Ask Debby Herbenick | What should I do if my fiancée is considering having a sex change?

Q My fiancée sometimes expresses concerns about her gender; she’ll say that she sometimes wonders what it would be like to live her life as a man, whether she could pass as a man, and that she doesn’t always feel like a woman. We’re both kind of alternative types and we have plenty of queer friends, so I don’t know if this is just about the fact that we hang out with people who question these things about themselves or whether she is really going through a gender-questioning period herself. When I’ve asked if she is thinking about really becoming a man she says no, of course not, but I still wonder, because she has brought up these issues before. Once she even asked me if I would still want to be with her if she were a guy, and I said I didn’t know. I would still love her, I am sure, but I don’t think I would want to have sex with her or be married to her, which upset her because she said we should love each other no matter what. But why does that even matter if she says she’s not going to be a guy anyway? We are planning to get married. This isn’t just a hypothetical coffee-shop conversation to me. I need to know if the woman I want to marry wants to stay a woman. What am I supposed to do?

A First, let me say how impressed I am that you and your fiancée can have these types of conversations. Not all couples can talk peacefully about whose turn it is to take out the trash, let alone what might happen if one of them decided to live their life as another gender. Transgender issues are a challenging topic for many people, particularly within the context of intimate relationships. And not all couples are able to stay together when one of them chooses to live life as another gender, so it is important that you two talk about this now, prior to getting married, just as it is important for couples to discuss other big issues that can make or break marriages and relationships, such as whether they want to have children, and if so, how many. Some couples do choose to stay together even after one transitions. Others don’t stay romantically linked, but they may evolve their relationship into a strong friendship. It sounds like your fiancée is certainly turning over issues related to gender in her head, and there is something there that she may want to explore in more depth for herself and with you, and I think it is okay to let her know that this is something you want to figure out more together before you get married. Sometimes people who love each other do not end up marrying each other, often because, for whatever reason, their lives don’t fit together—for example, if one wants kids but the other doesn’t, or if they have very different passions for where in the world they want to put down roots, or if one person wants a monogamous relationship and the other wants an open one. Even though you two have friends who can talk about these issues and offer resources, it may also be useful to bring in some outside sources. There are quite a few resources listed on ChicagoGender.com, and Howard Brown Health Center can also connect you with support and information (howardbrown.org). This is a difficult issue but, then again, relationships always have at least one or two big challenges. Be patient and gentle with yourselves while you figure it out so that you can both live your lives in ways that feel right.

Q My boyfriend of two years and I are in a long-distance relationship, and we only see each other for long weekends. For the past two days we were together, and we had marathon oral and vaginal sex sessions. The sex was fantastic. Today, however, I woke up feeling sore. Really sore. It burns when I use the bathroom, and I have the symptoms of a bad yeast infection—the worst I have ever had—so I am using an OTC treatment. And now that I am paying more attention down there, I notice a few small, painless, raised red bumps (the size of large freckles) on the inside of the labia. Perhaps they could be ingrown hairs (I shave down there) or irritation from my man’s stubble (I have really sensitive skin), but I am worried. I have been in what I believe to be a monogamous, trusting and loving relationship with this man. Every previous Pap smear has been negative. I plan on seeing the doctor if this does not clear up within the week. Can you get a yeast infection from oral or vaginal sex? If so, how can it be prevented? Can my boyfriend get a yeast infection? What are the chances that I contracted an STI from my boyfriend if we have been in a monogamous relationship for five years? What I mean is: Can symptoms of an STI show up years later (we no longer use condoms)? If not, and it is an STI, and I have been 100 percent faithful, how do I approach my boyfriend about this?

A Some women are more prone to yeast infections than others; however, most women will get at least one in her life. And yes, cunnilingus can increase a woman’s risk of a yeast infection. So can having vaginal sex with a guy whose penis you have just gone down on, as your spit is on your partner’s penis and then it gets in your vagina. Even having sex with a guy who masturbates with his own saliva can put a yeast infection-prone woman at higher risk. Vaginas, as it turns out, are not always No. 1 fans of saliva. Since you have no other reason to believe you have a sexually transmissible infection (STI), a yeast infection and irritation from lots of sex and your boyfriend’s stubble is the more likely culprit. But it’s often a good idea to get tested to be absolutely certain. You can reduce your risk of subsequent yeast infections by using a barrier method (such as a dental dam or a condom cut in half) for cunnilingus or maybe even by wiping any saliva off your partner’s penis before he puts it into your vagina. If you use lube, try using a different brand (perhaps one without glycerin, which some believe promotes yeast infections). Of course, it may be a fluke, so how much you want to change your sex life really depends on whether this happens again. Men rarely get yeast infections, but if he has penile irritation, he should certainly check in with his doc. As for whether STIs can show up after a long time, it depends. Herpes can occasionally lay dormant, and results in sores that are often noticeable and painful. The human papillomavirus (HPV) can go unnoticed too, but HPV-related changes are typically not painful. Chlamydia and gonorrhea can cause discharge and itching but they are easily transmitted, so you likely would have tested positive in an earlier gyn visit (unless your boyfriend recently got it and gave it to you)—but they are rarely painful either. In other words, your symptoms are more consistent with a yeast infection, a urinary tract infection, or even, thanks to tons of vaginal sex, slight tearing around your urethra (where you pee from). However, there are other possibilities, and you’re smart to be headed to the doctor.