool.
• Visit FindSTDTest.org, a website from the CDC to find free, confidential testing centers near you.
• Text your ZIP code to KNOW IT (566948) to receive information about local HIV testing sites.