Safe sex

a condom, for example, the male could intentionally pull

o the condom and continue penetrating without the female or male receptive partners consent and notice. This
is a high-risk behavior that betrays trust, and it may spread
an STI.
Although some safe sex practices can be used as birth
control (contraception), 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 eective forms of contraception.

Condoms can be used by men for safe sex

1 Terminology

Dental dams can be used by persons that engage in cunnilingus

and/or anilingus for safe sex.

Safe sex is sexual activity engaged in by people who have

taken precautions to protect themselves against sexually
transmitted infections (STIs) such as HIV/AIDS.[1] It is
also referred to as safer sex or protected sex, while unsafe or unprotected sex is sexual activity engaged in
without precautions, especially forgoing condom use.
Some sources prefer the term safer sex to more precisely
reect the fact that these practices reduce, but do not always completely eliminate, the risk of disease transmission. The term sexually transmitted infections (STIs) has
gradually become preferred over sexually transmitted diseases (STDs) among medical sources, as it has a broader
range of meaning; a person may be infected, and may potentially infect others, without showing signs of disease.[2]
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. Safe sex is
regarded as a harm reduction strategy aimed at reducing
risks.[3][4] 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 compared to when they wear them is estimated to be about a four- to vefold.[5] Safe sex is eective in avoiding STIs only if both sexual partners agree on
it and stick to it. During sexual penetration while using

An AIDS prevention advertisement for gay and bisexual men,

showing condoms.

The term safer sex in Canada and the United States has
gained greater use by health workers, reecting that risk
of transmission of sexually transmitted infections in various sexual activities is a continuum. The term safe sex
is still in common use in the United Kingdom, Australia
and New Zealand.
1

SAFE SEX PRECAUTIONS

Although safe sex is used by individuals to refer to protec- incorporating a condom pocket and including the red ribtion against both pregnancy and HIV/AIDS or other STI bon symbol in the design, which were sold to support the
transmissions, the term was primarily derived in response charity.
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 eect that 2 Safe sex precautions
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 uid exchange, and resisting the use of drugs that reduced inhibitions for highrisk sexual behavior.[6] Moreover, in 1985, the rst 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 or oral sex.
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 partners sexual history and
limiting the number of sexual partners. The rst 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, body-to-body rubbing, mutual masturbation, exhibitionism and voyeurism,
phone sex, sadomasochism without bruising or bleeding,
and use of separate sex toys); possibly safe (use of condoms); and unsafe.[6]

A shunga print by Kunisada depicting female masturbation.

2.1 Solitary sex

Known as autoeroticism, solitary sexual activity is relatively safe. Masturbation, the simple act of stimulating
ones own genitalia, is safe so long as contact is not made
with other peoples bodily uids. Some activities, such as
phone sex and cybersex, that allow for partners to engage
in sexual activity without being in the same room, eliminate the risks involved with exchanging bodily uids.[7]

2.2 Non-penetrative sex

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 urged chastity and heterosexual marriage, attacking the American Catholic bishops guidelines.
A study carried out in 2006 by Californian specialists
showed that the most common denitions 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).[6]
Watercolor of manual stimulation of the penis, Johann Nepomuk
Safer sex is thought to be a more aggressive term which Geiger, 1840.
may make it more obvious to individuals that any type of
Main article: Non-penetrative sex
sexual activity carries a certain degree of risk.
The term safe love has also been used, notably by the
A range of sex acts, sometimes called outercourse, can
French Sidaction in the promotion of mens underpants
be enjoyed with signicantly reduced risks of infection or

2.3

Barrier protection

pregnancy. U.S. President Bill Clinton's surgeon general,

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 red by President
Clinton in December 1994.[8][9][10]
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.[11]

2.3

Barrier protection

Various protective devices are used to avoid contact with

blood, vaginal uid, semen or other contaminant agents
(like skin, hair and shared objects) during sexual activity.
Sexual activity using these devices is called protected
sex.
Condoms cover the penis during sexual activity.
They are most frequently made of latex, and can
also be made out of synthetic materials including
polyurethane.
Female condoms are inserted into the vagina prior
to intercourse.
A dental dam (originally used in dentistry) is a sheet
of latex used for protection when engaging in oral
sex. It is typically used as a barrier between the
mouth and the vulva during cunnilingus or between
the mouth and the anus during analoral sex.
Medical gloves made out of latex, vinyl, nitrile, or
polyurethane may be used as a makeshift dental dam
during oral sex, or to protect the hands during sexual
stimulation, such as masturbation. 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
dildos and other sex toys. If a sex toy is to be used
in more than one orice or partner, a condom can
be used over it and changed when the toy is moved.
Condom machine

When latex barriers are used, oil-based lubrication can

break down the structure of the latex and remove the prousers.[12] However, if two condoms are used simultanetection it provides.
Condoms (male or female) are used to protect against ously (male condom on top of male condom, or male concondom), this increases the chance of
STIs, and used with other forms of contraception to im- dom inside female
[13][14]
condom
failure.
prove contraceptive eectiveness. For example, simultaneously using both the male condom and spermicide (ap- Proper use of barriers, such as condoms, depends on the
plied separately, not pre-lubricated) is believed to reduce cleanliness of surfaces of the barrier, handling can pass
perfect-use pregnancy rates to those seen among implant 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%.[15] Condoms must be put on before any bodily
uid could be exchanged, and they must be used also during oral sex.[16]
Female condoms are made of two exible polyurethane
rings and a loose-tting polyurethane sheath.[15] According to laboratory testing, female condoms are eective in
preventing the leakage of body uids 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 nd 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 ve uses if it is disinfected with
water and household bleach. However, regardless of this
study, specialists still recommend that female condoms
be used only once and then discarded.

2.4

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 against various viral infections that
can be transmitted sexually. The most common vaccines are HPV vaccine, which protects against the
most common types of human papillomavirus that
cause cervical cancer, and the Hepatitis B vaccine.
Immunization before initiation of sexual activity increases eectiveness.

SAFE SEX PRECAUTIONS

implemented a program of mandatory testing and

quarantine early in the AIDS epidemic.[21] In the US
pornographic lm 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.[22] Douching with soap and water
disrupts the vaginal ora and might increase risk of
infection.[23][24]
Monogamy or polydelity, 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
polydelitous people, who face higher risks depending on how many people are in the polydelitous
group.
For those who are not monogamous, reducing the
number of ones sexual partners, particularly anonymous sexual partners, may also reduce ones potential exposure to STIs. Similarly, one may restrict ones sexual contact to a community of trusted
individualsthis is the approach taken by some
pornographic actors and other non-monogamous
people.
When selecting a sexual partner, some characteristics can increase the risks for contracting sexually
transmitted diseases.[25] These include an age discordance of more than ve years;[25] having an STI
in the past year;[25] problems with alcohol;[25] having
had sex with other people in the past year.[25]
Communication with ones 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.

Male circumcision and HIV: Some research has

suggested that male circumcision can reduce the
risk of HIV infection in some countries. The
If a person is sexually active with a number of
World Health Organization cites the procedure as
partners, regular sexual health check-ups by a
a measure against the transmission of HIV between
doctor, and on noticing unusual symptoms seekwomen and men; some African studies have found
ing prompt medical advice; HIV and other infecthat circumcision can reduce the rate of transmistious agents can be either asymptomatic or involve
sion of HIV to men by up to 60%.[17] Some adnonspecic symptoms which on their own can be
vocacy groups dispute these ndings.[18][19] In submisdiagnosed.[26][27]
Saharan Africa, at least, condom use and behavior
change programs are estimated to be more ecient
and much more cost-eective than surgical proce- 2.5 Limitations
dures such as circumcision.[20]
While the use of condoms can reduce transmission of
Periodic STI testing has been used to reduce STIs HIV and other infectious agents, it does not do so comin Cuba and among pornographic lm actors. Cuba pletely. One study has suggested condoms might reduce

5
HIV transmission by 85% to 95%; eectiveness beyond
95% was deemed unlikely because of slippage, breakage,
and incorrect use.[28] It also said, In practice, inconsistent use may reduce the overall eectiveness of condoms
to as low as 6070%".[28]p. 40.

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
During each act of anal intercourse, the risk of the recep- copper intrauterine device present however a greater risk
tive partner acquiring HIV from HIV seropositive part- of being exposed to any type of STI, especially gonorrhea
ners not using condoms is about 1 in 120. Among people or chlamydia.
using condoms, the receptive partners risk declines to 1 Coitus interruptus (or pulling out), in which the pein 550, a four- to vefold reduction.[5] Where the part- nis is removed from the vagina, anus, or mouth before
ners HIV status is unknown, Estimated per-contact risk ejaculation, is not safe sex and can result in STI transmisof protected receptive anal intercourse with HIV-positive sion. This is because of the formation of pre-ejaculate, a
and unknown serostatus partners, including episodes in uid that oozes from the urethra before actual ejaculation,
which condoms failed, was two thirds the risk of unpro- may contain pathogens such as HIV. Additionally, the mitected receptive anal intercourse with the comparable set crobes responsible for some diseases, including genital
of partners.[5]p. 310.
warts and syphilis, can be transmitted through skin-toIn March 2013, Bill Gates oered a US$100,000 grant skin contact, even if the partners never engage in oral,
through his foundation for a condom design that signi- vaginal, or anal sexual intercourse.
cantly preserves or enhances pleasure to encourage more
males to adopt the use of condoms for safer sex. The
grant information states: The primary drawback from 4 Abstinence
the male perspective is that condoms decrease pleasure as
compared to no condom, creating a trade-o that many
men nd unacceptable, particularly given that the decisions about use must be made just prior to intercourse.
Is it possible to develop a product without this stigma, or
better, one that is felt to enhance pleasure? The project
has been named the Next Generation Condom and anyone who can provide a testable hypothesis is eligible to
apply.[29]

Ineective methods

Most methods of contraception, except for certain forms

of "outercourse" and the barrier methods, are not eective at preventing the spread of STIs. This includes the
birth control pills, vasectomy, tubal ligation, periodic abstinence and all non-barrier methods of pregnancy prevention.
The spermicide Nonoxynol-9 has been claimed to reduce
the likelihood of STI transmission. However, a recent
study by the World Health Organization [30] has shown
that Nonoxynol-9 is an irritant and can produce tiny tears
in mucous membranes, which may increase the risk of
transmission by oering pathogens more easy points of
entry into the system. Condoms with Nonoxynol-9 lubri- U.S. World War II anti-venereal disease poster.
cant do not have enough spermicide to increase contraSexual abstinence is sometimes promoted as a way to
ceptive eectiveness and are not to be promoted.
avoid the risks associated with sexual contact, though
The use of diaphragm or contraceptive sponge provides STIs may also be transmitted through non-sexual means,
some women with better protection against certain sexu- or by involuntary sex. HIV may be transmitted through
ally transmitted diseases,[31] but they are not eective for contaminated needles used in tattooing, body piercing,
all STIs.
or injections. Medical or dental procedures using conThe hormonal protecting methods are by no means ef- taminated instruments can also spread HIV, while some
fective against transmission of STIs, even though they are health-care workers have acquired HIV through occupamore than 95% eective against unwanted pregnancies. tional exposure to accidental injuries with needles.[32] Ev-

idence does not support the use of abstinence only sex

education.[33] Abstinence-only education programs have
been found to be ineective in decreasing rates of HIV
infection in the developed world[34] and unplanned pregnancy.[33]

SEX TOYS

by using a nger 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 nger. Especially for beginners, using a condom on the nger 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;[40] water-based and siliconebased lubricants are available instead. 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). The female
condom may also be used eectively by the anal receiving partner.

Some groups, such as some Christian denominations, oppose sex outside marriage and therefore object to safe-sex
education programs because they believe that providing
such education promotes promiscuity. Virginity pledges
and sexual abstinence 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 until
marriage do engage in pre-marital sex and are then onethird less likely to use contraceptives than their peers who
have received more conventional sex education.[35]
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.

Anal sex

It is important that the man washes and cleans his penis after anal intercourse if he intends to penetrate the
Unprotected anal penetration is a high risk activity, re- vagina. Bacteria from the rectum are easily transferred
gardless of sexual orientation. Anal sex is a higher risk ac- to the vagina, which may cause vaginal infections.[41]
tivity than vaginal intercourse because the thin tissues of
When anal-oral contact occurs, protection is required
the anus and rectum can be easily damaged.[36][37] Slight
since this is a risky sexual behavior in which illnesses as
injuries can allow the passage of bacteria and viruses, inHepatitis A or STIs can be easily transmitted, as well as
cluding HIV. This includes by the use of anal toys. Conenteric infections. The dental dam or the plastic wrap
doms may be more likely to break during anal sex than
are eective protection means whenever anilingus is per[38]
during vaginal sex, increasing the risk.
formed.
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
6 Sex toys
couples (heterosexual or homosexual) can derive pleasure from some form of 'bottom stimulation'.[36] 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 and A and Escherichia coli 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.[39] Other researchers state that gay men are not necessarily more
likely to engage in anal sex than heterosexual couples.[36]

5.1

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 eective.
In order to make anal sex safer, the couple must ensure Two sex toys intended for anal use (note the ared bases)
that the anal area is clean and the bowel empty and the
partner on whom anal penetration occurs should be able Putting a condom on a sex toy provides better sexual hyto relax. Regardless of whether anal penetration occurs giene and can help to prevent transmission of infections

7
if the sex toy is shared, provided the condom is replaced
when used by a dierent 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 specically 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 eective.
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.[42] A sex toy
should be cleaned not only when it is shared with other
individuals but also when it is used on dierent 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. It is best
if the damaged sex toy is replaced by a new undamaged
one. Even more hygiene protection should be considered
by pregnant women when using sex toys. Sharing any
type of sex toy that may draw blood, like whips or needles, is not recommended, and is not safe.
When using sex toys in the anus, sex toys "...can easily get
lost as rectal muscles contract and can suck an object
up and up, potentially obstructing the colon"; to prevent
this serious problem, sex toy users are advised to use sex
"...toys with a ared base or a string. [43]

See also
Bareback (sex)
Celibacy
Human sexual activity
Misconceptions about HIV/AIDS
Party and play
Post-exposure prophylaxis
Sisters of Perpetual Indulgence
Terrence Higgins Trust

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[36] Dean, John; Delvin, David. Anal sex. Netdoctor.co.uk.
Retrieved 29 April 2010.
[37] Voeller B. AIDS and heterosexual anal intercourse. Arch
Sex Behav 1991; 20:233276. as cited in Leichliter, Jami
S. PhD, Heterosexual Anal Sex: Part of an Expanding Sexual Repertoire?" in Sexually Transmitted Diseases:
November 2008 Volume 35 Issue 11 pp 910911
Accessed 26 January 2010
[38] Can I get HIV from anal sex?". Retrieved 19 August
2011.
[39] Gay mens dream: A 'magic' lube: Researchers discuss rectal microbicide development at NIAID workshop, Bob Roehr, (15 June 2001) Bay Area Reporter
http://www.aegis.com/news/bar/2001/BR010617.html
[40] Steiner, M., Piedrahita, C., Glover, L., Joanis, C., Spruyt,
A. and Foldesy, R. (1993). The impact of lubricants on
latex condoms during vaginal intercourse. International
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[41] Anal Sex - Facts and Safe Sex Information. Retrieved 5
April 2010.
[42] Are sex toys safe?". Retrieved 31 March 2010.
[43] https://www.scientificamerican.com/article/
good-vibrations-us-consumer-web-site-aims-to-enhance-sex-toy-safety/

External links
Prevention - Sexually Transimitted Disease,
AGUM (Association of Genital Urinary Medicine)
Arrow: The Asian-Pacic Resource & Research
Centre for Women
Guidelines, British Association for Sexual health
and HIV (BASHH)
Safer-Sex Methods, HIV InSite
Guide to Safer Sex, Sexuality.org, Concise version
(20k)

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10.1

TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

Text and image sources, contributors, and licenses

Text

Safe sex Source: http://en.wikipedia.org/wiki/Safe_sex?oldid=665753428 Contributors: Damian Yerrick, AxelBoldt, Tobias Hoevekamp,
Eloquence, Mav, The Anome, Tarquin, Gareth Owen, Ed Poor, Chris Q, Frecklefoot, Lir, Patrick, Stormwriter, Marco~enwiki, Tannin,
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Spaully, Splash, Epolk, Donwarnersaklad, Gaius Cornelius, Wimt, Nowa, GBDimple, Catamorphism, Chooserr, Irishguy, Kenkoo1987,
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10.3

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