When delivering training on HIV transmission, I like to ask the participants to name the five bodily fluids that can transmit HIV.
Blood is always stated first. Next, the participants will (incorrectly) state saliva. People usually get semen next. And often one person will identify breastmilk. The remaining two tend to be a bit of a puzzle. The answers are of course, anal mucous and vaginal fluid.
I have yet to encounter any participant who is not already working/volunteering in the field who knows what anal mucous is (in Canada we tend to call it the more palatable name of rectal fluid). Luckily, there is some pretty clear information available from the HIV community on what this bodily fluid actually is and what it does. For example, CATIE has this nice factsheet, cleverly titled, ‘Getting to the bottom of it.’
But I’ve always been a bit surprised that even the women in the room cannot think to name vaginal fluid as one of the five bodily fluids that can transmit HIV. The more I thought about it though, the more I realised that there’s a considerable lack of understanding, respect and information-sharing going on about the basic elements of women’s sexual health, enjoyment, and reproduction.
As I have previously written on PositiveLite.com, training has led me to more thoroughly research, understand and define terminology that I have causally thrown about for years. One of these terms is ‘vaginal fluid’. What do we actually mean by this and what does it in actually refer to?
It struck me that it is incredibly important to define this for my course participants. After all, I name ‘vaginal fluid’ as one of the five bodily fluids that can transmit HIV in every HIV course I run. But if most people don’t even think to name it as a possibility, do they even understand this term or know what I’m talking about?
Here’s the information that I think is missing.
HIV can be transmitted through the vaginal fluid that is released during sexual arousal. When a female is sexually aroused, she releases a natural form of lubrication in the vagina. This is produced by the Bartholin's gland and through the gland ducts. Never heard of them? It’s not surprising – it’s just another important element of female anatomy that is not given it’s due. In fact, when vaginal fluid is described or defined, the fluid’s function is usually framed around the facilitation of sexual intercourse.
I find this focus is overly heteronormative and ignores its incredible role in not just making sex easier but also much, much more pleasurable – and this goes for all types of sex, and masturbation too, not just penile penetration!
Sadly, most HIV organisations do not provide any explanation of what vaginal fluid is (if you can prove me wrong with a great example please do and leave a link in the comments section below!)
Worse, information about cervical fluid is missing entirely from almost all HIV transmission and prevention information. I have wondered, from time to time, whether cervical fluid can transmit HIV. Turns out, it can.
In fact, this information is noticeably absent from most HIV literature.
This is, however, part of a wider problem. Cervical fluid – though it plays an imperative role in conception – is pretty well ignored by not just the HIV sector, but by sexual health education and information on reproductive health in a much, much, wider sense.
For example, I was dismayed to read the NHS Choices website recently on puberty. On ‘later signs of puberty in girls’ they referred to ‘vaginal discharge.’ Vaginal discharge is a, I believe, a derogatory term but also an entirely misleading and uninformed description of cervical mucous.
Cervical mucous is not a ‘discharge’ any more than semen is ‘discharge.’ In fact, cervical mucous is released from cervical crypts throughout the menstrual cycle. The mucous changes throughout the menstrual cycle, following a rough pattern of scant to sticky/pasty to creamy to watery, to the stretchy consistency of raw egg whites.
When the mucous is sticky/pasty, it’s playing a vital role in trapping and preventing bacteria from making its way to the uterus. At this time, the cervical mucous is acidic and even hostile to sperm.
When the mucous changes to the consistency of raw egg whites, it’s actually playing a critical role in conception, as the mucous serves to support, nourish, filter and transport sperm. This mucous is necessary for the sperm to travel through the reproductive tract. At this time the mucous is alkaline and nourishes the sperm, filtering out the morphologically abnormal sperm and allowing healthy sperm to be stored in the cervical crypts – in essence, giving the sperm a longer life to await ovulation.
Despite so much emphasis put on the role of sperm in conception, the sperm simply could not do its job without the right cervical mucous.
Despite the incredible role cervical mucous plays in conception (and can also be a tool in natural birth control), it is, sadly, usually completely absent in the information given to women and girls on sexual health reproductive information and even information on conception or for that matter, contraception.
This information was even missed by me: For years I have instructed people on how HIV is transmitted yet never bothered to define these bodily fluids. How could I have missed this important piece of information for so long?
In my course on Women & HIV, I have decided to include some more information on vaginal fluid and cervical mucous to help educate participants on what we actually mean by ‘vaginal fluid.’ I think it’s important to know what these substances actually are, the amazing job they do, as well as the risks they pose in HIV transmission.
A final point. Rectal fluid is the moist, natural lubricant that lines the rectum, a mucous membrane. Rectal fluid is present all the time. It can, on its own, transmit HIV through anal sex.
I have wondered if a small amount of vaginal fluid exists (even when a woman is not sexually aroused or if no cervical mucous is present), which would also present a risk of transmission. I would assume that the answer is yes as this would make sense; the vaginal is a mucous membrane and I would assume that the naturally moist lining would also contain HIV. But sadly I am not be able to confirm this, since so little information exists on this topic; it is difficult to even find a satisfying definition of vaginal fluid in the context of HIV transmission.