Guide to Safer Sex


Guide to Safer Sex (Lengthy)


1. Introduction

1.1 Goal

3.1 Sex

Sex is any activity that one engages in for erotic pleasure or reproduction.

  • “Safe Sex” is sex which affords NO risk for disease transmission or injury. Fantasy, masturbating yourself, hot talk, and non-sexual massage on healthy skin, for example, fall in this category.
  • “Safer Sex” is sex which affords ALMOST NO risk for disease transmission or injury. When using effective barriers, vaginal/anal intercourse, cunnilingus/analingus, fellatio, and manual penetration all fall in this category.
  • “Unsafe Sex” is sex which affords a HIGH risk for infection or injury. Anal or vaginal intercourse without a condom falls in this category.

3.3 Barriers

A barrier is any physical object which allows sex that would otherwise be unsafe to be safer or safe by preventing transmission of body fluids. Barriers discussed in this document include condoms, gloves, and oral barriers.

12.3.1 HIV/AIDS

The fact that someone looks healthy gives you no information as to their disease status; people may carry HIV and infect others with it before they exhibit a single symptom or know they are infected. Also, the fact that someone was HIV negative a while ago means little if their behavior has not been safe since that time, and the fact that someone just passed an HIV test may not guarantee that they are not infected and not contagious (generally, it can take up to six months from the time of initial HIV infection for the presence of the virus to be detectable by the HIV tests). For these reasons and others, most STD prevention organizations are now emphasizing the widespread use of safer sex rather than widespread disease testing.

 

Sex Safety

Sex safety doesn’t end with condoms…

Safer sex does not just entail wearing a condom, but also includes keeping clean, knowing what to avoid and making the right decisions.

Keeping clean

Practicing safer sex is indeed much more involved than simply wearing a condom. Couples must be conscious of the potential dangers and avoid engaging in risky behavior.

Vaginal Sex

Recommendations:

  • ABCs should be clearly defined, consistent and not contradictory.
  • Leadership initiatives must leverage positive views toward A and B in promotion of C.
  • Youth prevention programs should barriers and include complimentary activities that enable individuals to implement ABC behaviors.
  • Youth sexual education programs must be improved and offered at all levels of education.

 Safe Sex and Condoms
Essential facts

Why safe sex is important

Sexually transmitted diseases (STDs) are infectious conditions transmitted through sexual activity – vaginal, oral or anal. Some of the STDs can be easily treated but unfortunately there is no cure for many of them, and these incurable STDs tend to be the most common and longest lasting. Some, for example HIV and hepatitis B, can have serious health consequences.

A person can have any of the STDs without any symptoms. They may therefore be unaware that they have an infection and may be passing it on each time they have sex.

Reducing the risk

The only way to be 100% certain of never getting an STD is never to have sex at all. This means that if you do have sex, you need to consider ways that you can reduce your risk of acquiring an infection (or passing on an STD you may not know you have!) There are various strategies you can use. Some relate to whom you have sex with, others relate to what you do while you are having sex. Choose whichever strategies best suit your situation – they don’t all work for everyone.

Have an STD check up after sex with a new partner. If you have picked up an infection it may be possible to treat it before complications develop, and the sooner you know you have an STD, the less likely it is that you will unknowingly pass it on to someone else.

If you are in a stable relationship and neither you nor your partner have any other sexual partners, you can make sure that sex is safe by both having an STD check up. If all the results are negative (both yours and your partner’s) it may be OK to have unprotected sex. You should discuss this with a doctor or health adviser because sometimes extra tests are required.

If you have sex with more than one partner or if you often change your partners, one way you can reduce your risk of exposure to an STD is to reduce the number of partners. The more people you have sex with, the more likely it is that one or more of your partners will have an STD.

Be especially careful if you have sex with people you don’t know well. You are less likely to know if they have an STD or have had a check up recently.

Unless you are certain that you and your partner do not have any STDs (i.e. by having a full STD check-up) use safe sex practices when you have sex.

Safe sex practices

Safe sex means not allowing your partner’s body fluids (blood, semen, vaginal fluids) into your body and vice versa. It can also mean covering up or avoiding contact with parts of the body that might be infectious (e.g. herpes sores or warts)

With some forms of sex, it’s possible to avoid any transfer of body fluids, e.g. massage and mutual masturbation (“hand jobs”).

Oral sex carries a lower risk of transmitting most (not all) of the STDs. If you have oral sex, you can reduce the risk of infection by following these guidelines:

using condoms (flavoured ones are available!) or dental dams (see below)

not getting semen or blood in your mouth

avoiding oral sex if you have mouth ulcers or bleeding gums; not brushing your teeth immediately before oral sex

if you get cold sores, don’t give your partner oral sex when you have an outbreak. (Cold sores are caused by the herpes virus.)

Safer sex guidelines
More details/Information for students

Three prerequisites are necessary for sexual assessment and counselling:

  1. comfort in discussing sexuality
  2. knowledge of human sexuality
  3. skill in interviewing and counselling about sexual issues.

As well as examining our own attitudes, values, and beliefs about the various sexual behaviours and orientations, it is essential to realise that acquisition of knowledge about high risk sexual practices will be an ongoing process.

At present there are no absolute guidelines for some sex practices. Recommendations are necessarily based on epidemiologic investigations and as new evidence becomes known there can be alterations in the advice which should be given. This of course can complicate the education and counselling of clients especially when some people expect precise information about what to do or what to avoid.

Safer sex recommendations also vary with the particular STD— for example safe sex guidelines for avoiding herpes or chlamydia will vary slightly from specific advice given for avoiding HIV infection (one needs to be aware of the mode of transmission of each STD). Therefore, general guidelines for safer sex should focus on, non exchange of body fluids and to a lesser extent on avoiding penetrative sex (see Safer sex recommendations also vary with the particular STD— for example safe sex guidelines for avoiding herpes or chlamydia will vary slightly from specific advice given for avoiding HIV infection (one needs to be aware of the mode of transmission of each STD). Therefore, general guidelines for safer sex should focus on, non exchange of body fluids and to a lesser extent on avoiding penetrative sex (see Table 2.).

Safer sex means avoiding sexual contact where semen, blood or vaginal secretions of one person can enter the body or bloodstream of another person. Condoms, used properly, are the most effective means of reducing the transmission of semen or vaginal fluids from one person to another. It is necessary to continuously reinforce the correct use of condoms and encourage people to use them. Although it has been clearly shown that condoms effectively reduce the transmission of most STDs many people are still reluctant to use them. This is due to many factors—but often it relates to a lack of perception of being ‘at risk’. It has also been reported that even in motivated gay men who practise safer sex ‘always’, there are times when condoms are not used—for example when under the influence of alcohol. Safer sex guidelines therefore need to focus on general principles of moderating behaviour and lifestyle as well as specific advice with regard to sexual practices. Other reasons given for not using condoms include decreased sensation, unacceptability to the sexual partner, embarrassment associated with purchase or lack of knowledge or interest.

Condoms

To be effective, condoms must be used routinely and correctly and must remain intact. The following guidelines have been adopted for use in decreasing the risk of HIV infection among sexually active men and women.

Condoms must be used each and every time one has genital, anal, or oral sexual contact

Condoms must be put on as soon as an erection occurs and before the penis is inserted into the partner. Any contact with the vagina, penis mouth, or rectum before a condom is put on is considered unsafe.

The rim of the condom should be rolled carefully to the base of the penis before insertion into the partner. If a condom lacks a reservoir tip, a half-inch of empty space should be left at the tip to catch semen.

Petroleum jelly (“Vaseline”) or vegetable oils may cause deterioration of latex and should not be used as lubricants. Sufficient lubrication is needed so condoms will not tear or cause trauma to the partner. Water-based jellies (KY), spermicide jellies, or spermicide foams can be used as lubricants. Saliva is not recommended.

The condom should be used only once. Under no circumstances should condoms be reused. Condoms should be disposed of safely (not flushed down the toilet).

The penis should be withdrawn soon after ejaculation. If loss of erection occurs, the condom may slip off. After sexual contact, the penis should be withdrawn carefully, holding the rim of the condom to protect against slippage and contact with semen or the partner’s genitalia or secretions.

Condoms should be checked to see if they are still intact. If condoms tear or come off in the vagina, use of spermicide foams or jellies may be helpful.

Condoms should be stored in a cool, dry place. If condoms are kept in a relatively dry environment which is not excessively hot, condom life probably exceeds 5 years.

Instructions for condom use with diagrams

Spermicides

Spermicides have been shown to potentially provide a chemical barrier for the prevention of sexually transmitted diseases. In vitro studies have demonstrated that spermicides can inactivate several sexually transmitted pathogens, including herpes simplex virus, N.gonorrhoeae, T.pallidum, T.vaginalis, and U.urealyticum.

Further, epidemiologic studies suggest that the use of vaginal spermicides may decrease the risk of acquiring cervical gonorrhoea. Contraceptive sponges impregnated with nonoxynol-9 have also been shown to decrease the incidence of infection with C.trachomatis and gonorrhoea but increase the risk of infection with candida probably due to a change in the vaginal acid-base balance. Although spermicides are generally not irritating to the urethral mucosa or vagina, allergic reactions and irritation have been described.

The effectiveness of spermicide use with condoms in the prevention of HIV infection is not known. Preliminary data suggest that nonoxynol-9 can inhibit HIV replication and kill lymphocytes. Whether its use with condoms will further decrease the risk of HIV infection is unknown. Questions have been raised as to whether spermicides can cause deterioration of latex and therefore potentially increase the risk of breakage of latex condoms.

Injecting drug use

When discussing safer sex strategies with clients it is also important to elicit any history of intravenous drug use. Information about needle exchange programs can then be given and also specific advice about cleaning needles between use. Household bleach is adequate and the client should be advised to rinse the syringe and needle twice in water, twice in bleach and then twice in water again. (This is known as the 2-2-2 technique). It is important to remember that hepatitis C transmission has been documented even when correct cleaning techniques have been used.

 

Men with urethral discharge have a high probability of having gonorrhoea or chlamydia. Contacts of any STD are at increased risk of having that STD. Women with gonorrhoea have a high risk of other STDs, particularly chlamydia.

 Table 2: Some examples of safer sex guidelines

SAFE

POSSIBLY SAFE

UNSAFE

Mutual masturbation (male or female)

Social kissing (dry)

Body massage, hugging

Body-to-body rubbing (frottage)

Light S/M activities (without bruising or bleeding)

Using one’s own sex toys

Anal intercourse with a condom

Fellatio interruptus

Mouth-to-mouth kissing

Urine contact

Vaginal intercourse with a condom

Oral-vaginal contact (cunnilingus)

Receptive anal intercourse without condom

Insertive anal intercourse without a condom

Manual-anal intercourse

Fellatio

Oral-anal contact

Vaginal intercourse without condom

K.K. Holmes et al
Sexually Transmitted Diseases. 2nd Edition

Prevention of STDs
More details/information for students

Some ways to reduce the chance of having sexual contact with a member of the infected pool, and thus of becoming part of that pool include:

  1. If you are born of uninfected parents and abstain from sexual activity, your chances of acquiring STD are remote. Abstinence (not having sex) makes life fairly uninteresting and cannot be recommended as a realistic option.
  2. You can enjoy a varied and active sex life with very little risk of infection if you are careful in selecting your partners. Some of the characteristics of individuals in high risk groups are discussed on the safer sex guidelines page. The most important factor is familiarity with your partner, with whom you should have a steady social and monogamous sexual relationship. Risk of getting infection is greatly increased by having sex with a casual acquaintance, whether a sex worker, a businessman, or any occupational grouping. If he or she had sex on a casual basis with you, he or she has probably done so with others, some of whom may have had an STD.
  3. If you cannot resist the thrill of having sex with each new acquaintance, you can take many measures to minimise infection even if some of your partners are infected. Examining your sex partner may be feasible (particularly if you are a woman) and frequently reveals evidence of infection. Use of a condom greatly reduces the risk of passing on infection to either partner and also protects the female from pregnancy. Urination immediately after coitus and thorough washing of the genitals with soap and water are probably of very limited value but are better than nothing.
  4. After unprotected sex with a casual partner, seek medical examination before further sexual activity. Symptoms show an immediate need for such medical care, but it is important to remember that infection in both men and women may not show symptoms. Freedom from symptoms is an unreliable guide to freedom from infection.
  5. Once medical treatment is started, it is essential to undergo all prescribed re-examinations until cure can be proven, to assist in ensuring that all sex partners are examined to prevent reinfection, and to refrain from sexual activity until proof of cure.

Accepting at least one of these alternatives should not prove too restrictive of any individual’s sex life. The behaviour of a large proportion of western society currently conforms to these guidelines, but until virtually everyone does, sexually transmitted diseases will not be controlled.

How do I know if I have an STD?

Because there are many different STDs, there are many possible signs that you may have caught one. Sometimes there are no signs at all. If you are sexually active, it is sensible to have a check-up for STDs every so often, just in case.

These are some of the signs that you have caught an STD. The signs of HIV infection are not included here (see details in HIV/AIDS section):

Unusual discharge of any fluid from the penis or vagina

Pain or irritation when urinating, or during intercourse

Sores, blisters, ulcers, warts, lumps or rashes anywhere in the genital or anal area

Itchiness or irritation in the genital or anal area

Persistent or recurring diarrhoea

Of course, some of these signs may be caused by things other than STDs. But if you have any of them, you should see a doctor at once. Don’t just wait for them to go away; even if they do, this does not mean the disease has gone. Some STDs may cause a generalised illness including some forms of jaundice.

Most STDs can go undetected and cause serious illness later. Having no symptoms is no guarantee that you do not have a sexually transmitted disease. And you will still be able to infect other people you have sex with.

If you have symptoms of STD, you can check the “Should I see a doctor?” section to help you decide how to seek help.

How can I avoid STDs?

It is not difficult to avoid catching STDs. The risk of catching the more serious STDs can be reduced by using condoms during vaginal or anal sex. Scientific research has shown that latex condoms are an effective barrier against HIV and the viruses and bacteria that cause major STDs (but, some STDs, like herpes and wart virus, can spread through any skin-to-skin contact).

Condoms, though, will only protect you against disease if you use them every time you have sex. Sometimes is not good enough. Information about how to use condoms.

Other Ways to Avoid STDs

Not to have sex at all. You should not feel you have to have sex if you don’t want to.

To have sex only in ways that do not spread major STDs. Kissing, sensuous touching and mutual masturbation are safe in terms of all serious STDs.

To have sex only with a single partner in a monogamous relationship (that is, where neither partner has any other sexual partners). This is only safe if the relationship is really monogamous, and if both partners have been tested for STDs and are uninfected.

Posted on March 3, 2012, in Categorized and tagged , , , , , , , . Bookmark the permalink. 1 Comment.

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