If My Husband Goes Down On Me, Something Terrible Might Happen to Him

How to Do It is Slate’s sex advice column. Have a question? Send it to Stoya and Rich here. It’s anonymous!

Dear How to Do It, 

I have been with my partner for about 12 years. The last time we had PIV intercourse was before the pandemic. Since then, an array of physical and mental health issues on both our parts has taken sex off the table, although we still remain intimate with cuddling, holding hands, hugs, etc. Recently, we’ve started talking about getting back into it again.

But one thing has me stumped, and I’m hoping you and your experts can weigh in. My partner is on an immunosuppressant with a warning that it lowers the ability to fight fungal infections, and specifically warns against oral sex.

How likely is this to be an issue in a practical sense? I’ve never had a yeast infection or UTI, and I generally keep things pretty clean and dry down there (naturally, no soap or douching). Are there things I can do to limit his exposure? I don’t want to blow off his concerns, since he’d bear most of the risk and I’d be getting most of the benefit, but I’d love to get this back in our repertoire, especially because PIV might still be a ways off.

—No Fungus Among Us

Dear No Fungus Among Us, 

My source, Dr. H. Hunter Handsfield, professor emeritus, University of Washington, and a nationally recognized STI expert, found the no-oral guidance to be odd, for a number of reasons that he explained to me over email and the phone. Assuming the warning was specifically referring to yeast (or Candida) infections, Handsfield pointed out that: “Yeast is rarely transmitted by sex—and oral sex is probably even lower risk than vaginal or anal.”

Handsfield said that in cases of profound immunodeficiency, like people who are undergoing (or have recently undergone) bone-marrow or organ transplants, he’s heard of patients being told to avoid sex entirely (for a period). “But for the average person who’s healthy and well and using a drug like HUMIRA for their Crohn’s disease, or methotrexate for their arthritis, I’ve never heard—and neither have my colleagues who handle immunodeficient patients—of proscribing either oral sex or any other kind of sex on account of those treatments for yeast infection,” he continued.

Handsfield also pointed out that “sex partners share their microbiomes, especially their genital microbiome.” We share a lot with those with whom we live with (especially when we use the same bathroom) and “sex, per se, isn’t the thing that’s going to tip the scales very often,” he said. Assuming that you and your partner are monogamous, that makes the no-oral guidance even less intuitive. Keep in mind that yeast infections, too, tend to be a flare up of one’s own yeast that already exists in their microbiome.

But! Handsfield and I agree that it seems wrong to tell you to ignore a doctor’s orders. If I were you, I’d get more information on this directive. Why is only oral sex banned? Why is any sex banned? Can the doctor cite studies or share a little bit more about the thinking behind warning against oral? Could a dental dam mitigate the alleged risk? A second doctor’s opinion could also be useful for your collective knowledge and/or peace of mind, and will give you the best idea of the options available to you.

—Rich

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