The Ins & Outs of Happy Sex

Dr. Rachael Ross slaps no bandage on the deep wounds of the epidemic. Instead her Rx is to kill the virus at its intimate roots
by Dann Dulin

Photographed Exclusively for A&U by Sean Black

[dropcap]T[/dropcap]he doctor is in and she’s making house calls.

Though slight in stature and calm in demeanor, make no bones about it, sexologist Dr. Rachael Ross means business. She’s fervent about shaking up her viewers on The Doctors with her signature hardball style. “HIV prevention has been the center of my existence before I was legal to drink,” says Dr. Ross, who’s cautious to reveal her age.

Raised in Gary, Indiana, she comes from a close family of doctors and nine siblings. Her father, David, and brother, Nathaniel, are in practice and so was her sister Rebekkah until her death in 2011 from complications related to sickle cell anemia. Dr. Rachael, who lives in Chicago, still maintains her family practice in Gary. Losing her sister, who was thirteen months Rachael’s junior, was a colossal blow to Rachael. Both were acutely committed to mentoring girls in their hometown. In 2012, Dr. Ross received the prestigious Northwest Indiana’s International Service Award for her work. The National Council of Negro Women also recognized the medical duo’s philanthropy.

Dr. Ross is the author of Down Right Feel Right–Outercourse: For Her & For Him (2009), an uncomplicated manual about safer intimate sex. She also speaks at colleges and high schools, and is a spokesperson for OraQuick, a self-administered rapid HIV test.

The Doctors, with guest Vicki Lawrence. Photo by Craig T. Mathew/Mathew Imaging
The Doctors, with guest Vicki Lawrence. Photo by Craig T. Mathew/Mathew Imaging

“We just never talk about sex—and how you get it,” she complains, bedecked in a black T-shirt that reads, “I Can’t Breathe” (referring to the words Eric Garner uttered to New York policemen who held him in the chokehold that killed him), a longish non-descript grey unbuttoned sweater, blue Jeans and navy blue UGGS. “Doesn’t seem like there is really anybody totally honest about it. We’ll say, ‘Use a condom,’ but what about the sex? We’re not addressing the fact that half way through intercourse the guy takes it off. We’re not talking about how it feels better without it. We’re not talking about ways to please your partner other than through penetration. Consequently, there’s a whole lot of education that’s lost,” she rhapsodizes, appending, “India has really staved off their infection rate to some extent because the government teaches ‘outer-course.’”

She continues. “We’re not talking about how you get that virus. We’re not talking about how you’re less likely to contract the virus if things are wetter, smoother, and gliding, or how vaginal dryness increases one’s risk. We’re not talking about why the anus makes one more susceptible than the vagina and why oral sex is less risky than penetration,” grumbles Rachael, taking a breath. “Having another STD also increases your risk.

“Such dialogue is missing from sex education and HIV prevention. It’s terrible,” laments Dr. Ross with frustration. “We’re in a piercing and tattoo culture, and we’re not talking about how putting holes in the skin increases one’s risk,” she stops and whispers, “if it’s not healed up. And if the virus gets on the needle, it can enter the bloodstream.” She breaks and crosses her legs. “This should be common knowledge.”

[quote_center]”The conversation and the dollars aren’t targeting prevention. So if you don’t have a community that’s dedicated to prevention and pushing the message, then it gets drowned out.”[/quote_center]Rachael is always surprised by the college students she encounters when she speaks on American campuses because they don’t have full knowledge about sex. “They…have…no…idea!” she balks, taking a moment. “Drug companies make so much money off treating people who have the virus, and now they’re going to make even more money off people who don’t have it,” grouses Dr. Ross, referring to PrEP. “The conversation and the dollars aren’t targeting prevention. So if you don’t have a community that’s dedicated to prevention and pushing the message, then it gets drowned out.”

The African-American community is especially vulnerable. While studying at Vanderbilt in the mid-nineties, Rachael had a premonition. “Being in college, sex was in the air. We’d be at parties and people were having sex up against the wall. I said to myself, ‘This is going to be a black people problem—watch.’ I knew it!” she says assertively. Right then she had an epiphany and decided to devote her career to educating people about STDs.

DrRachael_SGB_2348EH-PATHShe was further convinced during a trip to New York for spring break where she worked for an AIDS organization. She met two men who were dying, an older man and a young man who still appeared healthy. “This [scene] really hit home,” she remarks with an emotional plunk. “People were getting a deadly virus just by their love for each other by a physical act.”

Dr. Rachael graduated with a BA in anthropology from Vanderbilt University. She earned her MD from Meharry Medical College in 2001 and her PhD from the American Academy of Clinical Sexologists.

Dr. Rachael’s ease in talking about intimate topics is refreshing. She gabs about it as though she were talking about last night’s dinner. Imagine the public health benefits if we could discuss sex with such bearing.

Cozied up on a light olive-colored malleable sofa in her petite but homey dressing room on the Paramount lot, Rachael just completed a taping of The Doctors. She has no airs and is charming and personable. Moments before we met, as I waited for her to leave the set, I was speaking with Andrea McKinnon, the show’s delightful publicist. Dr. Ross approached us, politely extended her hand, and said, “I wanted to introduce myself and I’ll see you soon in my dressing room.”

Once we’re together in her dressing room, she offers me something to drink. Rachael reaches into the miniature fridge and grabs a Pelligrino for me and chooses a Lime La Croix for herself.

[quote_center]“In the nineties, when I first started HIV outreach the target was gay men. Now HIV and AIDS has become a major problem within the African-American community.”[/quote_center]“I think about the changing face of HIV,” she comments, her high-cheek-boned covergirl face looking as though she just ascended from a Chanel ad. “In the nineties, when I first started HIV outreach the target was gay men. Now HIV and AIDS has become a major problem within the African-American community.” She swiftly brushes her dazzling cascading hay-colored hair behind her ear, revealing a large hoop earring. “It’s different now than it was years ago with the gay community, who took it upon themselves to eradicate the virus. HIV has sort of become a chronic illness. It’s taken a backseat to prevention and so now things have shifted to just putting everybody on medication. And so the whole education component is just out the window.”

Rachael attributes the high rate of infection in the African-American community to behavior and socio-economic factors. “I think that’s the difference between what’s happening in the African-American community versus what was happening in the gay community. There’s none of that hope or pride or love,” she clarifies, taking a sip of her sparkling water. “There are so many reasons to live! But there are so many problems in the hood,” indicates Dr. Ross with a deliberate fake chuckle. “It’s just like, ‘Take a number bitch!’”

Dr. Rachael Ross participates in a flash mob at Shriner's Hospital for Children, one of the many ways she engages the community. Photo courtesy R. Ross
Dr. Rachael Ross participates in a flash mob at Shriner’s Hospital for Children, one of the many ways she engages the community. Photo courtesy R. Ross

Denial is a huge part of the problem, she believes. “It’s devastating to see the denial among African-American women. When I look at their rate of infection in comparison to Latina and White women….” Rachael halts, not being able to find the words to finish, due to irritation. “When I look at what’s happening in the culture, I know it’s due to partner-sharing. The reason our risk is so high is because we’re attracted to a group of people who have a higher incidence of infection than other groups,” she says. “The culture of hip-hop pushes partner-sharing. Listen to our radio stations. Too many of the songs talk about sleeping with someone else’s girl or messin’ with someone else’s man. All of that is propelling us into an HIV culture. And since so few are dying of it anymore…,” she softens and lowers her voice, “… it’s become the silent killer.”

On The Doctors, Dr. Ross has adamantly stated, “There’s no such thing as safe sex.” She expounds, “There’s only saf-er sex.The difference between safe sex and safer sex is that safe sex is the sex you have with yourself. Safer sex is reducing one’s risk. Saf-er sex is using a condom. Saf-er sex is knowing your risk stratification.

“They should teach risk stratification in the schools like, ‘What’s the riskiest thing I can do at the moment?’ ‘What’s the least riskiest thing I can do sexually at this moment?’ ‘If I’ve got cuts all over my fingers and I bite my fingernails, well my fingers are off-limits.’ Understand that you have a greater risk through anal sex than you would through oral sex. Yes, you can still contract STDs but it’s safer. Saf-er,” she repeats. “It’s clinically proven to be safer. So when I say safer, I mean risk stratification.

“Ever since I was a youngster, in every sexual situation I think: ‘Who is this person? What are my risks? And what are the top things that I should not do and what things do I think I can get away with?’”

Dr. Rachael addresses the question of risk in Down Right Feel Right. It’s a dual-purpose book. One side of the book is for him, flip it over and the other side is for her. “The whole idea is to titillate and to educate at the same time,” she resolves. “It talks about the stuff we used to do as kids before we went on to penetration. This is the saf-er forms of sex. When we become adults, we get so caught up in penetration that we forget that there are other ways to orgasm, and other ways to please yourself and your partner.”

Outercourse is anything other than penetrative sex. “We’ve called it foreplay for so long because we’re used to believing that the real play is penetration,” the doctor explains.


When one person in a relationship is HIV-positive, outercourse becomes a huge part of their life. In that situation they must create strategies to please each other and still be intimate. “As HIV rates go up, the likelihood of falling in love with someone who is HIV-positive becomes quite high. Studies show time and time again that people don’t automatically leave their partners when they find out that they have herpes or find out that they are HIV-positive,” she insists. “Love is love and you find a way to deal with that.”

Her book illustrates how people can decrease their risk of contracting HIV. It’s worth mentioning again: it’s about risk stratification—the riskiest and the least riskiest behaviors. When you are the receiver of penetrative sex, you are at way more risk than the person who is the penetrator. “The tissue of the vagina is designed to be a lot more resistant to tearing than the anus,” she points out, leaning forward. “For men having sex with men, it’s much easier [to contract HIV] because the anus tears more vigorously.”

“As for sex between a man and a woman, it is very easy for a woman to contract the virus, which is why the rates of infection for women are increasing. It’s because it’s so much easier for us.” Dr. Ross momentarily looks off toward the freestanding makeshift rack of clothes and the many pairs of shoes that line one side of the wall. On the shelf above are framed family photographs, a few wine bottles, books, including Reader’s Digest, votive candles, and other paraphernalia.

[quote_center]”If you take a straight couple that doesn’t even know the female condom exists, and I introduce them to it, they look at it and say, ‘Okay, what is this contraption? It looks kind of crazy.’ Then they use it. Nine times out of ten they’re going to say they enjoyed it way more than the male condom.”[/quote_center]“If you think about the lining of a vagina, it’s kind of like your mouth, it’s easy to cut. If you eat some Cheerios or suck on a sucker too hard, you get a little sore in your mouth. HIV goes in through the cut and the vagina is so porous. But the penis is not too different from the skin on your hand. And without there actually being a herpes lesion or a cut on there, it’s harder for HIV to pass through to the bloodstream,” she says.

What about male condoms versus female condoms? Dr. Rachael displays a spirited foxy smile. “You know what? Women ….and men,” she pauses for effect, “enjoy the female condom. If you take a straight couple that doesn’t even know the female condom exists, and I introduce them to it, they look at it and say, ‘Okay, what is this contraption? It looks kind of crazy.’ Then they use it. Nine times out of ten they’re going to say they enjoyed it way more than the male condom. The female condom feels freer. It’s not like he has a sheath on. I love female condoms,” she exclaims. “I’m a big fan.”

In developing countries people wash out the condom for reuse. In America, typically, people will use it once. Female condoms are used for anal sex in developing countries, as well, but the marketers aren’t comfortable about advertising this in the USA. “When you talk to the manufacturers and you ask them, ‘Why don’t you market these more?!’ They answer, ‘American women are too squeamish to spend the time to stick [the condom] in. It’s just not a culturally sound thing for them to do.’ Thus, the company doesn’t spend as much marketing dollars here as they do in other countries because they recognize our fear of even touching ourselves or talking about ourselves down there.

“I’m excited about this type of technology,” raves Rachael. “Anything that creates a sheath along the part that’s vulnerable—the anus or the vagina—is definitely going to be a winner. It also warms up to body temperature. It’s made out of polyurethane, so you have less allergic reactions because there’s no latex involved. You put the lube on it and everything just slips and slides.

“The female condom is easy to use. You can put it in before you go out on a date. When that heat of the moment comes, you’re prepared,” she spiritedly offers.

As for the male condom, everyone has heard guys chant, “Condoms disturb the flow of intimacy.” Dr. Rachael responds, “If that’s your thought process, you can end up dead.” To get over that mental obstacle, she instructs men to practice with condoms, learning how to open the packet in the dark. “Get familiar with the condom,” she urges. “Masturbate wearing a condom. Get used to cumming in one. Train yourself.”

She adds, “There’s such a hang-up about anal sex, too. ‘If I tell my girlfriend or my wife that that’s something I want to do, I’m less of a man. But if I just get a guy to do it, then it evens itself out.’ It’s such a weird thought process….”

In addition to the pervasive macho attitudes in many cultures, the false notion commonly exists that if you know someone well, you can trust them. “‘I’ve known him for a month now,’” mimics Rachael countering, “Yeh, but just because you’ve known him for four weeks doesn’t mean he doesn’t have anything. We get too comfortable. Only when both of you have tested negative, can you trust each other,” she advises then ponders.

Tilting her head, Dr. Ross slightly grins, “Eventually there still may be some risk—because people do lie…and that’s evident on-line. Studies show that by the time people meet, after they have exchanged photos and texted each other, they are more likely to trust and have unprotected sex quicker,” she contends. “On-line meeting breeds this false comfort. After all, you still don’t know this joker…!” She shifts positions then daintily adjusts her sweater, her hot pink nails evident. “On the Internet, most people are making up stories anyway. I try to encourage kids not to be on there [social media] all the time. If you can get them to temper their social media, they really start to feel better about themselves,” she insists. “This works well for adults, too!”

Media can certainly contain mixed messages that haze our reality. Case in point, several years agoEdit_MG_2441 when there appeared an ad for OraQuick, it was a photograph of a smiling Magic Johnson dressed in a white T-shirt, with the caption, “You can live healthy with HIV.” Emphasizes Dr. Ross, “It was a billboard that was in every major ghetto in America. To me, it insinuates that we’ve lost the fight for not getting it. We’re saying, ‘Well, it’s okay if you get infected. You can be healthy and you can live long as long as you take your medicine like I do.’ That’s the part of that message I don’t like,” she remarks minimally perturbed. “I don’t like the idea that it’s okay to get HIV and take medication for the rest of your life. Who knows what this medication is going to do in the long-term?!”

There’s a tap on the door. A peer peeks in to remind her of a short production meeting coming up before they tape another show. Rachael replies that she’ll be there soon. Dr. Ross carries on where she left off, passionate about saving lives. You want her on your side.

“Also, since there are different types of HIV strains. If someone gets infected, maybe the particular drugs on the market will not treat your kind of virus.” As for her take on PrEP, Dr. Rachael doesn’t have a definitive answer. “I’m not convinced that a whole community needs to be popping a pill that I know can cause renal failure. We just don’t know enough about the long-term effects of antiviral drugs.”

Dr. Ross hopes that media coverage about the virus will not continue to decline. “What saddens me is that when it’s Black HIV Awareness Day or World AIDS Day, it’s virtually impossible to get booked on a show to talk about it. It’s become old news and nobody’s interested in the subject right now. What they’d rather have me talk about is how to give somebody a great blowjob!”

Though the epidemic may not be a sexy topic, Dr. Ross is—and she’s our Town Crier. Charismatic and engaging, people perk up and tend to listen to her sage words. During our time together I tell her that she’s the new Dr. Ruth (a sex therapist who became an icon in the eighties known for her frankness, opening the closet on talking freely about sex). She’s very gracious to my compliment. But Rachael insists that it’s going to take someone like Rock Hudson or Ryan White to come forward to put the epidemic back in the news.

“I know there are celebrities out there who are HIV-affected and I wish some of them would come forward—‘I have HIV and this is what I’m living with…’ It’s going to take something like this to reenergize the movement.” She broadens her sparkling mahogany-ebony eyes and concludes, “The face of HIV and AIDS is gonna have to be somebody who…has the virus.”


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A special thank you to Susie Odjakjian for her keen ear and grammatical expertise. Post-production (Digital Styling): Eve Harlowe Art & Photography; Make-up and hair: Geno Freeman.


Dann Dulin interviewed actor Daniel Franzese for the July cover story.


  1. How come when you hear it from this Dr. Rachael it makes more sense, could it be because she’s one of the most prettiest Doctor I have ever seen. My care provider team would agree hands down. She makes a lot of sense and why didn’t I think to explain it like she does about the how to and why’s about condom use. I recommend this article for any and everyone to read…. Because we must be unafraid to open a dialogue on HIV/AIDS and STI’s in our homes,schools,churches and social groups… Bravo Dr. Rachael Ross…

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