STI testing: Overview, purpose, and when to get tested
Frequently Asked Questions About Sexual Health
Menopause is a term used to describe the end of a woman's fertility. It literally means the end of menstruation. Female menopause is characterized by changes in hormone production. Men do go through a form of menopause, but obviously, it is different from that of a woman. The male testes, unlike the woman's ovaries, do not lose the ability to make hormones. A healthy male may be able to make sperm well into their 80's or longer.
On the other hand, subtle changes in the function of the testes may occur as early as 45-50 years of age, and more dramatically after the age of 70. Because men do not go through a distinct male menopause period, some doctors refer to this as androgen (testosterone) deficiency in the aging male (ADAM). Men typically experience a decline in testosterone production due to aging, but it can also be related to some diseases like diabetes.
Whether waning function of the testicles contributes to such symptoms as fatigue, weakness, depression, decreased sexual desire, or impotence remains uncertain. If testosterone levels are low, replacing that hormone may help relieve them. However, replacing male hormones can worsen prostate cancer and high cholesterol levels. Talk to your doctor to see if hormone treatment is right for you.
A Pap test is recommended for women age 21 and older. The American College of Obstetrics and Gynecology recommends routine screening for women ages 21 to 65 years every three years. More frequent Pap tests may be needed if an abnormal test result is found or if you are at high risk of cervical cancer.
Combining a Pap test with a human papillomavirus (HPV) test can safely extend the interval between cervical cancer screenings from three years to five years in many women between the ages of 30-65, according to the U.S. Preventive Services Task Force (USPSTF).
Also according to USPSTF guidelines, HPV testing is not recommended for women in their 20s, because people in that age group can have HPV infections that resolve without treatment.
Women over age 65 can stop getting screened if they've had at least three consecutive negative Pap tests or at least two negative HPV tests within the previous 10 years, according to the guidelines. But certain women who have a history of a precancerous abnormality should continue to be screened for at least 20 years.
And women of any age who've had a hysterectomy with removal of the cervix and no history of cervical cancer or precancerous abnormalities do not need to be screened, according to the guidelines.
Circumcision in newborn boys for medical or health reasons is an issue that continues to be debated. In 2012, the American Academy of Pediatrics (AAP) reported that circumcision has potential medical benefits and advantages, as well as risks. The existing scientific evidence is not sufficient to recommend routine circumcision. Therefore, because the procedure is not essential to a child's current well-being, we recommend that the decision to circumcise is one best made by parents in consultation with their pediatrician, taking into account what is in the best interests of the child, including medical, religious, cultural, and ethnic traditions.
Male circumcision may also make it easier to keep the end of the penis clean, although studies have shown that good hygiene can help prevent certain problems with an uncircumcised penis, including infections and swelling. In addition, using a condom during sex will help prevent sexually transmitted diseases and other infections.
As with most medical procedures, there are risks associated with circumcision. These include:
A woman normally produces a vaginal discharge that usually is described as clear or slightly cloudy, non-irritating, and odor-free. During the normal menstrual cycle, the amount and consistency of discharge can vary. At one time of the month, there may be a small amount of a very thin or watery discharge; and at another time, a more extensive thicker discharge may appear. All of these excretions could be considered normal.
A vaginal discharge that has an odor or that is irritating usually is considered an abnormal discharge. The irritation might be itching or burning, or both. The itching may be present at any time of the day, but it often is most bothersome at night. These symptoms often are made worse by sexual intercourse. It is important to see your gynecologist if there has been a change in the amount, color, or smell of the discharge.
There has been much debate by the scientific community regarding hormone replacement therapy, or HRT. In general, hormone treatment is believed to maintain healthy bones after menopause, in addition to relieving menopausal symptoms. But, like all treatments, there may be some harmful side effects, including an increased risk for breast cancer. The risk for endometrial cancer is largely gone if you also use progesterone.
Hormone replacement therapy isn't right for everyone. Talk to your doctor to determine if hormone treatment is right for you.
Yes. Even though breastfeeding may suppress or delay menstruation, you can still get pregnant. Ovulation will occur before you start having menstrual periods again, so follow your doctor's recommendation on the appropriate birth control method to use.
Some women may experience changes in sexual function after a hysterectomy (surgical removal of the uterus). These changes may comprise a loss of desire, decreased vaginal lubrication, and genital sensation. Furthermore, surgery can damage nerves and blood vessels considered critical to a woman's sexual functioning.
Yes. Syphilis is a sexually transmitted disease. A person with syphilis can spread the infection during the first two stages of the disease. If you come in contact with an open sore (first stage) or skin rash (second stage), you can pick up the bacteria that cause the infection. If the bacteria enter your body through an opening such as the penis, anus, vagina, mouth, or broken skin, you can get syphilis.
If a person has had syphilis for more than two years, it's unlikely that they can spread the disease. Don't take a chance. Use a lubricated condom during sex.
A person gets HIV when an infected person's body fluids (blood, semen, fluids from the vagina, or breast milk) enter their bloodstream. The virus can enter the blood through linings in the mouth, anus, or sex organs (the penis and vagina), or through broken skin.
Both men and women can spread HIV. A person with HIV can feel okay and still transmit the virus to others. Pregnant women with HIV also can pass the virus to their babies.
Common ways people get HIV:
You cannot get HIV from:
No. Use only water-based lubricants, such as K-Y Jelly, with condoms. Oil-based lubricants, like Vaseline, can weaken the condom and cause it to break.
If you forget to take a birth control pill, take it as soon as you remember. If you don't remember until the next day, go ahead and take two pills that day. If you forget to take your pills for two days, take two pills the day you remember and two pills the next day. You will then be back on schedule. If you miss more than two pills, call your health care provider for instructions. Those instructions may be to take one pill daily until Sunday and then start a new pack or to discard the rest of the pill pack and start over with a new pack that same day.
Any time you forget to take a pill, you must use another form of birth control until you finish the pill pack. When you forget to take a birth control pill, you increase the chance of releasing an egg from your ovary. However, if you forget to take any of the last seven out of the 28 day pills, you will not raise your chance of pregnancy, because these pills contain only inactive ingredients. If you miss your period and have forgotten to take one or more pills, get a pregnancy test. If you miss two periods even though you have taken all your pills on schedule, you should get a pregnancy test.
Pulling out before the man ejaculates, known as the withdrawal method, is not a foolproof method for birth control. Some ejaculate (fluid that contains sperm) may be released before the man actually climaxes. In addition, some men may not have the willpower or be able to withdraw in time.
HPV Rates Skyrocket Despite Safe, Effective Vaccine
June 26, 2023 – The human papillomavirus (HPV) vaccine may now be as critical as ever, though young people are taking the shot in fewer and fewer numbers. An epidemic of sexually transmitted HPV is now swirling around the U.S. And the U.K., with some serious cases leading to oropharyngeal cancer, which can affect the back of the throat, tonsils, and tongue.
HPV is the leading cause (70%) of this oropharyngeal cancer, according to the CDC. It is the most common sexually transmitted disease (STD) in the nation, and around 3.6% of women and 10% of men report oral HPV specifically. But over the past decade, oropharyngeal cases have been steadily falling a little under 4% and 2%, respectively, according to the National Cancer Institute.
HPV is often undetectable and can clear up within a few months. But unfortunately for some, serious disease, such as throat cancer, can develop if HPV isn't treated.
Studies show the HPV vaccine to be extremely effective in lowering sexually transmitted HPV cases. Yet, only 54.5% of young people ages 13-15 have taken the recommended two to three doses, according to the National Cancer Institute.
Why Aren't More Young People Taking the Vaccine?
Low public awareness of the dangers of HPV may be behind young people's poor vaccination rates, according to Teresa Lee, MD, an assistant professor at the Fox Chase Cancer Center in Philadelphia. "For example, while the link with head and neck cancers have been well-studied, the FDA labeling was not changed to reflect this as an indication until 2020," she said.
Other reasons can include one's socioeconomic background, poor health literacy, cultural or religious stigmas around vaccines, and lack of quality, low-cost health care, says Emmanuel Aguh, MD, a board-certified family medicine doctor. "Some individuals and families are still resistant to vaccines and the noted lack of uptake."
Doctors and other health care professionals should also be sure to tell patients of all ages about the risks of HPV infection and how well the vaccine works, Lee said. "Not everyone who is now eligible may have been offered the vaccine as a child, and the first time young adults may receive counseling on this subject may not be until they are entering a very busy period of their lives with many responsibilities – when it may be hard to fit in things like health maintenance."
How Safe Is the HPV Vaccine?
The FDA and CDC have studied the HPV vaccine for years to find out how safe it is and how well it works, Aguh said. No major side effects have been reported, and the most common side effect is soreness where you get the shot (which is normal after most vaccines). Some dizziness and fainting in adolescents can also occur, so young people are usually asked to sit or lie down during the shot and for 15 minutes afterward, he said.
"Serious adverse events have not been reported at higher rates than expected following HPV vaccination, meaning there is no clear evidence they are related to the vaccine," Lee said. "The vaccine is highly effective in decreasing rates of detectable infection with the high-risk HPV strains responsible for HPV-associated cancers."
The HPV vaccine is largely recommended for people ages 9 to 26, and sometimes up to age 45, depending on the individual, Aguh said. If you are over 26, talk to your doctor about whether you should consider getting the vaccine.
"It is usually given in two doses for complete protection if taken before the 15th birthday," Aguh said. "If taken afterward, or in those with a weak immune system, they might require three doses to be fully protected."
The vaccine produces antibodies that can stop HPV from infecting cells and lowers your chances of catching an HPV-related cancer, such as throat cancer or cancer of the cervix, he said.
While the vaccine is not guaranteed to protect you from the more than 100 strains of HPV, it can protect you from HPV 16 and HPV 18 – two high-risk strains that cause around 70% of cervical cancers.
What Is Fueling the Rise of HPV Cases?
A misconception that oral sex is somehow a "safe and risk-free" alternative to anal or vaginal sex could be one reason, Aguh said.
"It is important to know that with oral sex, you are exposed to many of the risks associated with vaginal intercourse, especially if you do not take any measures to protect yourself and/or your partner," Aguh said. "[With oral sex] it is possible to end up contracting an infection like chlamydia, gonorrhea, and even HPV, leading to an increased risk of HPV-associated oropharyngeal cancers."
A lack of public awareness of what can cause throat cancer could also explain this phenomenon. The number of people you have oral sex with, along with the age you begin sexual activity, can greatly determine your risk of the disease, according to Lee. She echoes a report by Hisham Mehanna, PhD, in The Conversation.
"For oropharyngeal cancer, the main risk factor is the number of lifetime sexual partners, especially oral sex," wrote Mehanna, a professor at the Institute of Cancer and Genomic Sciences at the University of Birmingham in England. "Those with six or more lifetime oral-sex partners are 8.5 times more likely to develop oropharyngeal cancer than those who do not practice oral sex."
What Are Symptoms of Oropharyngeal Cancer?
Labored breathing or swallowing, a cough that won't go away, and crackling or hoarseness of your voice could all be signs of throat cancer. Other symptoms include earaches, swelling of the head or neck, and enlarged lymph nodes, among others, Aguh said.
"The signs and symptoms of HPV-related throat cancers can be difficult to identify and recognize, as they can be vague and are also associated with other medical conditions. Sometimes, there are no signs at all, or they are not easily noticeable due to the location," he said.
You should go see your doctor if you have any of these ailments for an extended period.
How to Reduce Your Risk
In addition to having six or more oral-sex partners, smoking and drinking heavily could also raise your risk of throat cancer, said Lee. Proper dental health – like seeing your dentist regularly and practicing proper oral hygiene – can also shave your risk.
"[Good dental health] can help not just with head and neck cancer risk, but with many other inflammation-related diseases," Lee said.
Using dental dams and condoms can also be a good method of protection, Aguh said. A dental dam is a stretchy sheet of latex, or polyurethane plastic, in the shape of a square that is made for blocking body fluid to lower your risk of contracting an STD via oral sex.
Keep in mind: Even with these protections, make sure you and your partner discuss each other's sexual history, any prior or current STDs, and their preferred protection from STDs, said Aguh.
If you or your partner is being treated for an STD, consider opting out of oral sex and consulting a doctor.
The HPV vaccine is another common method of protection. The shot is "approved for prevention of nine of the most high-risk strains of HPV," or those that are most commonly linked to cancer, according to Lee. The vaccine "reduces the frequency of infection" with these viruses, which can ultimately lower the risk of cancers linked to HPV, including cervical, anal, and vulvar and vaginal cancers, she said.
"The best time to receive treatment for prevention of disease is prior to onset of sexual intercourse," said Lee.
To get your HPV vaccine, head to your family doctor, school- or community-based health center, or state health department, suggests the CDC.
Click here learn more about the HPV vaccine and here for more information about oral HPV and cancer.
What If Your Attacker Became Your Lawyer – And You Didn't Know It?
Loneliness has long been a marked facet of Yifen Chen's life.
Chen, a 26-year-old with a certain quiet and polite self-assurance, grew up in Taipei, Taiwan, caring for her mother, who had lupus. When she was a little girl, she would cook her own meals and go to school unaccompanied.
"I did not have a family that I could totally rely on in my childhood," she told me. "I had to make sure I was able to survive by myself."
Chen's father, a physical therapist, sent them money, but her mother rarely allowed her to speak with him. It wasn't until she was 17, when her mom passed away, that a closer relationship with her dad formed.
Chen started working as a content creator in her early 20s, broadcasting her favorite music and livestreaming her day-to-day life. Soon, her face was posted in metro stations on massive ads for streaming apps. She was successful, but that wasn't the life she wanted. She'd always imagined going to the US, where she wished to attend school and find a job.
She moved to San Francisco in late 2019 to study graphic design at the Academy of Art University. She was 22, studious, and prone to overwork despite feeling unwell at the time with occasional chest pain and dizziness. In spring 2020, amid early Covid shutdowns, she considered taking time off from school to rest. Since she was on a student visa, she was concerned a break might affect her ability to stay in the US, so she consulted a lawyer with experience in China-US immigration.
His name was Zheng Liu.
The lawyer had also immigrated to the US as an international student 20 years ago, starting a career in computer science before going to law school at UC Davis. He had "sympathized" with her, he later wrote in court documents, and "offered to help". According to Chen, he suggested she transfer to a new school, the College of San Mateo, which would give her some time off before the next semester began.
He also expressed a romantic interest in her, and soon the two were dating. "He told me he liked me," Chen said. "I felt he was a nice person. And he was really gentle and kind to me at first."
There was a significant age difference – at 39, Liu was 17 years her senior – but Chen didn't think much of it. Since she was living in a new country with unfamiliar customs, no relatives and few friends, she felt Liu could provide her with the sense of family she longed for.
The dream of a perfect relationship didn't last. She'd soon report that Liu abused her, and that one day, he became especially enraged during an argument and raped her. When she tried to seek help, he pushed her straight into a Machiavellian maze from which there was no way out.
At the start of their relationship, Chen had been renting an apartment with a roommate in San Mateo. Liu soon invited her to move into his house in adjacent Foster City, a wealthy planned community jutting into the San Francisco Bay, where large waterfront homes built on little islands overlook tranquil lagoons. Billed as an escape from the frenetic energy of the Bay Area conurbation, it ranks among the safest cities in the country; the average home price is over $1.5m.
She moved in that May, about a month after they met, but Liu's house didn't turn out to be the oasis Chen had hoped it would be. Chen was surprised by how dusty and uncared for the multimillion-dollar home seemed. There was a rodent problem, and she found fleas in the carpets and on the dogs. She started to worry about the young children whose custody Liu shared with his ex-wife, a son and daughter who were four and five.
About a month in, Liu became aggressive and spiteful. Chen recalls a day when she was upset about something and sat on the floor crying. Liu thought she was going to leave him, so he yelled at her: "Fuck you, and fuck your mother!" The curse cut deep into her grief from her mother's passing five years earlier.
In June, her dad died from cancer only a couple of weeks after his diagnosis. She had wanted to be by his bedside, but she needed a new travel endorsement from her school to accompany her student visa, which was complicated by the fact that she was mid-transfer. She also would have had to quarantine for 14 days upon her return to Taiwan. She was still trying to figure out the travel logistics when she got the dreaded call from one of his friends.
As she mourned her father, she later recalled, Liu showed little compassion: "He laughed at me that I am lonely in this world," she said. Chen began to think his earlier kindness was an act, but she had just moved in and had feelings for him; she wasn't ready to leave so soon.
Looking back, she said, she didn't realize she was in such a dangerous situation. In the months to come, Liu became violent and once became so angry that he put both of his hands around her neck and squeezed, Chen wrote in court documents.
Eventually, she told him she wanted to break up. She made plans to move out but about a week later, on the evening of 25 October 2020, Liu confronted her about a new man she was dating. By her account, which is documented in a police report, Liu pushed her into a door, grabbed her phone, and smashed it with a hammer.
Chen said she was so terrified that she complied without hesitation when Liu told her to slap herself across the face and call herself a bitch; then – insisting on helping – he slapped her too.
Chen ran to an upstairs bedroom, where Liu's kids were sleeping. She felt safer there: she thought he'd think twice about hurting her in front of the children. Without a car or working phone and unsure what to do, she took out her laptop and sent a frantic message to one of her friends, explaining that her boyfriend was hurting her and she needed help.
Early that morning, the friend tracked down Chen's former roommate in San Mateo. Chen activated her old phone with the sim card from the broken one, and the roommate was able to call her for a moment that afternoon. She heard Liu in the background, then she heard Chen scream, "Please don't hurt me!" The line disconnected, and the roommate called the police. (The roommate, who corroborated this account, asked me not to publish her name, fearing retaliation from Liu.)
As Chen tried to gather her belongings to leave, Liu came in and unpacked her luggage. Then, Chen said, Liu raped her. "I repeatedly told him to stop, but he was too intoxicated and angry to listen," she recalled.
When officers from the Foster City police department arrived at Liu's house, Chen detailed the series of events from the night before, as well as her rape. Liu was taken into custody, then released with an emergency protective order prohibiting him from coming within 100 yards of Chen for one week. The police brought Chen to the station for further questioning, then to the San Mateo medical center for a forensic exam. She made it back to her apartment in San Mateo late that night, still in shock, nervous about what might come next.
"I hid in my apartment for a few days," she said. "But after that, Zheng Liu called me and threatened me."
Chen said Liu had told her to sign a statement rescinding her rape allegation. If she didn't, he would sue her and get her deported. "I really wanted to stay in this country because this is my dream. I didn't want to leave," Chen said. Scared for her future, she signed the statement.
Illustration: Ángel Hernández/The GuardianTime passed without her hearing anything from investigators, and Chen assumed the case had been dropped because of her retraction. But sexual assault guidelines for police departments account for the fact that victims recant for various reasons, including fearing their abusers.
Chen's abjuration, on its own, did not stall law enforcement's response. Something else was going on.
The Foster City police department was already familiar with Zheng Liu. In December 2019, officers were dispatched to his house for a welfare check after, according to Liu's account in court documents, he accidentally dialed 911 while trying to turn off his smartphone alarm. He claimed it was another 911 misdial when the police were called again in February 2020.
In March, officers returned to Liu's house for a third time after his ex-wife called 911 during a custody swap. He'd reportedly pushed her to the ground and elbowed her in the chest, according to an emergency protective order included in court documents. (Liu's ex-wife could not be reached for comment.)
On 20 November, almost four weeks after Liu was arrested on suspicion of raping Chen, he sent an email to Foster City police requesting a certificate of detention – a document issued after someone has been arrested but not charged with a crime. This reclassifies the arrest as a mere "detention" in public records. Liu threatened to sue if the department did not comply. The police declined because the investigation was still in progress.
Following through on his ultimatum, on 1 December, Liu filed his first lawsuit against the police department. In court documents, Liu claimed that Chen had clarified that the encounter was "consensual". Thus, Liu believed he was entitled to a certificate of detention.
Kai Ruess, the city attorney representing the police department, received an unusual email from Liu a week later. In it, Liu made an astounding claim: he was now representing Chen.
An aerial view of residential Foster City, California. Photograph: Melpomenem/Getty Images/iStockphoto"Yifen Chen has retained our office as her counsel for FCPD's threatened charge against her for filing a false police report," the email read. "These charges are bogus and FCPD knows it."
Liu went on to say that all communications to Chen should be directed to him.
"If FCPD officers do not refrain from harassing Ms Yifen Chen, we will file suit against FCPD for malicious prosecution and witness intimidation."
None of this made any sense to Ruess: he didn't know of any charges being considered against Chen for filing a false police report. But what gave him the most concern was why Chen would seek representation from Liu for anything, especially the case in which he was suspected of attacking her.
After discussing it with the department, he replied to Liu: "While I personally believe this presents an incredible ethical issue, we will respect your direction to communicate with Ms Chen through your office." (Police are allowed to verify that someone hired a lawyer. It's unclear if FCPD attempted to do so, and they did not respond to questions sent by the Guardian.)
Ruess continued: "You should receive contact from officers shortly to set up a time for a follow‐up interview with your client. Because you are the suspect in the case, you will not be able to sit with Ms Chen during that interview."
Liu replied by doing his best to cut off all contact between Chen and police. He responded: "Ms Chen respectfully declines any interview requests by FCPD." Sixteen minutes later, Liu sent another email to the thread: "Ms Chen has specifically invoked and continues to maintain her right to remain silent and right to counsel."
In court documents, Ruess explained that even though Liu had not yet been charged, the DA was still reviewing the case, and their decision had been prolonged by Liu refusing to make Chen available for further interviews.
The deputy district attorney, Lucas King, told me: "It seemed so stupid that he would enter as her attorney. [The police] were asking for my input, and I had to explain, 'No, that's not my role. I'm not allowed to give legal advice.'" King decided not to prosecute, writing to police that he didn't believe they had enough to prove anything beyond a reasonable doubt, and Liu was issued a detention certificate in January 2021. (Multiple requests to interview Foster City police were sent without success.)
Liu proceeded to file three more lawsuits against FCPD. In one, he claimed that an officer who responded to the December 2019 misdial had unlawfully pushed open the door to his house and stuck a foot into the doorway. In the subsequent suit, Liu claimed he "suffered false imprisonment" – among other errors by law enforcement causing him "severe emotional distress" – when he was suspected of battering his ex-wife back in March.
And finally, he filed a suit claiming in a rambling complaint that police had humiliated him and infringed his rights during the rape investigation.
By early 2021, Chen was enrolled at the College of San Mateo. She wanted to dive into her studies and try to move past her ordeal, but Liu had other plans. She said he warned her of deportation if she didn't remain his partner. "I was pretty new in the US, and I thought that would be possible," she said.
Grace Huang, the policy director at the Asian Pacific Institute on Gender-Based Violence, told me that abusers were "notorious for making threats about immigration and deportation". The Immigration Marriage Fraud Act of 1986 required anyone immigrating through marriage to stay married for at least two years. According to Huang, attorneys and advocates saw victims staying in abusive marriages only to fulfill the two-year condition, so the Immigration Act of 1990 created a waiver of the two-year requirement for abused spouses.
Nevertheless, many abusive US citizens never actually submitted immigration applications for their spouses. The Violence Against Women Act of 1994 addressed this issue by providing immigrants a way to apply on their own, without having to rely on their abuser to petition for them.
Then, in 2000, the U visa was created for victims of certain crimes, including sexual assault, who are willing to help law enforcement. Huang said those provisions were intentionally put into law because of the ability of abusers to use the immigration system to manipulate people.
Getting a U visa isn't so straightforward, though. The process can be difficult to navigate without help from a lawyer. Police sometimes refuse to sign the required form to verify a victim's cooperation. And the backlog of applications is in the hundreds of thousands. The government is limited to issuing just 10,000 U visas per year.
Regardless, Chen didn't know anything about the U visa, and she continued to suffer through the rest of the year.
She later described in court documents, which included pictures of her injuries, the different incidents during which Liu had allegedly grabbed her neck, bruised her knee with a flashlight, scratched her with a key while she was sleeping, threw boiling water at her ankle, and pressed her hand against a hot kettle, leaving her fingers blistered.
I showed Chen's photos to Catherine Garcia, a retired San Diego police department detective. Garcia now teaches sexual assault and domestic violence investigations to law enforcement in California. I was curious if, in her opinion, the pictured injuries aligned with the events Chen described.
Speaking broadly, she said, "these would be very supportive of a case, definitely".
Chen decided she had to leave Liu for good in December 2021. She left his house after another violent outburst and promised herself never to return.
Soon after, Liu started sending her emails, which he later included in court documents, demanding debt payments for expenses he covered during their relationship. On 1 January 2022, he sent a list of credit card transactions totaling $8,746.33. He followed up on the 10th: "Please remit payment as soon as possible … If not, a lawsuit will be filed against you for breach of contract and money lent."
By the time he followed up a fourth time, 10 days later, the total Liu claimed she owed was "at least $20,000". The next day, Chen found a letter, also included in court documents, signed by Liu on her door demanding she pay back "more than $30,000".
Chen said Liu had offered to pay for certain things, including her tuition, while they dated. "I have never had any contract with him. He just allowed me to use his credit card, and he wrote some checks to me."
She provided me with emails sent between her and Liu in July 2021. According to an independent translator hired by the Guardian, Liu wrote: "I'll take care of you … if I want to fuck you I'll fuck you, if I want you to fuck off you'll fuck off." Then, in an email Chen sent him in August 2021, she wrote: "Didn't you say you would pay my tuition? We start school tomorrow." Liu responded: "Can do."
Worried his demands for money would escalate to a physical attack, Chen got a temporary restraining order against Liu in late January 2022. Not long after, she found unfiled drafts of legal complaints regarding Liu's money that had been left at her door.
She called the San Mateo police department because she thought Liu was violating the order – and this is when, Chen said, the responding officer told her something she hadn't known. From a quick records check, it appeared that Liu's ex-wife and children had a restraining order against her – one that had been in effect for almost a full year.
Chen had seen Liu's children on several occasions during that time, but nobody had ever mentioned any court order. "I thought there was no issue between us," she said.
The officer wrote in a report that, while he was interviewing Chen, Liu had called her cellphone. Noting they had spoken in Mandarin, he continued: "Based on Liu's speech, I could tell that he was probably intoxicated. Chen told me that Liu was trying to convince her to get back with him and boasted about suing FCPD officers stating something to the effect of, 'They need to see how powerful I am.'"
Two days later, Liu sent the same officer an email with links to the lawsuits he had filed against Foster City police.
In the early weeks of 2022, Chen met a man I will call by the pseudonym Coby, at his request (he's concerned about harassment from Liu).
Coby and Chen found each other on a dating app, but both could tell there was no romantic spark as they made small talk over sushi on their first date. Chen thought they were too culturally different: Coby was born in Japan and raised almost entirely in the US. He interpreted her tense body language and quiet demeanor as a sign she wasn't so into him. Curious about what kind of guys she did like, he asked about her last relationship.
Chen told him about Liu, cautiously at first. Coby couldn't keep himself from prying, and he could tell Chen was relieved to have someone to talk to. "She doesn't have any really close friends here in the US," Coby said. He decided to try to find her some help.
Coby called dozens of lawyers, hoping to find someone who would represent Chen on her student budget, without much luck. He also searched through court records to see what he could learn about Liu's conflict with the FCPD and the mysterious restraining order Liu's ex-wife had against Chen. He followed fragments of the narrative from one lawsuit to the next, flipping over each card in Liu's stack.
And then came the big reveal. Coby and Chen were stunned to find records of Liu pretending to be her lawyer. Ruess, the police department lawyer, had filed copies of the emails Liu had sent him over the detention certificate. It was the first time Chen had heard of Liu's purported representation of her, and she didn't understand how anyone believed she had willingly agreed to that.
There was more: they also learned that Chen stood accused of strangling Liu's daughter with a ribbon, poisoning Liu's milk and his son's water bottle with Drano, and threatening to hurt Liu's ex-wife, according to the petition for the restraining order against her.
"I felt really mad, then sad, because I actually treated his daughter really, really nice," Chen said. "The children love me a lot, and I also love them." She denies all of the allegations.
Next, they wondered how a restraining order against her had been in place without her ever knowing it. That's when they realized that Liu had signed a proof of service claiming he had served her the initial temporary restraining order in person at his house in February 2021. Liu signed two further proofs of service, claiming he served Chen at his address in Foster City in March and October.
Chen said she had never been served.
She missed every court date, and the restraining order against her was extended three years, until October 2024.
Chen was late to battle, but she chose to march forward. And she needed a lawyer to help her extend her restraining order against Liu.
The first one who was willing to take her case was an eccentric lawyer-cum-programmer-cum-photo-studio-owner and Democratic congressional candidate named Andrew Watters. "We had a very limited budget; we told Andrew that," Coby said. "But clearly, it was not even close to enough."
Chen spent thousands of dollars – whatever she could spare – on Watters, but it only got them through one court appearance. "All that money was gone," Coby went on, "and then we couldn't get any help from him any more. It was a big bummer."
Watters said that Liu was "inundating us and the court with correspondence and filings". This included a motion in which Liu unsuccessfully argued that the alleged harassment was protected speech. Watters said most of Chen's payments went to responding to Liu's filings, rather than the actual trial of her case.
Liu added Watters to his list of enemies. "I'm no longer involved with that case, and yet, I'm still suffering harassment from this guy," Watters told me. He said Liu had made multiple accounts on Yelp, where he reposted screenshots of state bar complaints against Watters that Liu had written, as well as cases Watters had lost. (One screenshot documented in court records included the added text: "Court ordered Watters' client pay 50K to the other side. GREAT attorney work.")
Liu also sent Watters emails accusing him of ghostwriting legal documents filed by Chen. "He wanted me to assure him that I was no longer helping Yifen with her case, which I wasn't. I told him, even though you have no right to prevent me from helping her, I am not, in fact, helping her, so will you please take down the photos?"
Liu wrote back: "OK. I will clean up your Yelp. It was a misunderstanding. Apologize for the inconvenience."
He started posting the Yelp reviews again about a month later, according to Watters. (Watters reported the posts to Yelp, and they have since been removed. Watters also sued Liu for defamation and posted about him on his blog.)
From then on, Liu escalated his hostilities.
His next move was to forward emails to Chen that showed he had made Title IX reports to her college as well as the University of California, Santa Cruz, where she had been accepted as a transfer student.
He told staff there that Chen had tried to strangle his daughter with a ribbon because he had refused to lend her money to pay for her tuition, and included a photo of a pinkish mark on a young child's neck with the face cropped out.
I showed it to Garcia, the retired San Diego police department detective. She was dubious.
"That's ridiculous. Like they're going to do something? That's not who investigates something like that. If you're that worried about your child, you call the police, and you call child protective services, and you keep that kid away from this person. So he's just using entities – that's what it seems like to me – to cause her trouble."
Nightmares kept Chen up at night. She feared she would lose her scholarship and admission to UC Santa Cruz, and was terrified of what Liu might do next.
Liu offered Chen a way to bring everything to an end. He proposed to withdraw the Title IX reports, as well as criminal complaints he'd made against her for assaulting his daughter and credit card theft, if she dismissed her action for a restraining order and withdrew her criminal complaints against him, according to a draft settlement agreement Chen included in court documents.
That was not an option Chen was willing to consider. Accepting the settlement wouldn't fix anything – she had tried to move on with her life, but he had still showed up at her doorstep demanding more.
Indeed, Liu's ultimate act of hubris was still to come.
In early June last year, Chen was at the San Mateo county courthouse to extend her temporary restraining order against Liu when she was served with a civil lawsuit. The plaintiff was a John Doe, but she knew immediately it was Liu.
Chen's eyes jumped to the numbers. He was seeking $17m in compensatory damages and $10m in punitive damages.
The lawsuit made several stunning allegations. Liu claimed Chen had sexually assaulted him by insisting they have sex without a condom, and that unbeknownst to him at the time, she was "having unprotected sex with numerous males, went through diagnosis of chlamydia trachomatis and gonorrhea, and was thus aware of her increased risk of transmitting sexually transmitted diseases". After he realized that Chen had "exposed him to such STDs", the lawsuit claimed, he suffered "extreme emotional distress".
To bolster his claims, Liu cited anonymous profiles on what he called "sex-for-money" websites, alleging they belonged to Chen, and included a screenshot of an unknown person's pubic region. Later, in an amended complaint, Liu added screenshots of Chen's profile on the dating site Seeking.Com, formerly known as Seeking Arrangement, which had a reputation as a platform for sugar dating.
He named three men, and claimed Chen provided them with her services "for somewhere between $400 and $500 per sexual encounter". As evidence, he included copies of Chen's bank statements from late 2019 and early 2020, showing Zelle payments and wires from these men to Chen.
One of them is Chen's ex-boyfriend, who did give her money. The other two men, according to Chen, were Chinese friends in the Bay Area with whom she had exchanged Taiwan dollars for US currency. (None of them responded to my interview requests.)
Liu divulged in his complaint that, around the time of the money transfers, Chen got an STD test at Planned Parenthood, suggesting she knew she was putting him at risk. Chen showed me the test results, which were negative, and said it "was just a doctor's recommendation". (The CDC recommends women get tested for gonorrhea and chlamydia every year.)
Chen denied ever having sex for money, or doing any type of sex work. She also told me it wasn't Liu who wanted to use a condom, but her: "I have a birth control, but I sometimes cannot get my medication because it is out of stock, so I asked him to wear the condom, and actually, he's the one who forced me not to use [one]."
As for Coby, he was admittedly suspicious of Chen when he first learned of her possibly selling sex online. "It wouldn't be surprising if she did it," he initially thought. But the more he got to know her, the more unlikely it seemed. "As far as I can tell, after talking to her for so long, it doesn't seem like any of it is true. Now, did she have an ex-boyfriend who spent money on her? Absolutely. That seems to be the type of guy that maybe she wants to have as a boyfriend. But that alone isn't illegal."
I will confess, after everything I had learned, I was nervous to call Liu unannounced. I typed his number into my phone and hit the green button as fast as I could, not giving myself a moment to reconsider it.
"Hello." Liu's tone was like a barbell hitting the floor.
I explained who I was and why I was calling. At first, Liu seemed unsure about why I was interested in his lawsuits. I started a question, saying, mistakenly, "I see you sued the Foster City police department three times …"
Liu interrupted. "No, actually four times. And I won."
Liu was wrong – he lost his first lawsuit. The police issued the detention certificate he wanted, but the judge later ruled in favor of FCPD. The other three lawsuits were indeed settled in January 2022, so I asked him how much the settlement was.
Liu didn't want to say, nor did he want to talk much about those lawsuits: he didn't want to come across as badmouthing the police department. That wasn't a concern when it came to my questions about Chen.
"Did Yifen actually agree to have you represent her as her attorney?" I asked.
He replied: "Is there anything that would suggest otherwise?"
"Yes. She said in her response to your civil lawsuit that you represented her without her consent."
"Exactly! Did she have any actual proof to support her allegations? So far, I don't see any ... And then, I would say, in t
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