Safe sex
Encyclopedia
Safe sex is sexual activity engaged in by people who have taken precautions to protect themselves against sexually transmitted disease
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...

s (STDs) such as AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

. It is also referred to as safer sex or protected sex, while unsafe or unprotected sex is sexual activity engaged in without precautions. Some sources prefer the term safer sex to more precisely reflect the fact that these practices reduce, but do not completely eliminate, the risk of disease transmission. In recent years, the term "sexually transmitted infections" (STIs) has been preferred over "STDs", as it has a broader range of meaning; a person may be infected, and may potentially infect others, without showing signs of disease.

Safe sex practices became more prominent in the late 1980s as a result of the AIDS epidemic. Promoting safe sex is now one of the aims of sex education
Sex education
Sex education refers to formal programs of instruction on a wide range of issues relating to human sexuality, including human sexual anatomy, sexual reproduction, sexual intercourse, reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, contraception, and...

. Safe sex is regarded as a harm reduction
Harm reduction
Harm reduction refers to a range of public health policies designed to reduce the harmful consequences associated with recreational drug use and other high risk activities...

 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 to compared to when they wear them is estimated to be about a four- to fivefold.

Although some safe sex practices can be used as contraception
Contraception
Contraception is the prevention of the fusion of gametes during or after sexual activity. The term contraception is a contraction of contra, which means against, and the word conception, meaning fertilization...

, most forms of contraception do not protect against all or any STIs; likewise, some safe sex practices, like partner selection and low risk sex behavior, are not effective forms of contraception.

Terminology

The term safer sex in Canada and the United States has gained greater use by health workers, reflecting that risk of transmission of sexually transmitted infections in various sexual activities is a continuum
Continuum (theory)
Continuum theories or models explain variation as involving a gradual quantitative transition without abrupt changes or discontinuities. It can be contrasted with 'categorical' models which propose qualitatively different states.-In physics:...

. The term safe sex is still in common use in the United Kingdom and Australia.

Although "safe sex" is used by individuals to refer to protection against both pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...

 and HIV/AIDS or other STI transmissions, the term was primarily derived in response to the HIV/AIDS epidemic. It is believed that the term of "safe sex" was used in the professional literature in 1984, in the content of a paper on the psychological effect that HIV/AIDS may have on homosexual men. The term was related with the need to develop educational programs for the group considered at risk, homosexual men. A year later, the same term appeared in an article in the New York Times. This article emphasized that most specialists advised their AIDS patients to practice safe sex. The concept included limiting the number of sexual partners, using prophylactics, avoiding bodily fluid exchange, and resisting the use of drugs
DRUGS
Destroy Rebuild Until God Shows are an American post-hardcore band formed in 2010. They released their debut self-titled album on February 22, 2011.- Formation :...

 that reduced inhibitions for high-risk sexual behavior. Moreover, in 1985, the first safe sex guidelines were established by the 'Coalition for Sexual Responsibilities'. According to these guidelines, safe sex was practiced by using condoms also when engaging in anal
Anal sex
Anal sex is the sex act in which the penis is inserted into the anus of a sexual partner. The term can also include other sexual acts involving the anus, including pegging, anilingus , fingering, and object insertion.Common misconception describes anal sex as practiced almost exclusively by gay men...

 or oral sex
Oral sex
Oral sex is sexual activity involving the stimulation of the genitalia of a sex partner by the use of the mouth, tongue, teeth or throat. Cunnilingus refers to oral sex performed on females while fellatio refer to oral sex performed on males. Anilingus refers to oral stimulation of a person's anus...

.

Although this term was primarily used in conjunction with the homosexual male population, in 1986 the concept was spread to the general population. Various programs were developed with the aim of promoting safe sex practices among college students. These programs were focused on promoting the use of the condom, a better knowledge about the partner's sexual history and limiting the number of sexual partner
Sexual partner
Sexual partners are people who engage in sexual activity together. The sexual partners can be of any gender or sexual orientation. The sexual partners may be in a committed relationship, either on an exclusive basis or not, or engage in the sexual activity on a casual basis...

s. The first book on this subject appeared in the same year. The book was entitled "Safe Sex in the Age of AIDS", it had 88 pages and it described both positive and negative approaches to the sexual life. Sexual behavior could be either safe (kissing, hugging, massage
Massage
Massage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...

, body-to-body rubbing, mutual masturbation, exhibitionism
Exhibitionism
Exhibitionism refers to a desire or compulsion to expose parts of one's body – specifically the genitals or buttocks of a man or woman, or the breasts of a woman – in a public or semi-public circumstance, in crowds or groups of friends or acquaintances, or to strangers...

 and voyeurism
Voyeurism
In clinical psychology, voyeurism is the sexual interest in or practice of spying on people engaged in intimate behaviors, such as undressing, sexual activity, or other activity usually considered to be of a private nature....

, telephone sex, sado-masochism without bruising or bleeding, and use of separate sex toys); possibly safe (use of condoms); and unsafe.

In 1997, specialists in this matter promoted the use of condoms as the most accessible safe sex method (besides abstinence) and they called for TV commercials featuring condoms. During the same year, the Catholic Church in the United States issued their own "safer sex" guidelines on which condoms were listed, though two years later the Vatican
Holy See
The Holy See is the episcopal jurisdiction of the Catholic Church in Rome, in which its Bishop is commonly known as the Pope. It is the preeminent episcopal see of the Catholic Church, forming the central government of the Church. As such, diplomatically, and in other spheres the Holy See acts and...

 urged chastity
Chastity
Chastity refers to the sexual behavior of a man or woman acceptable to the moral standards and guidelines of a culture, civilization, or religion....

 and heterosexual marriage, attacking the American Catholic bishops' guidelines.

A study carried out in 2006 by Californian specialists showed that the most common definitions of safe sex are condom use (68% of the interviewed subjects), abstinence (31.1% of the interviewed subjects), monogamy (28.4% of the interviewed subjects) and safe partner (18.7% of the interviewed subjects).

"Safer sex" is thought to be a more aggressive term which may make it more obvious to individuals that any type of sexual activity carries a certain degree of risk
Risk
Risk is the potential that a chosen action or activity will lead to a loss . The notion implies that a choice having an influence on the outcome exists . Potential losses themselves may also be called "risks"...

.

The term "safe love" has also been used, notably by the French Sidaction
Sidaction
Sidaction is a major French public event that started in 1994 in France for raising awareness and collecting charitable funds for AIDS. It donates important sums to various AIDS charities, AIDS research, institutions specializing in medical care and social aid for those suffering of HIV/AIDS in...

 in the promotion of men's underpants incorporating a condom pocket and including the red ribbon symbol in the design, which were sold to support the charity.

Safe sex precautions

Avoiding physical contact

Known as autoeroticism
Autoeroticism
Autoeroticism is the practice of stimulating oneself sexually. The term was popularized toward the end of the 19th century by British sexologist Havelock Ellis, who defined autoeroticism as "the phenomena of spontaneous sexual emotion generated in the absence of an external stimulus proceeding,...

, solitary sexual activity is relatively safe. Masturbation
Masturbation
Masturbation refers to sexual stimulation of a person's own genitals, usually to the point of orgasm. The stimulation can be performed manually, by use of objects or tools, or by some combination of these methods. Masturbation is a common form of autoeroticism...

, the simple act of stimulating one's own genitalia, is safe so long as contact is not made with other people's bodily fluids. Some activities, such as "phone sex
Phone sex
Phone sex is a type of virtual sex that refers to sexually explicit conversation between or other persons via telephone, especially when at least one of the participants masturbates or engages in sexual fantasy...

" and "cybersex
Cybersex
Cybersex, also called computer sex, Internet sex, netsex, mudsex, TinySex and, colloquially, cybering, is a virtual sex encounter in which two or more persons connected remotely via computer network send each other sexually explicit messages describing a sexual experience...

", that allow for partners to engage in sexual activity without being in the same room, eliminate the risks involved with exchanging bodily fluids.

Non-penetrative sex

A range of sex acts, sometimes called "outercourse", can be enjoyed with significantly reduced risks of infection or pregnancy. U.S. President Bill Clinton
Bill Clinton
William Jefferson "Bill" Clinton is an American politician who served as the 42nd President of the United States from 1993 to 2001. Inaugurated at age 46, he was the third-youngest president. He took office at the end of the Cold War, and was the first president of the baby boomer generation...

'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.

Non-penetrative sex includes practices such as kissing, mutual masturbation, rubbing or stroking and, according to the Health Department of Western Australia, this sexual practice may prevent pregnancy and most STIs. However, non-penetrative sex may not protect against infections that can be transmitted skin-to-skin such as herpes and genital warts.

Barrier protection

Various protective devices are used to avoid contact with blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

, vaginal fluid, semen
Semen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...

 or other contaminant agents (like skin, hair and shared objects) during sexual activity. Sexual activity using these devices is called protected sex.

  • Condom
    Condom
    A condom is a barrier device most commonly used during sexual intercourse to reduce the probability of pregnancy and spreading sexually transmitted diseases . It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner...

    s cover the penis during sexual activity. They are most frequently made of latex
    Latex
    Latex is the stable dispersion of polymer microparticles in an aqueous medium. Latexes may be natural or synthetic.Latex as found in nature is a milky fluid found in 10% of all flowering plants . It is a complex emulsion consisting of proteins, alkaloids, starches, sugars, oils, tannins, resins,...

    , and can also be made out of synthetic materials including polyurethane
    Polyurethane
    A polyurethane is any polymer composed of a chain of organic units joined by carbamate links. Polyurethane polymers are formed through step-growth polymerization, by reacting a monomer with another monomer in the presence of a catalyst.Polyurethanes are...

    .
  • Female condom
    Female condom
    A female condom is a device that is used during sexual intercourse as a barrier contraceptive and to reduce the risk of sexually transmitted infections and unintended pregnancy...

    s are inserted into the vagina
    Vagina
    The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...

     prior to intercourse.
  • A dental dam
    Dental dam
    A dental dam or rubber dam is a rectangular sheet of latex used in dentistry, in particular endodontic therapy, to reduce contamination, and where dental composite are being placed, due to the need for the area to remain dry during filling placement...

     (originally used in dentistry) is a sheet of latex used for protection when engaging in oral sex
    Oral sex
    Oral sex is sexual activity involving the stimulation of the genitalia of a sex partner by the use of the mouth, tongue, teeth or throat. Cunnilingus refers to oral sex performed on females while fellatio refer to oral sex performed on males. Anilingus refers to oral stimulation of a person's anus...

    . It is typically used as a barrier between the mouth and the vulva
    Vulva
    The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....

     during cunnilingus
    Cunnilingus
    Cunnilingus is an oral sex act performed on a female. It involves the use by a sex partner of the mouth, lips and tongue to stimulate the female's clitoris, vulva, or vagina...

     or between the mouth and the anus during anal–oral sex
    Anal–oral sex
    Anilingus Anilingus Anilingus (from anus + lingus (Latin Lingere: to lick), also spelled analingus, also referred to or described as anal–oral contact or anal–oral sex, is a form of oral sex involving contact between the anus or perineum of one person and the mouth (lips) or tongue of another....

    .
  • Medical gloves
    Medical gloves
    Medical gloves are disposable gloves used during medical examinations and procedures that help prevent contamination between caregivers and patients. Medical gloves are made of different polymers including latex, nitrile rubber, vinyl and neoprene; they come unpowdered, or powdered with cornstarch...

     made out of latex, vinyl, nitrile
    Nitrile rubber
    Nitrile rubber, also known as Buna-N, Perbunan, or NBR, is a synthetic rubber copolymer of acrylonitrile and butadiene. Trade names include Nipol, Krynac and Europrene....

    , or polyurethane may be used as a makeshift dental dam during oral sex, or to protect the hands during sexual stimulation, such as masturbation
    Masturbation
    Masturbation refers to sexual stimulation of a person's own genitals, usually to the point of orgasm. The stimulation can be performed manually, by use of objects or tools, or by some combination of these methods. Masturbation is a common form of autoeroticism...

    . Hands may have invisible cuts on them that may admit pathogens or contaminate the other body part or partner.
  • Another way to protect against pathogen transmission is the use of protected or properly cleaned dildo
    Dildo
    A dildo is a sex toy, often explicitly phallic in appearance, intended for bodily penetration during masturbation or sex with partners.- Description and uses :...

    s and other sex toy
    Sex toy
    A sex toy is an object or device that is primarily used to facilitate human sexual pleasure. The most popular sex toys are designed to resemble human genitals and may be vibrating or non-vibrating...

    s. 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.


When latex barriers are used, oil-based lubrication
Personal lubricant
Personal lubricants are specialized lubricants to reduce friction between body parts, or between body parts and other objects...

 can break down the structure of the latex and remove the protection it provides.

Condoms (male or female) are used to protect against STIs, 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, if two condoms are used simultaneously (male condom on top of male condom, or male condom inside female condom), this increases the chance of condom failure.

Proper use of barriers, such as condoms, depends on the cleanliness of surfaces of the barrier, handling can pass contamination to and from surfaces of the barrier unless care is taken.

Studies of latex condom performance during use reported breakage and slippage rates varying from 1.46% to 18.60%. Condoms must be put on before any bodily fluid
Bodily fluid
Body fluid or bodily fluids are liquids originating from inside the bodies of living people. They include fluids that are excreted or secreted from the body as well as body water that normally is not.Body fluids include:-Body fluids and health:...

 could be exchanged, and they must be used also during oral sex.

Female condom
Female condom
A female condom is a device that is used during sexual intercourse as a barrier contraceptive and to reduce the risk of sexually transmitted infections and unintended pregnancy...

s are made of two flexible polyurethane
Polyurethane
A polyurethane is any polymer composed of a chain of organic units joined by carbamate links. Polyurethane polymers are formed through step-growth polymerization, by reacting a monomer with another monomer in the presence of a catalyst.Polyurethanes are...

 rings and a loose-fitting polyurethane sheath. According to laboratory testing, female condoms are effective in preventing the leakage of body fluids and therefore the transmission of STIs and HIV. Several studies show that between 50% and 73% of women who have used this type of condoms during intercourse find them as or more comfortable than male condoms. On the other hand, acceptability of these condoms among the male population is somewhat less, at approximately 40%. Because the cost of female condoms is higher than male condoms, there have been studies carried out with the aim of detecting whether they can be reused. Research has shown that structural integrity of polyurethane female condoms is not damaged during up to five uses if it is disinfected with water and household bleach. However, regardless of this study, specialists still recommend that female condoms are used only once and then discarded.

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 STI transmission and unwanted pregnancy.
  • Immunization
    Immunization
    Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an agent ....

     against various viral infections that can be transmitted sexually. The most common vaccines are HPV vaccine
    HPV vaccine
    The human papilloma virus vaccine prevents infection with certain species of human papillomavirus associated with the development of cervical cancer, genital warts, and some less common cancers...

    , which protects against the most common types of human papillomavirus
    Human papillomavirus
    Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...

     that cause cervical cancer
    Cervical cancer
    Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...

    , and the Hepatitis B vaccine
    Hepatitis B vaccine
    Hepatitis B vaccine is a vaccine developed for the prevention of hepatitis B virus infection. The vaccine contains one of the viral envelope proteins, hepatitis B surface antigen . It is produced by yeast cells, into which the genetic code for HBsAg has been inserted...

    . Immunization before initiation of sexual activity increases effectiveness.
  • Male circumcision and HIV
    Circumcision and HIV
    Over forty epidemiological studies have been conducted to investigate the relationship between male circumcision and HIV infection. Reviews of these studies have reached differing conclusions about whether circumcision could be used as a prevention method against HIV.Experimental evidence was...

    : Some research has suggested that male circumcision
    Circumcision
    Male circumcision is the surgical removal of some or all of the foreskin from the penis. The word "circumcision" comes from Latin and ....

     can reduce the risk of HIV infection in some countries. The World Health Organization cites the procedure as a measure against the transmission of HIV between women and men; some African studies have found that circumcision can reduce the rate of transmission of HIV to men by up to 60%. Some advocacy groups dispute these findings. In sub-Saharan Africa, at least, condom use and behavior change programs are estimated to be more efficient and much more cost-effective than surgical procedures such as circumcision.
  • Periodic STI testing has been used to reduce STIs 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, 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 STIs no more than 6 months old. AIM Medical foundation claims that program of testing has reduced the incidence of sexually transmitted infection to 20% of that of the general population. Douching with soap and water disrupts the vaginal flora it might increase risk of infection.
  • Monogamy
    Monogamy
    Monogamy /Gr. μονός+γάμος - one+marriage/ a form of marriage in which an individual has only one spouse at any one time. In current usage monogamy often refers to having one sexual partner irrespective of marriage or reproduction...

     or polyfidelity
    Polyfidelity
    Polyfidelity is a form of polyamory where all members are considered equal partners and agree to be sexually active only with other members of the group. The term originated in the Kerista Village commune in San Francisco which practiced polyfidelity from 1971 to 1991...

    , practiced faithfully, is very safe (as far as STIs 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 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 STIs. Similarly, one may restrict one's sexual contact to a community of trusted individuals—this is the approach taken by some pornographic actor
    Pornographic actor
    A pornographic actor/actress or a porn star is a person who appears in pornographic film. Most actors appear nude in films...

    s and other non-monogamous
    Forms of nonmonogamy
    Non-monogamy is a blanket term which covers several types of interpersonal relationships in which an individual forms multiple and simultaneous sexual and/or romantic bonds. This can be contrasted with its opposite, monogamy, and yet may arise from the same psychology...

     people.
  • When selecting a sexual partner, some characteristics can increase the risks for contracting sexually transmitted diseases. These include an age discordance of more than five years; having an STI in the past year; problems with alcohol; having had sex with other people in the past year.
  • Communication
    Communication
    Communication is the activity of conveying meaningful information. Communication requires a sender, a message, and an intended recipient, although the receiver need not be present or aware of the sender's intent to communicate at the time of communication; thus communication can occur across vast...

     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".
  • If a person is sexually active with a number of partners, regular sexual health
    Sexual health clinic
    Sexual health clinics specialize in the prevention and treatment of sexually transmitted infections.Sexual health clinics provide only some reproductive health services...

     check-ups by a doctor, and on noticing unusual symptoms seeking prompt medical advice; HIV
    HIV
    Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

     and other infectious agents can be either asymptomatic
    Asymptomatic
    In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical...

     or involve nonspecific symptoms which on their own can be misdiagnosed.

Limitations

While the use of condoms can reduce transmission of HIV and other infectious agents, it does not do so completely. One study has suggested condoms might reduce HIV transmission by 85% to 95%; effectiveness beyond 95% was deemed unlikely because of slippage, breakage, and incorrect use. It also said, "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".p. 40.

During each act of anal intercourse, the risk of the receptive partner acquiring HIV from HIV seropositive partners not using condoms is about 1 in 120. Among people using condoms, the receptive partner's risk declines to 1 in 550, a four- to fivefold 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."p. 310.

Ineffective methods

Most methods of contraception, except for certain forms of "outercourse
Non-penetrative sex
Non-penetrative sex is sexual activity without vaginal, anal, or oral penetration, as opposed to the penetrative aspects of those activities...

" and the barrier methods, are not effective at preventing the spread of STI
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...

s. This includes the birth control pills, vasectomy
Vasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...

, tubal ligation
Tubal ligation
Tubal ligation or tubectomy is a surgical procedure for sterilization in which a woman's fallopian tubes are clamped and blocked, or severed and sealed, either method of which prevents eggs from reaching the uterus for fertilization...

, periodic abstinence
Fertility awareness
Fertility awareness refers to a set of practices used to determine the fertile and infertile phases of a woman's menstrual cycle. Fertility awareness methods may be used to avoid pregnancy, to achieve pregnancy, or as a way to monitor gynecological health....

 and all non-barrier methods of pregnancy prevention.

The spermicide
Spermicide
Spermicide is a contraceptive substance that eradicates sperm, inserted vaginally prior to intercourse to prevent pregnancy. As a contraceptive, spermicide may be used alone. However, the pregnancy rate experienced by couples using only spermicide is higher than that of couples using other methods...

 Nonoxynol-9
Nonoxynol-9
Nonoxynol-9, sometimes abbreviated as N-9, is an organic compound that is used as a surfactant. It is a member of the nonoxynol family of nonionic surfactants. N-9 and related compounds are ingredients in various cleaning and cosmetic products. It is widely used in contraceptives for its...

 has been claimed to reduce the likelihood of STI transmission. However, a recent study by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

  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.

The use of diaphragm or contraceptive sponge provides some women with better protection against certain sexually transmitted diseases, but they are not effective for all STIs.

The hormonal protecting methods are by no means effective against transmission of STIs, even though they are more than 95% effective against unwanted pregnancies. Most common hormonal methods are the oral contraceptive pill, depoprogesterone, the vaginal ring and the patch.

The copper intrauterine device and the hormonal intrauterine device provide an up to 99% protection against pregnancies but no protection against STIs. Women with copper intrauterine device present however a greater risk of being exposed to any type of STI, especially gonorrhea
Gonorrhea
Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...

 or chlamydia.

Coitus interruptus
Coitus interruptus
Coitus interruptus, also known as the rejected sexual intercourse, withdrawal or pull-out method, is a method of birth-control in which a man, during intercourse withdraws his penis from a woman's vagina prior to ejaculation...

 (or "pulling out"), in which the penis is removed from the vagina, anus
Anus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...

, or mouth
Mouth
The mouth is the first portion of the alimentary canal that receives food andsaliva. The oral mucosa is the mucous membrane epithelium lining the inside of the mouth....

 before ejaculation
Ejaculation
Ejaculation is the ejecting of semen from the male reproductory tract, and is usually accompanied by orgasm. It is usually the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. In rare cases ejaculation occurs because of prostatic disease...

, is not safe sex and can result in STI transmission. This is because of the formation of pre-ejaculate
Pre-ejaculate
Pre-ejaculate is the clear, colorless, viscous fluid that emits from the urethra of a man's penis when he is sexually aroused. It is similar in composition to semen, but has some significant chemical differences...

, a fluid that oozes from the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

 before actual ejaculation, may contain pathogens such as HIV. Additionally, the microbes responsible for some diseases, including genital warts and syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...

, can be transmitted through skin-to-skin contact, even if the partners never engage in oral, vaginal, or anal sexual intercourse.

Abstinence

Sexual abstinence
Sexual abstinence
Sexual abstinence is the practice of refraining from some or all aspects of sexual activity for medical, psychological, legal, social, philosophical or religious reasons.Common reasons for practicing sexual abstinence include:*poor health - medical celibacy...

 is sometimes promoted as a way to avoid the risks associated with sexual contact, though STIs may also be transmitted through non-sexual means, or by involuntary sex
Rape
Rape is a type of sexual assault usually involving sexual intercourse, which is initiated by one or more persons against another person without that person's consent. The act may be carried out by physical force, coercion, abuse of authority or with a person who is incapable of valid consent. The...

. HIV may be transmitted through contaminated needles used in tattoo
Tattoo
A tattoo is made by inserting indelible ink into the dermis layer of the skin to change the pigment. Tattoos on humans are a type of body modification, and tattoos on other animals are most commonly used for identification purposes...

ing, body piercing
Body piercing
Body piercing, a form of body modification, is the practice of puncturing or cutting a part of the human body, creating an opening in which jewelry may be worn. The word piercing can refer to the act or practice of body piercing, or to an opening in the body created by this act or practice...

, or injections
Injection (medicine)
An injection is an infusion method of putting fluid into the body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body...

. 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.

Evidence does not support the use of abstinence only sex education. Abstinence-only education programs have been found to be ineffective in decreasing rates of HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

 infection in the developed world and unplanned pregnancy
Unintended pregnancy
Unintended pregnancies are those in which conception was not intended by the female sexual partner. Worldwide, 38% of pregnancies were unintended in 1999 . Unintended pregnancies are the primary cause of induced abortion, resulting in about 42 million induced abortions per year...

.

Some groups, notably some evangelical Christians and the Roman Catholic Church
Roman Catholic Church
The Catholic Church, also known as the Roman Catholic Church, is the world's largest Christian church, with over a billion members. Led by the Pope, it defines its mission as spreading the gospel of Jesus Christ, administering the sacraments and exercising charity...

, oppose sex outside marriage
Marriage
Marriage is a social union or legal contract between people that creates kinship. It is an institution in which interpersonal relationships, usually intimate and sexual, are acknowledged in a variety of ways, depending on the culture or subculture in which it is found...

 and object to safe-sex education programs because they believe that providing such education promotes promiscuity
Promiscuity
In humans, promiscuity refers to less discriminating casual sex with many sexual partners. The term carries a moral or religious judgement and is viewed in the context of the mainstream social ideal for sexual activity to take place within exclusive committed relationships...

. Contrary to these fears, comprehensive sex education, provision of contraceptives and family planning services does not increase sexual activity. Virginity pledge
Virginity pledge
Virginity pledges are commitments made by teenagers and young adults to refrain from sexual intercourse until marriage.They are most common in the United States, especially among Catholic and Evangelical Christian denominations....

s and sexual abstinence
Sexual abstinence
Sexual abstinence is the practice of refraining from some or all aspects of sexual activity for medical, psychological, legal, social, philosophical or religious reasons.Common reasons for practicing sexual abstinence include:*poor health - medical celibacy...

 education programs are often promoted in lieu of contraceptives and safe-sex education programs. This may entail exposing some teenagers to increased risk of sexually transmitted infections, because about 60 percent of teenagers who pledge virginity
Virginity
Virginity refers to the state of a person who has never engaged in sexual intercourse. There are cultural and religious traditions which place special value and significance on this state, especially in the case of unmarried females, associated with notions of personal purity, honor and worth...

 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
Sex
In biology, sex is a process of combining and mixing genetic traits, often resulting in the specialization of organisms into a male or female variety . Sexual reproduction involves combining specialized cells to form offspring that inherit traits from both parents...

 education.

Anal sex

Unprotected anal penetration
Anal sex
Anal sex is the sex act in which the penis is inserted into the anus of a sexual partner. The term can also include other sexual acts involving the anus, including pegging, anilingus , fingering, and object insertion.Common misconception describes anal sex as practiced almost exclusively by gay men...

 is a high risk activity, regardless of sexual orientation. Anal sex is a higher risk activity than vaginal intercourse because the thin tissues of the anus and rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...

 can be easily damaged. Slight injuries can allow the passage of bacteria and viruses, including HIV. This includes by the use of anal toys.
Condoms may be more likely to break during anal sex than during vaginal sex, increasing the risk.

Anal sex is practiced by many heterosexuals, as well as homosexual couples. The anal area has many erotic nerve endings in both men and women. Because of this, many couples (heterosexual or homosexual) can derive pleasure from some form of 'bottom stimulation'. Safety measures are required also when anal sex occurs between heterosexual partners. Apart from the STI transmission risks, other risks such as infection are high regarding anal intercourse. The main risks which individuals are exposed to when performing anal sex are the transmission of HIV, Hepatitis C
Hepatitis C
Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...

 and A and Escherichia coli
Escherichia coli
Escherichia coli is a Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms . Most E. coli strains are harmless, but some serotypes can cause serious food poisoning in humans, and are occasionally responsible for product recalls...

and HPV.

Some researchers suggest that although gay men are more likely to engage in anal sex, heterosexual couples are more likely not to use condoms when doing so. Other researchers state that gay men are not necessarily more likely to engage in anal sex than heterosexual couples.

Precautions

Anal sex should be avoided by couples in which one of the partners has been diagnosed with an STI until the treatment has proven to be effective.

In order to make anal sex safer, the couple must ensure that the anal area is clean and the bowel empty and the partner on whom anal penetration occurs should be able to relax. Regardless of whether anal penetration occurs by using a finger or the penis, the condom is the best barrier method to prevent transmission of STI.

Since the rectum can be easily damaged, the use of lubricants is highly recommended even when penetration occurs by using the finger. Especially for beginners, using a condom on the finger is both a protection measure against STI and a lubricant source. Most condoms are lubricated and they allow less painful and easier penetration. Oil-based lubricants damage latex, and water-based lubricant
Lubricant
A lubricant is a substance introduced to reduce friction between moving surfaces. It may also have the function of transporting foreign particles and of distributing heat...

s are available instead, and non-latex condoms are available for people who are allergic to latex (e.g., polyurethane condoms that are compatible with both oil-based and water-based lubricants).

Anal stimulation with a sex toy requires similar safety measures to anal penetration with a penis, in this case using a condom on the sex toy in a similar way.

It is important that the man washes and cleans his penis after anal intercourse if he intends to penetrate the vagina. Bacteria from the rectum are easily transferred to the vagina, which may cause vaginal infections.

When anal-oral contact occurs, protection is required since this is a risky sexual behavior in which illnesses as Hepatitis A or STIs can be easily transmitted, as well as enteric infections. The dental dam or the plastic wrap are effective protection means whenever anilingus is performed.

Sex toys

Putting a condom on a sex toy
Sex toy
A sex toy is an object or device that is primarily used to facilitate human sexual pleasure. The most popular sex toys are designed to resemble human genitals and may be vibrating or non-vibrating...

 provides better sexual hygiene and can help to prevent transmission of infections if the sex toy is shared, provided the condom is replaced when used by a different partner. Some sex toys are made of porous materials, and pores retain viruses and bacteria, which makes it necessary to clean sex toys thoroughly, preferably with use of cleaners specifically for sex toys. Glass sex toys are non-porous and more easily sterilized between uses.

In cases in which one of the partners is treated for an STI, it is recommended that the couple will not use sex toys until the treatment has proved to be effective.

All sex toys have to be properly cleaned after use. The way in which a sex toy is cleaned varies on the type of material it is made of. Some sex toys can be boiled or cleaned in a dishwasher. Most of the sex toys come with advice on the best way to clean and store them and these instructions should be carefully followed. A sex toy should be cleaned not only when it is shared with other individuals but also when it is used on different parts of the body (such as mouth, vagina or anus).

A sex toy should regularly be checked for scratches or breaks that can be breeding ground for bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

. It is best if the damaged sex toy is replaced by a new undamaged one. Even more hygiene
Hygiene
Hygiene refers to the set of practices perceived by a community to be associated with the preservation of health and healthy living. While in modern medical sciences there is a set of standards of hygiene recommended for different situations, what is considered hygienic or not can vary between...

 protection should be considered by pregnant women when using sex toys. Sharing any type of sex toy that may draw blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

, like whips or needles, is not recommended, and is not safe.

The best way to prevent being infected or infecting someone with an STI is by using protection during sexual intercourse.

See also

  • Barebacking
    Barebacking
    Bareback is a slang term to describe acts of sexual penetration without the use of a condom.The term comes from the equestrian term bareback, which refers to the practice of riding a horse without a saddle...

  • Celibacy
    Celibacy
    Celibacy is a personal commitment to avoiding sexual relations, in particular a vow from marriage. Typically celibacy involves avoiding all romantic relationships of any kind. An individual may choose celibacy for religious reasons, such as is the case for priests in some religions, for reasons of...

  • HIV and AIDS misconceptions
  • Human sexual behavior
    Human sexual behavior
    Human sexual activities or human sexual practices or human sexual behavior refers to the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts from time to time, and for a wide variety of reasons...

  • Post-exposure prophylaxis
    Post-exposure prophylaxis
    Post-exposure prophylaxis is any prophylactic treatment started immediately after exposure to a pathogen , in order to prevent infection by the pathogen and the development of disease.-Rabies:...

  • Party and play
    Party and play
    Party and play , also known as a chemical session, chem session, or simply as partying, is a phenomenon and subculture of recreational drug users who play together sexually, either one-on-one or in groups....

  • Sisters of Perpetual Indulgence
    Sisters of Perpetual Indulgence
    The Sisters of Perpetual Indulgence , also called Order of Perpetual Indulgence in Australia and elsewhere, is a charity, protest, and street performance organization that uses drag and Catholic imagery to call attention to sexual intolerance and satirize issues of gender and morality...

  • Terrence Higgins Trust
    Terrence Higgins Trust
    Terrence Higgins Trust is a British charity that campaigns on various issues related to AIDS and HIV. In particular, the charity aims to reduce the spread of HIV and promote good sexual health ; to provide services on a national and local level to people with, affected by, or at risk of...


External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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