Introduction
This guide focuses on the basics of safer sex, and on how to make whatever
precautions you choose feel as pleasurable as possible. Safer sex precautions
are obviously not necessary when neither you nor your partner(s) have anything
you could transmit to each other (and will be completely safe in your
interactions with anyone else during the course of your relationship, and when
birth control is not an issue, etc.), but in all other cases your peace of mind
can be enhanced by making your own choices about safer sex ahead of time and
sticking to them.
Please note that safer sex is about dramatic risk reduction against the most
serious sexually-transmitted ailments, not complete risk elimination for every
possible condition (for example: the virii for cold sores and warts can be
spread through unbarriered contact with any infected area, including
health-looking skin that a condom would not cover).
Intercourse
The single most effective thing you can do to stay healthy while being
sexually active is to use latex condoms for intercourse (whether vaginal or
anal). All condoms are not made alike; men should experiment with different
brands until they find the one they like best (many men prefer Kimono Microthins,
which are commonly available in drug stores, and which also taste fine for
fellatio if you get them without Nonoxynol-9). When you put on a condom, pinch
its tip as you unroll it (all the way down!) to prevent an air bubble from
forming in the reservoir tip. For intercourse, you should then put some
water-based lube (of the brands commonly available in drug stores Astroglide
probably being the best bet) on the outside of the condom for comfort, mutual
pleasure, and to keep the condom from tearing during sex. Note that some men
find that more sensation is transmitted to them if they put a drop or two of
water-based lube INSIDE the tip of their condom before putting it on. Also, it's
very important for men to hold onto the base of their condom as they withdraw
(i.e. after becoming soft) so it doesn't slip off.
For a while, health experts were recommending that people choose safer sex
products with Nonoxynol-9 to protect against HIV transmission: scientific
evidence resulted in this advice being formally retracted
by public health officials in the year 2000, and unless you are using
Nonoxynol-9 as a contraceptive rather than for HIV prevention it may be wise to
cease using it entirely.
If a condom fails during vaginal or anal intercourse, the receptive partner
shouldn't douche; if any Nonoxynol-9 contraceptive foam is handy it MIGHT help
for him or her to insert it and leave it in for about 15 minutes, and it would
certainly help to immediately remove the condom from inside the vagina or anus
if it was left there. Some sex educators have suggested that men might be able
to give themselves a little extra protection after a condom failure by
immediately visiting the restroom and urinating, though other experts have
questioned this advice. If unwanted pregnancy is a possible outcome of the
condom failure, you should visit http://ec.princeton.edu to find out about
emergency contraception in your area.
It should be obvious that a new condom needs to be used for each new partner,
and that condoms should not be reused. Also, if you're going to switch from anal
intercourse to vaginal intercourse, you should put on a new condom to avoid
causing vaginal infections.
Oral Sex
Opinions differ on the use of safer-sex barriers for oral sex. It's clear
that herpes can be transmitted from genitals to mouth or mouth to genitals
during unprotected oral sex, but some people feel the risk is acceptably low
outside of the most infectious period (which starts with the tingling "prodrome"
sensations that precede an outbreak, and continues until several weeks after the
sores go away). It is possible to pick up a bacterial infection of the mouth or
throat by going down on someone who currently has a bacterial STD (typically
Gonorrhea, more rarely Syphillis or Chlamydia), but these can usually be cured
with antibiotics once they're identified.
It is clear that the risk of transmitting HIV is much, MUCH lower for
unprotected oral sex than for unprotected anal or vaginal intercourse, and that
the risk is MUCH lower for the person being sucked or licked than for the person
doing the sucking or licking. For the person doing the sucking or licking, the
risk of transmission is lower if your gums (and lips/mouth/throat) are healthy,
if you don't let men come in your mouth, and if you don't perform cunnilingus on
a woman while she is menstruating.
Some sex educators recommend NOT flossing or brushing your teeth for an hour
before giving unprotected oral sex (use Cool Mint Listerine or some other
anti-bacterial mouthwash if you're concerned about bad breath or just want to
freshen up), and others recommend quickly looking over the genitals you're about
to go down on for obvious signs of contagious STDs (including genital warts,
which can on rare occasion be transmitted from genitals to mouth). If your
policy for performing unprotected fellatio is to not let your partner come in
your mouth and he does so anyway, it's better to immediately spit than to either
wait or swallow, and it may help (especially for bacterial STDs) to then go use
an anti-bacterial or peroxide mouthwash. Pre-cum can contain HIV, and although
not letting men come in your mouth SIGNIFICANTLY reduces your already low risk
to even lower levels, if you are concerned about becoming infected via pre-cum
while performing fellatio you have two risk-reduction options: not taking the
head of his penis in your mouth or using barriers for oral sex.
If after getting all the facts you decide that your personal safety standards
include barriers for oral sex, then you'll need to use latex condoms (without
Nonoxynol-9) for fellatio, and either regular saran wrap or one of those "Glyde"
dams for cunnilingus (for cunnilingus, put a little water-based lube on your
partner's side of the barrier to increase the sensation transmitted to her). The
same barrier techniques used for cunnilingus can also be used for analingus
(rimming), where they should be considered essential if the person doing the
licking isn't immunized against hepatitis A or if the person being licked may
have a bacterial infection.
Your Hands
If you've had your fingers in someone's vagina, or had someone come on your
hands, then it's a good idea to wash your hands with hot water and
anti-bacterial soap before touching your eyes or anyone else's genitals
(individually-packaged anti-bacterial towlettes might be useful if you're
outdoors). If your skin is compromised in any way, if you want to avoid needing
to leave the scene to wash your hands, if you're going to be engaging in anal
fisting or exposing yourself to any blood, or if you just want to be extra-safe,
then try using disposable latex "examination" gloves (available at most drug
stores).
If you're not going to use gloves, then just as a hygiene matter washing your
hands before putting them in someone is a good idea.
Of course, if you've just had your ungloved fingers in somebody's ass, then
you'll want to be sure to clean your hands particularly thoroughly
(especially under your fingernails) before putting your them in or near anyone's
mouth.
Safer Sex Kits
It's helpful to get a little hip pack for your safer-sex supplies, your
smaller bottle of water-based lube, and anything else you commonly use. You
might also want to pack a portable toothbrush and a travel-sized toothpaste tube
in case you end up staying overnight somewhere.
Vaccinations
There are two STDs for which permanent vaccines are available: hepatitis B
and hepatitis A. Hepatitis B can be spread easily through intercourse and (less
easily) through oral sex or rimming, and hepatitis A is easily spread through
rimming. Getting these two vaccinations (which you can do at the same time)
would be an excellent idea if you don't always use barriers for these
activities. By contrast, there is currently NO vaccine against Hepatitis C
(though Hep C is spread primarily through direct contact with human blood, e.g.
through sharing needles, and only rarely through sexual contact - see
http://www.cdc.gov/ncidod/diseases/hepatitis/c/faq.htm for more details).
Birth Control
If you're going to be engaging in intercourse with someone of the opposite
sex, birth control may be an issue. If the birth control that latex condoms
offer is good enough for you, then you're set. If you want more protection than
this, call Planned Parenthood (1-800-230-PLAN)
and discuss the options. Special doses of particular birth control pills can
reduce the chance of pregnancy by 75% if taken within 72 hours of contraceptive
failure, but can still be effective within five days; the Emergency
Contraception Website at http://ec.princeton.edu can tell you where
to go to get them.
Treatment, Testing, and Additional Information
If you have additional questions about STDs or HIV, call the National STD
Hotline at 1-800-227-8922 or visit http://www.thebody.com. Information about
testing clinics is available by calling the aforementioned National STD Hotline,
and since bacterial STDs are almost always curable with appropriate antibiotics
and the incurable viral STDs (such as HIV, herpes, hepatitis, and HPV) are now
more easily managed than ever, it's definitely in your best interest to get
tested if you think you might have been exposed to anything.
Please keep in mind that, for standard HIV testing, a minimum of three months
needs to go by since your last potential exposure for the test to be reliable:
in other words, if you and your partner would like to drop safer sex precautions
with each other and are primarily concerned about HIV, you'll need to go through
a period of time where you're completely safe with each other and everyone else
before you'll be able to get a meaningful test result (you'll also be advised on
this matter when you go in for testing).
If you require more detailed information on STD/HIV treatments, the best
online document is the CDC's Guidelines for Treatment of Sexually Transmitted
Disease at
http://www.cdc.gov/std/treatment/TOC2002TG.htm. The only element lacking in
this document is good pictures of herpes sores (and symptoms caused by other
STDs) for those who want a better chance of being able to identify some of them
by sight; for pictures, visit
http://www.thebody.com/sowadsky/symptoms/symptoms.html
Selecting and Obtaining Safer Sex Supplies
We've prepared guides to the different lubes and safer sex barriers currently available, which
may help you make your selections.
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