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Safe sex (also called safer sex or protected sex) is the practice of sexual activity in a manner that reduces the risk of infection with sexually transmitted diseases (STDs). Conversely, unsafe sex is the practice of sexual intercourse 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. The goal of safer sex is education and risk reduction.
In contrast to protected sex is unprotected sex, which can refer to:
- The practice of sex without protection from pregnancy
- The practice of sex without protection from STDs
Although safe sex practices can be used as a form of family planning, the term refers to efforts made to prevent infection as well as conception. Many effective forms of contraception do not offer protection against STDs.
Recently, and mostly 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 mainly used by sex educators.
Focus on HIV/AIDS
Much attention has focused on controlling HIV, the virus that causes AIDS, through the use of condoms. However, as many STDs can be transmitted through other activities, some sex educators recommend that barrier protection be used for all sexual activities which have the potential for disease transmission, such as manual penetration of the anal or vaginal cavities, or oral stimulation of the genitals.
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. However, some practices, such as self-bondage and autoerotic asphyxia, are made considerably more dangerous by the absence of people who can intervene if something goes wrong.
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.
- 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 of 1994.
Limiting fluid exchange
- 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 mutual masturbation. Hands may have invisible cuts on them that may admit pathogens that are found in the semen or the vaginal fluids of STD infectees. Although the risk of infection in this manner is thought to be low [How to reference and link to summary or text], gloves can be used as an extra precaution.
- Another way to avoid contact with blood and semen is penetration, but not by the penis, such as using (properly cleaned) dildos or other sex toys. If a sex toy is to be used in more than one orifice, a condom can be used over it and changed when the toy is moved. Fisting (penetration by the hand), has its own risks, but the risk of HIV transfer can be reduced by latex gloves or a condom. Pegging, female-to-male anal sex with a strap-on dildo, as promoted by sex educator Carol Queen does not involve fluid transfer.
If a latex barrier is being used, any lubrication must not be oil based, as this can break down the structure of the latex and undo the protection it gives.
Condoms (male or female) may be used along with other forms of contraception to protect against STDs and 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.
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.
- 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 or polyfidelity, 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; the same risks apply to polyfidelitous people, who face slightly 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 pornographic actors and other non-monogamous people.
- 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.
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[How to reference and link to summary or text]; it can, however, contain pathogens such as HIV.
If you keep ejaculate fluid out of any orifices this will do a great deal to help protect pregnancy and diseases. Especially important to note if you have cuts in your mouth. In addition, open sores on either partner can permit transmission, as can microscopic breaks in the skin which arise due to friction, or other irregularities in the skin of either partners genitalia or other body parts.
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 more risky than vaginal, since being very thin tissues of anus and rectum can be easily damaged during such sex activities as anal intercourse or 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. Through putting a condom on the sex toy a user provides better hygiene and prevents transmission of infections if the sex toy is shared. 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-porus 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 abstain from sexual activity entirely, which nearly eliminates the chances of contracting STDs (the only alternative methods of infection being non-sexual as described below).
Some groups, notably some evangelical Christians and the Roman Catholic Church oppose sex outside marriage, and object to safe-sex education programs because they believe that providing such education promotes promiscuity. Virginity pledges and sexual abstinence education programs are often promoted in lieu of contraceptives and safe-sex education programs. This can place some teenagers at higher risk of unintended pregnancy and STDs, because about 60 percent of teenagers who pledge virginity 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 sex education.
STDs may also be transmitted through non-sexual means. Thus, abstinence from sexual behavior does not guarantee complete protection against STDs. For example, 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.
- Bareback sex
- Bugchasing and giftgiving
- Condom fatigue
- Contraceptive security
- HIV and AIDS misconceptions
- Psychosexual behavior
- Party and play
- Getting Out the Wrecking Ball - TIME
- Joycelyn Elders: From Sharecropper's Daughter to Surgeon General of the United States of America. - book reviews | Washington Monthly | Find Articles at BNET.com
- President Clinton Makes a Celebratory Return to His Starting Point in Arkansas - New York Times
- Kestelman P, Trussell J (1991). Efficacy of the simultaneous use of condoms and spermicides.. Fam Plann Perspect 23 (5): 226–7, 232.
- Does using two condoms provide more protection than using just one condom?. Condoms and Dental Dams. New York University Student Health Center. URL accessed on 2008-06-30.
- Are two condoms better than one?. Go Ask Alice!. Columbia University. URL accessed on 2008-06-30.
- WHO agrees HIV circumcision plan. BBC World News. BBC. URL accessed on 2008-07-12.
- Circumcision and HIV
- Circumcision and AIDS
- Li, J. Z., E. C. Mack, and J. A. Levy. (2003). Virucidal Efficacy of Soap and Water against Human Immunodeficiency Virus in Genital Secretions. Antimicrobial Agents and Chemotherapy 47 (10): 3321-3322.
- Kahn, J. O. and Walker, B. D. (1998). Acute Human Immunodeficiency Virus type 1 infection. N. Engl. J. Med. 331 (1): 33–39.
- 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.
- Researchers find no sperm in pre-ejaculate fluid. Contraceptive Technology Update. Volume 14, Number 10, October 1993, pp.154-6.
- 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).
- "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
- Recent Findings from The 'Add Health' Survey: Teens and Sexual Activity
- 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.
- 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:
- 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.
- Epigee Women's Health - Comprehensive STD info
- STD Advice
- Safe SEX Guide on Google Groups
- more safe sex info from Google Groups
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
Family planning and reproductive health
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