Safer Sex Guidelines

There are a few reasons why safer sex is so important.  The first and most dramatic reason is that safer sex reduces the risk of transmitting STDs (Sexually Transmitted Diseases) to your sexual partner.  The second reason is to prevent unwanted pregnancies; birth control.  The purpose to this safer sex guide is to give factual information to help you make safer sex choices that work for you, so you can have the best sex possible. 

Safer sex became a huge concern in the homosexual community in the 1980's when we became aware of the HIV/AIDS (Acquired Immune Deficiency Syndrome) epidemic among gay and bisexual men.  In the years since HIV/AIDS has become the worst global health crisis we have ever faced - now afflicting people regardless of sexual orientation or gender.

Besides HIV there are other sexually transmissible diseases, such as Chlamydia, Gonorrhea, genital warts, and Hepatitis A, B, & C. Although there are some differences between how these diseases are transmitted, the safer sex information presented in this article is equally effective in reducing the risk of infection of these STD's.   

Level of Risk

There are different levels of risk for transmission of a STD.

HIV

HIV is a retro virus that destroys the immune system in human beings and leaves the body vulnerable to other infections.  HIV also affects the nervous system, which in it's advanced stage is known as AIDS dementia.   

The HIV virus enters the body through body fluids such as blood and semen and once inside the body the HIV virus attaches to cells and begins to replicate.  The HIV virus can remain dormant for a long period of time before it begins to multiply, but when it does start to replicate, it does so quickly.

There is no cure for HIV at present; once HIV is inside the body there is no way to kill the virus.  Outside of the body the HIV virus can be killed quite easily.  The virus is killed immediately when exposed to soap & water, bleach, and the spermicidal lubricant, nonoxynol-9.  Using condoms with nonoxynol-9 is an additional step to reducing HIV transmission risk during sexual activity.

Chlamydia

Chlamydia is transmitted via sexual contact and is caused by the Chlamydia trachomatis bacterium.  Symptoms of Chlamydia in women can include an unusual vaginal discharge, vaginal bleeding, and abdominal pain.  In men symptoms may include a penile discharge, a burning sensation when  urinating, and/or swollen testicles.  Chlamydia is easily treated with antibiotics.  

Hepatitis A, B, & C

Hepatitis A is a liver disease caused by the hepatitis A virus and is spread from person to person by putting something in the mouth that has bee contaminated by the feces of someone infected with the Hepatitis A virus, or through sexual contact with a person infected with Hepatitis A.   Casual contact, such as hand shaking, hugging, etc., does not spread the virus.  Symptoms of Hepatitis A include, jaundice, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, and fever. There is no chronic long term infection with hepatitis A, and once you've had hepatitis A you cannot get it again.  In some cases people infected with Hepatitis A can have symptoms over a 6-9 month period.

There are vaccinations available through your doctor that prevent hepatitis A infection.  Using condoms and barriers to prevent body fluid transfer during sex will also reduce, but not eliminate, the risk of transmitting hepatitis A.

For more information on hepatitis a visit: http://www.cdc.gov/ncidod/diseases/hepatitis/a/fact.htm

Hepatitis B is a liver disease caused by the hepatitis B virus and occurs when the Hepatitis B virus is transmitted through the body fluids of an infected person to a person that is not immune to Hepatitis B.  Symptoms of hepatitis B include jaundice, fatigue, abdominal pain, loss of appetite, vomiting, and joint pain.  The groups that are most at risk are people who have multiple sex partners, homosexual and bisexual men, injection drug users, and health care workers.  The best way to prevent hepatitis B is by getting the Hepatitis B vaccination.  Using condoms and barriers to prevent body fluid transfer during sex will also reduce, but not eliminate, the risk of transmitting hepatitis B.  About a quarter of people infected with hepatitis B develop a chronic hepatitis B infection which can lead to cirrhosis of the liver, liver failure and death.  People who suffer from cirrhosis also have a higher incidence of developing liver cancer. (The Gay Men's Wellness Guide:  The National Lesbian and Gay Health Association's complete Book of Physical, Emotional, and Mental health and well being for every gay male - by Rovery E. penn.  Hentry Holt and Co, N, NY published   by owl books 1997)

For more information on hepatitis C visit: http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm

Hepatitis C is a liver disease caused by the hepatitis C virus.  Upwards of 75-85 percent of people infected with Hepatitis C develop a chronic infection and 70 percent of people with Hepatitis C develop chronic liver disease.  (Center for Disease Control - http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm).  Hepatitis C is primarily transmitted through sharing needles used by persons infected with Hepatitis C, and from infected mother to child during birth.  While it is rare for  Hepatitis C to be spread through sexual contact, using a condom or barrier during sexual interaction will further reduce the risk of transmitting the disease.  Never share sharing needles with anyone and never share personal items that have blood on them.

Kissing

Whether or not swapping spit when kissing can transmit HIV is a controversial topic.  According to The Institute for Advanced Study of Human Sexuality (1999), The general rule remains that when the mouths of the individuals kissing are healthy, kissing is safe.  However, an often overlooked problem is that people who are in advanced stages of HIV disease... overwhelmingly have chronic bleeding conditions in their mouths... This is why oral contact is in the Probably Safe, Possibly Risky category." (p. 57-58)

Breaks in skin on hands, face, etc.

Herpes Simplex can be transmitted easily through facial-facial, and facial genital, contact with someone who has an active case of herpes.  There is also a risk of transmitting AIDS through broken skin on the hands or face.   Safer sex practices to reduce the risk of transmitting an STD include wearing latex gloves for fisting, mutual masturbation, or any insertive activity.  Using a barrier between the face and genitalia will also reduce the risk of std transmission.  if someone has a cold sore on his/her face, don't kiss them!

Oral sex

In general the risk of catching an STD through oral sex is much lower for unprotected sex than for unprotected vaginal or anal intercourse.  The risk of passing infection through oral sex is increases when there are skin breaks inside the mouth of the person who is performing oral sex or on the penis of the person receiving.  Infection can pass through the skin break and into the blood stream.  There is also risk of a bacterial infection in the mouth and throat, such as Chlamydia and Syphilis, when you perform oral sex on someone who has such an infection.  While bacterial infections are unpleasant, they can be treated using antibiotics.  

The best way to ensure the lowest risk of transmitting an STD via oral sex is to use a condom or other barriers between your mouth and your partner's genitals.  If you choose not to use a condom or barrier, you can reduce the chance of transmitting STD's by not allowing your male partner to cum in your mouth, and by not going down on a woman while she is menstruating.  Semen and menstrual blood are the means by which HIV and hepatitis are transmitted to one's sexual partner.

Many people choose not to use the barrier method for oral sex because they feel that barriers reduce the sensations of oral sex and it doesn't feel as good as skin to skin contact.  Latex condoms are the best for going down on cock.  To increase sensation, use a water based lube such as Probe and let the mans cock down before you put the condom on.  the lube inside the condom will give more of a sliding sensation and will feel a hell of a lot better than if it was dry inside.

When going down on a women, the same principle applies.  Putting lube on her clit and vagina before you put the dental dam or barrier over her vagina will give her much more sensation than without lube.  Make sure to have a large enough barrier that there's no risk of fluid transmission.

Vaginal Sex

The number of cases of HIV transmitted by penis/vaginal intercourse is low compared to transmission between penis and anus.  Still, penile-vaginal intercourse is considered a high risk activity for both the person with the penis, and the person with the vagina. Pay careful attention to this; both people are at risk.  HIV and hepatitis can be transmitted through the man's semen coming in contact with the mucous membrane in the vagina, especially if there are microscopic tears or sores inside the vagina.  Let's face it, vigorous sex can often cause minor teats inside the vagina.  Men are also at risk, even though researchers have not come up with a full explanation of how HIV and Hepatitis are transmitted from the vagina to the penis.  The standard accepted idea is that microscopic tears on the penis, or urethral swelling inside the penis could allow the virus access to the blood stream.

The risk can be reduced by using condoms with a spermicidal lubricant.  Risk can further be reduced by the man removing his penis from the vagina before he orgasms so that all of the semen remains outside her body, while still wearing a condom.  Be creative - find a new place to orgasm.  

The rhythm method is neither recommended, nor safe, for preventing pregnancy or as a safer sex method.  

Anal Sex

Anal intercourse is the highest risk of all sexual activities.  As with Penile-vaginal intercourse, the risk can be reduced for transmitting an STD through using condoms with spermicidal lubricant.  According to the Canadian Aids Society (1994) there is a higher risk to the receptive partner than the insertive partner, but the insertive person is also at risk.  All of the recommendations for safer sex with Penile-Vaginal intercourse are the same for Penile-anal intercourse.  

BDSM Activities

Most BDSM activities are safe in terms of  STD transmission.  As with sexual practices, the risk increases if blood, semen, or bodily fluids come into contact, with any mucous membranes, anus, vagina, or an open cut or sore, with you or your partner.  

Water Sports

The risk of transmitting HIV via urine on unbroken skin on the external portion of the body poses no risk (Canadian Aids Society, 1994, p. 20).  Ingesting urine carries a "theoretical risk" (ibid) of STD transmission and is considered very low risk activity.

Condoms

Always use latex condoms, and use them before the expiry date. 

Use water based lubricants with latex condoms.  Oil based lubricants (petroleum jelly, cooking oils) break down latex condoms and make them weaker.  

Only use a condom once.  You can't wash them and reuse them.  Bad idea.  

It's easier to put a condom on if your cock is erect.  If you put a drop of lube on the tip of your penis or in the tip of the inside of the condom before you roll it on, it'll give the head of the penis more sensation.  If you have an intact foreskin, retract it before you put the condom on.  Feels much better that way.

Check regularly during intercourse to make sure the condom hasn't broken or slipped off.  Besides the fact that it's safer sex, it can be a tad challenging to fish a condom out of a vagina, depending on how far back it's been pushed.

Photos to come soon on how to use a condom.

Female Condom

The female condom is made of polyurethane, which has been shown as an effective barrier to the HIV virus.  

Photos to come soon on how to use the female condom.

Diaphragms

Diaphragms and sponges are not effective methods of blocking the transmission of the HIV virus (Canadian Aids Society, 1994).  

Treatment and Testing

If you feel you may have had high risk contact that has exposed you to an STD, contact your doctor and ask what the appropriate tests might include. 

If you want to stop using barriers with you and a fidelitous long term partner, also speak to your doctor about getting tested before stopping using barriers when having sex.  

Vaccinations

There are currently vaccines for hepatitis A and B.  If you have not been vaccinated and engage in rimming or intercourse with no barrier, speak to your doctor about getting the vaccinations for both Hepatitis A and B.

Safer Sex Kits

I think it's always a good idea to carry safer sex supplies in any situation where there's even a slight possibility you could have sex.  This could include 3 or 4 condoms, a small bottle of water based lube, a few dental dams, and some gloves.

If you're planning an orgy, I recommend providing safer sex supplies rather than relying on participants to bring their own.   

(c) D. Raven 2004

Sources

Canadian Aids Society.  Safer Sex Guidelines:  Healthy Sexuality and HIV: a resource guide for educators and counselors. Ottawa, Canadian Aids Society.  1994.

Center for Disease Control. "Viral Hepatitis." 2003. http://www.cdc.gov/ncidod/diseases/hepatitis/ (14 Jan 2004).

Engender Health. "Chlamydia". 2003. http://www.engenderhealth.org/wh/inf/dchl.html (13 Jan 2004)

Lerman, Evelyn.  Safer Sex; The New Morality. California, Morning Glory Press, 2000.

Penn, Robert E.  The Gay Men's Wellness Guide: The National Lesbian and Gay Health Association's complete Book of Physical, Emotional, and Mental health and well being for every gay male. New York, Henry Holt and Co.  1997.

The Institute for Advanced Study of human Sexuality. The Complete Guide to Safer Sex. Ed. McIlvenna, Ted.  New York: Barricade Books, 1999. 

Worden, Jeni, Dr. "Chlamydia Infections". 2000.  http://www.netdoctor.co.uk/diseases/facts/chlamydia.htm (13 Jan 2004)