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Safe sex (also called safer sex) is the practice of sexual activity in a manner that lowers the risk of infection with sexually transmitted diseases (STDs). Conversely, unsafe sex or unsafer sex is the practice of sexual intercourse or other sexual contact without regard for prevention of STDs.

Safe sex practices became more prominent in the late 1980s as a result of the AIDS epidemic. Promoting safe 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 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."

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, 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 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

Sex by yourself

Known as autoeroticism, solitary sexual activity is relatively safe. Masturbation, the simple act of stimulating one's own genitalia, is a generally safe sex practice as long the object used for the stimulation, like the hand or a sex toy, is not infected or later used by someone else, and bodily fluids are not exchanged.

When stimulation of the anus is involved, specially before vagina stimulation, masturbation carries a higher risk of STD infection.

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, reducing the risks involved with a sexual intercourse between partners.

Partner selection

• Long-term mutually monogamous relationship with an uninfected partner is one of the most reliable ways to avoid transmission of sexually transmitted diseases. However, many infected persons may be unaware of their infections because STDs are often asymptomatic or unrecognized, partners may be sexually unfaithful or contract STD through other means, like by contact with infected blood.
• Every relation with a new sexual partner carries a statistic risk of STD infection, which can be high or low, depending of the disease prevalence in that community. So reducing the number of sexual partners, particularly to sexual partners whose previous sexual history is known, may also reduce one's potential exposure to STDs.
• 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.
• Request of STD testing. Tests by definition are only informative and not preventative, specially because some infections are not detectable during incubation and others stages of the disease. But requesting the results of recent STD testing is an additional information when choosing a sexual partner. This is the approach taken by some pornographic actors.

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.

Male condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV. In addition, the same procedure, reduces the risk of diseases transmitted by genital secretions, such as gonorrhea, chlamydia, and trichomoniasis, and to a lesser degree, to those STDs that are primarily transmitted through contact with infected skin or mucosal surfaces, like genital human papillomavirus (HPV) infection and genital ulcer diseases, such as such as genital herpes, syphilis, and chancroid.

• 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.

Limitations for HIV transmission

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."

Other Precautions

Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safe sex suggest that other methods be used to minimize the risks of STD transmission.

• Immunization, before sexual exposure, against various viral infections that can be transmitted sexually. For example, HPV vaccine, which protects against the types of human papillomavirus that are the most common causes of cervical cancer, and Hepatitis B vaccine.
• 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.
• Where condoms are not always and correctly used circumcision is 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.
• Community control. In Cuba HIV testing and quarantine is mandatory to restrict sexual contact with HIV-positive individuals.

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.

Specific sex practices

Non-penetrative sex

Although generally safe when talking about contraception, non-penetrative sex still carries risk of sexual transmission of STD. The risk varies depending on how much contact there's with partner genitalia and bodily fluids. Rubbing each other genitalia, for example, carries very high risk of STD infection, while a dressed individual using a latex glove to perform a hand job carries low infection risk.

Oral sex

A barrier protection, like a condom or Dental dam should be used when practicing oral sex. Oral contact should be limited to the protected areas.

If the receiving partner has wounds or open sores on their genitals, or if the giving partner has wounds or open sores on or in their mouth, or bleeding gums, this poses an increased risk of STD transmission. Brushing the teeth, flossing, undergoing dental work, or eating crunchy foods, such as chips, relatively before or after giving oral sex can also increase the risk of transmission, because all of these activities can cause small scratches in the lining of the mouth.

Anal sex

Anal sex is a higher risk sexual activity regardless of sexual orientation because very thin tissues of anus and rectum can be easily damaged, exposing blood and damaged tissue, increasing transmission risks. That area of the body also harbors pathogens that can be transmitted to the partner, to other areas of the body or, through the damaged tissue, to the blood system.

Sex toys

Sex toys, specially penetrative ones, should also be used with condoms (male or female) or other barrier protection. By using a protection the user provides better hygiene and reduces or prevent the transmission of infections if the sex toy is shared with another person or another area of the body. Sharing of sex toys are not recommended, however, if that's still the case a new condom must be replaced when that switch is made. Its also not recommended to use a sex toy which previous use is unknown or original packaging was violated before purchase.

Specially when condoms are not used the cleaning of sex toys is also a very important matter as many sex toys are made of porous materials which can highly retain viruses and bacteria. For this reason users should clean sex toys thoroughly, preferably with using an antiseptic solution.

Glass sex toys are more preferred for sexual uses because of their less porous nature and ability to be heat 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.

Religious criticism

Some religious groups, notably some evangelical Christians and the Roman Catholic Church oppose sex outside marriage. Sexual abstinence and monogamy are the only safe sex practices supported by those groups. These same groups strongly object the promotion of condoms as a safe sex practice which they see as promotion of sex outside marriage. Critics of those religious positions, believe those religious supported practices are not strictly followed by the members of those religious groups, which may lack or ignore safe sex information from different sources.

See also

• Bareback sex
• Bugchasing and giftgiving
• Condom fatigue
• Contraceptive security
• Dual protection
• HIV and AIDS misconceptions
• Human sexual behavior
• Party and play
• Sex Toys
• Sisters of Perpetual Indulgence
• Terrence Higgins Trust

References

1. Markus J. Steiner and Willard Cates, Jr. (2006). "Condoms and Sexually-Transmitted Infections". N. Engl. J. Med. 354 (25): 2642–3. doi:10.1056/NEJMp068111. PMID 16790696.
2. ^ "Condoms and STDs: Fact Sheet for Public Health Personnel". Centers for Disease Control and Prevention. July 15, 2009. Retrieved 2009-09-13.
3. ^ 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.
4. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 16385221, please use {{cite journal}} with |pmid=16385221 instead.
5. 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.
6. "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.
7. "Are two condoms better than one?". Go Ask Alice!. Columbia University. 2005-01-21. Retrieved 2008-06-30.
8. ^ 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
9. ^ Cite error: The named reference Vittinghoff was invoked but never defined (see the help page).
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.
15. Researchers find no sperm in pre-ejaculate fluid. Contraceptive Technology Update. Volume 14, Number 10, October 1993, pp.154-6.
16. 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).

External links

• Advise safer sex - 10 articles about condoms.
• "Guide to Safer Sex" from the Society for Human Sexuality's sexuality.org site. Very explicit information on making various sexual practices safer:
  • Concise version (20k)
  • Long version (97k)
• Safer-Sex Methods from HIV InSite
• SexInfo's Methods of Contraception For Men and Women - Detailed information on contraception (also includes a step-by-step guide with pictures on how to make a dental dam out of a condom)
• Tiny Nibbles Safer Sex Chart - Presents risk levels of a variety of sexual activities and most major STDs.
• Condoms4Life
• Epigee Women's Health - Comprehensive STD info
• STD Advice
• Safe SEX Guide on Google Groups
• more safe sex info from Google Groups
• Template:Fr icon Condom use — with many pictures.
• The Asian-Pacific Resource & Research Centre for Women Useful links to other organisations are available, as well as information on women's sexual and reproductive health and rights in the Asian-Pacific region

v t e HIV/AIDS topics
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Conditions	Signs and symptoms AIDS-defining clinical condition Diffuse infiltrative lymphocytosis syndrome Lipodystrophy Nephropathy Cardiomyopathy Neurocognitive disorders Pruritus Opportunistic infection Superinfection Tuberculosis co-infection HIV Drug Resistance Database Innate resistance to HIV Serostatus HIV-positive people Nutrition Pregnancy
History	History Epidemiology Multiple sex partners Timeline World AIDS Museum Timothy Ray Brown Berlin Patient The London Patient City of Hope Patient Women and HIV/AIDS HIV and homosexual men
Social	AIDS orphan Religion Catholic Church and HIV/AIDS Circumcision and HIV Criminal transmission Discrimination against people Economic impact Cost of treatment HIV-affected community HIV/AIDS activism HIV/AIDS denialism Red ribbon Safe sex Sex education List of HIV-positive people People With AIDS Self-Empowerment Movement HIV/AIDS in the porn industry HIV.gov AIDS Memorial Quilt Product Red
Culture	Discredited HIV/AIDS origins theories European and Developing Countries Clinical Trials Partnership Elton John AIDS Foundation International AIDS Conference International AIDS Society Joint United Nations Programme on HIV/AIDS (UNAIDS) Media portrayal of HIV/AIDS Misconceptions about HIV/AIDS President's Emergency Plan for AIDS Relief (PEPFAR) The SING Campaign Solidays Treatment Action Campaign The Global Fund World AIDS Day YAA/Youthforce "Free Me" Larry Kramer Gay Men's Health Crisis ACT UP Reports from the Holocaust AIDS–Holocaust metaphor Silence=Death Project Day Without Art The Freddie Mercury Tribute Concert Ayds
Locations	Africa Angola Benin Botswana Democratic Republic of the Congo Egypt Eswatini Ethiopia Ghana Guinea Côte d'Ivoire (Ivory Coast) Kenya Lesotho Madagascar Malawi Mali Mozambique Namibia Niger Nigeria Rwanda Senegal Tanzania South Africa Uganda Zambia Zimbabwe Asia Afghanistan Armenia Azerbaijan Bahrain Bangladesh Bhutan Cambodia China (PRC) Yunnan East Timor India Indonesia Iran Iraq Japan Jordan North Korea Laos Malaysia Myanmar (Burma) Nepal Pakistan Philippines Saudi Arabia Sri Lanka Taiwan (ROC) Thailand United Arab Emirates Turkey Vietnam Europe United Kingdom Russia Ukraine North America Canada Mexico El Salvador Guatemala Honduras Nicaragua United States New York City Caribbean Haiti Jamaica Dominican Republic South America Argentina Bolivia Brazil Colombia Guyana Peru Uruguay Oceania Australia New Zealand Papua New Guinea
List of countries by HIV/AIDS adult prevalence rate List of HIV/AIDS cases and deaths registered by region

• Articles with specifically marked weasel-worded phrases from September 2009
• Birth control
• HIV/AIDS
• Prevention
• Sexual health
• Public health