There’s a version of college adulthood most people are not warned about. It doesn’t take much to end up in someone’s cramped double, on sheets unchanged since the previous block party, giving more of ourselves than we ever planned to. And yet the question we can’t seem to ask of our partners (or even ourselves) is the simplest one: “When were you last tested?”
Sex has been more rehearsed than sexually transmitted disease or infection (STD/STI) talk, despite how vulnerable it is. Awkwardness during sex, morning-after regret and the like are expected, even humanizing. But asking about sexual status (before or after), let alone being consistently aware of your own, feels like a line most people would rather not cross.
Sex is everywhere I look. It’s referenced casually online, joked about day-to-day and framed as an inevitable part of young adult life… and for a lot of people, it is. But why do we separate the act of sex from the responsibility of it?
STIs are extraordinarily common. One in five people in the United States has an STI right now. Many have no symptoms at all. Chlamydia, the most reported infectious disease in the country, is frequently called a “silent” infection because the majority of people affected have no clue they actually have it. You can feel completely fine and have no visible signs, but still transmit or face the consequences of the infection.
We are taught, early and often, how to be desirable — we are not taught nearly enough how to protect ourselves. Topics like testing and contraception are almost taboo and seen as private rather than normalized and important. Without clear framing for how to initiate these conversations, people are often pushed to avoid the discussions that matter most.
Talking about testing, protection, and more is perceived as presumptuous — asking in the moment may feel disruptive, and asking afterward may seem irresponsible. Because it’s hard to see the ‘correct’ timing to bring it up, people just don’t. While attitudes toward sex have been liberalized, testing and STI discussions still hold a tone of accusation.
The conversation about sexual health consequences tends to halt at STDs themselves, or more narrowly, at pregnancy. But what no one tells you when you’re 19 and honestly kind of careless, until you find yourself at the health center, is that those represent only a fraction of what sex can set in motion, notably for women.
If you’re a woman who’s been sexually active, chances are that you’ve navigated risk more than you realized. Not inherently because you were reckless, but because the odds were never quite equal, and nobody tells us that. Beyond transmission likelihood, the long-term consequences of untreated infections fall more heavily on women. Fertility complications, chronic pelvic pain and increased risk of cervical cancer can change the course of our lives in ways that cannot be changed.
HPV is present in nearly 80% of sexually active women at some point in their lives. Most strains clear on their own, but certain high-risk strains can cause cervical cancer, which develops over time. Herpes affects roughly one in six people, and it’s not included in the standard STI panel, so you would probably have to advocate for yourself to get tested for it.
Undetected or undertreated chlamydia and gonorrhea can develop into Pelvic Inflammatory Disease (PID), an infection that heavily impacts the health of our reproductive organs. PID is one of the leading preventable causes of infertility in women.
Urinary tract infections (UTIs), though not necessarily STDs, are similarly undiscussed, but are infections often resulting from sex that disproportionately impact women. They are the second most common infection of the body. And because they’re so normalized, (grab some AZO, drink your cranberry juice) the risks get dismissed along with it. But a UTI that goes untreated or keeps coming back isn’t just uncomfortable. Bacteria can travel from the bladder to the kidneys and cause a kidney infection, which, yes, can be life-threatening. Recurring UTIs can also signal antibiotic resistance or an underlying issue that would require far more serious action.
Pregnancy is often the first consequence people reach for when discussing the risks of sex, and it is absolutely significant. However, it is one of the few visible outcomes, has a time limit, and comes with a clear decision point. Silent infections don’t always grace us with any announcement. Slow-developing complications and fertility damage may only surface once we feel ready to start a family. There is something worth protecting here, not just our fertility or our physical health, but our futures, our choices, our autonomy.
Feeling too awkward to ask or have a conversation is temporary; the cost of avoiding it can be permanent.
