Dear Doc, I'm wondering if a condom is necessary between monogamous couples because of germs. My partner and I have not used one in eleven years, but we trust each other not to be with other men. Some recommend that if the trust level is not high, you should always use a condom.

Can we catch anything from each other? We always clean up afterwards, and although it may be physically dangerous, we find sex in the shower is a lot of fun. -Rob

Dear Rob, I think that if you are a monogamous couple over time you mirror image each other with flora. Just kissing deeply with a new friend can give you organisms that can cause diarrhea or other issues theoretically.

Sex in the shower is good. I think that sex in a hot tub can be wonderful and the high level of chlorine adds safety there too.

Our gut flora can range far and wide. Tetanus bacilli can even live in our guts as commensals that cause no problems. Again it is our amazing immune systems that keep it all stable. Being a little dirty is a good thing and if more people challenged their immune systems and did not use all the antibacterial soaps and such there would be less asthma and autoimmune diseases. Sterility was not the original plan, intelligently designed or otherwise. Ellar, M.D.