August, 1997 column

I'm confused about the differences among hepatitis A, B and C. How do I know if I've contracted one of them? Besides condom use, what can I do to protect myself?

You're ahead of the game just by knowing that some forms of hepatitis are sexually transmitted -- and that all of them pose a threat to your health. All types of hepatitis (including the far less common D and E strains) attack the liver, sometimes producing flu like symptoms; hepatitis B and C can lead to chronic liver disease and may also increase the risk of liver cancer. Although vaccines are available to prevent hepatitis A and B, more than half a million Americans are infected by some form of the virus each year -- and thousands eventually die from it.
Not all types of hepatitis are transmitted sexually, however. While unprotected anal or oral sex are two ways to hepatitis A is transmitted, this type is usually contracted by eating or drinking contaminated food or water. (One source of contamination: infected food workers not washing their hands after using the bathroom.) Symptoms, including jaundice, fatigue, nausea, vomiting and diarrhea, tend to last a few weeks.
Hepatitis B, on the other hand, is transmitted mostly through vaginal or anal intercourse. It doesn't always produce symptoms, so you and your partner should see a doctor for a blood test if you're having unprotected sex. If one of you tests positive, the other can prevent infection by getting immunized within two weeks of exposure.
Hepatitis C is more serious still, Screening is available but there's no vaccine, and the infection leads to chronic liver problems in 70 to 75 percent of those infected. It can be passed on through unprotected anal or vaginal sex, blood transfusions and possibly even body piercing or tattoos.
Your best bet against all types of hepatitis? Use condoms, and if you plan to get pierced or tattooed, be sure the needles ate sterile and aren't being reused. Never share razors, toothbrushes or anything else that might transmit blood. Finally, if you're traveling abroad, ask your doctor if you need a hepatitis A vaccine. For more tips, see the Centers for Disease Control and Prevention's Web site,

My boyfriend refused to wear a condom when I asked. We had sex anyway, but I felt terrible aferward. He was surprised; he said he didn't think I cared that much. How could I have expressed myself better?

Good communication can be tricky, particularly in the heat of passion. To make matters worse, when we're not sure how someone is going to react to our message, we often express ourselves in an indirect manner that's easily misinterpreted. When it comes to something as important as condom use, however, offer your partner no outs, no choices and no ambivalence. Instead of saying, "Will you use a condom?" you might try, "We must use a condom." Therapists also suggest broaching sensitive topics with "I" statements, as in, "I need to use a condom to feel relaxed and safe," instead of potentially threatening "you" requests such as, "You should use a condom."
Of course, if you did clearly communicate your desire to use condoms and your boyfriend simply ignored you, you may need to rethink your relationship. He shouldn't look for loopholes or place the burden of condom use solely on you. Both of you need to participate in maintaining a healthy, safe love life together.

Glamour, August 1997

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