Are You A Sexual Secret Keeper?

If so, speak up! Talking can improve your relationships—and maybe even save your life.

There's just not enough talk about sex. Sure, we'll joke about length versus width with our friends, marvel at what you can see on TV these days and gossip endlessly about who's hooking up. But none of that truly counts. Because in the two places where women most need to be open about sex—in the bedroom and at the doctor's office—there's a resounding silence.

Consider this: Half of women say they've never broached the topic of HIV or other STDs with any health-care provider, and a quarter have never discussed their sexual history (including number of partners or past infections), according to the new survey for SELF by the Kaiser Family Foundation. We're not terribly open with our intimates, either. Nearly two thirds of women have never discussed STD testing with their current partners, and a stunning 9 out of 10 believe that women in general are sometimes less than honest about what they've done and with whom in the past. Even more surprising, 47 percent believe that sexuality simply isn't something women should discuss.

Almost half of those surveyed believe that sexuality simply isn't something women should discuss.

Clearly, the health and happiness ramifications of being tight-lipped on such an important topic are enormous; just check out "Be a (Safe) Sex Goddess" . We're not suggesting you carry around a laminated copy of your sexual resume, but before you say, "My sex life is nobody's business," keep reading. It could be the difference between life and death.

Don't ask, don't tell

Around the time she started to think about having children, Paula Banks, 35, a university professor in Toronto, experienced a strange little dance of mutual self-censorship with an ob/gyn. "I was sexually abused when I was younger and worried that there might be some lasting physical damage," Banks says. "So I asked the doctor to check if everything was OK down there. I never told him why, and he never asked. Even after he found some scar tissue, which I knew was from the time I was raped with a small knife, he still didn't ask me about it." Banks took this as a sign that her traumatic sexual history wasn't his concern. "He was a well-respected doctor who was very busy, and I thought my little problem wasn't worth his time. I didn't even blame him."

Banks's story is an extreme example of what experts say is a common communication problem. It's the rare woman who looks forward to detailing an outbreak of genital warts, but in many cases, physicians don't encourage the openness that leads to the best treatment. "I don't blame women for not bringing these things up," says Rachel Masch, M.D., medical director of the NYU/Bellevue Reproductive Choice Service in New York City. "The onus is on the physician to ask the patient the appropriate questions in a nonjudgmental way." But if your doctor is pressed for time or, frankly, as embarrassed as you are, she may skip the interrogative portion of the exam—which sends a clear signal. "Since doctors ask about every other topic, not asking about something may convey a subtle message that it's not important," says Felicia Stewart, M.D., codirector of the Center for Reproductive Health Research and Policy at the University of California at San Francisco. Whether that's the doctor's true belief doesn't matter; the effect is the same.

A doctor's dismissal of the subject only reinforces women's already ingrained ideas about sexual infections. Women overwhelmingly agree that having an STD is more humiliating than having any other health condition, according to the survey. "Anyone can get an STD, the same way anyone can get strep throat," says Sallie Foley, a certified sex therapist in Ann Arbor, Michigan. "But the general reaction to an STD is that you got what you deserved."

"Women who are so meticulous they put paper on the toilet seat still don't ask a partner about STDs," says one expert.

Kerry Lanford (a pseudonym), a 29-year-old graduate student in Edison, New Jersey, found that her bout with human papillomavirus (which is linked to nearly all cervical cancers) carried a stigma. "When I told my mom about the HPV, she made me feel like a slut," Lanford says. "I figured anyone else, including my boyfriend, would react the same way." The fact is, up to three out of four sexually active men and women will acquire an HPV infection at some point in their life. And though many women with the virus never experience potentially dangerous cervical changes, Lanford did. Fortunately, she sought treatment, and a doctor removed the precancerous cells.