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[[Image:Laos AIDS education campaign.jpg|thumb|Poster for [[AIDS]] education campaign in [[Laos]]]]
[[Image:Laos AIDS education campaign.jpg|thumb|Poster for [[AIDS]] education campaign in [[Laos]]]]
'''Safe sex''' (also called '''safer sex''' or '''protected sex''') is the practice of [[sexual activity]] in a manner that lowers the risk of [[infection]] with [[sexually transmitted disease]]s (STDs). Conversely, '''unsafe sex''' or '''unprotected sex''' is the practice of [[sexual intercourse]] or other sexual contact without regard for prevention of STDs.
'''Safe sex''' (also called '''safer sex''') is the practice of [[sexual activity]] in a manner that lowers the risk of [[infection]] with [[sexually transmitted disease]]s (STDs). Conversely, '''unsafe sex''' or '''unsafer sex''' is the practice of [[sexual intercourse]] or other sexual contact without regard for prevention of STDs.


Safe sex practices became more prominent in the late 1980s as a result of the [[AIDS]] epidemic. Promoting safe sex is now a principal aim of [[sex education]]. From the viewpoint of society, safe sex can be regarded as a [[harm reduction]] strategy aimed at reducing risks.
Safe sex practices became more prominent in the late 1980s as a result of the [[AIDS]] epidemic. Promoting safe sex is now a principal aim of [[sex education]]. From the viewpoint of society, safe sex can be regarded as a [[harm reduction]] strategy aimed at reducing risks.


The risk reduction of safe sex is not absolute; "for example, experts estimate that consistent condom use reduces the risk of HIV transmission by about 80 to 90 percent."<ref name=Steiner />
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 to compared to when they wear them is estimated to be about a four- to five-fold.<ref name="Vittinghoff">Vittinghoff E, Douglas J, Judson F, McKirnan D, MacQueen K, Buchbinder SP. (1999). [http://aje.oxfordjournals.org/cgi/reprint/150/3/306 Per-contact risk of human immunodeficiency virus transmission between male sexual partners]. Am J Epidemiol. 150(3):306-11. PMID 10430236 </ref>


Although some safe sex practices can be used as [[contraception]], most forms of contraception don't protect against all or any STDs; likewise, some safe sex practices, like partner selection and low risk sex behavior, aren't effective forms of contraception.
Although some safe sex practices can be used as [[contraception]], most forms of contraception don't protect against all or any STDs; likewise, some safe sex practices, like partner selection and low risk sex behavior, aren't effective forms of contraception.


==Terminology==
==Terminology==
Recently, and mainly within [[Canada]] and the [[United States]], the use of the term ''safer sex'' rather than ''safe sex'' has gained greater use by health workers, with the realization the grounds that risk of transmission of sexually transmitted infections in various [[sexual activities]] is a continuum rather than a simple dichotomy between risky and safe. However, in most other countries, including the [[United Kingdom]] and [[Australia]], the term ''safe sex'' is still mostly used by sex educators.
Recently, and mainly within [[Canada]] and the [[United States]], the use of the term ''safer sex'' rather than ''safe sex'' has gained greater use by health workers, in order to make it clearer that these practices reduce risk of transmission along a continuum, rather than a simple dichotomy between risky and safe. However, in most other countries, including the [[United Kingdom]] and [[Australia]], the term ''safe sex'' is still mostly used by sex educators.


==Focus on condoms and HIV control==
==Focus on condoms and HIV control==
Much attention has focused on controlling [[HIV]], the [[virus]] that causes AIDS, through the use of barrier protection for the penis, specially [[condoms]]. However, the HIV is a delicate virus, so protections focused on HIV may not protect against other STIs, which can also be transmitted through other areas of the body where the pathogen (virus or bacteria) has higher prevalence and resistance. Thus some [[sex educator]]s recommend the use of barrier protection for any sexual contact with anal or vaginal cavities, or oral stimulation of those cavities or penis.
Much attention has focused on controlling [[HIV]], the [[virus]] that causes AIDS, through the use of barrier protection for the penis, specially [[condoms]]. However, the HIV is a delicate virus, so protections focused on HIV may not protect against other STIs, which can also be transmitted through other areas of the body where the pathogen (virus or bacteria) has higher prevalence and resistance. Thus some [[sex educator]]s recommend the use of barrier protection for any sexual contact with anal or vaginal cavities, or oral stimulation of those cavities or penis.{{Citation needed|condoms don't protect the skin around the penis/vagina|date=September 2009}}


==Safe sex precautions==
==Safe sex precautions==

[[Image:Kunisada surimono.jpg|thumb|right|[[Shunga]] print by [[Kunisada]] depicting masturbation]]
[[Image:Kunisada surimono.jpg|thumb|right|[[Shunga]] print by [[Kunisada]] depicting masturbation]]


===Sex by yourself===
===Sex by yourself===
Known as ''[[autoeroticism]]'', solitary sexual activity is relatively safe. [[Masturbation]], the simple act of stimulating one's own genitalia, is safe so long as contact is not made with other people's discharged bodily fluids. However, some practices, such as [[self-bondage]] and [[autoerotic asphyxia]], are made considerably more dangerous by the absence of people who can intervene if something goes wrong.
Known as ''[[autoeroticism]]'', solitary sexual activity is relatively safe. [[Masturbation]], the simple act of stimulating one's own genitalia, is a generally safe sex practice as long the object used for the stimulation, like the hand or a sex toy, is not infected or later used by someone else, and bodily fluids are not exchanged.
⚫
Modern technology does permit some activities, such as "[[phone sex]]" and "[[cybersex]]", that allow for partners to engage in sexual activity without being in the same room, eliminating the risks involved with exchanging bodily fluids.


When stimulation of the anus is involved, specially before vagina stimulation, [[masturbation]] carries a higher risk of STD infection.
⚫
=== Non-penetrative sex ===
[[Image:PeterJohannNepomukGeigerEroticWatercolor04.jpg|thumb|right|[[watercolor]] of manual stimulation of the penis, [[Johann Nepomuk Geiger]], 1840.]]
{{main|Non-penetrative sex}}


⚫
Modern technology does permit some activities, such as "[[phone sex]]" and "[[cybersex]]", that allow for partners to engage in sexual activity without being in the same room, reducing the risks involved with a sexual intercourse between partners.
A range of sex acts, sometimes called "outercourse", can be enjoyed by lovers with significantly reduced risks of infection and pregnancy. U.S. President [[Bill Clinton]]'s surgeon general, Dr. [[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 fired by President Clinton in December 1994.<ref>{{cite web|url=http://www.time.com/time/magazine/article/0,9171,982008,00.html|title=Getting Out the Wrecking Ball|publisher=Time|date=1994-12-19|accessdate=2009-03-08}}</ref><ref>[http://findarticles.com/p/articles/mi_m1316/is_n1-2_v29/ai_19034244 Joycelyn Elders: From Sharecropper's Daughter to Surgeon General of the United States of America. - book reviews | Washington Monthly | Find Articles at BNET.com<!-- Bot generated title -->]</ref><ref>{{cite web|url=http://query.nytimes.com/gst/fullpage.html?res=9C02E0D81038F935A35752C1A960958260|title=President Clinton Makes a Celebratory Return to His Starting Point in Arkansas|publisher=New York Times|date=1996-11-06|accessdate=2009-03-08}}</ref>


=== Barrier protection ===
===Partner selection===
*Long-term mutually [[Monogamy|monogamous]] relationship with an uninfected partner is one of the most reliable ways to avoid transmission of sexually transmitted diseases.<ref name="CDC condoms">{{cite web|url=http://www.cdc.gov/condomeffectiveness/latex.htm|title=Condoms and STDs: Fact Sheet for Public Health Personnel|date=July 15, 2009|publisher=Centers for Disease Control and Prevention|accessdate=2009-09-13}}</ref> However, many infected persons may be unaware of their infections because STDs are often asymptomatic or unrecognized,<ref name="CDC condoms"/> partners may be [[sexual infidelity|sexually unfaithful]] or contract STD through other means, like by contact with infected blood.
*Every relation with a new sexual partner carries a statistic risk of STD infection, which can be high or low, depending of the disease prevalence in that community. So reducing the number of sexual partners, particularly to sexual partners whose previous sexual history is known, may also reduce one's potential exposure to STDs.
⚫
*When selecting a sexual parter, some characteristics can increase the risks for contracting sexually transmitted diseases.<ref name="partner">{{cite doi|10.1097/OLQ.0b013e3181901e32}}</ref> These include: an age discordance of more than five years<ref name="partner"/>; having STD in the past year<ref name="partner"/>; problems with marijuana or alcohol<ref name="partner"/>; having had sex with other people in the past year<ref name="partner"/>.
*Request of [[STD testing]]. Tests by definition are only informative and not preventative, specially because some infections are not detectable during incubation and others stages of the disease. But requesting the results of recent [[STD testing]] is an additional information when choosing a sexual partner. This is the approach taken by some [[pornographic actor]]s.

===Barrier protection===
Various protective devices are used to avoid contact with [[blood]], [[vaginal fluid]], [[semen]] or other contaminant agents (like skin, hair and shared objects) during sexual activity.
Various protective devices are used to avoid contact with [[blood]], [[vaginal fluid]], [[semen]] or other contaminant agents (like skin, hair and shared objects) during sexual activity.
Practice of [[sexual activity]] using this devices is called '''protected sex'''.
Practice of [[sexual activity]] using this devices is called '''protected sex'''.

Male [[condoms]], when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV. In addition, the same procedure, reduces the risk of diseases transmitted by genital secretions, such as [[gonorrhea]],<ref name="gonorrhea">{{cite pmid|16385221}}</ref> [[chlamydia]],<ref name="gonorrhea"/> and [[trichomoniasis]], and to a lesser degree, to those STDs that are primarily transmitted through contact with infected [[skin]] or [[mucosal]] surfaces, like genital [[human papillomavirus]] (HPV) infection and genital ulcer diseases, such as such as [[genital herpes]], [[syphilis]], and [[chancroid]].<ref name="CDC condoms"/>


[[Image:Tysk kondomautomat.jpg|thumb|right|[[Condom machine]]]]
[[Image:Tysk kondomautomat.jpg|thumb|right|[[Condom machine]]]]
*[[Condom]]s cover the penis during sexual activity. They are most frequently made of [[latex]], but can also be made out of [[polyurethane]]<!-- removed animal intestine condoms from the list, because they "have larger microscopic openings and may allow the organisms that cause STDs to pass through and infect either partner". Also just you don't need to say "for those with latex allergies". If someone has a latex allergy they will naturally use polyurethane and not latex... -->. Polyurethane is thought to be a safe material for use in condoms, since it is nonporous and viruses cannot pass through it. However, there is less research on its effectiveness than there is on latex. <!-- the same reasoning as the above statement. -->
*[[Condom]]s cover the penis during sexual activity. They are most frequently made of [[latex]], but can also be made out of [[polyurethane]]<!-- removed animal intestine condoms from the list, because they "have larger microscopic openings and may allow the organisms that cause STDs to pass through and infect either partner". Also just you don't need to say "for those with latex allergies". If someone has a latex allergy they will naturally use polyurethane and not latex... -->. Polyurethane is thought to be a safe material for use in condoms, since it is nonporous and viruses cannot pass through it. However, there is less research on its effectiveness than there is on latex. <!-- the same reasoning as the above statement. -->
*[[Female condom]]s are inserted into the [[vagina]] prior to intercourse. They may also be used for [[anal sex]], although they are less effective.{{fact}}
*[[Female condom]]s are inserted into the [[vagina]] prior to intercourse. They may also be used for [[anal sex]], although they are less effective.{{Citation needed|date=September 2009}}
*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 [[anilingus]].
*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 [[anilingus]].
*[[Medical gloves]] made out of latex, vinyl, [[nitrile rubber|nitrile]], or polyurethane may be used as an makeshift dental dam during oral sex, or to protect the hands during sexual stimulation, like in [[masturbation]]. Hands may have invisible cuts on them that may admit pathogens or, more usually, serve as vehicle for contamination of other body part or partner.
*[[Medical gloves]] made out of latex, vinyl, [[nitrile rubber|nitrile]], or polyurethane may be used as an makeshift dental dam during oral sex, or to protect the hands during sexual stimulation, like in [[masturbation]]. Hands may have invisible cuts on them that may admit pathogens or, more usually, serve as vehicle for contamination of other body part or partner.
*Another way to protect against pathogen transmission is the use of protected or properly cleaned [[dildo]]s or other [[sex toy]]s. If a sex toy is to be used in more than one orifice or partner, a condom can be used over it and changed when the toy is moved.
*Another way to protect against pathogen transmission is the use of protected or properly cleaned [[dildo]]s or other [[sex toy]]s. If a sex toy is to be used in more than one orifice or partner, a condom can be used over it and changed when the toy is moved.


If any latex barrier is being used, oil-based [[Personal lubricant|lubrication]] should not be used, as this can break down the structure of the latex and remove the protection it provides.
If any latex barrier is being used, oil-based [[Personal lubricant|lubrication]] should not be used, as this can break down the structure of the latex and remove the protection it provides.
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Proper use of barriers, such as condoms, depends on the cleanness of surfaces of the barrier, care should be taken to avoid contamination of the barrier when handling it and to control contamination from used surfaces of a barrier.
Proper use of barriers, such as condoms, depends on the cleanness of surfaces of the barrier, care should be taken to avoid contamination of the barrier when handling it and to control contamination from used surfaces of a barrier.


⚫
====Limitations for HIV transmission====
⚫
=== Other Precautions ===
⚫
While the use of condoms can reduce HIV transmission, it does not do so completely. One study has suggested it might be around by a factor of 85% to 95% and questioned that effectiveness beyond 95% would be unlikely because of slippage, breakage, and incorrect use.<ref name="Varghese">Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. (2002). [http://ww2.aegis.org/files/AskDoc_refs/varghese2002-29-1.pdf Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use]. Sex Transm Dis. 29(1):38-43. PMID 11773877</ref> It also noted "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".<ref name="Varghese"/><sup>p.&nbsp;40.</sup>
⚫
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 STD transmission and unwanted pregnancy.
⚫
* [[Circumcision]] is now backed by the [[World Health Organization]] as a preventative measure against HIV. African studies have found that circumcision can reduce the transmission rate of HIV by up to 60%<ref>{{cite web |url=http://news.bbc.co.uk/2/hi/health/6502855.stm |title=WHO agrees HIV circumcision plan |accessdate=2008-07-12 |work=BBC World News |publisher=BBC |date=2007-03-03 }}</ref>. Some advocacy groups dispute these findings.<ref>[http://www.circumstitions.com/HIV-SA.html Circumcision and HIV<!-- Bot generated title -->]</ref><ref>[http://mgmbill.org/aids.htm Circumcision and AIDS<!-- Bot generated title -->]</ref>
* Periodic STD testing has been used to reduce STD infections in Cuba and among pornographic film actors. Cuba implemented a program of mandatory testing and quarantine early in the AIDS epidemic. <ref>{{cite web |url=http://www.thebody.com/content/art32967.html |title=Cuba fights AIDS in its Own Way |accessdate=2009-06-13 |work=The Body |publisher=The Body|date=2009-06-13 }}</ref> In the US pornographic film industry in the US, 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 STD's no more than 6 months old. AIM Medical foundation claims that program of testing has reduced the incidence of STD infection to 20% of that of the general population.
* [[Soap]] and [[water]] can reduce [[infectivity]] of HIV on devices, such as barrier contraceptives<ref name=soap>
{{cite journal
|title=Virucidal Efficacy of Soap and Water against Human Immunodeficiency Virus in Genital Secretions
|author=Li, J. Z.
|coauthors=E. C. Mack, and J. A. Levy.
|year=2003
|pmid=14506048
|pmc=201149
|volume=47
|issue=10
|doi=10.1128/AAC.47.10.3321-3322.2003
|pages=3321–3322
|journal=Antimicrobial Agents and Chemotherapy
}}</ref>. Douching with soap and water should be avoided because it has not been studied and by disrupting the vaginal flora it might increase risk of infection.<ref name=soap />
* [[Monogamy]] or [[polyfidelity]], practiced faithfully, is very safe (as far as STDs are concerned) when all partners are non-infected. However, many monogamous people have been infected with sexually transmitted diseases by partners who are [[sexual infidelity|sexually unfaithful]], have used injection drugs, or were infected by previous sexual partners; the same risks apply to polyfidelitous people, who face higher risks depending on how many people are in the polyfidelitous group.
* For those who are not monogamous, reducing the number of one's sexual partners, particularly anonymous sexual partners, may also reduce one's potential exposure to STDs. Similarly, one may restrict one's sexual contact to a community of trusted individuals - this is the approach taken by some [[pornographic actor]]s and other [[Forms of nonmonogamy|non-monogamous]] people.
⚫
*When selecting a sexual parter, some characteristics can increase the risks for contracting sexually transmitted diseases.<ref name="partner">{{cite doi|10.1097/OLQ.0b013e3181901e32}}</ref> These include:- an age discordance of more than five years<ref name="partner"/>; having STD in the past year<ref name="partner"/>; problems with marijuana or alcohol<ref name="partner"/>; having had sex with other people in the past year<ref name="partner"/>.
⚫
* [[Communication]] with one's 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".
⚫
* Refraining from the use of [[recreational drug]]s, including [[alcoholic beverage|alcohol]], before and during sexual activity can protect against associated risks such as lowered inhibitions, decreased immune response, impaired judgment, and loss of consciousness.
* If a person is sexually active with a number of partners, it is important that they get regular [[sexual health clinic|sexual health]] check-ups from a doctor. Anyone noticing unusual symptoms should get medical advice quickly as [[HIV]] is sometimes [[asymptomatic]] or symptoms will have a nonspecific nature and can even be misdiagnosed.<ref name=Kahn>{{cite journal
| author=Kahn, J. O. and Walker, B. D. | title=Acute Human Immunodeficiency Virus type 1 infection | journal=N. Engl. J. Med. | year=1998 | pages=33–39 | volume=331 | issue=1 | pmid=9647878 | doi=10.1056/NEJM199807023390107}}</ref><ref name="pmid11187417">{{cite journal |author=Daar ES, Little S, Pitt J, ''et al.'' |title=Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network |journal=Ann. Intern. Med. |volume=134 |issue=1 |pages=25–9 |year=2001 |pmid=11187417 |doi=}}</ref>


⚫
The risk of the receptive partner acquiring HIV from HIV seropositive partners not wearing condoms is 0.82% and from those wearing condoms is 0.18%, a four- to five-fold reduction.<ref name="Vittinghoff"/> Where the partner's HIV status is unknown, "Estimated per-contact risk of protected receptive anal intercourse with HIV-positive and unknown serostatus partners, including episodes in which condoms failed, was two thirds the risk of unprotected receptive anal intercourse with the comparable set of partners."<ref name="Vittinghoff"/><sup>p.&nbsp;310.</sup>
⚫
===Limitations===


⚫
===Other Precautions===
⚫
While the use of condoms can reduce HIV transmission, it does not do so completely. One study has suggested it might be around by a factor of 85% to 95% and questioned that effectiveness beyond 95% would be unlikely because of slippage, breakage, and incorrect use.<ref name="Varghese">Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. (2002). [http://ww2.aegis.org/files/AskDoc_refs/varghese2002-29-1.pdf Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use]. Sex Transm Dis. 29(1):38-43. PMID 11773877</ref> It also noted "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".<ref name="Varghese"/><sup>p. 40.</sup>
⚫
Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safe sex suggest that other methods be used to minimize the risks of STD transmission.


* [[Immunization]], before sexual exposure, against various viral infections that can be transmitted sexually. For example, [[HPV vaccine]], which protects against the types of [[human papillomavirus]] that are the most common causes of [[cervical cancer]], and [[Hepatitis B vaccine]].
⚫
The risk of the receptive partner acquiring HIV from HIV seropositive partners not wearing condoms is 0.82% and from those wearing condoms is 0.18%, a four- to five-fold reduction.<ref name="Vittinghoff"/> Where the partner's HIV status is unknown, "Estimated per-contact risk of protected receptive anal intercourse with HIV-positive and unknown serostatus partners, including episodes in which condoms failed, was two thirds the risk of unprotected receptive anal intercourse with the comparable set of partners."<ref name="Vittinghoff"/><sup>p. 310.</sup>
⚫
* [[Communication]] with one's 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".
⚫
* Refraining from the use of [[recreational drug]]s, including [[alcoholic beverage|alcohol]], before and during sexual activity can protect against associated risks such as lowered inhibitions, decreased immune response, impaired judgment, and loss of consciousness.
⚫
* Where condoms are not always and correctly used [[circumcision]] is backed by the [[World Health Organization]] as a preventative measure against HIV. African studies have found that circumcision can reduce the transmission rate of HIV by up to 60%<ref>{{cite web |url=http://news.bbc.co.uk/2/hi/health/6502855.stm |title=WHO agrees HIV circumcision plan |accessdate=2008-07-12 |work=BBC World News |publisher=BBC |date=2007-03-03 }}</ref>. Some advocacy groups dispute these findings.<ref>[http://www.circumstitions.com/HIV-SA.html Circumcision and HIV<!-- Bot generated title -->]</ref><ref>[http://mgmbill.org/aids.htm Circumcision and AIDS<!-- Bot generated title -->]</ref>
* Community control. In [[Cuba]] HIV testing and quarantine is mandatory to restrict sexual contact with HIV-positive individuals.<ref>{{cite web |url=http://www.thebody.com/content/art32967.html |title=Cuba fights AIDS in its Own Way |accessdate=2009-06-13 |work=The Body |publisher=The Body|date=2009-06-13 }}</ref>


== Ineffective methods ==
==Ineffective methods==
Note that most methods of contraception<!-- removed (birth control) because unless I'm wrong - which I may well be - contraception is a specific type of birth control barrier methods not falling under this category --> other than the barrier methods mentioned above are ''not'' effective at preventing the spread of STDs. This includes the "[[rhythm method]]".
Note that most methods of contraception<!-- removed (birth control) because unless I'm wrong - which I may well be - contraception is a specific type of birth control barrier methods not falling under this category --> other than the barrier methods mentioned above are ''not'' effective at preventing the spread of STDs. This includes the "[[rhythm method]]".


The [[spermicide]] [[Nonoxynol-9]] has been claimed to reduce the likelihood of STD transmission. However a recent study by the [[World Health Organization]] <ref>[http://www.who.int/reproductive-health/publications/rhr_03_8/Nonoxynol_9.pdf]</ref> 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. Condoms with Nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness and are not to be promoted.{{Fact|date=August 2009}}
The [[spermicide]] [[Nonoxynol-9]] has been claimed to reduce the likelihood of STD transmission. However a recent study by the [[World Health Organization]] <ref>[http://www.who.int/reproductive-health/publications/rhr_03_8/Nonoxynol_9.pdf]</ref> 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. Condoms with Nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness and are not to be promoted.{{Citation needed|date=August 2009}}


[[Coitus interruptus]] (or "pulling out"), in which the penis is removed from the vagina, [[anus]], or [[mouth]] before [[ejaculation]], is not safe sex and can result in STD transmission. This is because of the formation of [[pre-ejaculate]], a fluid that oozes from the [[urethra]] before actual ejaculation. In opposition to conventional wisdom, some recent studies awaiting confirmation suggest that pre-ejaculate may not contain sperm{{Fact|date=July 2008}}; it ''can'', however, contain pathogens such as HIV.<!--
[[Coitus interruptus]] (or "pulling out"), in which the penis is removed from the vagina, [[anus]], or [[mouth]] before [[ejaculation]], is not safe sex and can result in STD transmission.<ref name="HIV study">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12286905&query_hl=1&itool=pubmed_docsum Researchers find no sperm in pre-ejaculate fluid]. ''Contraceptive Technology Update''. Volume 14, Number 10, October 1993, pp.154-6.</ref><!--
--><ref name="HIV study">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12286905&query_hl=1&itool=pubmed_docsum Researchers find no sperm in pre-ejaculate fluid]. ''Contraceptive Technology Update''. Volume 14, Number 10, October 1993, pp.154-6.</ref><!--
--><ref>Zukerman, Z. et al. [http://www.ingentaconnect.com/content/klu/jarg/2003/00000020/00000004/00461193 Short Communication: Does Preejaculatory Penile Secretion Originating from Cowper's Gland Contain Sperm?] ''Journal of Assisted Reproduction and Genetics''. Volume 20, Number 4, April 2003, pp. 157-159(3).</ref>
--><ref>Zukerman, Z. et al. [http://www.ingentaconnect.com/content/klu/jarg/2003/00000020/00000004/00461193 Short Communication: Does Preejaculatory Penile Secretion Originating from Cowper's Gland Contain Sperm?] ''Journal of Assisted Reproduction and Genetics''. Volume 20, Number 4, April 2003, pp. 157-159(3).</ref>


==Dangers of anal sex==
==Specific sex practices==
⚫
=== Non-penetrative sex ===
Unprotected anal sex is a high risk activity regardless of sexual orientation. Research suggests that although gay men are more likely to engage in anal sex, heterosexual couples are more likely not to use condoms when doing so.<ref>"Gay men's dream: A 'magic' lube: Researchers discuss rectal microbicide development at NIAID workshop", Bob Roehr, (June 15, 2001) ''Bay Area Reporter'' [http://www.aegis.com/news/bar/2001/BR010617.html http://www.aegis.com/news/bar/2001/BR010617.html]</ref>
Although generally safe when talking about contraception, non-penetrative sex still carries risk of sexual transmission of [[STD]]. The risk varies depending on how much contact there's with partner genitalia and bodily fluids. Rubbing each other genitalia, for example, carries very high risk of STD infection, while a dressed individual using a latex glove to perform a [[hand job]] carries low infection risk.

===Oral sex===
{{Main|Oral sex#STD risk}}
A barrier protection, like a [[condom]] or [[Dental dam#Safe sex|Dental dam]] should be used when practicing oral sex. Oral contact should be limited to the protected areas.

If the receiving partner has wounds or open sores on their genitals, or if the giving partner has wounds or open sores on or in their mouth, or bleeding gums, this poses an increased risk of STD transmission. Brushing the teeth, flossing, undergoing dental work, or eating crunchy foods, such as chips, relatively before or after giving oral sex can also increase the risk of transmission, because all of these activities can cause small scratches in the lining of the mouth.

===Anal sex===
Anal sex is a higher risk sexual activity regardless of sexual orientation because very thin tissues of anus and [[rectum]] can be easily damaged, exposing blood and damaged tissue, increasing transmission risks. That area of the body also harbors pathogens that can be transmitted to the partner, to other areas of the body or, through the damaged tissue, to the blood system.


===Sex toys===
Anal sex is a higer risk activity than vaginal, because very thin tissues of anus and [[rectum]] can be easily damaged; this includes by the use of anal [[sex toys|toys]]. Even slight injuries can become "open gates" for various bacteria and viruses, including HIV. This implies that anal sex does require some certain safety measures. First of all, any partners who practice anal sex should be aware of the necessity of using a condom. The condom must be put on properly, otherwise it does not provide reliable protection. Users should keep in mind that oil-based lubricants damage latex. For this reason water-based [[lubricant]]s should be used for anal sex. Those who have allergy to latex should consider use of non-latex condoms, for instance polyurethane condoms that are compatible with both oil-based and water-based lubricants.
Sex toys, specially penetrative ones, should also be used with condoms (male or female) or other barrier protection. By using a protection the user provides better hygiene and reduces or prevent the transmission of infections if the sex toy is shared with another person or another area of the body. Sharing of sex toys are not recommended, however, if that's still the case a new condom must be replaced when that switch is made. Its also not recommended to use a sex toy which previous use is unknown or original packaging was violated before purchase.


Condoms should also be used with sex toys. By putting a condom on the sex toy, the user provides better hygiene and prevents transmission of infections if the sex toy is shared. However, the condom must be replaced when switching between partners. Cleaning of anal sex toys is also a very important matter as many anal sex toys are made of porous materials. Pores retain viruses and bacteria. For this reason users should clean anal toys (plugs, anal vibrators) thoroughly, preferably with use of special sex toy cleaners. Glass sex toys are more preferred for sexual uses because of their non-porous nature and ability to be sterilized between uses.
Specially when condoms are not used the cleaning of sex toys is also a very important matter as many sex toys are made of porous materials which can highly retain viruses and bacteria. For this reason users should clean sex toys thoroughly, preferably with using an antiseptic solution.


Glass sex toys are more preferred for sexual uses because of their less porous nature and ability to be heat sterilized between uses.
⚫
== Abstinence as an alternative to safe sex==
One way to avoid the risks associated with [[sexual contact]] is to maintain complete [[sexual abstinence]], which minimizes the risk of contracting [[STDs]]. Complete sexual abstinence does not guarantee complete protection against STDs, for the following reasons:


⚫
==Abstinence as an alternative==
*'''Non-sexual transmission''': STDs may also be transmitted through non-sexual means. HIV may be transmitted through contaminated needles used in [[tattoo]]ing, [[body piercing]], or [[Injection (medicine)|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.<!--
Refraining from any sexual contact with another individual is the surest way to avoid the risk of sexually contracting [[STDs]]. In that context complete [[sexual abstinence]], like [[autoeroticism]], is one of those practices that fit that definition. However, sexual abstinence is seen by critics as repressive, it is difficult to maintain for prolonged periods of time and practitioners may restrict the abstinence only to specific sexual practices they see associated with increased STD risk or with other purposes of sexual abstinence, like [[contraception]] and some definitions of [[virginity]].
--><ref name="HIV">{{cite journal | author=Do AN, Ciesielski CA, Metler RP, Hammett TA, Li J, Fleming PL | title=Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States | journal=Infect Control Hosp Epidemiol | year=2003 | pages=86–96 | volume=24 | issue=2 | pmid=12602690 | doi = 10.1086/502178}}</ref>


===Religious criticism===
*'''Non-consensual sex''': A person maintaining complete sexual abstinence may be [[rape]]d or [[sexual assault|sexually assaulted]], during which STDs may be transmitted.
{{See also|Condoms#Position of the Roman Catholic Church}}


Some religious groups, notably some [[evangelical Christians]]{{Which?|date=September 2009}} and the [[Roman Catholic Church]] oppose sex outside [[marriage]]. [[Sexual abstinence]] and [[monogamy]] are the only safe sex practices supported by those groups. These same groups strongly object the promotion of condoms as a safe sex practice which they see as promotion of sex outside [[marriage]]. Critics of those religious positions, believe those religious supported practices are not strictly followed by the members of those religious groups, which may lack or ignore safe sex information from different sources.
===Christian promotion of abstinence===
Some groups, notably some [[evangelical Christians]] and the [[Roman Catholic Church]] oppose sex outside [[marriage]], and object to safe-sex education programs because they believe that providing such education promotes [[promiscuity]]. [[Virginity pledge]]s and [[sexual abstinence]] education programs are often promoted in lieu of contraceptives and safe-sex education programs. This can place some [[teenagers]] at higher risk of unintended [[pregnancy]] and STDs, because about 60 percent of teenagers who pledge [[virginity]] until marriage do engage in pre-marital sex and are then one-third less likely to use contraceptives than their peers who have received more conventional [[sex]] education.<ref>[http://www.guttmacher.org/pubs/tgr/04/4/gr040401.html Recent Findings from The 'Add Health' Survey: Teens and Sexual Activity]</ref>


==See also==
==See also==
Line 121: Line 116:


==External links==
==External links==
{{Commonscat|Safer sex}}
{{Commons category|Safer sex}}
*[http://www.bcsviet.com/tuvan/10_bi_mat_ve_bao_cao_su_3/3.aspx Advise safer sex] - 10 articles about condoms.
*[http://www.bcsviet.com/tuvan/10_bi_mat_ve_bao_cao_su_3/3.aspx Advise safer sex] - 10 articles about condoms.
* "Guide to Safer Sex" from the [[Society for Human Sexuality]]'s sexuality.org site. Very explicit information on making various sexual practices safer:
* "Guide to Safer Sex" from the [[Society for Human Sexuality]]'s sexuality.org site. Very explicit information on making various sexual practices safer:
Line 143: Line 138:
{{STD/STI}}
{{STD/STI}}


{{DEFAULTSORT:Safe Sex}}
[[Category:Birth control]]
[[Category:Birth control]]
[[Category:HIV/AIDS]]
[[Category:HIV/AIDS]]

Revision as of 13:52, 14 September 2009

File:Laos AIDS education campaign.jpg
Poster for AIDS education campaign in Laos

Safe sex (also called safer sex) is the practice of sexual activity in a manner that lowers the risk of infection with sexually transmitted diseases (STDs). Conversely, unsafe sex or unsafer sex is the practice of sexual intercourse or other sexual contact without regard for prevention of STDs.

Safe sex practices became more prominent in the late 1980s as a result of the AIDS epidemic. Promoting safe sex is now a principal aim of sex education. From the viewpoint of society, safe sex can be regarded as a harm reduction strategy aimed at reducing risks.

The risk reduction of safe sex is not absolute; "for example, experts estimate that consistent condom use reduces the risk of HIV transmission by about 80 to 90 percent."[1]

Although some safe sex practices can be used as contraception, most forms of contraception don't protect against all or any STDs; likewise, some safe sex practices, like partner selection and low risk sex behavior, aren't effective forms of contraception.

Terminology

Recently, and mainly within Canada and the United States, the use of the term safer sex rather than safe sex has gained greater use by health workers, in order to make it clearer that these practices reduce risk of transmission along a continuum, rather than a simple dichotomy between risky and safe. However, in most other countries, including the United Kingdom and Australia, the term safe sex is still mostly used by sex educators.

Focus on condoms and HIV control

Much attention has focused on controlling HIV, the virus that causes AIDS, through the use of barrier protection for the penis, specially condoms. However, the HIV is a delicate virus, so protections focused on HIV may not protect against other STIs, which can also be transmitted through other areas of the body where the pathogen (virus or bacteria) has higher prevalence and resistance. Thus some sex educators recommend the use of barrier protection for any sexual contact with anal or vaginal cavities, or oral stimulation of those cavities or penis.[citation needed]

Safe sex precautions

Shunga print by Kunisada depicting masturbation

Sex by yourself

Known as autoeroticism, solitary sexual activity is relatively safe. Masturbation, the simple act of stimulating one's own genitalia, is a generally safe sex practice as long the object used for the stimulation, like the hand or a sex toy, is not infected or later used by someone else, and bodily fluids are not exchanged.

When stimulation of the anus is involved, specially before vagina stimulation, masturbation carries a higher risk of STD infection.

Modern technology does permit some activities, such as "phone sex" and "cybersex", that allow for partners to engage in sexual activity without being in the same room, reducing the risks involved with a sexual intercourse between partners.

Partner selection

  • Long-term mutually monogamous relationship with an uninfected partner is one of the most reliable ways to avoid transmission of sexually transmitted diseases.[2] However, many infected persons may be unaware of their infections because STDs are often asymptomatic or unrecognized,[2] partners may be sexually unfaithful or contract STD through other means, like by contact with infected blood.
  • Every relation with a new sexual partner carries a statistic risk of STD infection, which can be high or low, depending of the disease prevalence in that community. So reducing the number of sexual partners, particularly to sexual partners whose previous sexual history is known, may also reduce one's potential exposure to STDs.
  • When selecting a sexual parter, some characteristics can increase the risks for contracting sexually transmitted diseases.[3] These include: an age discordance of more than five years[3]; having STD in the past year[3]; problems with marijuana or alcohol[3]; having had sex with other people in the past year[3].
  • Request of STD testing. Tests by definition are only informative and not preventative, specially because some infections are not detectable during incubation and others stages of the disease. But requesting the results of recent STD testing is an additional information when choosing a sexual partner. This is the approach taken by some pornographic actors.

Barrier protection

Various protective devices are used to avoid contact with blood, vaginal fluid, semen or other contaminant agents (like skin, hair and shared objects) during sexual activity. Practice of sexual activity using this devices is called protected sex.

Male condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV. In addition, the same procedure, reduces the risk of diseases transmitted by genital secretions, such as gonorrhea,[4] chlamydia,[4] and trichomoniasis, and to a lesser degree, to those STDs that are primarily transmitted through contact with infected skin or mucosal surfaces, like genital human papillomavirus (HPV) infection and genital ulcer diseases, such as such as genital herpes, syphilis, and chancroid.[2]

Condom machine
  • Condoms cover the penis during sexual activity. They are most frequently made of latex, but can also be made out of polyurethane. Polyurethane is thought to be a safe material for use in condoms, since it is nonporous and viruses cannot pass through it. However, there is less research on its effectiveness than there is on latex.
  • Female condoms are inserted into the vagina prior to intercourse. They may also be used for anal sex, although they are less effective.[citation needed]
  • 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 anilingus.
  • Medical gloves made out of latex, vinyl, nitrile, or polyurethane may be used as an makeshift dental dam during oral sex, or to protect the hands during sexual stimulation, like in masturbation. Hands may have invisible cuts on them that may admit pathogens or, more usually, serve as vehicle for contamination of other body part or partner.
  • Another way to protect against pathogen transmission is the use of protected or properly cleaned dildos or other sex toys. If a sex toy is to be used in more than one orifice or partner, a condom can be used over it and changed when the toy is moved.

If any latex barrier is being used, oil-based lubrication should not be used, as this can break down the structure of the latex and remove the protection it provides.

Condoms (male or female) may be used to protect against STDs, and used with other forms of contraception to improve contraceptive effectiveness. For example, simultaneously using both the male condom and spermicide (applied separately, not pre-lubricated) is believed to reduce perfect-use pregnancy rates to those seen among implant users.[5] However, two condoms should not be used simultaneously (male condom on top of male condom, or male condom inside female condom), since this increases the chance of condom failure.[6][7]

Proper use of barriers, such as condoms, depends on the cleanness of surfaces of the barrier, care should be taken to avoid contamination of the barrier when handling it and to control contamination from used surfaces of a barrier.

Limitations for HIV transmission

While the use of condoms can reduce HIV transmission, it does not do so completely. One study has suggested it might be around by a factor of 85% to 95% and questioned that effectiveness beyond 95% would be unlikely because of slippage, breakage, and incorrect use.[8] It also noted "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".[8]p. 40.

The risk of the receptive partner acquiring HIV from HIV seropositive partners not wearing condoms is 0.82% and from those wearing condoms is 0.18%, a four- to five-fold reduction.[9] Where the partner's HIV status is unknown, "Estimated per-contact risk of protected receptive anal intercourse with HIV-positive and unknown serostatus partners, including episodes in which condoms failed, was two thirds the risk of unprotected receptive anal intercourse with the comparable set of partners."[9]p. 310.

Other Precautions

Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safe sex suggest that other methods be used to minimize the risks of STD transmission.

  • Immunization, before sexual exposure, against various viral infections that can be transmitted sexually. For example, HPV vaccine, which protects against the types of human papillomavirus that are the most common causes of cervical cancer, and Hepatitis B vaccine.
  • Communication with one's 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".
  • Refraining from the use of recreational drugs, including alcohol, before and during sexual activity can protect against associated risks such as lowered inhibitions, decreased immune response, impaired judgment, and loss of consciousness.
  • Where condoms are not always and correctly used circumcision is backed by the World Health Organization as a preventative measure against HIV. African studies have found that circumcision can reduce the transmission rate of HIV by up to 60%[10]. Some advocacy groups dispute these findings.[11][12]
  • Community control. In Cuba HIV testing and quarantine is mandatory to restrict sexual contact with HIV-positive individuals.[13]

Ineffective methods

Note that most methods of contraception other than the barrier methods mentioned above are not effective at preventing the spread of STDs. This includes the "rhythm method".

The spermicide Nonoxynol-9 has been claimed to reduce the likelihood of STD transmission. However a recent study by the World Health Organization [14] 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. Condoms with Nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness and are not to be promoted.[citation needed]

Coitus interruptus (or "pulling out"), in which the penis is removed from the vagina, anus, or mouth before ejaculation, is not safe sex and can result in STD transmission.[15][16]

Specific sex practices

Non-penetrative sex

Although generally safe when talking about contraception, non-penetrative sex still carries risk of sexual transmission of STD. The risk varies depending on how much contact there's with partner genitalia and bodily fluids. Rubbing each other genitalia, for example, carries very high risk of STD infection, while a dressed individual using a latex glove to perform a hand job carries low infection risk.

Oral sex

Main article: Oral sex § STD risk

A barrier protection, like a condom or Dental dam should be used when practicing oral sex. Oral contact should be limited to the protected areas.

If the receiving partner has wounds or open sores on their genitals, or if the giving partner has wounds or open sores on or in their mouth, or bleeding gums, this poses an increased risk of STD transmission. Brushing the teeth, flossing, undergoing dental work, or eating crunchy foods, such as chips, relatively before or after giving oral sex can also increase the risk of transmission, because all of these activities can cause small scratches in the lining of the mouth.

Anal sex

Anal sex is a higher risk sexual activity regardless of sexual orientation because very thin tissues of anus and rectum can be easily damaged, exposing blood and damaged tissue, increasing transmission risks. That area of the body also harbors pathogens that can be transmitted to the partner, to other areas of the body or, through the damaged tissue, to the blood system.

Sex toys

Sex toys, specially penetrative ones, should also be used with condoms (male or female) or other barrier protection. By using a protection the user provides better hygiene and reduces or prevent the transmission of infections if the sex toy is shared with another person or another area of the body. Sharing of sex toys are not recommended, however, if that's still the case a new condom must be replaced when that switch is made. Its also not recommended to use a sex toy which previous use is unknown or original packaging was violated before purchase.

Specially when condoms are not used the cleaning of sex toys is also a very important matter as many sex toys are made of porous materials which can highly retain viruses and bacteria. For this reason users should clean sex toys thoroughly, preferably with using an antiseptic solution.

Glass sex toys are more preferred for sexual uses because of their less porous nature and ability to be heat sterilized between uses.

Abstinence as an alternative

Refraining from any sexual contact with another individual is the surest way to avoid the risk of sexually contracting STDs. In that context complete sexual abstinence, like autoeroticism, is one of those practices that fit that definition. However, sexual abstinence is seen by critics as repressive, it is difficult to maintain for prolonged periods of time and practitioners may restrict the abstinence only to specific sexual practices they see associated with increased STD risk or with other purposes of sexual abstinence, like contraception and some definitions of virginity.

Religious criticism

See also: Condoms § Position of the Roman Catholic Church

Some religious groups, notably some evangelical Christians[which?] and the Roman Catholic Church oppose sex outside marriage. Sexual abstinence and monogamy are the only safe sex practices supported by those groups. These same groups strongly object the promotion of condoms as a safe sex practice which they see as promotion of sex outside marriage. Critics of those religious positions, believe those religious supported practices are not strictly followed by the members of those religious groups, which may lack or ignore safe sex information from different sources.

See also

References

  1. ^ Cite error: The named reference Steiner was invoked but never defined (see the help page).
  2. ^ a b c "Condoms and STDs: Fact Sheet for Public Health Personnel". Centers for Disease Control and Prevention. July 15, 2009. Retrieved 2009-09-13.
  3. ^ a b c d e Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1097/OLQ.0b013e3181901e32, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1097/OLQ.0b013e3181901e32 instead.
  4. ^ a b Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 16385221, please use {{cite journal}} with |pmid=16385221 instead.
  5. ^ Kestelman P, Trussell J (1991). "Efficacy of the simultaneous use of condoms and spermicides". Fam Plann Perspect. 23 (5): 226–7, 232. doi:10.2307/2135759. PMID 1743276.
  6. ^ "Does using two condoms provide more protection than using just one condom?". Condoms and Dental Dams. New York University Student Health Center. Retrieved 2008-06-30.
  7. ^ "Are two condoms better than one?". Go Ask Alice!. Columbia University. 2005-01-21. Retrieved 2008-06-30.
  8. ^ a b Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW. (2002). Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Dis. 29(1):38-43. PMID 11773877
  9. ^ a b Cite error: The named reference Vittinghoff was invoked but never defined (see the help page).
  10. ^ "WHO agrees HIV circumcision plan". BBC World News. BBC. 2007-03-03. Retrieved 2008-07-12.
  11. ^ Circumcision and HIV
  12. ^ Circumcision and AIDS
  13. ^ "Cuba fights AIDS in its Own Way". The Body. The Body. 2009-06-13. Retrieved 2009-06-13.
  14. ^ [1]
  15. ^ Researchers find no sperm in pre-ejaculate fluid. Contraceptive Technology Update. Volume 14, Number 10, October 1993, pp.154-6.
  16. ^ Zukerman, Z. et al. Short Communication: Does Preejaculatory Penile Secretion Originating from Cowper's Gland Contain Sperm? Journal of Assisted Reproduction and Genetics. Volume 20, Number 4, April 2003, pp. 157-159(3).
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