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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 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 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

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

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.

• 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. In opposition to conventional wisdom, some recent studies awaiting confirmation suggest that pre-ejaculate may not contain sperm; it can, however, 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 to safe sex

One way to avoid the risks associated with sexual contact is to maintain complete sexual abstinence, which minimizes the risk of contracting STDs. 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 tattooing, body piercing, or injections. 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.

• Non-consensual sex: A person maintaining complete sexual abstinence may be raped or sexually assaulted, during which STDs may be transmitted.

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. ^ 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
2. "Getting Out the Wrecking Ball". Time. 1994-12-19. Retrieved 2009-03-08.
3. Joycelyn Elders: From Sharecropper's Daughter to Surgeon General of the United States of America. - book reviews | Washington Monthly | Find Articles at BNET.com
4. "President Clinton Makes a Celebratory Return to His Starting Point in Arkansas". New York Times. 1996-11-06. Retrieved 2009-03-08.
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. "WHO agrees HIV circumcision plan". BBC World News. BBC. 2007-03-03. Retrieved 2008-07-12.
9. Circumcision and HIV
10. Circumcision and AIDS
11. "Cuba fights AIDS in its Own Way". The Body. The Body. 2009-06-13. Retrieved 2009-06-13.
12. ^ 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)
13. ^ 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.
14. 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)
15. 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)
16. ^ 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
18. Researchers find no sperm in pre-ejaculate fluid. Contraceptive Technology Update. Volume 14, Number 10, October 1993, pp.154-6.
19. 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).
20. "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
21. Do AN, Ciesielski CA, Metler RP, Hammett TA, Li J, Fleming PL (2003). "Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States". Infect Control Hosp Epidemiol. 24 (2): 86–96. doi:10.1086/502178. PMID 12602690.{{cite journal}}: CS1 maint: multiple names: authors list (link)

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

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• Articles with specifically marked weasel-worded phrases from September 2009
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