Article

F*c&!ng First Aid: A Quick Guide to Common Sex Injuries

It’s remarkably easy to hurt ourselves in the pursuit of feeling good. From genital abrasions to broken skin to pulled muscles to infections to allergic reactions, even fractures or breaks, exploring our bodies and their capacities sexually can sometimes mean finding out⁠ what’s past a bodies’ limits. We can think there was enough lube, but who among us (cough) hasn’t found out at least once that there wasn’t? We can forget that when it feels to us like we couldn’t possibly get enough of something, our body parts may have an entirely different and considerably threshold (um). Heck, you can hurt yourself just getting a date a glass of water (says my once-broken toe, bitterly).

Let’s get this bit over with first. For whatever ridiculous reason (probably a combination of ableism⁠ , totally inhumane sexual⁠ ideals and maybe some leftover stuff from our DNA way back when we lived a wilder existence), if and when people get hurt during sex⁠ , they often feel ashamed or embarrassed, and like they have ruined something. Getting hurt in our bodies is just as acceptable an experience as feeling good in them. It’s not “weak” to get hurt, and it doesn’t mean anyone failed at anything, it just means we are living in the body of a mere mortal, not a sexual superhero. So, if — and, in the whole of a lifetime, more likely when — some kind of sex injury happens to you or a partner⁠ , don’t get hung up on any negative feelings about it. Instead, turn your attention to yourself or whoever got hurt. Not only might you or they need physical care, caring for ourselves and each other in attentive, tender ways is only likely to enhance our sexual experiences and the ways we connect to ourselves or one another through them. This kind of care, much like general sexual aftercare, can be something that is a highlight of a sexual experience, even when something painful or bummerful happened which that care is centered around.

It’s well-known that way more sexual injuries happen than are every reported because many people are so embarrassed by sex, period⁠ , let alone hurting themselves during sex, that they don’t go to the ER or doctor when they need to. People also tend to want to avoid the ER or doctor, period, and with the state of most healthcare systems, it’s not like anyone could blame them. But when we need medical help, we just need medical help. Please, please, please seek out medical care when you or someone else needs it. By all means, especially with certain injuries or ways they happened, you might feel too embarrassed to have anyone know. But you can survive embarrassment, and it won’t do you any harm. The same absolutely cannot be said about something like a foreign object inside your body or an untreated sexually transmitted infection⁠ .

The following list covers the most common sexual injuries for people in the age group we serve (on the whole, with people 40+, the frequency of injuries will often increase as will the ways we can injure ourselves during sex — for example, potential cardiovascular events aren’t very likely for most young people while they are for many people over 60), tells you what they are, and what needs to be done when and after they have happened, including if a doctor or emergency room visit is needed or not. It also tells you how you can best prevent them, even though sometimes we or others can get hurt even when we’re doing what we can to avoid it, and tells you some other ways most of these same injuries have happened in the event that having a story that doesn’t involve sex makes you more willing to seek out needed medical help.

an a to z of intimate injury:

allergic reactions:

what are they? In the context of sex, allergic reactions or sensitivities that get activated are usually reactions to a latex, semen⁠ , lubricants or other substances brought into sexual play. Like any other allergy or sensitivity⁠ , they’re a way a person’s immune system can react to something in ways that other people’s don’t. Reactions can include rashes and other skin reactions, anaphylaxis, coughing and other common allergic reactions.

what do you need to do if it happens? That really depends on the severity of the allergy and your level of discomfort with an allergic reaction. If your allergy and/or allergic reaction is severe or potentially life-threatening, you’ll want to use an epi-pen if you carry one with you. If you don’t use one, or that didn’t do the trick, you’ll need to get to an emergency room right away, and should probably call an ambulance.

do you need to go to the doctor or ER? It depends of your level of allergy or reaction. If there’s any trouble breathing, severe or increasing swelling, or other severe or potentially severe reactions, then emergency medical help will probably be required.

how do you prevent them? Knowing what you’re allergic to is key to allergy prevention. If you don’t already know what, if any, things you are allergic or sensitive to, things you’d be allergic to with sex are part of a full allergy panel a general healthcare provider⁠ can do. If you know already — or have found out the hard way — then avoiding what you’re allergic or sensitive to is the name of the game. If it’s semen, you’ll want to use barriers with any partners whose bodies produce it, if it’s a certain ingredient in a lubricant⁠ , you’ll want to always bring or have your own that’s safe for you, if it’s latex, you’ll want to stick to non-latex barriers.

anal fissures and other similar injuries

what are they? Fissures are tiny tears or cracks of membrane of the anus⁠ . People can and often do get them due to straining with constipation or other bowel stuff, but with sex, they most often occur with anal play, especially if and when someone isn’t using lube or enough lube. Bleeding will often occur with fissures, and they can be sore or painful, especially with repeated sex or bowel movements.

what do you need to do if it happens? While it can often take some time — weeks to a couple months — fissures will often heal up on their own, so long as you’re gentle on the tissue where they are, and that will include a break from any kind of anal sex⁠ while they do. For some at-home care, you can help them heal by keeping your stool soft (if hard stools are an issue), warm baths, and using something like hemorrhoid cream, Aquaphor or aloe vera on the anus to help the tissue heal.

do you need to go to the doctor or ER? If fissures are causing a lot of pain or discomfort, don’t appear to be healing, or you keep getting them (if they become chronic), you’ll want to make an appointment with a healthcare provider. They can prescribe treatments for fissures that you can’t get over the counter, and also fill you in on any other medical options or suggested treatment.

how do you prevent them? Mostly by just being — and having partners be — gentle during sexual activity and remembering that rectal tissue is actually really delicate stuff. This absolutely means always using plenty of lube.

a bite or other kind of puncture wound

what is it? Puncture wounds are a little different than a wound like a scrape. They are a wound caused by something pointed — like a tooth, a pen, or the tip of a blade. That kind of wound can and often does go deeper than the surface of the skin, which means infection can be more likely.

what do you need to do if it happens? Wash it with warm water and soap, apply an anti-bacterial ointment, and then cover it with a bandage if possible. Be extra sure to keep this kind of wound extra clean⁠ , and keep a close eye out for any sign of infection: funky pus, a yucky smell, increased redness or other discoloration or a lack of healing over time.

do you need to go to the doctor or ER? Probably not, unless the wound is severe. If it is severe — you can’t stop it bleeding, it is particularly deep, you are in a lot of pain — then you should seek medical attention.

how do you prevent them? This is one of the answers to this one that’s just ridiculously obvious: you don’t have anyone bite you (like so many parts of sex, biting should always be a choice you make and something you agree to first), and if you’re going to play with biting, you and any partners keep it very gentle and don’t bit so hard it breaks or scrapes the skin. In terms of other puncture wounds, not having sex in hardware stores is highly recommended, but otherwise, just keep spaces you’re being sexual in clear of sharp, pointy things.

carpet/rug burn

what is it? Whether it’s from literally being sexual on the carpet or some other surface, it’s when you get abrasions from friction that happens by way of being on top⁠ of something like a rug, blanket, some kinds of restraints (like rope) or other rough surface.

what do you need to do if it happens? Usually you just need to stop doing whatever you were on that surface or with whatever scratchy thing is messing with your skin, or change up the way you were doing a thing so it stops causing injury, and then clean and engage in basic first aid for any surface wound: clean it, cover it, and keep it clean and dry as it heals. You’ll also want to leave that area alone until it heals.

do you need to go to the doctor or ER? Unless any wounds later get infected or, when they happen, look like they clearly need more than basic first aid, no.

how do you prevent them? Much like you’d so to prevent bedsores in someone sick, switch your positioning around often and if something starts to irritate your skin, stop doing that thing.

choking injuries

what are they? Ideally, they do not exist because you and your partners are not going to do any intentional choking that can cause them.

We will always strongly advise against choking because it is incredibly dangerous, and there are safer ways to experience aspects of it instead, like neck holding without any choking, nose-pinching, breath swapping, face-sitting with oral sex⁠ , or simply holding your own breath. Choking injuries include external injuries like bruising or scratches, to far more serious outcomes like voice box, windpipe, larynx, trachea, arterial or brain damage and cardiac arrest, some of which can happen days after the fact, so you may not even know they are happening at the time. Death is also a possible outcome of choking.

what do you need to do if it happens? Ideally, none of this will happen because no one will be choking anybody because it is just not safe to do. But if they do, yes, medical attention is probably required, and if the injuries are anything beyond an external injury, like bruising, an ambulance/ER is likely needed.

do you need to go to the doctor or ER? Probably, yes.

how do you prevent them? Again, you ideally prevent them by not engaging in choking at all. But if you’re going to do anything in that arena, you stick to kind of breath play that are safe.

eye irritation/conjunctivitis

what is it? Something wound up in an eye that irritated it: in the context of sex, that could be semen or vaginal fluids, a stray hair, lube or something else. Whatever it was, it can result in red, itchy eyes, and potential eye infections. While I’m here, this seems a good time to mention that it’s never a good idea to ejaculate in or near someone’s eyes. Not only does it usually cause a great deal of pain, especially when the fluid is semen, it’s a way some STIs and other infections can be transmitted or developed.

what do you need to do if it happens? You can first try getting whatever it is out of your eye, by flushing your eye with saline or warm water, or using a q-tip to help you get out whatever is in there.

do you need to go to the doctor or ER? If you can’t get something out of your eye by yourself, or with someone else’s help, it doesn’t work its own way out pretty quickly, or you’re in or having increasing pain, then you will need medical help.

how do you prevent them? One of the obvious ones: keep stuff out of your eyes that isn’t supposed to be in there. Since reflexively wiping our eyes with fingers or hands is also a very common thing people do, washing your hands after contact with lube or genital fluids is also a good idea.

genital rawness or soreness

what is it? It is what it sounds like. Sex that our bodies or their parts decide is too rigorous or just plain too much, sex without adequate lubrication, and some kinds of infections, too, can cause our genitals⁠ to look or feel sore and raw. Feeling sore or raw can sometimes also be a reaction to an allergy or sensitivity, like a latex allergy.

what do you need to do if it happens? First, you will need to stop doing anything with your genitals or the part or parts of them that feel raw or sore. Next, you’ll need to give your body whatever time it needs to heal: until you’re feeling all the way better, you won’t want to masturbate or have sex with a partner with the body parts in question. You can help speed healing or manage soreness with…

do you need to go to the doctor or ER? If it is and stays very painful and stays feeling that way, even after you have given it at least a few days left alone to heal, an appointment with a healthcare provider is a good idea. If soreness or rawness keeps happening even when you’re doing what you can to prevent it, that, too, would be a good reason to check in with a healthcare provider.

how do you prevent them? Lube, lube, lube, lube lube. Before and during, and plenty of it. But even lube can only do so much, so sometimes we just need to try not to overdo it. Remember, there are lots of ways to be sexual that don’t involve genitals as a whole or a given part of anyone’s genitals, so this is one of many excellent reasons to expand and switch up what you’re doing often. If this is about an allergic reaction, then obviously to prevent those you’ll need to prevent any contact with what you’re allergic to.  Pro-tip: if this is about a latex allergy, remember that not only are non-latex condoms now widely available, they offer some other benefits too, like conducting body heat better and feeling softer.

getting something stuck inside the anus or another orifice

what is it? What happens when you don’t listen to sex educators and you put things into the anus that don’t have a flared base or aren’t a body part firmly attached to someone else’s body. These are one of the most common kinds of sexual injuries seen in emergency rooms, though, so if this happens to you, know you are not near alone. A lot of the world is sometimes a little too curious about what they can put into buttholes, go figure. The vagina⁠ works differently than the rectum⁠ , so it’s much less likely to wind up with something stuck in or lost up there, but it can happen that sometimes something — a cervical barrier⁠ , a condom⁠ , a tampon⁠ , a small toy — is just in there in such a way that a person or a partner can’t get it out.

what do you need to do if it happens? If and when something is all the way inside the anus, vagina or other similar orifice and it doesn’t expel itself when you bear down (when you internally push like you do when having a bowel movement), and you or someone else can’t get a thing out, then you will need to get medical help immediately.

do you need to go to the doctor or ER? If you can’t remove it yourself/yourselves, or what is inside has ANY known or possibly sharp parts (some toys don’t have sharp things on the outside but do inside the toy), then the ER would be where to go. This isn’t something to wait on.

how do you prevent them? Don’t put things inside your body that aren’t designed to go there or otherwise aren’t safe. If it’s about your butt, unless what the thing is is someone else’s body part, never ever ever put anything in there that doesn’t have a flared base.

hickies/bruising

what is it? Any kind of bruise is caused by some kind of force to the skin, where blood vessels break and pool under the skin. Bruising generally isn’t a big deal, and will tend to just clear up on its own in time.  With sexual activity, they can happen from people sucking on each other’s skin, from pressing down on someone’s body with your hands, other body parts or your whole body, from various kinds of impact play⁠ , or from your body being pressed into something else — like the edge of a bed frame — during sex. Some of us bruise more easily than others, so some things that don’t bruise one person at all can make another look like they were run over by a truck.

what do you need to do if it happens? Usually nothing, unless you want to. If you’re in any pain or you want to speed healing, you can apply a cold compress and take an anti-inflammatory over-the-counter medication like naproxen or ibuprofen.

do you need to go to the doctor or ER? Probably not unless the injury itself that is causing the bruising is severe or otherwise something to seek medical attention for.

how do you prevent them? Often enough, bruises and other marks happen during sex, especially if you’re someone who bruises easily. Even when people don’t mean to leave marks, hands and hipbones and other parts can leave impressions behind. You can always ask a partner to be mindful about leaving any marks on you, though, if you like.

muscle cramps or pulled muscles

what are they? A cramp is a sudden, involuntary, and typically uncomfortable or painful contraction of a muscle or muscle group. They can cause twitching or a feeling if intense tightness. Cramps like leg or foot cramps are usually caused by a combination of muscle fatigue and dehydration. A cramp hurts, but it’s not an injury, exactly. A pulled muscle, or muscle strain, on the other hand, is an injury to a muscle or a tendon, usually by way of overextension or overuse. It will tend to hurt for longer than a cramp, and often give you grief when you’re doing other things that engage it, not just whatever you were doing that caused the injury in the first place.

what do you need to do if they happen? Cramps will usually pass in a very short period of time. Drinking some water can help, and massaging the area can help, too. If anything you were doing seemed to have a direct hand in the cramp you got, then you’ll obviously want to stop doing that for the time being. If you think you have injured a muscle or tendon, you’ll want to give it some more care.  This is a situation where RICE — rest, ice, compression and elevation — are the right thing to do. So, that’s rest for a few days by avoiding anything you can that causes you any discomfort, pain or swelling. You do want to try and do some gentle stretching though — only what feels okay — so you don’t get stiff. You will also apply ice to the area for about 20 minutes each hour for the first few hours or as long as icing feels good to you. You can find or get an elastic bandage (you might know these as ace⁠ bandages) or a specific kind of brace to compress the area. Lastly, you elevate by putting or keeping the pulled muscle above your heart. If it’s a leg, for instance, you can lay down and elevate it with a stack of pillows. You can also use over-the-counter anti-inflammatory medicines for pain, and if a heating pad feels good after a few days of icing, you can do that too. You’ll need to be gentle on yourself and the muscle for the first few days after you’ve pulled it.

do you need to go to the doctor or ER? For a cramp, that’s not at all likely. With pulled muscles or other muscle injuries, it depends. If it is very painful when it happens, medical attention might be a good idea. Otherwise, if it doesn’t seem to be getting better, if you’re unable to do things on or with it after a few days have passed, if it just doesn’t look right, including on the surface of the skin, or you continue to be in pain or your pain is increasing, then medical attention is the right next step.

how do you prevent them? Honestly, save just being careful not to do anything that could obviously cause them, things like this are just a common side-effect of inhabiting a body.  If it feels like it’s not right for your body, a good rule of thumb is to stop doing whatever that is. Staying hydrated can also help prevent or reduce cramps of all kinds.

labial cut or tear

what is it? It is what it sounds like: some kind of surface wound of the labia⁠ , most often the labia minora (inner labia). That can be anything from a scrape or abrasion, to a cut, a fissure or other small tear or a tear-tear. These can happen from everything from a lack of adequate lubrication, to one of the labia getting pulled into intercourse⁠ or another activity, to a cut from a fingernail, hangnail or sharp part of a sex toy.

what do you need to do if it happens? You’ll want to treat this a lot like you would with a similar injury on the lips on your face. Like the lips on your face, there can be more bleeding from these kinds of injuries compared to a similar wound on your arm, so more bleeding or redder bleeding doesn’t necessarily reflect the severity of the injury.  Generally, you will just use the basic first aid for wounds listed above.

do you need to go to the doctor or ER? If a cut or tear is severe — like if it looks like something has been detached or might be, if there is a lot of bleeding, or you are scared and just aren’t sure what to do, then seeking out medical care makes sense, and the ER or an urgent care would be the right places to go, rather than waiting on an appointment.

how do you prevent them? Be sure to use plenty of lubricant for any friction-based activities of or around your labia, keep anything sharp away from them, and just pay attention to them and ask for partners to do so too, if they aren’t. Injury can be more likely to happen for those with longer labia, especially during intercourse, so if they feel uncomfortable at any point, just pause and make an adjustment.

penile abrasion

what is it? Much like a vaginal, vulval, or other abrasion, it’s a surface wound caused by friction that occurs on the penis⁠ . When these happen, it’s usually because of too much friction with too little lubrication, like during masturbation⁠ or intercourse, or just too much friction, period (lube can only do so much).

what do you need to do if it happens? Treat it with the first aid practices listed earlier in this piece.

do you need to go to the doctor or ER? Probably not, unless it won’t stop bleeding, seems particularly deep, gets infected or doesn’t appear to be healing.

how do you prevent them? Lubrication is almost always the sole thing needed to prevent abrasions of the penis. Not overdoing it with anything you’re doing is another, as is making sure not to be using anything that isn’t safe for masturbation or other sexual activity.

penile fracture

what is it? A penis can’t break, because there aren’t any bones in it, but the corpus cavernosum, one of two columns of tissue inside the penis, can fracture if it’s bent too far, or with an awkward rebound from an orifice the person with the penis was thrusting into, or if it is hit in certain ways. If and when this happens, it will generally cause a great deal of pain, and there will typically be swelling. It might even make a popping sound when it happens.

what do you need to do if it happens? Go to the emergency room or urgent care. You’ll need medical care.

do you need to go to the doctor or ER? Yes, ideally as soon as possible.

how do you prevent them? This is one of those things that will nearly always be an accident, the kind where it just couldn’t have been prevented.  It also is quite rare, so it’s not likely to happen.

post-orgasm migraine or other illness

what is it? It’s not fully understood why, but some people experience headaches or other unpleasant neurological reactions with or after orgasm⁠ .

what do you need to do if it happens? That depends on what the effect is. If it is a headache, you’ll want to treat it like a headache, including the specific kind of headache it is, if you can: for instance, migraines tend to be most quickly or fully resolved by migraine-specific medication and other steps. But for just about any headache, just giving it time, resting your nervous system⁠ and the rest of your body, and, if you like, taking a general analgesic. If it’s something more like a seizure or paralysis, and these aren’t normal for you and already something you’ve had diagnosed and have treatment for, then seeking out medical care is the way to go.

Just so you know, if someone is having what’s called a tonic-clonic seizure, the kind with physical stiffness and spasms, here’s what to do until medical help is available:

  1. Turn the person having one on their side.
  2. Move anything near them that could cause them harm away from them.
  3. Do NOT put anything, like a pencil, into their mouth (that was common advice for a long time)

do you need to go to the doctor or ER? If you can’t kick the headache or other post-orgasm illness, then medical attention is a best next step. If you find yourself getting post-orgasm headaches often, you can also ask your healthcare provider about medications to help prevent or treat these kinds of headaches or other  neurological reactions or illness.

how do you prevent them? Once you know you get post-orgasm migraine or other related reactions, you can often prevent them through ongoing treatment of the reactions, like headaches or seizures. Your healthcare provider may also give you a protocol that involves taking a medication before sex begins.

skin reactions to pubic or facial hair

what is it? Some of our skin is more sensitive than it is for other folks, and rubbing up against someone’s pubes, facial hair or stubble can irritate it, resulting in redness, soreness, itching, a rash or acne.

what do you need to do if it happens? Just wash your face with a gentle cleanser and apply a light, soothing lotion meant for the face or fresh aloe vera gel if you have it. A cool compress can also help. Then take a break from that kind of contact until your skin has settled down.

do you need to go to the doctor or ER? Nope, not unless the reaction you are having seems very extreme.

how do you prevent them? If you have very sensitive skin, you might try using a skin barrier cream. You can also just limit how much contact like this you are having. Partners who want to and are able can remove their hair just before being with you, but just know that stubble can be just as much of — and sometimes more of — an irritant.

testicular injuries

what are they? There are a range of injuries that can happen to the scrotum or testes⁠ with sexual activity, everything from minor pain or bruising due to the testes getting accidentally squished or kicked, or the scrotum scratched or cut by fingernails or sharp edges of a toy, to more serious injuries like a rupture or fracture of the testes, caused by things like rough sexual play like pinching or binding. The testes and scrotum are both very sensitive  — so an injury is going to hurt — and very fragile, so it’s easier to cause injury or pain than you might suspect. However, most testicular injuries usually resolve, and most often without any long-term damage.

what do you need to do if it happens? Take a few minutes to let any pain you’re experiencing chill out. If the injury is a cut or scrape, do the genital wound first aid described earlier in this article. If you’re not seeing any swelling, if the pain isn’t severe and is subsiding, and you feel okay in 20 minutes or so, you’re probably just fine, but do keep an eye on the area over the next few days. You can take an over the counter anti-inflammatory medication (like Tylenol or Advil) if you have any residual soreness.

do you need to go to the doctor or ER? If you are seeing swelling, if bleeding won’t stop, if the pain is severe or isn’t subsiding pretty quickly, or if you have any reason to think your injury might be severe, then get yourself to an ER or urgent care.

how do you prevent them? Be careful with your testicles and scrotum and ask partners to, as well.

UTIs, cystitis, bacterial infections and other infections

what are they? Some infections — simply put, any infection is something that happens when germs — bacteria, viruses, yeast, fungi, or other microorganisms come into contact with and grow in our bodies in ways that aren’t healthy for us — are transmitted by various kinds of sexual contact, like HIV⁠ , genital Herpes⁠ or Chlamydia. Others can be sort of side effect from sex, like how urinary tract infections (UTIs) can be a result of bacteria being introduced to the urinary tract during sexual activity. 

Any kind of person in any kind of interpersonal relationship⁠ or interaction can acquire or develop these kinds of infections. If you’ve been part of any of the kinds of sexual activities that can transmit STIs, you can acquire or transmit an STI⁠ , and that’s much more likely if and when you or anyone else isn’t engaging in safety practices like using barriers and testing to help prevent them. Anyone with genitals can develop a genital infection, with or without sexual activity.

what do you need to do if it happens? Most infections that are sexually transmitted are asymptomatic most of the time: in other words, when most people have them, they often won’t know until or unless they become severe, spread to other sites of the body or create other illness. In order to treat STIs that can be treated — and most can be — we have to know we have them. Regular STI  testing and other sexual health screenings are how we find out if we have them. If and when we do, then we will need to get whatever treatment is prescribed for us and follow those and any other directions from our healthcare providers.

Sometimes we’ll know or suspect we have an infection because we do experience symptoms.

The most common symptoms of a UTI are: pain or discomfort when urinating, feeling like you have to go all the time but then going and only having a few painful drops come out, and, if they spread to the kidneys, which they can if untreated or if treatment doesn’t work, kidney pain (pain from the kidneys is usually felt mid-back, or around the ribs).

The most common symptoms of a bacterial infection are:  a funky smell (often fishy), unusual discharge, sometimes grayish or greenish, itching, burning or pain.

When STIs do present symptoms, some common ones are: discharge that looks or smells funkier than your usual, pain with sex or genital pain, for those with a vagina, bleeding with sex, genital sores or rawness.

do you need to go to the doctor or ER? Sexually transmitted or genital infections will not typically resolve on their own. In order to treat an infection, you’ll need healthcare. The ER isn’t usually needed, but if you know or think you have been exposed to HIV, that is one place you can get a post-exposure prophylaxis ( PEP⁠ ). Otherwise, you can make an appointment with your general doctor, OB?GYN, urologist or a sexual or general health clinic to access STI testing and treatment.

how do you prevent them? Try not to overdo any kinds of sex that involve friction or a lot of pressing around your urinary opening (alas, for those with a vulva⁠ , that will be most activities that involve that anatomy⁠ ). Be sure to wash your hands before masturbation and have partners wash their hands or whole bodies before sex with you. Using barriers may also help, though know that some people find that latex barriers in particular can seem to trigger⁠ UTIs for them, so if that seems like it might be the case for you, you can try switching to non-latex. Staying hydrated can also help prevent UTIs, being sure to fully treat any UTIs you do get, and if you find you are getting them chronically, there are some medication protocols for that a healthcare provider can set you up with. When it comes to STIs, the best prevention is a combination of using barriers (and PrEP⁠ , for those who want to use that to prevent HIV specifically), being sure you and any partners are regularly tested for all STIs y’all can be tested for, and that if and when an STI does pop up in the mix, that everyone is fully treated for it to the degree they can be.

vaginal or vulval abrasions

what are they? Scrapes, cuts or tears — which often are very small and not a thing we can see — of or around the vaginal canal, vaginal opening⁠ , or other part of the vulva, like the inner labia or clitoral hood. They’ll most often happen when people aren’t using any or enough lubricant during sexual activities that involve any kind of friction, when folks are engaging in more or more…enthusiastic, let’s say, genital sexual activity than our bodies can handle, or from toys or other objects that are too big or have rough edges or surfaces. These are also more likely to happen to people whose estrogen⁠ levels are lower, like people using testosterone⁠ for gender⁠ affirmation, or for folks post-menopause, be it by way of hysterectomy⁠ or life stage, or for people for whom vaginal drynness is a side-effect of a medication (like birth control⁠ pills). Often bleeding will happen as a result of these kinds of injuries, but it won’t always. These kinds of injuries may or may not hurt when you’re not engaging in genital contact, but will usually cause pain or discomfort with any kind of vaginal or vulval sexual activity.

what do you need to do if it happens? Usually, just giving your body time to heal without doing anything to make the injury worse or aggravate it will take care of it.  When you get this kind of injury, it’s really important to back off from sex that has any contact with the area of injury until you feel all the way healed up.

do you need to go to the doctor or ER? Probably not, but if you experience very heavy bleeding and/or bleeding that doesn’t stop after thirty minutes — or where you’ll stop bleeding for a couple days, only for it to show up again and again — pain that doesn’t go away, any weird discharge or smells, or it just doesn’t feel like you’re healing as time passes, then a visit to the doctor is in order. If bleeding won’t stop, though, or you feel like your injury is severe (like a visible tear in your tissue), the ER or other urgent care os the way to go.

how do you prevent them? Be careful with the vagina and vulva. While not as delicate as rectal tissue, it’s still much more delicate tissue than, say, the skin on your arms, so you need to be gentle with it. That always includes using plenty of lubricant, especially with any genital sex⁠ you’re going to be having that isn’t gentle. Only use safe toys or things designed for vaginal or vulval use. If you’re someone finding this is happening often, check in with a healthcare provider to be treat any possible fungal infections or — usually this will be the case if you are using testosterone for gender-affirming therapy or are post-menopause, at any age — see if you might not need vaginal estrogen.


Of course, nearly any way you could hurt yourself just walking around in your room, or playing a sport, or doing just about any other daily-life thing you do with your body is also usually a way you can hurt yourself — or someone else — with sex. We can sprain or break something by falling off a bed, and catch or transmit all kinds of common communicable illness like a cold, lice or COVID. While sometimes sex can feel like a magically protected space, our bodies remain just as mortal as always, and the fact is that since we’re often not paying as much attention to other things as we might be if we weren’t being actively sexual, we can sometimes be more inclined to injury with sex than we would be doing something else. So, have fun, but do be careful out there!

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