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Surgeon dating a great guy who is positive
Oct 7, 2004

(Sorry I think I may be sending this twice)

It has been a whirlwind over the past 3 years since I came out. Abusive boyfriend, drugs, recovery, ... I am a 29 yo practicing plastic surgeon who is "out" at work. I dated a guy last year for a few months and this was the first time that I had dealt with the issue of discordant sex. I looked online and came up with the idea that as long as I used a condom anal sex was fine and that I was okay with oral sex without progressing to orgasm. That relationship ended after a couple months because we were getting close and he said that he could only let himself fall for someone who was positive because it worried him too much to transmit it to a negative partner. Now a year later I am finding myself in a similar situation, but now I have more questions. Do my sexual practices seem appropriate ? This guy is one of those guys that would be in it for the long-haul, my kind of guy. For some reason I was okay when I had safe sex for only a couple months last time around and only had occasional "worries about having converted". This time because I see it as a life-time thing, my worries are a bit accentuated. Do my sexual practices seem reasonable for a discordant couple ? And the question that I don't feel asking elsewhere is -- I am worried about what a patient may say when and if someone found out that the guy I was dating was positive and that I am operating on their loved one. Have you dealt with this issue before ? I had decided after the last relationship that I wouldn't date a positive guy, but that is fine and dandy until they have a face. Well I would appreciate your advice and support.

Response from Dr. Frascino

Hi,

You're a 29-year-old practicing plastic surgeon? Wow, how did you get through your residency so quickly?

You ask, "Do my sexual practices seem appropriate or reasonable for a discordant couple?" Ultimately only you can answer that question. What I can tell you is that many magnetic couples, including Steve and me, have very successful and satisfying sexual relationships. What you and your partner must discuss is "negotiated risk," or perhaps more aptly termed, "negotiated safety." That means you and your partner create a safer-sex ritual that you both agree to and adhere to. You need to discuss what each feels is unsafe based on individual comfort level and medical facts. That is the only way to assure your sexual practices are appropriate for you and your Mr. Right. For a concise review of risk associated with specific sexual practices, try the "Safer-Sex Methods" HIV InSite Knowledge Base Chapter (Dec. 2003), which, along with medical literature references, can be downloaded at http://hivinsite.ucsf.edu/InSite?page=kb-07-02-02.

As for worrying about what a patient may say when and if someone found out your partner/boyfriend was positive, certainly a patient can "elect" to go elsewhere for an "elective" procedure. That's always their prerogative. Most reasonable patients will accept reason, logic, and scientific fact about the efficacy of "universal precautions." Form my personal experience and that of other physicians in similar situations, the number of patients who choose to go elsewhere is very small. Personally, I would never compromise the honesty and integrity of my private or professional life and most certainly not to appease a patient's irrational fear of a nonexistent risk.

Hope that helps!

Dr. Bob



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