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'''Safer sex''' is a term used to specify sexual practices and sexual behaviors that reduce the risk of contracting and transmitting ].<ref>Pan American Health Organization (PAHO)/World Association of Sexology (WAS) (2000). Promotion of Sexual
'''Safe sex''' (also called '''safer sex''' or '''protected sex''') is the practice of ] in a manner that lowers the risk of ] with ]s (STDs), conversely, '''unsafe sex''' is sexual contact without regard for prevention of STDs. The term '''unprotected sex''' is used for ] or ] without a condom<ref>{{cite web|url=http://www.aidsmap.com/cms1044912.aspx|title=aidsmap|publisher=NAM|date=2009-01-01|accessdate=2009-09-16}}</ref> (colloquially known as ]).
Health: Recommendation for Action. Washington, DC.</ref>. The term '''safe sex''' was the first term coined for that purpose but its use has been replaced by health officials.<ref>" Assimilating safer sex: young heterosexual men's understanding of "safer sex" In: AIDS: foundations for the future, edited by Peter Aggleton, Peter Davies and Graham Hart. London, England, Taylor and Francis, 1994. :97-109. (Social Aspects of AIDS)</ref>


Safe sex practices became more prominent in the late 1980s as a result of the ] epidemic. Promoting safe sex is now a principal aim of ]. From the viewpoint of society, safe sex can be regarded as a ] strategy aimed at reducing risks. Promotion of safer sex became more prominent in the late 1980s as a result of the ] epidemic. Promoting safer sex is now a principal aim of ]. From the viewpoint of society, safe sex can be regarded as a ] strategy aimed at reducing risks.


⚫ The risk reduction of safer sex is not absolute; for example the reduced risk to the receptive partner of acquiring HIV from HIV seropositive partners not wearing condoms compared to when they wear them is estimated to be about a four- to five-fold.<ref name="Vittinghoff">Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. (1999). . Am J Epidemiol. 150(3):306-11. PMID 10430236 </ref>
There is strong evidence that ] use reduces the risk of transmission of ], ], ], and ] in men and women, and the risk of ] (HPV) infection in women.<ref name="Steiner">{{cite journal |author=Markus J. Steiner and Willard Cates, Jr. |title=Condoms and Sexually-Transmitted Infections |journal=N. Engl. J. Med. |volume=354 |issue=25 |pages=2642–3|year=2006 |doi=10.1056/NEJMp068111 |pmid=16790696| url = http://content.nejm.org/cgi/content/full/354/25/2642}}</ref>

The risk reduction of safe sex is not absolute; "for example, experts estimate that consistent condom use reduces the risk of HIV transmission by about 80 to 90 percent."<ref name=Steiner />


Although some safe sex practices can be used as ], most forms of contraception don't protect against all or any STDs; likewise, some safe sex practices, like partner selection and low risk sex behavior, aren't effective forms of contraception. Although some safe sex practices can be used as ], most forms of contraception don't protect against all or any STDs; likewise, some safe sex practices, like partner selection and low risk sex behavior, aren't effective forms of contraception.


==Terminology== ==Terminology==
Recently, and mainly within ] and the ], the use of the term ''safer sex'' rather than ''safe sex'' has gained greater use by health workers, in order to make it clearer that these practices reduce risk of transmission along a continuum, rather than a simple dichotomy between risky and safe. However, in most other countries, including the ] and ], the term ''safe sex'' is still mostly used by sex educators. Recently, and mainly within ] and the ], the use of the term ''safer sex'' rather than ''safe sex'' has gained greater use by health workers, with the realization the grounds that risk of transmission of sexually transmitted infections in various ] is a continuum rather than a simple dichotomy between risky and safe. However, in most other countries, including the ] and ], the term ''safe sex'' is still mostly used by sex educators.


==Focus on condoms and HIV control== ==Focus on condoms and HIV control==
Much attention has focused on controlling ], the ] that causes AIDS, through the use of barrier protection for the penis, specially ]. However, the HIV is a delicate virus, so protections focused on HIV may not protect against other STIs, which can also be transmitted through other areas of the body where the pathogen (virus or bacteria) has higher prevalence and resistance. Thus some ]s recommend the use of barrier protection for any sexual contact with anal or vaginal cavities, or oral stimulation of those cavities or penis. Much attention has focused on controlling ], the ] that causes AIDS, through the use of barrier protection for the penis, specially ]. However, the HIV is a delicate virus, so protections focused on HIV may not protect against other STIs, which can also be transmitted through other areas of the body where the pathogen (virus or bacteria) has higher prevalence and resistance. Thus some ]s recommend the use of barrier protection for any sexual contact with anal or vaginal cavities, or oral stimulation of those cavities or penis.{{Citation needed|date=September 2009}}


==Safe sex precautions== ==Safe sex precautions==
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===Sex by yourself=== ===Sex by yourself===
Known as '']'', solitary sexual activity is relatively safe. ], the simple act of stimulating one's own genitalia, is safe so long as contact is not made with other people's discharged bodily fluids. However, some practices, such as ] and ], are made considerably more dangerous by the absence of people who can intervene if something goes wrong. Known as '']'', solitary sexual activity is relatively safe. ], the simple act of stimulating one's own genitalia, is safe{{Citation needed|date=September 2009}} so long as contact is not made with other people's discharged bodily fluids.
Modern technology does permit some activities, such as "]" and "]", that allow for partners to engage in sexual activity without being in the same room, eliminating the risks involved with exchanging bodily fluids. Modern technology does permit some activities, such as "]" and "]", that allow for partners to engage in sexual activity without being in the same room, eliminating the risks involved with exchanging bodily fluids.

===Partner selection===
⚫ * ], practiced faithfully, is very safe (as far as STDs are concerned) when all partners are non-infected. However, many monogamous people have been infected with sexually transmitted diseases by partners who are ], have used injection drugs, or were infected by previous sexual partners; the same risks apply to ] people, who face higher risks depending on how many people are in the polyfidelitous group.
⚫ * For those who are not monogamous, reducing the number of one's sexual partners, particularly anonymous sexual partners, may also reduce one's potential exposure to STDs. Similarly, one may restrict one's sexual contact to a community of trusted individuals - this is the approach taken by some ]s and other ] people.
⚫ *When selecting a sexual parter, some characteristics can increase the risks for contracting sexually transmitted diseases.<ref name="partner">{{cite doi|10.1097/OLQ.0b013e3181901e32}}</ref> These include: an age discordance of more than five years<ref name="partner"/>; having STD in the past year<ref name="partner"/>; problems with marijuana or alcohol<ref name="partner"/>; having had sex with other people in the past year<ref name="partner"/>.


=== Non-penetrative sex === === Non-penetrative sex ===
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{{Main|Non-penetrative sex}} {{Main|Non-penetrative sex}}


A range of sex acts, sometimes called "outercourse", can be enjoyed by lovers with significantly reduced risks of infection and pregnancy. U.S. President ]'s surgeon general, Dr. ], tried to encourage the use of these practices among young people, but her position encountered opposition from a number of outlets, including the White House itself, and resulted in her being fired by President Clinton in December 1994.<ref>{{cite web|url=http://www.time.com/time/magazine/article/0,9171,982008,00.html|title=Getting Out the Wrecking Ball|publisher=Time|date=1994-12-19|accessdate=2009-03-08}}</ref><ref></ref><ref>{{cite web|url=http://query.nytimes.com/gst/fullpage.html?res=9C02E0D81038F935A35752C1A960958260|title=President Clinton Makes a Celebratory Return to His Starting Point in Arkansas|publisher=New York Times|date=1996-11-06|accessdate=2009-03-08}}</ref> A range of sex acts,{{Which?|date=September 2009}} sometimes called "outercourse", can be enjoyed by lovers with significantly reduced risks of infection{{Citation needed|date=September 2009}} and pregnancy. U.S. President ]'s surgeon general, Dr. ], tried to encourage the use of these practices among young people, but her position encountered opposition from a number of outlets, including the White House itself, and resulted in her being fired by President Clinton in December 1994.<ref>{{cite web|url=http://www.time.com/time/magazine/article/0,9171,982008,00.html|title=Getting Out the Wrecking Ball|publisher=Time|date=1994-12-19|accessdate=2009-03-08}}</ref><ref></ref><ref>{{cite web|url=http://query.nytimes.com/gst/fullpage.html?res=9C02E0D81038F935A35752C1A960958260|title=President Clinton Makes a Celebratory Return to His Starting Point in Arkansas|publisher=New York Times|date=1996-11-06|accessdate=2009-03-08}}</ref>


=== Barrier protection === === Barrier protection ===
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Proper use of barriers, such as condoms, depends on the cleanness of surfaces of the barrier, care should be taken to avoid contamination of the barrier when handling it and to control contamination from used surfaces of a barrier. Proper use of barriers, such as condoms, depends on the cleanness of surfaces of the barrier, care should be taken to avoid contamination of the barrier when handling it and to control contamination from used surfaces of a barrier.

⚫ ====Limitations====

⚫ While the use of condoms can reduce HIV transmission, it does not do so completely. One study has suggested it might be around by a factor of 85% to 95% and questioned that effectiveness beyond 95% would be unlikely because of slippage, breakage, and incorrect use.<ref name="Varghese">Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. (2002). . Sex Transm Dis. 29(1):38-43. PMID 11773877</ref> It also noted "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".<ref name="Varghese"/><sup>p.&nbsp;40.</sup>

⚫ The risk of the receptive partner acquiring HIV from HIV seropositive partners not wearing condoms is 0.82% and from those wearing condoms is 0.18%, a four- to five-fold reduction.<ref name="Vittinghoff">Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. (1999). . Am J Epidemiol. 150(3):306-11. PMID 10430236</ref> Where the partner's HIV status is unknown, "Estimated per-contact risk of protected receptive anal intercourse with HIV-positive and unknown serostatus partners, including episodes in which condoms failed, was two thirds the risk of unprotected receptive anal intercourse with the comparable set of partners."<ref name="Vittinghoff"/><sup>p.&nbsp;310.</sup>

===STD testing===
{{Main|STD testing}}

⚫ * If a person is sexually active with a number of partners, or otherwise at high risk for STD, it is important that they get regular ] check-ups. Anyone noticing unusual symptoms should get medical advice quickly as ] is sometimes ] or symptoms will have a nonspecific nature and can even be misdiagnosed.<ref name=Kahn>{{cite journal
⚫ | author=Kahn, J. O. and Walker, B. D. | title=Acute Human Immunodeficiency Virus type 1 infection | journal=N. Engl. J. Med. | year=1998 | pages=33–39 | volume=331 | issue=1 | pmid=9647878 | doi=10.1056/NEJM199807023390107}}</ref><ref name="pmid11187417">{{cite journal |author=Daar ES, Little S, Pitt J, ''et al.'' |title=Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network |journal=Ann. Intern. Med. |volume=134 |issue=1 |pages=25–9 |year=2001 |pmid=11187417 |doi=}}</ref>
* Tests for some STDs may be advisable before starting to have sex with a new partner. Some pathogens are only detectable a while after infection, so it may be necessary to wait a while after stopping sexual contact with a former partner before testing to improve test accuracy.
⚫ * Periodic STD testing has been used to reduce STD infections in Cuba and among pornographic film actors. Cuba implemented a program of mandatory testing and quarantine early in the AIDS epidemic. <ref>{{cite web |url=http://www.thebody.com/content/art32967.html |title=Cuba fights AIDS in its Own Way |accessdate=2009-06-13 |work=The Body |publisher=The Body|date=2009-06-13 }}</ref> In the US pornographic film industry in the US, many production companies will not hire actors without tests for Chlamydia, HIV and Gonorrhea that are no more than 30 days old-and tests for other STD's no more than 6 months old. AIM Medical foundation claims that program of testing has reduced the incidence of STD infection to 20% of that of the general population.


=== Other Precautions === === Other Precautions ===
Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safe sex recommend that some of the following methods be used to minimize the risks of STD transmission and unwanted pregnancy. Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safe sex recommend that some of the following methods be used to minimize the risks of STD transmission and unwanted pregnancy.
⚫ * ] is now backed by the ] as a preventative measure against HIV. African studies have found that circumcision can reduce the transmission rate of HIV by up to 60%<ref>{{cite web |url=http://news.bbc.co.uk/2/hi/health/6502855.stm |title=WHO agrees HIV circumcision plan |accessdate=2008-07-12 |work=BBC World News |publisher=BBC |date=2007-03-03 }}</ref>. Some advocacy groups dispute these findings.<ref></ref><ref></ref>

⚫ * Periodic STD testing has been used to reduce STD infections in Cuba and among pornographic film actors. Cuba implemented a program of mandatory testing and quarantine early in the AIDS epidemic.<ref>{{cite web |url=http://www.thebody.com/content/art32967.html |title=Cuba fights AIDS in its Own Way |accessdate=2009-06-13 |work=The Body |publisher=The Body|date=2009-06-13 }}</ref> In the US pornographic film industry in the US, many production companies will not hire actors without tests for Chlamydia, HIV and Gonorrhea that are no more than 30 days old-and tests for other STD's no more than 6 months old. AIM Medical foundation claims that program of testing has reduced the incidence of STD infection to 20% of that of the general population.
* ] against various viral infections that can be transmitted sexually before starting to have sex. For example, ], which protects against the types of ] that are the most common causes of ], and ].
* ] and ] can reduce ] of HIV on devices, such as barrier contraceptives<ref name=soap> * ] and ] can reduce ] of HIV on devices, such as barrier contraceptives<ref name=soap>
{{cite journal {{cite journal
Line 84: Line 64:
|journal=Antimicrobial Agents and Chemotherapy |journal=Antimicrobial Agents and Chemotherapy
}}</ref>. Douching with soap and water should be avoided because it has not been studied and by disrupting the vaginal flora it might increase risk of infection.<ref name=soap /> }}</ref>. Douching with soap and water should be avoided because it has not been studied and by disrupting the vaginal flora it might increase risk of infection.<ref name=soap />
⚫ * ] , practiced faithfully, is very safe (as far as STDs are concerned) when all partners are non-infected. However, many monogamous people have been infected with sexually transmitted diseases by partners who are ], have used injection drugs, or were infected by previous sexual partners.
⚫ * For those who are not monogamous, reducing the number of one's sexual partners, particularly anonymous sexual partners, may also reduce one's potential exposure to STDs. Similarly, one may restrict one's sexual contact to a community of trusted individuals - this is the approach taken by some ]s .
⚫ *When selecting a sexual parter, some characteristics can increase the risks for contracting sexually transmitted diseases.<ref name="partner">{{cite doi|10.1097/OLQ.0b013e3181901e32}}</ref> These include:- an age discordance of more than five years<ref name="partner"/>; having STD in the past year<ref name="partner"/>; problems with marijuana or alcohol<ref name="partner"/>; having had sex with other people in the past year<ref name="partner"/>.
* ] with one's sexual partner(s) makes for greater safety. Before initiating sexual activities, partners may discuss what activities they will and will not engage in, and what precautions they will take. This can reduce the chance of risky decisions being made "in the heat of passion". * ] with one's sexual partner(s) makes for greater safety. Before initiating sexual activities, partners may discuss what activities they will and will not engage in, and what precautions they will take. This can reduce the chance of risky decisions being made "in the heat of passion".
* Refraining from the use of ]s, including ], before and during sexual activity can protect against associated risks such as lowered inhibitions, decreased immune response, impaired judgment, and loss of consciousness. * Refraining from the use of ]s, including ], before and during sexual activity can protect against associated risks such as lowered inhibitions, decreased immune response, impaired judgment, and loss of consciousness.
⚫ * If a person is sexually active with a number of partners, it is important that they get regular ] check-ups from a doctor. Anyone noticing unusual symptoms should get medical advice quickly as ] is sometimes ] or symptoms will have a nonspecific nature and can even be misdiagnosed.<ref name=Kahn>{{cite journal
⚫ * Male ] is acknowledged by the ] as a preventative measure against HIV transmission from women to men. African studies have found that circumcision can reduce the rate of transmission of HIV to men by up to 60%.<ref>{{cite web |url=http://news.bbc.co.uk/2/hi/health/6502855.stm |title=WHO agrees HIV circumcision plan |accessdate=2008-07-12 |work=BBC World News |publisher=BBC |date=2007-03-03 }}</ref> Some advocacy groups dispute these findings.<ref></ref><ref></ref> However, at least in sub-Saharan Africa, condom use is estimated to be much more cost effective.<ref>{{cite journal | author = Mcallister RG, Travis JW, Bollinger D, Rutiser C, Sundar V| title = The cost to circumcise Africa | journal = ] | publisher = Men's Studies Press | ISN = 1532-6306 (Print) 1933-0278 (Online) | volume = 7| number = 3 | year = Fall 2008 | doi = 10.3149/jmh.0703.307 | page = 307-316 | url = http://www.thefreelibrary.com/The+cost+to+circumcise+Africa.-a0189486243 }}</ref>
⚫ | author=Kahn, J. O. and Walker, B. D. | title=Acute Human Immunodeficiency Virus type 1 infection | journal=N. Engl. J. Med. | year=1998 | pages=33–39 | volume=331 | issue=1 | pmid=9647878 | doi=10.1056/NEJM199807023390107}}</ref><ref name="pmid11187417">{{cite journal |author=Daar ES, Little S, Pitt J, ''et al.'' |title=Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network |journal=Ann. Intern. Med. |volume=134 |issue=1 |pages=25–9 |year=2001 |pmid=11187417 |doi=}}</ref>

⚫ ===Limitations===

⚫ While the use of condoms can reduce HIV transmission, it does not do so completely. One study has suggested it might be around by a factor of 85% to 95% and questioned that effectiveness beyond 95% would be unlikely because of slippage, breakage, and incorrect use.<ref name="Varghese">Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. (2002). . Sex Transm Dis. 29(1):38-43. PMID 11773877</ref> It also noted "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".<ref name="Varghese"/><sup>p.&nbsp;40.</sup>

The risk of the receptive partner acquiring HIV from HIV seropositive partners not wearing condoms is 0.82% and from those wearing condoms is 0.18%, a four- to five-fold reduction.<ref name="Vittinghoff"/> Where the partner's HIV status is unknown, "Estimated per-contact risk of protected receptive anal intercourse with HIV-positive and unknown serostatus partners, including episodes in which condoms failed, was two thirds the risk of unprotected receptive anal intercourse with the comparable set of partners."<ref name="Vittinghoff"/><sup>p.&nbsp;310.</sup>


== Ineffective methods == == Ineffective methods ==
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The ] ] has been claimed to reduce the likelihood of STD transmission. However a recent study by the ] <ref></ref> has shown that Nonoxynol-9 is an irritant and can produce tiny tears in mucous membranes, which may increase the risk of transmission by offering ] more easy points of entry into the system. Condoms with Nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness and are not to be promoted.{{Citation needed|date=August 2009}} The ] ] has been claimed to reduce the likelihood of STD transmission. However a recent study by the ] <ref></ref> has shown that Nonoxynol-9 is an irritant and can produce tiny tears in mucous membranes, which may increase the risk of transmission by offering ] more easy points of entry into the system. Condoms with Nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness and are not to be promoted.{{Citation needed|date=August 2009}}


] (or "pulling out"), in which the penis is removed from the vagina, ], or ] before ], is not safe sex and can result in STD transmission. This is because of the formation of ], a fluid that oozes from the ] before actual ejaculation. In opposition to conventional wisdom, some recent studies awaiting confirmation suggest that pre-ejaculate may not contain sperm{{Citation needed|date=July 2008}}; it ''can'', however, contain pathogens such as HIV.<!-- ] (or "pulling out"), in which the penis is removed from the vagina, ], or ] before ], is not safe sex and can result in STD transmission. This is because {{fact}} of the formation of ], a fluid that oozes from the ] before actual ejaculation. Pre-ejaculate ''can'' contain pathogens such as HIV.<ref name="HIV study">. ''Contraceptive Technology Update''. Volume 14, Number 10, October 1993, pp.154-6.</ref><!--
--><ref name="HIV study">. ''Contraceptive Technology Update''. Volume 14, Number 10, October 1993, pp.154-6.</ref><!--
--><ref>Zukerman, Z. et al. ''Journal of Assisted Reproduction and Genetics''. Volume 20, Number 4, April 2003, pp. 157-159(3).</ref> --><ref>Zukerman, Z. et al. ''Journal of Assisted Reproduction and Genetics''. Volume 20, Number 4, April 2003, pp. 157-159(3).</ref>


==Anal sex== ==Dangers of anal sex==
Unprotected anal sex is a high risk activity regardless of sexual orientation. Research suggests that although gay men are more likely to engage in anal sex, heterosexual couples are more likely not to use condoms when doing so.<ref>"Gay men's dream: A 'magic' lube: Researchers discuss rectal microbicide development at NIAID workshop", Bob Roehr, (June 15, 2001) ''Bay Area Reporter'' </ref> Unprotected anal sex is a high risk activity regardless of sexual orientation. Research suggests that although gay men are more likely to engage in anal sex, heterosexual couples are more likely not to use condoms when doing so.<ref>"Gay men's dream: A 'magic' lube: Researchers discuss rectal microbicide development at NIAID workshop", Bob Roehr, (June 15, 2001) ''Bay Area Reporter'' </ref>


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Condoms should also be used with sex toys. By putting a condom on the sex toy, the user provides better hygiene and prevents transmission of infections if the sex toy is shared. However, the condom must be replaced when switching between partners. Cleaning of anal sex toys is also a very important matter as many anal sex toys are made of porous materials. Pores retain viruses and bacteria. For this reason users should clean anal toys (plugs, anal vibrators) thoroughly, preferably with use of special sex toy cleaners. Glass sex toys are more preferred for sexual uses because of their non-porous nature and ability to be sterilized between uses. Condoms should also be used with sex toys. By putting a condom on the sex toy, the user provides better hygiene and prevents transmission of infections if the sex toy is shared. However, the condom must be replaced when switching between partners. Cleaning of anal sex toys is also a very important matter as many anal sex toys are made of porous materials. Pores retain viruses and bacteria. For this reason users should clean anal toys (plugs, anal vibrators) thoroughly, preferably with use of special sex toy cleaners. Glass sex toys are more preferred for sexual uses because of their non-porous nature and ability to be sterilized between uses.


== Abstinence as an alternative to safe sex== ==Abstinence as an alternative==
Refraining from any sexual contact with another individual is the surest way to avoid the risk of sexually contracting ].<ref name="CDC condoms"/> In that context complete ],<ref name="CDC condoms">{{cite web|url=http://www.cdc.gov/condomeffectiveness/latex.htm|title=Condoms and STDs: Fact Sheet for Public Health Personnel|date=July 15, 2009|publisher=Centers for Disease Control and Prevention|accessdate=2009-09-13}}</ref> like ], is one of those practices that fit that definition.
One way to avoid the risks associated with ] is to maintain complete ], which minimizes the risk of contracting ]. Complete sexual abstinence does not guarantee complete protection against STDs, for the following reasons:

*'''Non-sexual transmission''': STDs may also be transmitted through non-sexual means. HIV may be transmitted through contaminated needles used in ]ing, ], or ]. Medical or dental procedures using contaminated instruments can also spread HIV, while some health-care workers have acquired HIV through occupational exposure to accidental injuries with needles.<!--
--><ref name="HIV">{{cite journal | author=Do AN, Ciesielski CA, Metler RP, Hammett TA, Li J, Fleming PL | title=Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States | journal=Infect Control Hosp Epidemiol | year=2003 | pages=86–96 | volume=24 | issue=2 | pmid=12602690 | doi = 10.1086/502178}}</ref>

*'''Non-consensual sex''': A person maintaining complete sexual abstinence may be ]d or ], during which STDs may be transmitted.

Long term abstinence is difficult to maintain - those intending to be abstinent may not follow through with that intention, thus when studying or advocating abstinence as a form of safer sex, it is important to consider the failure rate in typical use.<ref></ref>


However, sexual abstinence is seen by critics as repressive, it is difficult to maintain for prolonged periods of time and practitioners may restrict the abstinence only to specific sexual practices they see associated with increased STD risk or with other purposes of sexual abstinence, like ] and some definitions of ].
===Christian promotion of abstinence===
Some groups, notably some ] and the ] oppose sex outside ], and object to safe-sex education programs because they believe that providing such education promotes ]. ]s and ] education programs are often promoted in lieu of contraceptives and safe-sex education programs. This can place some ] at higher risk of unintended ] and STDs, because about 60 percent of teenagers who pledge ] until marriage do engage in pre-marital sex and are then one-third less likely to use contraceptives than their peers who have received more conventional ] education.<ref></ref>


==See also== ==See also==
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{{STD/STI}} {{STD/STI}}


{{DEFAULTSORT:Safe Sex}}
] ]
] ]

Revision as of 16:28, 20 September 2009

File:Laos AIDS education campaign.jpg
Poster for AIDS education campaign in Laos

Safer sex is a term used to specify sexual practices and sexual behaviors that reduce the risk of contracting and transmitting sexually transmitted infections.. The term safe sex was the first term coined for that purpose but its use has been replaced by health officials.

Promotion of safer sex became more prominent in the late 1980s as a result of the AIDS epidemic. Promoting safer sex is now a principal aim of sex education. From the viewpoint of society, safe sex can be regarded as a harm reduction strategy aimed at reducing risks.

The risk reduction of safer sex is not absolute; for example the reduced risk to the receptive partner of acquiring HIV from HIV seropositive partners not wearing condoms compared to when they wear them is estimated to be about a four- to five-fold.

Although some safe sex practices can be used as contraception, most forms of contraception don't protect against all or any STDs; likewise, some safe sex practices, like partner selection and low risk sex behavior, aren't effective forms of contraception.

Terminology

Recently, and mainly within Canada and the United States, the use of the term safer sex rather than safe sex has gained greater use by health workers, with the realization the grounds that risk of transmission of sexually transmitted infections in various sexual activities is a continuum rather than a simple dichotomy between risky and safe. However, in most other countries, including the United Kingdom and Australia, the term safe sex is still mostly used by sex educators.

Focus on condoms and HIV control

Much attention has focused on controlling HIV, the virus that causes AIDS, through the use of barrier protection for the penis, specially condoms. However, the HIV is a delicate virus, so protections focused on HIV may not protect against other STIs, which can also be transmitted through other areas of the body where the pathogen (virus or bacteria) has higher prevalence and resistance. Thus some sex educators recommend the use of barrier protection for any sexual contact with anal or vaginal cavities, or oral stimulation of those cavities or penis.

Safe sex precautions

Shunga print by Kunisada depicting masturbation

Sex by yourself

Known as autoeroticism, solitary sexual activity is relatively safe. Masturbation, the simple act of stimulating one's own genitalia, is safe so long as contact is not made with other people's discharged bodily fluids. Modern technology does permit some activities, such as "phone sex" and "cybersex", that allow for partners to engage in sexual activity without being in the same room, eliminating the risks involved with exchanging bodily fluids.

Non-penetrative sex

watercolor of manual stimulation of the penis, Johann Nepomuk Geiger, 1840.
Main article: Non-penetrative sex

A range of sex acts, sometimes called "outercourse", can be enjoyed by lovers with significantly reduced risks of infection and pregnancy. U.S. President Bill Clinton's surgeon general, Dr. Joycelyn Elders, tried to encourage the use of these practices among young people, but her position encountered opposition from a number of outlets, including the White House itself, and resulted in her being fired by President Clinton in December 1994.

Barrier protection

Various protective devices are used to avoid contact with blood, vaginal fluid, semen or other contaminant agents (like skin, hair and shared objects) during sexual activity. Practice of sexual activity using this devices is called protected sex.

Condom machine
  • Condoms cover the penis during sexual activity. They are most frequently made of latex, but can also be made out of polyurethane. Polyurethane is thought to be a safe material for use in condoms, since it is nonporous and viruses cannot pass through it. However, there is less research on its effectiveness than there is on latex.
  • Female condoms are inserted into the vagina prior to intercourse. They may also be used for anal sex, although they are less effective.
  • A dental dam (originally used in dentistry) is a sheet of latex used for protection when engaging in oral sex. It is typically used as a barrier between the mouth and the vulva during cunnilingus or between the mouth and the anus during anilingus.
  • Medical gloves made out of latex, vinyl, nitrile, or polyurethane may be used as an makeshift dental dam during oral sex, or to protect the hands during sexual stimulation, like in masturbation. Hands may have invisible cuts on them that may admit pathogens or, more usually, serve as vehicle for contamination of other body part or partner.
  • Another way to protect against pathogen transmission is the use of protected or properly cleaned dildos or other sex toys. If a sex toy is to be used in more than one orifice or partner, a condom can be used over it and changed when the toy is moved.

If any latex barrier is being used, oil-based lubrication should not be used, as this can break down the structure of the latex and remove the protection it provides.

Condoms (male or female) may be used to protect against STDs, and used with other forms of contraception to improve contraceptive effectiveness. For example, simultaneously using both the male condom and spermicide (applied separately, not pre-lubricated) is believed to reduce perfect-use pregnancy rates to those seen among implant users. However, two condoms should not be used simultaneously (male condom on top of male condom, or male condom inside female condom), since this increases the chance of condom failure.

Proper use of barriers, such as condoms, depends on the cleanness of surfaces of the barrier, care should be taken to avoid contamination of the barrier when handling it and to control contamination from used surfaces of a barrier.

Other Precautions

Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safe sex recommend that some of the following methods be used to minimize the risks of STD transmission and unwanted pregnancy.

  • Circumcision is now backed by the World Health Organization as a preventative measure against HIV. African studies have found that circumcision can reduce the transmission rate of HIV by up to 60%. Some advocacy groups dispute these findings.
  • Periodic STD testing has been used to reduce STD infections in Cuba and among pornographic film actors. Cuba implemented a program of mandatory testing and quarantine early in the AIDS epidemic. In the US pornographic film industry in the US, many production companies will not hire actors without tests for Chlamydia, HIV and Gonorrhea that are no more than 30 days old-and tests for other STD's no more than 6 months old. AIM Medical foundation claims that program of testing has reduced the incidence of STD infection to 20% of that of the general population.
  • Soap and water can reduce infectivity of HIV on devices, such as barrier contraceptives. Douching with soap and water should be avoided because it has not been studied and by disrupting the vaginal flora it might increase risk of infection.
  • Monogamy , practiced faithfully, is very safe (as far as STDs are concerned) when all partners are non-infected. However, many monogamous people have been infected with sexually transmitted diseases by partners who are sexually unfaithful, have used injection drugs, or were infected by previous sexual partners.
  • For those who are not monogamous, reducing the number of one's sexual partners, particularly anonymous sexual partners, may also reduce one's potential exposure to STDs. Similarly, one may restrict one's sexual contact to a community of trusted individuals - this is the approach taken by some pornographic actors .
  • When selecting a sexual parter, some characteristics can increase the risks for contracting sexually transmitted diseases. These include:- an age discordance of more than five years; having STD in the past year; problems with marijuana or alcohol; having had sex with other people in the past year.
  • Communication with one's sexual partner(s) makes for greater safety. Before initiating sexual activities, partners may discuss what activities they will and will not engage in, and what precautions they will take. This can reduce the chance of risky decisions being made "in the heat of passion".
  • Refraining from the use of recreational drugs, including alcohol, before and during sexual activity can protect against associated risks such as lowered inhibitions, decreased immune response, impaired judgment, and loss of consciousness.
  • If a person is sexually active with a number of partners, it is important that they get regular sexual health check-ups from a doctor. Anyone noticing unusual symptoms should get medical advice quickly as HIV is sometimes asymptomatic or symptoms will have a nonspecific nature and can even be misdiagnosed.

Limitations

While the use of condoms can reduce HIV transmission, it does not do so completely. One study has suggested it might be around by a factor of 85% to 95% and questioned that effectiveness beyond 95% would be unlikely because of slippage, breakage, and incorrect use. It also noted "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".

The risk of the receptive partner acquiring HIV from HIV seropositive partners not wearing condoms is 0.82% and from those wearing condoms is 0.18%, a four- to five-fold reduction. Where the partner's HIV status is unknown, "Estimated per-contact risk of protected receptive anal intercourse with HIV-positive and unknown serostatus partners, including episodes in which condoms failed, was two thirds the risk of unprotected receptive anal intercourse with the comparable set of partners."

Ineffective methods

Note that most methods of contraception other than the barrier methods mentioned above are not effective at preventing the spread of STDs. This includes the "rhythm method".

The spermicide Nonoxynol-9 has been claimed to reduce the likelihood of STD transmission. However a recent study by the World Health Organization has shown that Nonoxynol-9 is an irritant and can produce tiny tears in mucous membranes, which may increase the risk of transmission by offering pathogens more easy points of entry into the system. Condoms with Nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness and are not to be promoted.

Coitus interruptus (or "pulling out"), in which the penis is removed from the vagina, anus, or mouth before ejaculation, is not safe sex and can result in STD transmission. This is because of the formation of pre-ejaculate, a fluid that oozes from the urethra before actual ejaculation. Pre-ejaculate can contain pathogens such as HIV.

Dangers of anal sex

Unprotected anal sex is a high risk activity regardless of sexual orientation. Research suggests that although gay men are more likely to engage in anal sex, heterosexual couples are more likely not to use condoms when doing so.

Anal sex is a higer risk activity than vaginal, because very thin tissues of anus and rectum can be easily damaged; this includes by the use of anal toys. Even slight injuries can become "open gates" for various bacteria and viruses, including HIV. This implies that anal sex does require some certain safety measures. First of all, any partners who practice anal sex should be aware of the necessity of using a condom. The condom must be put on properly, otherwise it does not provide reliable protection. Users should keep in mind that oil-based lubricants damage latex. For this reason water-based lubricants should be used for anal sex. Those who have allergy to latex should consider use of non-latex condoms, for instance polyurethane condoms that are compatible with both oil-based and water-based lubricants.

Condoms should also be used with sex toys. By putting a condom on the sex toy, the user provides better hygiene and prevents transmission of infections if the sex toy is shared. However, the condom must be replaced when switching between partners. Cleaning of anal sex toys is also a very important matter as many anal sex toys are made of porous materials. Pores retain viruses and bacteria. For this reason users should clean anal toys (plugs, anal vibrators) thoroughly, preferably with use of special sex toy cleaners. Glass sex toys are more preferred for sexual uses because of their non-porous nature and ability to be sterilized between uses.

Abstinence as an alternative

Refraining from any sexual contact with another individual is the surest way to avoid the risk of sexually contracting STDs. In that context complete sexual abstinence, like autoeroticism, is one of those practices that fit that definition.

However, sexual abstinence is seen by critics as repressive, it is difficult to maintain for prolonged periods of time and practitioners may restrict the abstinence only to specific sexual practices they see associated with increased STD risk or with other purposes of sexual abstinence, like contraception and some definitions of virginity.

See also

References

  1. Pan American Health Organization (PAHO)/World Association of Sexology (WAS) (2000). Promotion of Sexual Health: Recommendation for Action. Washington, DC.
  2. " Assimilating safer sex: young heterosexual men's understanding of "safer sex" In: AIDS: foundations for the future, edited by Peter Aggleton, Peter Davies and Graham Hart. London, England, Taylor and Francis, 1994. :97-109. (Social Aspects of AIDS)
  3. ^ Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. (1999). Per-contact risk of human immunodeficiency virus transmission between male sexual partners. Am J Epidemiol. 150(3):306-11. PMID 10430236
  4. "Getting Out the Wrecking Ball". Time. 1994-12-19. Retrieved 2009-03-08.
  5. Joycelyn Elders: From Sharecropper's Daughter to Surgeon General of the United States of America. - book reviews | Washington Monthly | Find Articles at BNET.com
  6. "President Clinton Makes a Celebratory Return to His Starting Point in Arkansas". New York Times. 1996-11-06. Retrieved 2009-03-08.
  7. Kestelman P, Trussell J (1991). "Efficacy of the simultaneous use of condoms and spermicides". Fam Plann Perspect. 23 (5): 226–7, 232. doi:10.2307/2135759. PMID 1743276.
  8. "Does using two condoms provide more protection than using just one condom?". Condoms and Dental Dams. New York University Student Health Center. Retrieved 2008-06-30.
  9. "Are two condoms better than one?". Go Ask Alice!. Columbia University. 2005-01-21. Retrieved 2008-06-30.
  10. "WHO agrees HIV circumcision plan". BBC World News. BBC. 2007-03-03. Retrieved 2008-07-12.
  11. Circumcision and HIV
  12. Circumcision and AIDS
  13. "Cuba fights AIDS in its Own Way". The Body. The Body. 2009-06-13. Retrieved 2009-06-13.
  14. ^ Li, J. Z. (2003). "Virucidal Efficacy of Soap and Water against Human Immunodeficiency Virus in Genital Secretions". Antimicrobial Agents and Chemotherapy. 47 (10): 3321–3322. doi:10.1128/AAC.47.10.3321-3322.2003. PMC 201149. PMID 14506048. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  15. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1097/OLQ.0b013e3181901e32, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1097/OLQ.0b013e3181901e32 instead.
  16. Kahn, J. O. and Walker, B. D. (1998). "Acute Human Immunodeficiency Virus type 1 infection". N. Engl. J. Med. 331 (1): 33–39. doi:10.1056/NEJM199807023390107. PMID 9647878.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. Daar ES, Little S, Pitt J; et al. (2001). "Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network". Ann. Intern. Med. 134 (1): 25–9. PMID 11187417. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  18. ^ Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. (2002). Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Dis. 29(1):38-43. PMID 11773877
  20. Researchers find no sperm in pre-ejaculate fluid. Contraceptive Technology Update. Volume 14, Number 10, October 1993, pp.154-6.
  21. Zukerman, Z. et al. Short Communication: Does Preejaculatory Penile Secretion Originating from Cowper's Gland Contain Sperm? Journal of Assisted Reproduction and Genetics. Volume 20, Number 4, April 2003, pp. 157-159(3).
  22. "Gay men's dream: A 'magic' lube: Researchers discuss rectal microbicide development at NIAID workshop", Bob Roehr, (June 15, 2001) Bay Area Reporter http://www.aegis.com/news/bar/2001/BR010617.html
  23. ^ "Condoms and STDs: Fact Sheet for Public Health Personnel". Centers for Disease Control and Prevention. July 15, 2009. Retrieved 2009-09-13.

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