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Valentine's Day--Of Lovers, Whips, Saints, Condoms, and Valentines

St. Valentine's Day, the day for lovers, has in the past been declared National Condom Day. For today's sexually active women, there are a lot of creepy things out there, and unprotected sexual activity is an excellent way to welcome them into your life. Condoms suddenly make sense.

Many women wonder just how many things there are out there that they can "catch." It's a pretty long list indeed, and symptoms can be a tip off to a gynecologist. Pain could indicate a bacterial infection (such as gonorrhea) or the virus, herpes. A rash or painless lesion might indicate syphilis. A vaginal discharge could be anything from a simple yeast infection to any of several Sexually Transmitted Diseases (STDs). Are there suddenly warts in her life, and if so, did her partner have any? Fevers, burning with urination, even sore joints can implicate STDs. How long have the symptoms been going on? Could it be that the patient had symptoms before the actual sexual episode she's worried about? If so, then maybe her partner is the one at risk. Since herpes can affect the eyes, hepatitis can be sexually acquired, joints can swell painfully from gonorrhea, and lice can be unknown to the patient, a physical exam should be a careful head-to-toe appraisal without exception. Swollen lymph nodes can accompany herpes or any other inflammatory STD. Herpes can also cause fever, but so can gonorrhea and other pelvic inflammatory diseases. Tenderness over the liver area can indicate hepatitis contracted from a sexual partner, but it can also indicate a type of generalized peritonitis caused by infections in the tubes (fallopian tubes). One of the most sensitive indicators of a sexually acquired pelvic infection is tenderness during the actual pelvic exam. At Charity Hospital where I trained, the doctors used to call it the "Chandelier Sign," meaning that when such a finding occurred, the patient reached for the chandelier (or hit the roof, in other vernacular) because of the discomfort the exam caused. A "wet prep" is a smear of vaginal secretions to rule out sexually acquired bacterial infections or trichomonas (a flimsy living organism that can cause burning and itching). Laboratory evaluations include a pap smear to rule out presence of the Human Papilloma Virus (HPV), which can cause genital warts or, worse, precancerous changes at the mouth of the womb (cervix). Vaginal cultures can check for gonorrhea, herpes, and chlamydia (often a silent cause of future infertility). And blood work can check for HIV (the cause of AIDS), syphilis, and hepatitis.

Except for hepatitis--which can kill you--and AIDS--which is determined to kill you, all of the other things have excellent medications and procedures to eliminate them. An STD can cause such potentially damaging results to a women's reproductive potential, as well as literally cause an explosion of infection throughout a community because of it's pyramid effect, that most physicians recommend treatment even for possible exposure from casual sex. There are so many things out there and a comprehensive check can be so expensive, that it's simpler to re-assess one's sexual habits and institute safeguards to eliminate these worries from an already busy life. If you know what I mean. Condoms are not the end-all barrier against everything. Lice are not prevented. Even herpes and warts can spread to other areas of contact not covered by the condom. But the real killers like hepatitis and AIDS, and the reproductive cripplers of gonorrhea and chlamydia are much less likely with condoms. Only abstinence gives a guarantee (now there's a thought!).

I find it especially relevant that awareness for a prophylactic/sexual disease barrier happen any time in February, although few people even know where the name February came from. Allow me to tell all, so that you, too, can appreciate the irony.

One of the greatest of Roman feasts, "The Lupercalia," was celebrated on February 15 to honor the god Pan in what was then the last month of the Roman year--February. Pan was the god who drove away wolves and was therefore the protector of the flocks, thereby allowing more of them to survive and reproduce, their numbers increasing. It wasn't much of a stretch that this festival came to be a devotion for an increase in the numbers of humans, too, through the gift of fertility. Priests offered in sacrifice a goat (from the flock) and a dog (guardian of the flock)--or even a human shepherd. Two young men were led to the altar, their foreheads smeared in the blood of the sacrificed. I'm not sure what happened to them, but the priest in charge cut thongs from the hides of the sacrificial animals. These were then used to whip the bare buttocks of barren women who thronged to the city walls--perfectly naked-- believing that this "blessing" would "open their wombs."

Go figure.

The thongs were called "februa," the festival Februatio, and the day dies februatus. From all this comes the name of our shortest, often coldest month of the year. This festival on February 15 gradually became associated with the feast day on February 14 of two third-century Roman martyrs, both of whom were named St. Valentine. As a calendar coincidence, paganism and Christianity clashed within twenty-four hours of each other to make February 14 the day we honor lovers and venerate St. Valentine as their patron saint. Wouldn't both St. Valentines be surprised! And from the acts of lovers come reproduction.

And AIDS and hepatitis and genital warts and cervical cancer and herpes and all of the other sexually transmitted diseases. And out of the old joke that describes the eternal entombment within wallets of post-pubescent self-proclaimed pseudo-studs rises the formerly maligned condom, now the most effective way of putting a barrier between the possible diseases of sex partners. They're given away at schools; they're advertised on music television; they're bought by as many women as men. From the whipping by ancient februa to the patron saints of lovers whose feast day came coincidentally the day before--to national recognition for the condom--February is one busy short month in the history of men and women together. And have I mentioned Mardi Gras?