Wednesday, January 24, 2007

Herpes revisited - a followup Ask Dr Peg question

Dear Dr. Peg

Recently my girlfriend was diagnosed with vaginal Herpes Type 1 that I’ve given her orally. We are both pretty good kids and haven't kissed too many other people. But my question is, seeing as how it can pretty much be assumed that I’ve transmitted the disease to her, is there any danger in me continuing to perform oral sex on her? If I already have it and we know that between the two of us all we have is herpes Type 1, is there still a danger?

Dear Kisser,

This is a great question, because it brings up two issues: virus spread, and herpes in relationships. I’ll address them one at a time. In my column Curious About Cold Sores, I explained that there are two Types of Herpes Simplex viruses, Type 1(HSV1) and Type 2 (HSV2). Usually HSV1 lives on the face and HSV2 lives on the genitals. However, as you and your girlfriend so clearly illustrate, Herpes viruses are flexible, and can take up residence in either location.

I’m not sure exactly what you mean by danger, but I’m guessing you are referring to contagion. As it stands now, you have oral herpes and she has genital herpes, both HSV1. You have already passed the virus to her genitals, so continuing to perform oral sex on her won’t do anything, except make her happy. Go for it.

It is possible, but unlikely, that she could now develop oral lesions and/or that you could develop genital lesions. Once you have one established herpes site on your body, it’s rare to develop another, probably because your immune system makes antibodies to the virus. Also, now that you have HSV1, you are less likely to catch HSV2. There appears to be some cross-protection in the antibodies that are formed. Finally, people with HSV1 tend to have fewer recurrent outbreaks than those with HSV2. So you could even consider yourself lucky.

The second issue this brings up is how to handle herpes as a couple. What do you do if one of you has it and the other doesn’t? How do you talk about this with a prospective partner?

The couples I’ve known who deal with herpes in the healthiest way are those who tell me, “We have herpes.” In other words, they see it as a shared problem. They don’t expend a lot of energy trying to prevent passing it to each other, or let it put a crimp in their sex life. Their love for each other and their desire to express that love sexually overrides their worry about contagion.

I’m not suggesting you blithely rub your open sores all over each other. It still makes sense to avoid contact with open sores, for comfort’s sake if nothing else. I’m just pointing out that, for the sake of your relationship, it makes sense not to obsess about it. And medically speaking, herpes is very rarely a big deal.

If you have herpes and are in a new relationship, I think it’s only fair to inform your prospective partner before you have sex. Ideally, you’ll be close enough emotionally by that time that you can talk freely about such things, and figure out how you as a couple want to handle the situation. I realize this isn’t always easy, since our society still has lots of judgment and stigma around sex-related topics of any kind, and having a sexually transmitted infection can be emotionally upsetting. If you need help, the medical practitioners and/or the counselors at the Student Health Center would be happy to meet with you and your partner to answer questions and help you discuss it together.

Wednesday, January 17, 2007

Hooked on Hookah - the latest Ask Dr. Peg column

Dear Dr Peg,

Some friends introduced me to Hookah smoking a few months ago, and we’ve been getting together to smoke a couple of times a week. It’s fun to hang out, and the smoke smells nice. I know cigarette smoking is dangerous, so I’ve never done it, but hookah smoking is safe, right? Doesn’t the water filter out all the bad stuff from the smoke? And isn’t hookah tobacco healthier than the tobacco in cigarettes?

-Hooked on hookah

Dear Hooked,

I’m sorry to disappoint you, but you are wrong on all counts. As usual, I’ll start with the basics.

What is a hookah? A hookah is a water pipe. Other names for hookah include nargile, sheesha, okka, kalyan and hubbly-bubbly. It is a device for smoking a flavored tobacco mixture. The mixture is placed in a small bowl at the top of the device. From the bowl, a hollow pipe leads straight down into a chamber called the base, which is partly filled with water. The pipe extends below the surface of the water. From the side of the base, above water line, a hose leads to a mouthpiece. To smoke a hookah, you light a piece of charcoal, place it on top of the tobacco mixture, put the mouthpiece in your mouth, and suck hard. The smoke goes down the pipe, bubbles up through the water into the air at the top of the base chamber, up the hose and into your lungs. Hookahs can be quite ornate and beautiful, and can cost hundreds of dollars.

Hookahs have been around for centuries, probably originating in the Middle East or India, where it is a common social custom for men to gather, smoking and chatting for hours. In the US, the hookah has become very popular in recent years, especially with young people of both sexes. Hookah smoking is promoted as an aesthetic social activity, touting the sweet smell of the tobacco and the bubbling sound of the water as pleasant, relaxing influences. A typical hookah session lasts 2 or 3 hours and involves several friends smoking from the same pipe. Commercial Hookah bars have sprung up all over the country. There are at least five here in Albuquerque, where you can go just to smoke.

What does one smoke in a hookah? Typically, the mixture is 1/3 tobacco and 2/3 flavorings. The flavorings may include molasses, dried fruit, honey and other ingredients. The resulting aroma was likened to a baking apple pie by one hookah-selling website. Sounds pretty benign, doesn’t it? It isn’t. Like many fads, it has been hyped with false claims in order to increase its popularity and profits.

What are the dangers of hookah? Tobacco is tobacco, no matter how you get it, and tobacco smoke is hazardous. In fact, hookah smokers get more smoke than cigarette smokers, and here’s why. Cigarette smoke is uncomfortably hot if you inhale it deeply. Hookah smoke has been cooled by its passage through the water. In addition, you have to inhale hard to pull the smoke through the hookah. The result is cooler smoke going farther into your lungs. Add to that the duration of a typical hookah session, and the result is huge volumes of smoke being deposited into your lungs. A study done by the World Health Organization showed that one hookah session of a mere few hours can deliver as much smoke into your lungs as 100 cigarettes. Five packs! It’s a rare cigarette smoker who gets that much in one day.

Tobacco smoke contains nicotine, a highly addictive substance that is not filtered out by the water in a hookah. In addition to nicotine, you are pulling other dangerous substances through that hose. Tar is not water-soluble, so it comes on through the pipe, the same amount in one session as in a whole pack of cigarettes. Tar causes cancer. Other carcinogens (cancer-causing agents) also make it through, like heavy metals and carbon monoxide. In fact, because of the charcoal which is burned on top of the tobacco mixture, hookah smoke has a higher level of heavy metals and carbon monoxide than cigarette smoke. Hookah smokers risk cancer of the lung, lip, tongue and bladder.

As you doubtless know by now, tobacco smoke affects the cardiovascular system, causing an increased blood pressure and heart rate, and increasing the risk of heart attack and stroke. Smoke of any kind is also a lung irritant, which can trigger asthma and allergies. And of course, there are all the second hand smoke issues to consider.

In addition to the tobacco, there are the smoked flavorings to consider. Unfortunately, nobody has yet studied the effects of inhaling dried apricots, but I would bet they aren’t all good.

Finally, think about sharing the mouthpiece. It’s like kissing everyone in the group. Hookah pipes can spread herpes, flu, strep throat, a cold, even tuberculosis. And wiping it on your sleeve doesn’t sterilize it.

I’m a big believer in social gatherings and relaxation time. By all means, gather away, and relax like crazy. But if you are concerned with the health of your young lungs, think about gathering around a cup of tea, or relaxing with exercise and a bath instead of a water pipe. And if you are already addicted to any form of tobacco, I strongly urge you to quit. The Student Health Center has people and programs to help you.

Monday, January 15, 2007

Hakomi Therapy - Mind, Body, Heart

“How do you stand in relation to these many realms?” This is the literal translation of the Hopi word Hakomi, the name adopted by Ron Kurtz for a psychotherapy technique developed by him and his staff in 1980. A more modern translation might be “Who are you?” The Hakomi Method is an efficient and powerful process for discovering and then studying mind/body patterns and core beliefs as you experience them (

Hakomi is a unique form psychotherapy that honors the interconnectedness of body, mind and heart. Drawing on concepts and techniques from Buddhism to Neurolinguistic Programming, and based on the precept that we all have innate wisdom and goodness, Hakomi provides a nonjudgemental and nourishing environment for exploring the self at a natural pace. The basic structure of Hakomi is 1) the establishment of a client-therapist relationship that allows the client to feel safe to honestly and fully explore their own experience, 2) careful observation of present life experiences, including body awareness, in a way that leads to the discovery of core material, and 3) willing modification and healing of core material to enhance growth and wholeness.

The following passage from the Hakomi Institute website describes the essential concept of core material. Core material is composed of memories, images, beliefs, neural patterns, and deeply held emotional dispositions. This material shapes the styles, habits, behaviors, perceptions, physical postures and attitudes which define us as individuals. Our responses to the major themes of life--safety, belonging, support, power, freedom, responsibility, appreciation, sexuality, spirituality, etc.—are all organized by our core material.

Some of this core material is helpful to us. Some, the result of difficult experience or trauma, limits our access to the person we want to be. Hakomi is a gentle yet profoundly powerful way to transform and heal. Visit the Hakomi Institute website ( to find a Hakomi therapist near you.

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