QUESTION
My girlfriend suggested that we have anal sex without a condom. It would be our first time. I thought you were always supposed to use one because of the risk of infection. If you and your partner don't have any STDs or HIV, is it safe to not use a condom for anal sex? All of the information I've found out there assumes you don't know your partner's status in regards to STDs and HIV.

ANSWER
You're right -- in order for you to be exposed to HIV or STDs, your sex partner(s) has to be infected. So, if you're in a relationship and you've both tested negative for STDs recently, and neither of you is having sex with anyone else, you're not at risk for getting or giving an STD.

That said, many STDs are asymptomatic, and a person can even be a carrier of an STD and spread it to others without knowing it. You can't tell a person is "clean" just by looking - a recent series of STD tests or knowledge that your partner hasn't had any other sex partners is necessary to be sure that they are free of STDs.

It's important to talk with your partner about what it means to have sex without a condom, particularly anal sex, which is a more risky activity for spreading STDs and HIV than vaginal intercourse. It won't be an easy conversation, but it's better to have it now than to worry later. You can cover subjects like being exclusive, trust, drawing the lines for safer sex, STD testing and more. A few tips for the talk:

1. Pick a time when you won't be interrupted.
2. Pick a neutral place to chat (not the bedroom, or in the throes of passion).
3. Be sober.
4. Be open to the possibilities.
5. Have a sense of humor and use it—remember sex is about having fun.

To your health,
Dr. K