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Conclusive answer wanted: is HIV - female more likely to be infected during menstruation by receptive penile sex?
Mar 8, 2010

Dear Doctor, While you website is incredibly comprehensive and coherent in most topics, it is with frustration and much dissapointment that I have been able to find so little information devoted to the potential increased risk for a woman to be exposed to HIV infected sperm (via receptive vaginal sex ) while she is menstruating. And what I have been able to find is full of contradictions or quite vague.

Considering ALL the realities of heterosexual transmission, this seems grossly inproportionate to the amount of material dedicated to the risk for a negative male being exposed to the menstrual blood of a potentially positive female.

Here are two I have found so far suggesting a greater danger to a negative female during menstruation:

If a female had HCV the menstrual blood would be infectious. While she is menstruating a female has a wide open lining of the uterus so that if there was any HCV in the semen it could easily get into her blood stream. That is why it is risk. If you must have sex during your period, then use condoms for that time. DTD.

While this is not about HIV, this theory about menstuating increasing the chances of contracting blood transmitted diseases in also used a few times elsewhere in relation to HIV.

Also a link to this information, suggesting a strong probabilty in the likely hood of a link:

http://www.catie.ca/eng/PreventingHIV/fact-sheets/Women-Biology.shtml

Then to contradict these, a response from Dr. Bob:

Hey pd,

Vaginal sex during menstruation may increase the risk of HIV transmission from an infected female to an uninfected male; however, it probably does not increase the risk of transmission from an infected male to an uninfected female. Hope that clarifies any confusion.

Yes, we are still planning to be in Buenos Aires in November. That is if we can master the Tango by then.

Dr. Bob

This is also addressed in the introduction: Heterosexual intercourse is presumed to be the most common mode of HIV infection worldwide. Studies of male-to-female and female-to-male transmission provide strong epidemiologic evidence that heterosexual transmission of HIV does occur via penile-vaginal intercourse.(31-41) Vaginal sex during menstruation may increase the risk of transmission from an infected female to an uninfected male,(40) but probably does not increase the risk of transmission from an infected male to an uninfected female.(43,55,56)

an example of a very vague response, that then continues to again address the danger to the menstruating woman's partner:

Hi. Thank you for your question.

I am not aware of any study looking specifically at this issue. However, it is well established that anytime a woman has unprotected sex with an infected person (whether it be HIV or other Sexually Transmitted Diseases), that there would be a significant risk of infection. I'm just not aware of any studies looking to see if the risk would increase during menstruation....

So, the most on your website seems to suggest no increase in transmission to the woman while she is menstruating, although I am still far from convinced by the reasoning your doctors use, and the issue seems to be relatively ignored compared to others.

I find it impossible to believe that there are not conclusive results on whether it is more dangerous or not, when it has been made for other diaseases. Are you able to clarify a reason for this? Or enlighten us with new information.

Thanks,

R.

Response from Dr. Frascino

Hi R.,

Sorry, there is no "new information." As I hope you can appreciate, collecting information on this topic would be incredibly challenging. You certainly cannot do a controlled clinical trial to gain more detailed information on this subject as it would be unethical! The bottom line, however, is fairly clear. Unprotected vaginal receptive sex is risky business with or without extenuating circumstances such as menstruation. I have not changed my opinion on this topic.

Remember, sex is always cleaner with a packaged wiener!

Stay safe.

Dr. Bob



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