Safe sex
Safe sex is sexual activity using methods or contraceptive devices (such as condoms) to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV.[1] "Safe sex" is also sometimes referred to as safer sex or protected sex to indicate that some safe sex practices do not eliminate STI risks. It is also sometimes used colloquially to describe methods aimed at preventing pregnancy that may or may not also lower STI risks.
For the film, see Safe Sex (film).
The concept of "safe sex" emerged in the 1980s as a response to the global AIDS epidemic, and possibly more specifically to the AIDS crisis in the United States. Promoting safe sex is now one of the main aims of sex education and STI prevention, especially reducing new HIV infections. Safe sex is regarded as a harm reduction strategy aimed at reducing the risk of STI transmission.[2][3]
Although some safe sex practices (like condoms) can also be used as birth control (contraception), most forms of contraception do not protect against STIs. Likewise, some safe sex practices, such as partner selection and low-risk sex behavior, might not be effective forms of contraception.
Ineffective methods[edit]
Most methods of contraception are not effective at preventing the spread of STIs. This includes birth control pills, vasectomy, tubal ligation, periodic abstinence, IUDs and many non-barrier methods of pregnancy prevention. However, condoms, when used correctly, significantly reduces the risks of STI transmission and unwanted pregnancy.[39]
The spermicide nonoxynol-9 has been claimed to reduce the likelihood of STI transmission. However, a technical report from 2001[40] 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. They reported that nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness cautioned they should not be promoted. There is no evidence that spermicidal condoms are better at preventing STD transmission compared to condoms that do not have spermicide. If used properly, spermicidal condoms can prevent pregnancy, but there is still an increased risk that nonoxynyl-9 can irritate the skin, making it more susceptible for infections.[40][41]
The use of a diaphragm or contraceptive sponge provides some women with better protection against certain sexually transmitted infections,[42] but they are not effective for all STIs.
Hormonal methods of preventing pregnancy (such as oral contraceptives [i.e. 'The pill'], depoprogesterone, hormonal IUDs, the vaginal ring, and the patch) offer no protection against STIs. 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 may be subject to greater risk of infection from bacterial infectious such as gonorrhea or chlamydia, although this is debated.[43]
Coitus interruptus (or "pulling out"), in which the penis is removed from the vagina or mouth before ejaculation, may reduce transmission of STIs but still carries significant risk. This is because pre-ejaculate, a fluid that oozes from the penile urethra before ejaculation, may contain STI pathogens. Additionally, the microbes responsible for some diseases, including genital warts and syphilis, can be transmitted through skin-to-skin or mucous membrane contact.[44]
Anal sex[edit]
Unprotected anal penetration is considered a high-risk sexual activity because the thin tissues of the anus and rectum can be easily damaged.[45][46] Slight injuries can allow the passage of bacteria and viruses, including HIV. This includes penetration of the anus by fingers, hands, or sex toys such as dildos. Also, condoms may be more likely to break during anal sex than during vaginal sex, increasing the risk of STI transmission.[47]
The main risk that individuals are exposed to when performing anal sex is the transmission of HIV. Other possible infections include hepatitis A, B and C; intestinal parasite infections like Giardia; and bacterial infections such as Escherichia coli.[48]
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. Enemas should not be used as they can increase the risk of HIV infection[49] and lymphogranuloma venereum proctitis.[50]
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 should not be used with condoms;[51] water-based and silicone-based lubricants are available instead. Non-latex condoms are available for people who are allergic to latex made out of polyurethane or polyisoprene.[52] Polyurethane condoms can safely be used with oil-based lubricant.[53] The "female condom" may also be used effectively by the anal receiving partner.
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 and urinary tract infections.[54]
When anal–oral contact occurs, protection is required since this is a risky sexual behavior in which illnesses such as hepatitis A or STIs can be easily transmitted, as well as enteric infections. The dental dam or plastic wrap[55] are effective protection means whenever anilingus is performed.
Abstinence[edit]
Sexual abstinence reduces STIs and pregnancy risks associated with sexual contact, but STIs may also be transmitted through non-sexual means, or by rape. 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.[59] Evidence does not support the use of abstinence-only sex education.[60] Abstinence-only sex education programs have been found to be ineffective in decreasing rates of HIV infection in the developed world[61] and unplanned pregnancy.[60] Abstinence-only sex education primarily relies on the consequences of character and morality while health care professionals are concerned about matters regarding health outcomes and behaviors.[62] Though abstinence is the best course to prevent pregnancy and STIs, in reality, it leaves young people without the information and skills they need to avoid unwanted pregnancies and STIs.[62]