We might be led to believe that the more sexual partners we have, the greater our collection of sexually transmitted and blood-borne infections (STBBIs); Balfe et al., 2010). This would be in line with the belief that a person can contract an STI because it is "immoral" or "irresponsible" (Balfe et al., 2010; Shepherd and Gerend, 2014).
In recent years, however, there has been a relative decline in the number of sexual partners among young adults (Twenge et al., 2015, 2017), but... an increase in the rate of STIs (Blouin et al., 2023).
This is simply because the link between the number of partners and the rate of STIs is not as simple as it seems.
This is not a cause-and-effect relationship: rather, the number of sexual partners is a factor in the number of sexual partners. risk factor. Just as having had only one sexual partner doesn't mean you don't have an STI, having or having had many partners doesn't mean you'll have one or more STIs, but it does increase your risk.
By the way, how many partners do you have to have before it's officially considered "a lot"?
Rather than thinking that "multiple partners" rhymes with "STIs", it would be wiser to reflect on the practices and contexts that may explain why multiple partners are considered a risk factor.
Among other things, these practices and contexts include:
Do not use condoms or use them inconsistently
Beyond complete sexual abstinence, which means having no sexual contact with another person (whether or not it involves penetration), the methods that offer the most protection against STIs are «barrier» protection methods, which include external («male» or traditional) and internal («female») condoms, as well as dental dams and latex gloves.
However, even though we know that condoms and other methods are an effective strategy for protecting against STIs, many of us don’t use them or don’t use them properly. According to data from a Club Sexu survey, 44 % of people who were not in a relationship reported not using protection against STIs during their most recent sexual encounters (this figure rises to 74 % among people in relationships). Data from the Institut national de santé publique du Québec (2017), which show similar results, also indicate that, among young people aged 17 to 29 who used a condom during their last sexual encounter, 20 % engaged in penetration before removing the condom from its packaging. Oops.
But if we know condoms are effective, why do so many of us not use them? According to the Canadian Community Health Survey, in which more than 11,000 young people participated, 47 % said they do not use condoms because they are in a monogamous relationship, and 47 % because they use another method of contraception (specifically hormonal contraception, which offers no protection against STIs); Rotermann and McKay, 2020). In addition, 24 % believe they are at no risk of contracting an STI, while 22 % do not like the sensation condoms.
2. Not getting screened or not getting screened regularly
While young adults are particularly affected by STIsBlouin et al., 2023) research shows that most do not get screened regularly (Boudewyns and Paquin, 2011; Martin-Smith et al., 2018). In a sample of sexually active Quebecers aged 17 to 29, only 31 % of men and 42 % of women reported having taken a screening test in the past 12 months (Lambert et al., 2017).
It goes without saying that if you don't get tested, especially if you're lax with condoms, the probability of contracting and transmitting an STI can increase from one partner to another, and, in some cases, even from one monogamous relationship to another. (Ott et al., 2011).
Once again, the reasons given for not getting tested are abundant. Among other things, beyond a lack of general knowledge related to STIs and the screening process...McDonagh et al., 2018), people:
- do not perceive themselves as being at risk of contracting an STI;
- are afraid or ashamed of receiving a positive diagnosis and having to talk about it with their exes;
- worry about being judged by others—including by doctors—for having unprotected sex or for having «too many» partners (McDonagh et al., 2018).
In short, we are afraid of being seen as irresponsible and as having veered too far from the famous monogamy.
3. Avoid frank and open discussions about one's sexual health
It is completely fine to stop using condoms or dental dams after a certain period of seeing someone. The problem is that people tend to do so for reasons that aren't very valid from a health perspective.
For example, we drop the protection:
- when one wishes for the relationship to become «serious» (Skakoon-Sparling and Cramer, 2020);
- when, in heterosexual relationships, the person who has a uterus starts taking a method of hormonal contraception or wearing an IUDMorroni et al.., 2014);
- or when you feel comfortable and safe with the other person, even when you have no information about their sexual healthSparling and Cramer, 2015).
Instead of deciding not to use condoms for these reasons, it's better to have an open discussion with your partner(s) about your sexual health. Rather than asking questions like «Do you have an STI?» or «Are you cleanThe following questions are much more useful to ask:
- «When was the last time you got tested?»
- «What were the results?»
- If the results were positive: «Did you take your full treatment?»
- If the results were negative: «Have you had other sexual partners since?»
4. The relational context in which the sexual relations took place
If several of us think that having many sexual partners inevitably leads to contracting one or more STIs, then several of us also believe that monogamy can protect us from STIs. However, research paints a much more nuanced picture...
According to a 2021 survey conducted by Club Sexu among its subscribers, people in non-monogamous relationships (open relationships, polyamory, etc.) and people in monogamous relationships report comparable rates of STI diagnoses over their lifetime. Yes, you read that right! The results of the only scientific study on the subject (to my knowledge) point in the same direction.Lehmiller, 2015).
Here are some possible explanations. First, monogamy as it is practiced today is not an effective prevention strategy against STIs (Conley et al., 2020). Monogamy can be interpreted in different ways, and in its «pure» form—that is, having only one partner for one’s entire life—monogamy provides nearly 100% protection against the risks associated with STIs. The catch is that most of us have more than one partner in our lives and engage in certain behaviors that put us at greater risk:
- Our tendency to have sex before being «officially» exclusive or without having had an explicit discussion about exclusivity.;
- Our susceptibility to stop using condoms or dental dams when
- We want a so-called «serious» relationship (Skakoon-Sparling and Cramer, 2020)
- We want to establish a bond of trust and increase intimacy.Starks et al., 2018)
- The risk of pregnancy is reducedMorroni et al., 2014)
- Let's go believes safe without having had a frank discussion about their sexual health and getting tested (Sparling and Cramer, 2015).
Secondly, people in non-monogamous relationships are more likely to adopt prevention strategies, such as condom use and frequent STI testing, than people in monogamous relationships.Lehmiller, 2015A study comparing these two groups also highlighted that people in monogamous relationships took fewer precautions to limit the transmission of STIs with their other partners (during infidelity; Conley et al., 2012).
Yes, indeed., infidelity, the elephant in the room, is a relatively common behavior and it introduces a risk of contracting an STI.
According to a study, 21.2 % to 31.8 % of women and 36.6 % to 52.8 % of men in monogamous relationships have already engaged in sexual activities that carry a risk of STI transmission (oral sex, anal intercourse, etc.) with someone other than their romantic partner (Luo et al., 2010).
So, what exposes us to the risk of contracting an STI is more about not using protection than having multiple partners.
In summary...
Having multiple partners can indeed be a risk factor for contracting an STI. After all, if you have no sexual contact with others, the risk of contracting an STI is almost zero. This risk increases with the number of partners simply because the chances of encountering an infected person increase.
However, absolutely believing that more sexual partners means more STIs can be a risk factor in itself, because this belief has the effect of increasing or maintaining the stigma of STIs. This does nothing to protect us from STIs and increases the likelihood that we avoid to use condoms, get tested, and have an open discussion about sexual health, which can... increase STI rates.
So, rather than perpetuating the Slut-shaming and the stigmatization of STIs, by avoiding people who have had or have multiple partners, it is more effective, from the perspective of reducing STI transmission, to do the following:
- Use barrier protection methods (condoms, dental dams, or latex gloves) consistently with your partner.
- Use it until we have an open discussion about your sexual health.
- Use it until we go get tested at a screening clinic like Prelib.
