Now for a toughie – genital herpes and other people. Because by now you can cope with having herpes, right? But what about coping with other people knowing you have herpes? Especially if they’re people you want to have sex with.
Mr Zacharioudakis (we met him in the section ‘Genital Herpes and Psychotherapy‘) recognises just what a stressful issue this is:
“The dilemma/challenge of HSV+ status disclosure to potential romantic/sex partners is probably the single most stressful and anxiety/depression inducing issue confronting patients, since this disclosure directly exposes one’s self and sexuality to the risk of (in)direct rejection… As VanderPlate and Aral (1987) note, ‘it is around this issue that persons must encounter the social realities of the disease and confront their own fears, insecurities, or apprehensions concerning it’… For many patients, the decision is anything but easy or predictable.”
Let’s look at how genital herpes and other people mix.
How potential partners may react
More than the attitude of society as a whole, it is perhaps – to a person living with herpes – the attitude of a partner that matters most. Because if a person you care for has a positive reaction, it can make the rest of society’s perception irrelevant (think Romeo and Juliet). But if that person has a negative reaction, it can (if you let it) devastate you in a way no social condemnation ever could.
So, given that, every day, tens of thousands of people like you are finding the courage to tell their (potential) partners that they have genital herpes, what do we know about the way those potential partners react? Well, according to my research – late nights at the library – it would seem that, broadly speaking, three main reactions exist.
First, a certain percentage of partners will react by saying: “Really? I have herpes, too”.
Sometimes, this is the reaction that you’ll have half been hoping for. It means that the condition will remain a personal inconvenience and not a potential barrier to physical intimacy. It also means that there will be no question of feeling ‘grateful’ to the other person for their participation in the relationship.
But other times, after an initial period of relief, you may question the extent to which the ‘sero-compatibility’ of the partner (by which I mean, the fact that you both have genital herpes) is proving a reason for staying in the relationship. Of course, objectively speaking, sero-compatibility is an advantage in a relationship, just as deserving of consideration as compatibility in, say, height, weight, beauty, and/or ability/willingness to have children. I mean, if you don’t want to have children and you happen to fall in love with a person who is infertile (there are more of them around than you think), you are likely to count yourself lucky and seldom, if ever, worry about the extent to which your ‘childo-compatibility’ is influencing your choice to stay with your partner.
Yet – and it’s perhaps a shame – there appears to remain a belief amongst some that HSV-compatibility should not be a factor in our choice of partner. In reality – so long as it is not the only reason a person stays in a relationship – it would seem to have a right to be one.
A little-known, perhaps overly selfless variant on this first scenario is where a new partner indicates, in response to your disclosure, that he or she has herpes too, whereas in fact they don’t (any later primary attack – if there is one – could be portrayed as a recurrence). From your point of view, you’d face the same advantages (Hey! No need to worry about infecting them!) and disadvantages (Am I staying with them just because they have herpes too?) of the first scenario. But for the partner, there’d be the possibility of what psychologists might call ‘cognitive distress’ (why don’t they just say ‘guilt about lying’?) and we can only imagine the pain that might be caused (to you!) if the truth were ever to emerge. For these reasons, this variant is probably pretty jolly rare, and better suited to enhancing a cinematic plot-line than to forming the basis for a relationship.
Second, a certain percentage of partners will accept the fact that you have herpes and continue with the relationship.
These partners may consider your condition a non-issue. They may consider it a concern, but a ‘risk’ they are willing to take. They may even change their mind from time to time about how much it is an issue for them:
- once the first throes of passion have passed, they may consider that the risk has become more of a concern than they originally decided, or on the other hand…
- once they have educated themselves, they may feel much more reassured about the (almost always) benign nature of the disease (it ain’t gonna kill you!).
There’s a variation on this reaction too. That’s when the new partner, while accepting to enter into a relationship with you, does so while hiding the fact the he or she ALSO has herpes.
There are temptations for people to do this. The new partner may enjoy any feelings of gratitude that you express. More cynically, he or she may enjoy the idea that they gain some measure of status or control by virtue of being (seen as) the uninfected party. In the extreme, the new partner may enjoy the guilt that they can provoke by portraying a recurrence as a primary outbreak caused by transmission from you.
Of course, there are good, practical reasons not to do this, too. There’s guilt about lying, and fear of retribution if their cover is blown (I personally, would be seriously peeved if this happened to me!). When you think about it, though, if a person is capable of enjoying such a perverse situation, it might be questionable to what extent they’d be troubled by these drawbacks.
Genital Herpes and Other People Note:
Don’t get me wrong – I’m not saying this kind of cynical situation is common. I’m just saying that it exists. People can do strange things sometimes.
Third, a certain percentage of partners will react by withdrawing from the relationship, either immediately or after a period of reflection.
Now it’s tempting to condemn these people as unkind and even cruel. But the ones who immediately withdraw have the merit, at least, of being honest, and the ones who withdraw after a period of reflection have the merit, notwithstanding their final decision, of having been open-minded, at least temporarily.
As an example of this third category, the following comment was posted on a herpes forum by a woman to whom an HSV+ man had recently revealed his status:
“I’ve determined that I will not continue the relationship if I test negative. I find it shocking how your site and many others describe genital herpes as ‘just an annoying skin problem’. I’m not sorry for telling the truth … It looks and sounds like a nightmare to have to go through. Plus, the absolute inability to determine which days an infected person is experiencing no symptoms whatsoever and still shedding contagious viral skin tissue is frightening. I’m even more shocked to find that most of those who have it expect total acceptance from those who do not. I agree that it’s not the end of the world to have it and those who do aren’t bad people. But equally, I’m not an uncompassionate bad person for not wanting to expose myself to contamination, no matter how small the risk.”
After receiving criticism from other people on the forum, the woman added the following post:
“I WILL REPEAT: I did not treat this man like a leper. I calmly listened to him and said I needed to get tested and educate myself. I further confided my sexual history and that I could VERY EASILY have it and not know it (all it takes is an asymptomatic carrier shedding skin cells). I’m a grown woman. I do not apologize for a natural healthy sex drive and DON’T EXPECT OTHERS TO EITHER. However, how can my response to him or in this written format possibly be cruel OR ignorant? It is RATIONAL. People SHOULD respond rationally to that which they know little about and especially to EVERY SINGLE THING that risks their health. It is unfair and irrational of those who have herpes to expect blind acceptance from those who do not. I educated myself. I never claimed to ‘know it all’. I AM sure that I’ve researched far more venues than those would-be-partners who have simply ‘run away’ as stated in some of the examples mentioned here. You DO need ‘people like me’ on this website/forum. … At least I listened, gathered information from many sources, got tested (how many of you have stated that your symptomatic AND asymptomatic partners WON’T get tested!), and made my decision accordingly (which I won’t reveal). IT’S PERFECTLY OK for people NOT TO RISK IT. It’s PERFECTLY OK if they do!!!!! HOWEVER, it’s NOT OK to label those will not risk it, just as it’s not OK to label and ostracize those who are infected. Deciding not to risk it (AFTER YOU TEST NEGATIVE!!!) doesn’t mean you lack compassion, are ignorant or ‘not a real man/woman’. It just means that you’ve weighed the options and it just isn’t for you for whatever reason/s. That is a well thought out decision. You may not receive the answer you wish, but at least it’s thorough. I know this will elicit more ‘lash out’ responses. I’m ready for them. I’m not going away. I will repeat: it’s OK to risk it, it’s OK not to.”
When a reaction is bad
How do you cope if you come across a person who reacts to your courageous decision to divulge your condition by withdrawing from the (budding) relationship?
One technique which has been suggested for use before telling a potential partner is simply – while of course hoping for the best – to prepare for the worst.
Zacharioudakis suggests this as a possible approach for therapists: “inoculate the patient with the worst possible problems (‘So I just met a nice wo/man and s/he wants to make love with me … and s/he does not know yet I have herpes and I am all anxious in my date, and I tell her/him and s/he freaks out and accuses me of misleading her/him and leaves me alone in the restaurant and never calls me ever again…’).” This technique is sometimes called exposure therapy, and it may help you cope when a rejection occurs, simply because – in your mind – you’ll have become used to the reaction.
A technique which can be used after you’ve told a potential partner, and once they’ve withdrawn from the relationship, is cognitive therapy.
Cognitive therapy would, in this case, be all about interpreting a rejection in a way least likely to upset you. The techniques cognitive therapy is based on have been described in the section ‘Herpes and Psychotherapy’ on this web site.
Of course, exposure therapy and cognitive therapy may not be right for you, so make sure you talk to a qualified professional first.
When a reaction is good – helping the people you tell… to cope themselves
Okay, so you’ve told your potential partner, and they seem to want to continue with the relationship. Well done. But now might be the time to remember the following, often over-looked fact – use of the term ‘herpes sufferer’ to designate those who carry the herpes virus is a little misleading, as it implies that the only people who suffer as a result of the disease are those who actually catch it.
In fact, the entourage of the person carrying the virus (nice word, ‘entourage’!) can also experience a degree of emotional pain. This can be the person you are beginning a relationship with, or indeed family in whom you have confided.
Don’t feel guilty about this. Someone who wants a relationship with you has to take the hard with the easy – and they can always leave if they feel overwhelmed. As for family, well… when you decide to have kids, you sign up for better or worse – that’s what parenting is.
Besides, guilt serves no purpose. It DOESN’T MAKE YOU A BETTER PERSON to feel guilty, and it sure as heck DOESN’T MAKE ANYONE FEEL BETTER. Anyone at all. So give it up! I’m serious – you don’t need it!
Instead, help your entourage to cope. Provide them with reliable information. If you think they need it, show them that psychologists have worked out ways to help people cope with difficult situations. And learn to listen to them – I mean really listen. Because they’ll have fears and questions, too – acknowledge those. Heard of ‘active listening’? No? Check it out. Get empathetic. Be your own counsellor, sure, but be theirs as well!
Together, you can make it!
Given that the person you disclose to is probably going to go through a rush of emotions too, might an effective way of ‘helping’ them be to not actually tell them in the first place? (Sorry about the split infinitive).
Now, personally, I always assumed that this way a big no-no. But look at this paragraph from Zacharioudakis:
“It is worth repeating that the obligations-responsibilities of a patient (and/or a clinician) toward facilitating the satisfaction of the self(s (patient’s) needs (e.g. in terms of happiness, sexual pleasure, companionship) versus others’/society’s needs (i.e. public health safety), are not necessarily allied and indeed can be rather conflictual. To illustrate, especially in cases where an HSV+ patient exhibits minimal contagion risk (i.e. has minimal, if any, symptoms/relapses, uses condoms and suppressive medication), and chooses to disclose, but instead of acceptance the patient is subjected to repeated romantic/sexual rejections (adversive consequences which, in operant terms, essentially punish the patient’s willingness to disclose), both patient and therapist will be forced to (re)examine the practical meaning and usefulness of the patient’s moral values and behaviour of disclosure.”
Lest I be accused of quoting Mr Zacharioudakis out of context, I hasten to add that the bulk of his article is aimed at ensuring people do disclose their status. But has he gone too far by suggesting – as he seems to – that there are some, rare situations when the patient’s interest in experiencing intimacy could outweigh a new partner’s right to make their own decision as to exposure?
Personally, I think he has gone too far. But whatever the answer, those considering keeping their status secret should bear in mind not only the moral considerations that Zacharioudakis refers to, but also the possible legal (think lawsuits), physical (think retribution) and emotional (think guilt) consequences of doing so.
Thinking about it, Zacharioudakis’ approach here, in fact, seems similar to that taken by public authorities when battling drug abuse. They accept that some people will do drugs, and they aim – by supplying clean needles, for instance – to make sure that those people do it as safely as possible. (Interestingly, there have been suggestions that self-harming patients in psychiatric clinics should be provided with clean razors, with the same objective).
Anyway, in this context, and putting aside the question of whether it is morally acceptable sometimes not to tell, maybe it is appropriate, when battling herpes:
- to accept that in practice some people will omit to inform their sexual partners of their HSV+ status (I mean, that’s how most of us ended up in this mess right?), and
- to make sure that they do so in the way least likely to cause harm to themselves or to others.
It’s certainly the case that some people don’t tell, at least occasionally. A survey from 1993 reported that 32% of herpes patients were uncertain whether they would ever disclose (Brookes et al., “Adjustment to the psychological and social sequelae of recurrent genital herpes simplex infection”, Genitourinary Medicine, 1993, 69, 384-387 – pheww, sorry about that long-winded reference).
And the following quotation suggests that this reality is unlikely to change very soon: “[T]he psycho-sexual dynamics of the decision [to tell or not to tell] are … complicated and conflict-ridden. The patient’s overall value/moral system, ego-strengths, impulsivity and frustration tolerance for sexual rejection/abstinence, personal fragility and confidence, short versus long-term relationship/commitment considerations, as well as one’s past experience/history with previous disclosures and/or partners creates an often unpredictable configuration of factors that do not necessarily, or consistently, lead to the socially sanctioned decision of HSV+ status disclosure… [In practice, t]he decision often depends on the kind of sex and the casualness or longevity of the relationship, with oral sex and casual sex partners often never becoming informed of the patient’s HSV+ status. Intellectual awareness of socially sanctioned morality (e.g. avoiding hurting unnecessarily one’s fellow beings), even with the often accompanying sense of shame and guilt when one transgresses it, as psychoanalysts have documented since Freud, is not a sufficient condition to motivate moral code compliance. Consistent HSV+ disclosure is difficult when, in the process, one’s immediate sexual gratification is delayed, potentially lost, or even reversed (i.e. becoming anxiety).”
So, should we be pushing a double message to HSV+ people?
One: disclose your status.
But two: if for whatever reason you don’t, then please, go on suppressive therapy, use a condom, only have sex between outbreaks, and so forth (none of which, by the way, will guarantee non transmission)?
The honest answer is: I don’t know.
And that uncertain note marks the end of Genital Herpes and Other People.
By the way, the article I quoted from for this page of the website is:
Manos A. Zacharioudakis, “Doing psychotherapy with patients with genital herpes: Issues and interventions”, Scandinavian Journal of Behaviour Therapy, vol.30(3), Aug 2001, 108-133