From Encyclopedia of Sex and Sexuality
While the term “safe sex” is sometimes used to denote sexual activity between two people that will never lead to the transference of sexually transmitted diseases (STDs), the sad truth is that there is no such thing. Precautions can be taken which greatly reduce the risks, but no one can say with absolute certainty that any safe sex practices guarantee risk-free sex. The only perfectly safe form of sexual release is masturbation. This can be a shared experience by watching a partner masturbate, but if there is any physical contact between the partners, the possibility, no matter how slim, exists that something might be transmitted between them. That is why the applicable term is “safer sex,” not safe sex. Having thus qualified the term, words like “prevent” and “protect” will be used because, for the most part, the spread of these diseases can be successfully prevented through safer sex—although not with 100 percent certainty.
Many people practice safer sex because they are afraid of catching aids: this dreadful disease is a killer, and they are right to do so. But there are many other sexually transmitted diseases, including syphilis, gonorrhea and chlamydia, hepatitis, and herpes, whose transmission can also be prevented by practicing safer sex, and that provide an added reason for doing so.
There are many levels to the practice of safer sex. As mentioned, the only one to guarantee absolute safety is masturbation. Two virgins who enter into a monogamous relationship are also safe, assuming both partners are telling the truth and remain monogamous. Love and trust, therefore, become important aspects of safer sex in sexual relationships, which is why a strong commitment should be encouraged if safer sex practices are ever abandoned.
In recent decades, monogamous marriages between two virgins have become less common. Young people are willing to delay getting married in order to further their education and their careers. It is more rare, however, for them to be willing to delay forming sexual relationships, which is why they must become informed about safer sex practices.
Many people ask if a specific activity, like French, or deep, kissing, is safe. They want to know what the risks of catching a communicable disease from kissing might be. Actually, the risks of transmitting AIDS through kissing are low. While we do know that the HIV virus is present in the saliva of infected persons, we do not know of any cases where HIV has been transmitted solely through kissing—even deep kissing. Does that mean that such practices are entirely safe? As with so many issues involving AIDS, the answer must be vague: you must use your own judgment. Again, the best way to practice safer sex is to only have sexual contact—even contact short of intercourse—with someone who has tested negative for STDs and with whom you have a relationship built on trust.
Let us say that you have met someone with whom you want to enter a relationship. Assuming that neither of you are virgins, you might decide that each person goes for an HIV test prior to having sexual relations. This practice is becoming more and more common. Going for such a test is part of the practice of safer sex but, sadly, it does not mean that the couple can engage in sex without practicing safer sex. The blood test does not detect the HIV virus itself, but only the body’s reaction against it. This reaction can take six months or longer to show up on a test, so an infected person could transmit the HIV virus and still pass the test. Although it is rare, the test can also give a false-negative result, so that a person may be told that he or she is disease-free when, in fact, they are not. Life was certainly easier before AIDS.
Of course, some practices are riskier than others. HIV is spread through the passing of bodily fluids—blood, semen, and possibly secretions of the cervix and vagina. These fluids may be exchanged in a limited number of ways: by anal or genital sexual intercourse or oral sex; by receiving contaminated blood; or by using a contaminated hypodermic needle. If contaminated blood or semen comes in contact with an open sore or wound in the mouth, vagina, or rectum, or through the mucous membranes that line the vagina, rectum, urethra, and possibly the mouth, the virus can be transmitted. Anal intercourse, particularly for the recipient, is considered the riskiest practice by many experts because there is a greater possibility that blood or an open wound will be present in the anus or rectum.
Many people inquire about the risks involved in oral sex. Fellatio is considered to be a high-risk sexual activity if the man ejaculates into his partner’s mouth. The HIV virus is present in semen and can be absorbed through the mucous membranes or through any small tears or cuts in the lining of the mouth, stomach, or intestinal tract. But even if the penis is withdrawn prior to ejaculation, there is always a small amount of pre-ejaculatory fluid that can also contain the virus. In terms of safer sex, using a condom when performing fellatio is important (be sure that it is of the nonlubricated variety).
Oral sex performed upon a woman becomes high-risk during menstruation because of the possible presence of the virus in menstrual blood. Even when a woman is not menstruating, the vaginal and cervical secretions of the woman can contain some concentrations of the virus.
Obviously, the greater the number of sexual partners, the greater the risk of the disease being transmitted. But in the same way that a woman can become pregnant the first time she has intercourse, HIV can be transmitted through a single sexual episode. When you have sex with someone, you are having sex with all of that person’s past and present partners, as far as risks are concerned. If you slept with ten partners in the past year, and each of them, before sleeping with you, slept with ten others, who in turn had slept with ten others, you have basically come into sexual contact with one thousand people and have raised your chances of catching AIDS or some other STD tremendously. (And this only considers everyone’s partners for one year!)
Some people wrongly consider HIV to be a disease limited to homosexuals: this piece of misinformation could have deadly consequences. In parts of Africa where AIDS is widespread, it is primarily a heterosexual disease, and the rate of infection among heterosexuals in the Western nations is growing rapidly. Both women and men can get the disease through heterosexual intercourse, though women seem to be at significantly greater risk. One study showed that women who were long-term partners of infected men were almost twenty times more likely to be infected with HIV than were men who were long-term partners of infected women.
But whether an individual is involved in male-to-male, male-to-female or female-to-female sex, because HIV and all other STDs are passed on through the transmission of bodily fluids, the best way to lower the odds of getting STDs is to use a barrier method to block the exchange of fluids. Since the most highly-infected fluid that is exchanged during sexual acts is semen, condoms are the most popular barrier method.
Do condoms work? Very effectively, provided that they are used. Some people say they use condoms, but not every time, or only prior to ejaculation. A condom that remains in your pocket or on the nightstand is useless. Sometimes condoms fail, in other words they break open during the sexual act and the semen spills out. Condoms were originally made to prevent both pregnancy and STDs, but now that a broken condom can result in death, the manufacturers of condoms are making them stronger than ever. However, nonlatex condoms, usually made out of a natural substance such as sheeps’ intestines (called “lambskin” by the manufacturers), provide good protection against pregnancy but much less protection against STDs. They contain microscopic holes large enough for a virus, such as HIV or hepatitis B, to pass through and are not recommended as part of a safer sex protection system.
Another difficulty in effective condom use is that of slippage, that is, the condom coming off the penis within the partner’s vagina or rectum during intercourse. There is a brand of condom that includes an adhesive that helps it stick to the penis for those concerned about this danger. A spermicide, such as nonoxynol-9 has also been shown in laboratory tests to have the ability to kill the HIV virus, and condoms that are coated with such a substance offer some protection from STDs even if there is slippage or breakage. However, nonoxynol-9 has not been proven 100 percent effective in protecting against HIV outside the laboratory, so it should never be used alone as a method of safer sex.
Some condoms come prelubricated, which is fine, but if an external lubricant is applied, always make sure that it is not oil-based: oil can break down the latex in the condom so that it is no longer as effective against disease transmission. Vaseline should be avoided, as should any other oil-based products. Always remember to use a new condom for each act of intercourse or oral sex.
When a condom is put on is also important. Some people wait until just before the actual act of penetration, but that can be too late. Before ejaculation small droplets of fluid appear at the opening of the penis. These droplets contains thousands of spermatozoa (which is why the withdrawal method is ineffectual for birth control) and in an HIV-infected person they also contain viruses. Penetration is not necessary for the virus to be passed to a partner if the penis comes into contact with vaginal fluids. The solution to this problem is simple; the condom should be placed on the erect penis before things get too hot and heavy. If both partners share in the experience, this does not have to be an interruption of foreplay—it can be part of the fun leading up to intercourse. (It would help if the condom was kept nearby, rather than in the glove compartment of your car!)
While a nonlubricated condom can be used during fellatio, condoms are inappropriate for cunnilingus. However, another product, the dental dam, can take its place. This is a piece of rubber that can be stretched to cover the entrance of the vagina or the anus. One problem with these dams is that during the movements that naturally occur during sex, they might slip. Special products to hold them in place with elastic can be found in specialty stores.
While these safer sex practices all apply to AIDS, some other safer sex practices, while not applicable to AIDS, can be effective to some degree against other STDs. Contraceptive creams foams and gels can help kill STD bacteria and viruses. Washing the genitals before intercourse can help remove bacteria. Urinating before and after intercourse can help keep bacteria out of the urethra. And finally, unlike HIV, many other STDs have visible signs. If you see a chancre, wart, herpes blister, or any discharge in or around the genitals of a potential partner, do not have sex with that person.
Until medical science finds a cure or vaccine for AIDS, the practice of safer sex is a must for any person having sex outside a long-term monogamous relationship—heterosexuals and homosexuals, men and women, non-intravenous drug users and those who do use such drugs. No matter how low you and your partner are in the risk pool, accidents do happen. With AIDS that accident could very well be fatal.