 Hi everyone, welcome back to our podcast from the Kamasutra to 2020 where we look at your questions, your concerns, even your worries around all things to do with sex and sexuality. As always, we have with us Dr. Anvita Madan Behel. Anvita, as you know, is a psychosexual therapist and she brings the psychological perspective to the advice that the Kamasutra has to give. But we're very, very lucky to also have with us Dr. Nivedita Manokaran. Nivedita is a sexual and reproductive health clinician based in Sydney, but she's our guest today because she is our resident expert on contraceptions and STIs. Nivedita, welcome. Thank you so much for having me, Seema. It's an absolute pleasure to be on board with you. Anvita and I have been wanting to cover this subject for a while, so we're really pleased to have the expert with us. STIs is something that we never speak about and it is one of the hardest subjects for people to discuss because, you know, if you don't talk about sex, the fact that we might be having a burning or an itching or, you know, oils or anything in our vagina or penis is a really tough conversation to go to a doctor and speak about or even tell friends and family, right? Like it's itching, where is it itching, you know, so just the conversation is so difficult. But sometimes very difficult even to go to the doctors to ask for medicine. True. I mean, I really want to I have this question that people ask me all the time, Anvita, they say why aren't doctors so sex positive or why aren't doctors very open about this? Why is it so difficult? They make us feel embarrassed. And I always tell people that, you know, we have to understand, especially I think we're talking about doctors in India, that we are also people of the same culture. We also grew up in the same background and we grew up, you know, understanding that sex is a taboo word or we are not supposed to use that word. And I think being a part of that culture, being a part of that community does not make us think any different than because this is what I want people to understand. And unfortunately, our medical degrees don't teach us otherwise either. It's not like when one person becomes a doctor, they're teaching us in our medical qualification that talking about sex is okay. You know, I have like personally experienced that I got trained in India as a benedologist and, you know, I, we were very good in clinical skills, we were great in treating people. But what they didn't genuinely teach us is to how to have a non-judgmental attitude, you know how when you're having a young person come to you. What is important to ask her the right questions, we were never taught. So I think that is what I had learned when I have moved to a different country and got myself qualified, you know, as a sexual and reproductive clinician here. What I've learned is you have certain questions that you have to ask. Like for example, when you see a youngster, rather than rolling your eyes, you want to know if her sex was forced or not. Because you're trying to rule out sexual assault, you're trying to rule out, you know, sexual abuse. And we missed that as clinicians because I wasn't taught to do it. Not because how come doctors are because doctors are also part of the community and if they're not taught, they don't know either. So that was, so those kinds of things, you know, asking the girl, you're having sex and you have an STI. So it means your boyfriend needs treatment as well. Where is he, you know, that kind of a question. And the second thing is if you're having sex, how are you protecting yourself from falling pregnant? So all these important questions were never taught to us. See, I think now we have grown very far. Like even in India, I think a lot of us are able to talk about the word sex in a group of women sitting on social media and actually pinning this down. It's a big development. It's a big, you know, growth. And I like to tell people just have to be patient because a lot of us have started this journey of changing things. See, you know, I really want to approach medical colleges and try to tell people that this has to be part of a learning curve. You have to teach doctors how to actually do it because it just doesn't come naturally to most people. So yeah, such a good point actually. That's a really, really good point. And I was going to share a story to move into our next question with it. I struggle with thrush now and then and everything, especially when I get ill. And most recently I had a bout of it and I needed to go and get the vaginal suppositories or something. But the neighborhood chemist is a South Asian man who I have now been frequenting with medicines and everything. The thought of me going to him and asking for vaginal suppositories was the worst thing in my head. I was thinking, which boots can I go to where somebody doesn't know me? Where can I go and ask? So despite me being a sexual health educator, being comfortable talking about sex, as soon as I know somebody, somebody one degree separated, you know, like an uncle or bhaiya or whatever the chemist. I still can't do it. So we understand how difficult or culturally ingrained it is. Like I can't go and ask him for medicine for yeast infection. So with that, let's talk about yeast infections or commonly known as thrush. So you just want to give us top five points on it and what it is. Absolutely. So I just want to start off by saying all vaginal discharges are not necessarily STIs. And I think that's what is very important because the minute people start having vaginal symptoms or vaginal discharge, redness, irritation and burning. And if they're sexually active individuals, the first thing they're probably freaking out or panicking is thinking that they have STI. They tend to self-diagnose. They tend to freak out, you know, and all of those things. So I want to tell people that thrush is a very, very common vaginal infection. It's called vulvo vaginal infection. It can be both outside in the vulva as well. It can be inside the vagina as well. And it's not an STI. So I think that's what something we have to know just because people talk about it in the vagina. Like, you know how you said, you know, you're worried, what are people going to say because I'm asking for something to put in the vagina. And I think that's what is important to understand is it's not an STI and not all vaginal issues have to be sexually transmitted. So that is very important to know about it. And thrush also is very common in women more than men because thrush loves your estrogen. So it is, you know, a very estrogen friendly fungus actually that grows in. So a lot of the thing that makes you grow the fungus actually grows it. Like, for example, when people are having unprotected sex and, you know, sperm is rich in protein. And when you have a protein medium sitting in there, people tend to grow the thrush if they have a tendency to have thrush. So if you notice people saying, I get thrush every time me and my partner have sex, you know, so that's the case. Sometimes I do check, do you use a condom? If not, why not trying using one, you know, so that you don't, you're not pooling that, you know, protein sperm in the vagina for it to grow the thrush, you know, things like that. So it's very important. Thrush symptoms can be pretty dramatic, you know, it can be red and swollen and itchy with burning. We and you also can have like a cheesy, thick, white discharge. So when you're having all of these things, definitely go and see a doctor. You know, I always tell people don't self diagnose because we tend to, we tend to Google, we tend to find symptoms and self diagnose. I definitely would tell whatever the symptom is, see a medical practitioner and get it checked out. And the most important bit is if you were freaking out that it is an STI, it means you've been sexually active and you're worried that it is an STI. So it's time for an STI screen. So I think you definitely have something has clicked in your brain, even though it was thrush, so it's very important to go and get tested for other STIs while you're having thrush as well. So they do a swab for thrush and tablets that are oral tablets. And you know, like Anita said, there are pessities that are vaginal creams. The treatment is pretty easy. You can use things up to a day to seven days and yeah, it goes away. Very important and last point about thrush is recurrence coming back again and again is common. So there's no need to freak out and you know, usually it can be frustrating guys sometimes it can be really frustrating. And what is important is to just do repeated treatment. That is why it's important to get tested because sometimes your treatment may not be working. You may be using the same cream over and over and it's not going away maybe because the type of thrush you have is resistant to the cream or the antifungal that you're using. So if you get a swab test by from a doctor, it tells you what antifungals you could be sensitive to and then using the right medication and then getting treated is very important. So don't get frustrated and yeah, it's a very common thing and it's not an STI. And so you said that men get it as well. Can you tell us more how it's seen in men? Men don't get it as frequent as women do. A lot of the times when men are getting like they get this fungal infection at the head of the penis. You see this fungal infection more in men who are not circumcised where it's moist where the fungus has space to grow in the moist. So that's very important. The most important factor or sometimes when men have it is either poor hygiene. They're not retracting the skin completely and cleaning and things like that. The second thing is when men become immunosuppressed or diabetic. For example, because sugar is again one of, you know, great medium for growth. So when somebody is diabetic, they start having thrush and they grow thrush again and again. So diabetes is again one of those things that you have to rule out when someone is having, you know, recurrent chronic thrush and also at a particular age and have other risk factors for diabetes. It's very, very uncommon. There is no research and it says that, you know, both the partners need to be treated for thrush. You know how for STIs, we say that both partners need to get tested and then treated and tested and not have sex for a period of time. It's not the same with thrush. However, there are some of us clinicians, you know, after trying all the things that we have tried, we do tend to give the partner the same cream and the treatment as well. And say, you know, just in case there's a little bit there that's coming to you or something like that, both of you use these creams and we'll see if that goes away. So we do tend to do partner treatment as a last resort, but there is no enough evidence and research that backs that every girl who has a partner, you know, that partner needs to be treated as well for thrush. Yeah. So that's the basic question for all STIs. Is having penetrative sex okay when you have thrush? And I can ask that for every STI that we speak about. See, like I said, thrush is not an STI and it makes a big difference when you are having sex when you have an STI or not having an STI. For example, if you're having thrush, the chance that you're transmitting it is unlikely and we don't have to worry about it as we will be worried about when we're having gonorrhea or chlamydia or herpes or things like that. So when you're having stuff like bacterial vaginosis, which is again one of the other things where you can have a foul smelling discharge, but it is not an STI. You know, it is just an imbalance that is caused in the vaginal flora and that's very important. And I think things like that, it's a personal choice, whether you want to have sex during that time or not. Like for example, if it's really sore, it's really itchy, it's swollen, you won't be able to have sex, right? So I think if that's the case, then people with thrush don't have sex. But in all honesty, sometimes people have what we know call as asymptomatic thrush. They have a curly discharge, but there's no itching, there's no swelling, there's nothing. This discharge is just there. It gets a little bit worse before your period because the estrogen is high and then after your period, it actually goes away. So in that case, we don't even treat people who have asymptomatic thrush. So people can have a bit of fungal, you know, thrush there, but not have any symptoms and not bother to treat. But they're also having sex. So let me just jump in at this point, just because there was a question that came in a few weeks ago saying, if I have UTI, can I also have sex at that point? And I remember thinking, oh my God, that's an absolute no note. Now on a personal level, if I have a UTI, I know how horribly burning it is down there. So I wouldn't want to. But basically you're saying that a UTI is not necessarily a sexually transmitted infection. And hence, if the person wanted to, they could still go ahead with having sex. That's correct. Okay, that's a question answered. I'm very pleased because that one was really kind of going around in my head. And that is going to us. So what we are leaving people with is that if it is uncomfortable, if it is painful, if it's swollen, it's itchy and it hurts while having sex, then please avoid. Please don't. Yes. Yes. But you will, the risk of giving it to your partner, the UTI or the yeast infection. Thrush or baby. But if you have sex and you have unprotected sex, then the sperm can increase the symptoms because of, like you said, the protein there. So just really, if you're going to have sex with the condom. Yeah. And also, you know how we brought in the UTI fact. Yes. You won't be giving your partner the bug that has cost you the UTI because it's not a sexually transmitted infection. However, again, with the method of having sex, by things getting pushed into the urethra or whatever contamination that's going to happen with this sexual encounter, it may probably worsen your symptoms of UTI that has already there. Do you know what I mean? So yes, it is not a sexually transmitted infection, but when things have been really rough down there, so down there, giving it a bit of a break is a good idea. Okay. So I was just going to say, I have a feeling that the hero of this particular conversation is going to be the condom, but we'll come to it at the end. Yeah. Yeah. So I was just going to say that maybe both UTI yeast infections, if you are deciding to have sex, use the condom because it will just, you know, feel much, it will not pass on things or make it. I'm just thinking it'll be more softer or more like less friction is what I'm thinking in my head. Well, I, well, I wouldn't, sorry, I wouldn't agree necessarily that condom wouldn't cause, you know, friction because it does, it's rubber and it is, it does. See, what I would really tell people who are having, you know, UTIs or STIs and when they want like, sorry, or thrush or when they want to have sex is yes, you can use condoms because condoms do prevent the spread of certain infections. However, however, use of a lubricant is probably the one that is going to make it smoother. So when you're using a condom, yes, the friction is going to be more. In fact, for thrush, especially when people are having it all red and swollen, irritated, if you're pouring down like a whole lot of a water-based lubricant, then your sex is actually going to be less painful and much pleasant. And same with the UTI rather than thrusting and rubbing it even with a condom, if you tend to use a good lubricant and keep it as smoother and easier as possible, then the tendency of pushing things into things or causing infections is less likely. So I think lubricant is probably the more the magical word to ease sex and to make sex smoother rather than the condom itself. Condom is more a preventive blanket that you can confidently use for many things, to be honest, even like bacterial vaginosis and things like that. Like I told you, if you're using a lubricant for bacterial vaginosis, it's smoother. When you don't have that smoothness and you're having the roughness rubbed inside the vagina, it destroys the vaginal flora. It destroys the lactobacillus, which is inside your vagina. And then that produces, you know, the lactobacillus is killed. You don't have any lactic acid there. So your acidic pH is lost. Then you start growing bugs that smell bad. And then it becomes like a cycle. You're thinking it smells bad. And usually you tend to wash or douche too much. Then you're killing more of the lactobacillus. Then no more lactic acid. Then it smells again. Then it smells again. Sorry, did I get cut out? Don't worry about it. Okay. And then it smells again, really bad. And then it's a vicious cycle with bacterial vaginosis. So if we're using a good lubricant that actually doesn't hurt or affect your vaginal flora as much, it actually reduces your chances of destroying that flora, destroying your healthy vagina and the lactobacillus. And in fact, it keeps it alive and doesn't cause that kind of a smelly discharge and things like that. So actually lubricant is really underrated sexual accessory, which I think I'm a big, you know, go advocate for it. So definitely. We've done an entire set of episodes on this because huge proponents of lubricant. Everything is better with lubricant. That's right. I agree. I agree. Okay. So going to our next one, which I think is quite big, but let's try and cover it in this video is herpes, which is a complicated one and a difficult one. So we'll start with the most complicated one. So just top few points on herpes and then, you know, the three of us can discuss it further. Sure. So as I tell people herpes is probably the longest consultation I have with my patients more than herpes itself. It's a psychological effect that it is left with it. So I have certain tricks that I always tell my patients. So what I want people to know is herpes is common. It is as common as the common cold and grandparents, grand-aunts and, you know, so many people just carry it around their mouths. When I'm saying that I'm talking about type one herpes, which is very commonly called the cold sore. And because of a lot of oral sex, an extensive oral sex that's happening, we see the same type of type one herpes in people's genital area as well. But because it's the genital area, we do have to classify it as genital herpes, which somehow weirdly has a completely different effect to the fact that half or more than 50% of the population actually have herpes. So I think, again, it comes down to the fact that when something is associated with the word sex, it somehow feels more traumatic or more stigmatizing than the fact that it is around your mouth. So this is what I want to tell people. It's the exact same virus. So as we are de-stigmatizing the word sex, I think we have to focus on de-stigmatizing something that comes from your mouth, from your mom or your aunt when they're kissing you as a child and you've acquired it. Let's just say, shouldn't be so traumatic. Shouldn't be so dramatic. So I think that's how we're going to go. And it's the exact same virus that comes in people's genital area. There are two strains when it comes to genital area, one and two. And yeah, I don't think either makes a big difference. It behaves in the same way. And that is very important. The second point I want to tell people is the reason why people get worried about herpes and freak out is because when they Google about herpes, I think the first thing that it tells them is you're going to have it for life. And the minute they hear the word or read the sentence saying you're going to have some kind of an infection for rest of your life, I think it's pretty traumatic for people when they actually read it. And I think they are extremely, you know, they're devastated that they almost feel like they're going to live with an STI for the rest of their life. But I think the truth is we all have viruses with which we live for rest of our lives. And I want to tell people, even people who have cold source, the virus is not going anywhere. It is in the, you know, in your spinal nerves and it is sitting there for rest of your life. We go and get vaccinated for chicken pox these days. And I want to tell people chicken pox is a virus which is exactly the same family as herpes. It's called Zoster and it stays in your body for rest of your life just in case people didn't know about it. So I tell people you manually go and get yourself a vaccine and put a virus in your system, which is going to last for rest of your life. And the chicken pox virus comes out again, exactly like how you have herpes outbreak. You can have chicken pox outbreak as well. And it's called shingles and you get it out when people have, you know, immunosuppressed state. And so this is something that we have been doing to our systems, to our bodies in the name of chicken pox, in the name of cold source, and we didn't care about it. And we shouldn't care about it the minute it comes around our genitalia. You know, and I think that is what we have to understand here. It's the exact same thing, exact same thing. You know, you carry chicken pox for rest of your life. Yes. And you will carry herpes for rest of your life. And so can you share what are the symptoms? And what are the treatments? Yes. Right. So as we all understand COVID, herpes is again, one of the viruses which behaves very much like COVID. So you can have no symptoms. You can just purely carry the virus around, you know, your skin area that comes and goes, and you can just give it to your sexual partners. And that's possible as well. So that's very important to know. So you know when people say, but I don't have any symptoms, or I don't feel like I have herpes, I don't think I have given it to you. That can't be true because you can transmit herpes asymptomatically. And I want people to be aware of the fact that that could happen as well. And coming to herpes symptoms, they are these tiny blisters that you see. So what we see is it usually looks like water dew on rose petals. You see like a red patch, you see like tiny blisters around. It's like a water dew. And you can have those blisters anywhere around your genital area, like in your buttock region, your vagina, your penis, your vulva, anywhere, the area in between anywhere. The first episode is usually very painful because your body has not developed antibodies because that's the first time you're being exposed to it or you're having a first outbreak. Never talk to anyone about herpes or counsel them or, you know, do anything in their first outbreak because I think it's extremely painful and people are usually falling apart. So what I tend to do them is give them a lot of numbing cream like lignacane, numb everything, a lot of analogies here, reassurance, bring them back even in a couple of days when things have settled down and then explain everything that I've explained now because otherwise they are in too much agony. Very important, herpes will never come back so painfully again and again like your first episode. So when people get herpes for the first time and when they Google that it's going to be there for the rest of their life, what they're thinking is it's going to be this painful for the rest of their lives but that's not true. That's like, again, having chicken pox all over your body for the first time but then when it comes back, it comes only in small, you know, blisters. Some people, it can come pretty often depending on how their immunity is or their body reacts to it and for some people you may not get herpes for years. People have it like once and they have said that they don't have outbreaks for like three years, four years. Lucky, but otherwise some people can get it every time before a period and unlucky. There are fantastic treatment for herpes. Honestly, we don't have to worry about it at all. There's like, you know, there are two types of treatment. I would like to say one is where you suppress your virus and you make sure you don't get any outbreaks. You can take a tablet every day. So things like that are available and sometimes when you know like before my period I want it only during the time we can do medications only during the time or let's say if you're someone who's going to get it in about three years you can carry the medication along and you may never use it. So herpes has all different kind of options and treatments which is so easy and the medication is not like antibiotics. It's not like you're going to develop resistance or something like that. It's pretty friendly and you can use them well. One tip I want to give people who have herpes whether it's cold source or genital is carry your antivirals when you're traveling. You know, especially when it's somebody's it always comes at a bad time guys when you're moving houses, when you've got exams when you've got somebody's wedding that's when things always pop up or pop up. So in the best of times carry your herpes medications and I think that will come very handy. And can you have sex? Why do you have a sex? So when you're having herpes symptoms you do not have sex because you're infectious and you're definitely spreading it to your sexual partner. So when people are having blisters or you know cuts or however your herpes symptom is painful do not please have sex wait for it to heal, scab and go away and then you can have sex. Herpes when you're having herpes let's say your partner also has herpes but is not having an active episode you having sex with them actually triggers for him or her to have an active episode. So it is you know sometimes I do have clients who come and tell me that you know but he already has herpes so how does it matter? It kind of matters is one because it's painful for you and two is it can trigger an outbreak for him which probably is unnecessary and you don't have to do that. So yeah so definitely when you're having symptoms ideally do not have sex at all but let's say you're having it in your buttock and it's not going to really affect your sexual act and your partner's desperately want to have sex. I always recommend even if you're regular partners who are not using condoms definitely use condoms because with herpes there's a lot of shedding there's a lot of touching and rubbing so the spread is definitely there so definitely use a condom if that's what you decided to do. And what if when people are asymptomatic because you said they can be asymptomatic but like could they be having an episode of herpes and be asymptomatic then? Yes, yes unfortunately the answer to that question is yes and I think that is the biggest consultation probably which you are going to have as well Anvita which I have is then how do I know that I'm giving it to a partner or then how do I stop from giving it to other partners and the anxiety causes is immense but the bottom line is I think again we have to go to my first statement where I said it is a common virus it is a common cold and unfortunately guys like COVID we really cannot stop spread of some viruses and I think we are at a time in era we just have to accept that you know if you're exposed to it and if you feel like you know could I spread herpes on times when I don't have symptoms honest truth is yes but yes you can use a condom it prevents the spread of any STI up to 80% so if you people are really worried about it you can do that and in all honesty if you're someone who has been diagnosed with herpes and you're freaking out we do give medications called suppressive treatment trying to suppress your viral shedding in that way you don't give it to a regular partner and then we called you and the regular partner for counseling to see how much acceptable you are of the fact that it is such a common virus do you really want to be on a medication every day of your life just worrying that one day you might give it or spread it and things like that so it is hard but it is doable it's a tough one that is the toughest one I think is to tell people that you could still give it to people and not know that you are I have a question here sorry I just have a question can you also transfer herpes orally yeah so kissing somebody on the mouth etc yeah but you don't have symptoms on your mouth like you need to have or it's asymptomatic it can be asymptomatic but you so what I am trying to understand is that you would be needing to have an episode of herpes at that time it's not like so for lifelong if you kiss somebody you would be giving herpes if you had herpes no you don't need to have an episode to give herpes to someone you can just quietly shed it asymptomatically that's one statement the second statement is that's true that it's not like any time you kiss someone you are going to give them herpes but unfortunately would I know when I am giving someone herpes and the answer is no you wouldn't know I think that's what happens if people usually have herpes then it's obvious then you tell people don't kiss children or don't go near them and people are pretty careful these days and yes if you had it in the past sometime and you are stressed and somebody is having a baby you might still shed before you start having lesions and actually the truth is Anvita you can shed your virus 24 hours before you start having an outbreak so let's say tomorrow you are going to have a lesion unfortunately you could have started shedding a day before and you already kissed whoever that you are kissing so my question here is that is there a partner or someone so let's say X has this virus that they carry and Y is the partner is there something that the partner can do to also prevent something becoming worse is there something that the other partner can do no so they can't actually take a preventative medication medication or something wow it is wow and I think that's hard I feel like the hardest counselling I have in my profession and sometimes people look at me like you are useless you haven't found anything I'm like true if anybody finds something for herpes and spread of herpes I think we will make a million bucks but you might not know the answer to this question and you might but just in case we have scared the world what is the percentage of people who get herpes like so the percentage of people who have type 1 herpes in a good population is over 60% in the world and genital herpes like how many get genital like I know the oral herpes type 1 so the type 2 herpes which is the genital herpes is less it's probably 40% it's not as much but the type 1 herpes nowadays coming in the genital area because of the lot of oral sex and everything is much more than how much type 2 comes in the genital area so type 1 actually is present more than 50% of the times in the genital area while type 2 is lesser than that see the bottom line here is yes it is there and yes we are going to face it every day in and day out and it is not the end of the world there are treatments available there are doctors like us sitting and telling you how it's not the end of the world honestly and land cold sores and herpes and you know they've been around for such a long time you know they've been around for such a long time and yes you know when people are sexually active and they're reading about it and they're knowing oh my god am I going to give this to or am I in all honesty yes you are I've been doing this for so long it's like telling like I don't want to get a flu I'm never going to get into a train because somebody is going to sneeze it's that common though sometimes I do feel it's easily said and done but in all honesty it's not that bad I'm sorry I think self-pleasure is the way forward I think self-pleasure saves life I'm going to do a video on this self-pleasure saves life tell me sorry I know I'm going to ask something but I just want to quickly ask is there a role that a condom can play in this yes it condom prevents it 80% of the times so your condom prevents from most STIs 80% of the time so yes definitely use condoms and it prevents you again most STIs the reason I'm not saying it's going to prevent herpes 100% is because herpes is a skin virus it's not a virus that comes to the ejaculate like for example if it's like gonorrhea or chlamydia or HIV that comes through the ejaculate then you say you drape a condom you're 99% protected but for two viruses one is the wart virus the HPV and the other is the herpes virus these two are skin viruses it comes from skin to skin rubbing so yes because you're covering a bit of your genital area the chance is lesser but there's still a chance that you could use even if you use condoms 100% of the times unfortunate but true okay yeah I was just going to say it's going to take me a while to wrap my head around this and with that you're right we probably scared the population out there into um I don't know something see I think in a way we scared them in a good way because people are going to be have to be careful about using condoms because it's going to prevent you know 80% and I think people are also going to be very diligent about going and getting themselves tested and asking these questions to the doctors and you know stuff like that so I think it's a good thing a little bit of fear with what you know youngsters are doing is very good I think you're so right and I really think that just taking away a lot of the learning from here because a lot of it is very new for me as well and actually taking away a good amount of understanding is I think one of the best things you can do to prevent problems yeah that's right and I'm thinking that part of I think what you're also doing is normalizing it in some way saying that you know a lot of people have it it's a common virus you know even what we're hearing about COVID it's asymptomatic before not causing hospitalizations it's going to become a common cold so in some ways it's the problem is that we don't speak about sexually transmitted infections because they've got to do with the genitals and sex that's right so it's normalizing it and so what I can say for this video is that the ones that we started with the first well yeast infections are not sexually transmitted infections but they are in the vagina but thing and herpes are both common and we are normalizing it saying it happens go seek help if you are in UK or London there are a lot of clinics called the gum clinics which work with sexual health so you can go to them and they will test you if you are in Australia obviously there are doctors yeah we have sexual and refractive health clinics everywhere in the state every city has it you just have to google it and you will find them they are all publicly funded and you don't need to be a citizen or Medicare card so anybody from travelers to students it's accessible to anyone between mine and my point is going to be that I want parents out there who are listening in to please take this on board and be there for your kids because in India there may not be that many that are accessible to young people and as parents you need to stop being judgy you can be upset that maybe your child is sexually active and they shouldn't be but for God's sakes don't close the door on them this is the time when you have to say come to me let's get your help this is not the time to say oh my god you've destroyed me what will the neighbors say and you can easily go as in please do make that trip to the doctor even if it is your regular GP or a gynecologist or somebody because it is very hard to self-treat sexually transmitted reactions you know it's not a headache it's not so please do go to a doctor and get that swab or get it tested because that will lead to the right course of treatment so I think we've had that enough for the first one and maybe I was going to say that and next time we can you know speak about HPV and Chlamydia and others and then we can do one on contraceptions and basically the of contraception condoms I was going to say there's a lot to take in over here and I think I'd like people to go in actually to really ingest this and work on it in their head try and come to a understanding of it and I think we should cover this in a couple of sessions Navidita we can't thank you enough really thank you I think also bringing so much understanding to both Anvita and me because there are so many questions that have been answered today for us as well thank you thank you so much and I think we slightly did mention about BV as well which is again one very common infection which is not an STI so I feel like we covered you know three different things so that's good definitely and we will come back to a whole thing like Anvita said on contraception particularly my hero the condom and the hero in the loop so I think we'll come back to that at another time for sure in the meantime let's do it I think that group chat is good that we started so let's just you know organize it and make more sessions about this and it'll be an absolute pleasure actually in the meantime please stay safe if you've enjoyed the video if you found it useful and I'm sure you have do like comment subscribe we will wait to hear from you what you would like to hear about as well if you need to get in touch with Anvita for any kind of consultation Anvita is on Anvita.medanbehel.com if you need to get in touch with Dr. Navidita Manokaran about any questions that you might have on STIs or contraception as you can see she really is the fount of all knowledge. Nivedita, you are on. I'm on Dr. Nivi Antabu's on Instagram and I'm very diligent with answering my DMs my email is niveditamanokaran at gmail.com so feel free to email me on there I'll try to get back to you as much as I can. That's wonderful and I of course info.seema.anand at gmail.com for any emails that you have to send all of these will be in the description below so don't worry if you haven't got it we'd like to wish you good sexual health stay safe and we'll see you up here again very soon.