Supplementary Information: Page 2

(This page is focussed on the topics other than HIV)

the purposes of this supplementary information “Productions” refers to studios and content creators in their filming and content owning capacity.

For the purposes of this supplementary information “Performers” refers to studio porn performers and content creators in their performance capacity.

This means content creators are often both Productions and Performers.

Useful Vaccinations for Performers
Vaccinations are available for Covid-19, HPV, Hepatitis A and Hepatitis B. Vaccination works best before viral exposure. Some of these vaccinations need multiple shots over time to complete, and a booster may be needed later.

Common STIs and Treatments
Common STIs and their treatments (varies from clinic to clinic) include:

    • Gonorrhoea - one injection to the buttocks, and a single pill.
    • Chlamydia - four pills taken at once, or pills over a several days.
    • Thrush - topical cream and sometimes pills (such as Canesten available over the counter at pharmacies). A change in non-fragranced soaps, and cotton underwear can help.
    • Lymphogranuloma venereum (LGV) - a stronger member of the chlamydia family – a course of pills between one to six weeks will be given.

Most sexually transmitted infections (STIs), if found early, can be cured without much discomfort. Some of these cannot be identified via urine sample and local swabs are needed for an accurate diagnosis.

Concern is increasing around antibiotic resistance in some STIs, however there is much ongoing research into new antibiotics use and novel treatments – such as phages. 

To access tests for STIs not screened for as standard on the NHS in the UK, Performers will need to be symptomatic or use tailored private testing services. Guidance available from porn industry trade associations and unions.

Syphilis is usually tested for in two ways via a blood test. The first test group is called CMIA (also sometimes referred to as an IgG/IgM test), along with this test-group the clinic will ask about any prior syphilis infections – as this means the Performer will have antibodies from a prior infection which with show up in this test and could be confused with an active infection.

If a positive result is returned the clinic will run the second test-group: an RPR (Rapid Plasma Reagin) test to flag any active infections and a TPPA (Treponema Pallidum Particle Agglutination) test to check for antibody levels.

In clinics using the CMIA test to check if a RPR and TPPA test is needed, it can be a challenge to get the RPR and TPPA tests when the CMIA was an unreactive result. However some American and European owned studios require both the RPR and TPPA tests for Performers to work. They may require this in any country being filmed in. When Performers need to provide RPR and TPPA tests but they are being denied it by their clinic, then they may have to use an alternative private testing company. Performers should speak to their trade associations and unions for links for how to access this most affordably.

In cases where Performers have had and treated Syphilis and the studio requires that Performers show a RPR and TPPA test, the studio may request Performers to asks their clinic to send the studio the relevant medical history, so the studio have it as evidence of Performers past treatment of syphilis. This is to evidence why antibodies found in the Performers test on their recent certificate are not an indicator of an active infection. 

The treatment for Syphilis is three injections to the buttocks, at weekly intervals, to cure. Some clinics offer a single injection. Those allergic to penicillin will be given a 28-day course of pills.

Hepatitis C (HCV)
Hepatitis C is curable in 99% of cases. Due to the high cost of the treatment, in the UK the NHS currently offers to cure someone once and any secondary times may need to be purchased privately or from ‘buying groups’ for generic treatment access. The NHS will continue trying to cure that person’s HCV until it is successful but will only do this once.

    • HCV is passed on through blood and sexual fluids. 
    • Some of the most common causes are sharing needles, rough sex where bleeding occurs, fisting without a glove, and condomless anal and vaginal/frontal sex.
    • Sharing toys, especially large toys, without sanitizing them first carries risk.
    • HCV may spread during the sharing of sports-bottles filled with fisting lube at group events.
    • Gloves should be inverted and binned straight after fisting, being aware of leaving surface contamination.
    • There is no vaccination against HCV

In cases where Performers have had and treated Hep C, a studio may request Performers ask their clinic to send the studio the relevant medical history, so the studio has it as evidence of the Performers past treatment of Hep C. This is to evidence why antibodies found in the Performers test on their certificate and that it is not an active infection. 

This bacterial infection is commonly caught via rimming and hardsport/scatplay. Shigella can cause severe stomach cramps, vomiting and diarrhoea

Recommendations are to use of dental dams or cutting a condom into a dental dam to avoid shigella during rimming. Shigella can clear itself in two weeks but for some treatment with specific antibiotics may be required, especially as antibiotic resistance in Shigella is rising. 

Remnants of the infection can remain in your bowels for up to four weeks after clearing your infection, so sex should be avoided during this time to avoid passing it on. Increased hygiene and handwashing must be observed throughout the entire period.

Herpes (HSV)
Herpes is not screened on standard STI tests as around 70-80% of sexually active adults have herpes regardless of whether they show symptoms or not.

    • There are two main strains of herpes. HSV1 is responsible for outbreaks on the face, and HSV2 is responsible for genital and anal outbreaks.
    • There is no cure for Herpes but it can become dormant, only flaring up in moments of extreme stress, when unwell with another illness, or if using topical creams that are designed to suppress the immune system locally (such as some genital psoriasis treatments).
    • Herpes can be passed on by general skin to skin contact but most commonly from a herpes sore area direct contact to a partner’s skin, this does not mean it is only passed on sexually. Herpes cannot be contracted from a shared toilet seat or drinking glasses etc.
    • Herpes is not harmful on its own but can impact self-confidence and impact Performers work.
    • Before a flare-up appears people with Herpes will notice a tingle in the area.
    • As soon as flare-up are noticed, or the tingle before a flare-up is noticed, people speak to their medical practitioner to ask them to prescribe you Acyclovir pills, in some nations Acyclovir is under a range of brands and are available in pharmacies. 
    • Flare-ups will end on their own but can become sore, like a friction burn.
    • Acyclovir can also be taken on a daily basis to prevent flare-ups for those who have been experiencing them frequently. This is called starting ‘suppressive therapy’ for Herpes. It is a common practice in the industry.

Human Papillomavirus (HPV)
Human Papillomavirus (HPV) is commonly known a Genital Warts, however there are around 100 strains of HPV virus with only some potentially causing symptoms of genital warts. A couple of the strains can develop into cancers of the cervix, anus, penis or throat. Many people may develop no symptoms however.

HPV can be spread via shedding and groin skin contact rather than sexual fluid exchange. This does not mean HPV transmission will happen whenever this groin skin contact happens. Nor does it mean that HPV symptoms would appear in uncharacteristic places just because of groin skin contact.

HPV is incurable however symptoms can be treated, and commonly with time HPV can become dormant and symptomless. People may still be able to pass on HPV in this state however. Around 80-90% of sexually active adults have a form of HPV. HPV is not screened on standard STI tests and there are multiple vaccinations to prevention HPV. It is good practice for Performers to have had vaccinations like this before starting in the industry.

Lice, Crabs, and Scabies
These are technically an infestation rather than an infection but are handled under the category of sexual health. 

If someone discovers they have got lice (also known as ‘crabs’) or scabies they should visit a pharmacy and ask for permethrin cream or malathion lotion (sold under the brand name Derbac M, amongst others).

Scabies and lice are passed on via skin to skin contact, such as during sex; they can also be passed on through contact such as hugging – as well as sharing bedding or towels with a person who has an infestation. 

If someone has scabies or lice, they should wash their bedding and towels on the hottest wash the fabric allows and do not share bedding and towels until they’ve cleared the infestation.

Mycoplasma Genitalium (MG)
Mycoplasma genitalium, sometimes called ’MG’ or ‘Mgen’ is a bacterial infection. Most people with the infection don’t have symptoms and it is not routinely tested for. Due to the low prevalence in the local community and minimal complications of Mycoplasma Genitalium in asymptotic patients, this infection is often only tested in those who are current contacts of the infection or have been diagnosed with Pelvic Inflammatory Disease (PID) or Non-Specific Urethritis (NSU).

It is only currently tested through the vagina/front hole and urine samples, it is not tested in the mouth or rectum. MG is transmitted by condomless sex and sharing sex toys. It is treated with oral antibiotics.

Trichomonas Vaginalis
Trichomonas, sometimes just called “Trich”, is a small parasitical infection that affects the urethra of people of any gender, and the vagina/front hole. 

Trich is passed on via condomless vaginal/frontal sex or sharing sex toys. It is treated with a weeklong course of antibiotics. Due to the low prevalence in the community and minimal complications of Trichomonas vaginalis in asymptotic patients, this infection is often only tested for in those who are contacts of those with the infection or if they themselves have symptoms e.g discharge or pain. It is only currently tested through the vagina/front hole and urine samples, it is not tested in the mouth or rectum. 

Non-Specific Urethritis (NSU)
This is a swelling of the urethra, in people of any gender, and whilst it isn’t a STI itself it can be caused by one. 43% of all NSU cases are as a result of a concurrent Chlamydia infection. Treatment will vary depending on what is causing NSU, but it is usually a course of antibiotics. 

Other Sexual Health Topics

– Pregnancy Prevention
Productions are rarely involved with how Performers avoid pregnancy. Pregnancy can be prevented with one or a combination of the following strategies.
The Condom or Femidom/Internal Condom, The Oral Contraceptive Pill, Intrauterine Device (IUD), The Contraceptive Implant, The Contraceptive Injection, Emergency Contraception Pill (The 'Morning After' Pill), Contraceptive Ring, Diaphragm, Sterilisation: for people who produce sperm: vasectomy, or for those with a uterus: Hysteroscopic Sterilisation,

Work During a Menstrual Cycle
Where Performers don’t rearrange work during this time, then many Performers use insertable sterile menstrual sponges, being sure to remove/replace them before 8 hrs of use to avoid complications connected to toxic shock syndrome.

Vaginismus is the body's reaction to the fear of some or all types of vaginal/frontal penetration. Whenever penetration is attempted, vaginal/frontal muscles tighten up on their own. Specialists treating this often suggest treatment including “Mindfulness” techniques and a range of relaxation exercises.

Vulvodynia is pain in and around the vulva which may be there all the time or it may come and go. Treatments for vulvodynia include painkilling gels from pharmacies, stronger prescription painkillers, physiotherapy and talking therapy. A cause for vulvodynia is not always found, sometimes it’s caused by nerve damage from surgery or giving birth.

This is when a foreskin is too tight for it to be retracted which makes daily washing beneath the foreskin a challenge.  Not addressing phimosis may lead to inflammation and serious health complications. It is important to speak with a sexual health professional and to check that there are no underlying conditions causing this to happen. 

Around the age of 12 to 20 a person’s body often responds well to them routinely  gently stretching their own foreskin back when in the bath or shower. If they are older than this gentle stretching grommets like those by ‘Phimostop’ can be a less invasive option than having an adult circumcision.

Erection Support
This is something that happens to most Performers with a penis at some point. It is best to not underestimate the impact it may have on Performers work and mental health however. If it happens Performers should try and take a moment to themselves, relax and bring themselves “back to the moment”. They should try flirting with the Performers they are working with, and try to create some fun natural chemistry.

When Performers are having the issue that Performers they are working with are losing their erection – then it is worth giving the struggling Performers some private space, or they should try and generate some natural chemistry between each other. For instance talking about being attracted to them for a while, separate to work. Relaxed eye contact, hand-holding or being bashfulness are all some of the strategies used to help Performers who have started losing their erection. This is because Performers who are losing their erection may be becoming paranoid about it, which may lead it to becoming worse.

Erection Meds (Oral)
Many Performers use Viagra (sildenafil) for filming however some experience headaches from this, but there are alternatives out there: Cialis (tadalafil) and Levitra (vardenafil hydrochloride). With any of these, they must not be used with blood pressure medications, or with the use of poppers (alkyl nitrites) as this can cause a dangerous drop in blood pressure, most should not be taken with alcohol in the system. Performers using erectile medication still need to be aroused for these medications to work but they lessen the ‘up and down’ effect that anxiety has on erections.

Caverject (alprostadil)
Caverject is an injectable erectile medication. Performers using Caverject for shows or filming need to be very careful about following the advice and not use Caverject too frequently. If Performers are going to use it they should be shown how to do it by someone with medical training.

Performers should not use more than 20mg at any one time.
If Performers erection have not gone down after 4-5 hrs they should sit in warm or cold water such as a bath. If their erection still hasn’t gone down after this time they should go to hospital for the treatment or long-term penile damage may occur.

If Performers are absolutely terrified about going out on stage, it will not matter if they take Viagra or Caverject (methods should not be taken together), an erection is a barometer of how stressed they are. Feeling sexy and having fun helps to distract from stress, Performers often try to avoid this by having a laugh or genuinely flirting with other Performers before going on stage or filming.

Trimix (in USA only)
Trimix is an injection for the penis which works in the same way as Caverject, however it is specifically made on a patient-by-patient basis by a compounding pharmacy based on a doctor’s prescription. 

Such pharmacies do not pass the FDA approval as individual locations may fail regulatory or hygiene requirements. Some Performers report fewer side effects on Trimix than Caverject however the compounding pharmacies are poorly regulated, and results will vary across America.

Using a penis pump is a common way to temporarily increase penis length and girth for a live show, but if done wrong it can cause damage. 

Removing pubic hair and lubricating the rim can help create a seal, as a sudden loss of pressure can hurt. Performers should not pump multiple times in the same day or every day of the week. If at any point the pumping starts to hurt they should stop pumping to avoid tissue damage.

"Tying off” is pumping and using a cock-ring to keep the pressure in the penis for an extended period of time – such as a stage show. A penis may go increasingly red while it is tied off. Avoid leaving the cock-ring on for longer than 10 minutes in this state. Do not put on the cock-ring on before the pumping. It is worn afterwards by bringing the stretchable cock-ring off the edge of the pump onto the body when pumping is finished, or using a closable cock ring.

Penile accidents
On rare occasions Performers can slam onto an erect penis, missing it penetrating them. If this happens hard enough, the dick may bend in half and cause excruciating pain. Performers with the damaged penis should seek medical attention and will need a lot of recovery time.

It is worth being aware that this event can be traumatic, both physically and emotionally, to both Performers.

Splitting a frenulum (also sometimes known as a ‘banjo string’) can happen during rough sex and will bleed a lot however usually heals well without the need for stitches. It is more likely to occur to those with dry skin.

Urinary Tract infections
Performers can reduce Urinary tract Infections by drinking plenty of liquids, especially water. Drinking cranberry juice. For people with a vagina/front hole to wipe from front to back after going to the loo. Urinating soon after intercourse. Avoiding potentially irritating feminine hygiene products or changing their birth control method to one right for their body.

Fissures and fistulas
Fissure and fistulas – Rough sex can cause tearing, in most cases taking a month or 2 away from sex and keeping the area sterile helps recovery. Medical intervention can be needed in come cases. It can be mentally traumatic so Performers should respect their own physical limits, not stretching their body to the point of tearing.

It is better for Performers to slowly work up in sizes (such as using an increasing scale of dildos) over a long time rather than expecting their body to stretch a lot in a single moment without this practice. Productions need to be aware of this and not create environments where Performers are choosing their income over their health, by Performers believing they must do something that stretches them to the point they may develop a fissure or fistula.

Haemorrhoids and Boils
Haemorrhoids and boil creams are available in pharmacies. They can help along with taking time off work however medical intervention can happen for more persistence cases. having sex with a boil in an uncomfortable place can be painful or have mental health impacts for Performers.

Mess During Anal Sex
Mess during anal sex happens, some people don’t douche before anal sex, some people do. Each person’s body is different and trial and error teaches that person what works best for them for clean anal sex. A lot of Performers do anally douche before filming, be it using a bulb douche, shower attachment or enema kit. Some people have trapped internal water after douching, which may be released during sex.

If this accident happens know that Performers are likely to feel ashamed and vulnerable. However Performers want to react to accidents, they should behave professionally and be supportive to other Performers who may be feeling uncomfortable. When cleaning up, respect Performers dignity explaining accidents happen and not to worry. Take a break so Performers can visit the loo if needed.