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Safe sex is
sexual activity Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts, ranging from activities done alone (e.g., masturbation) ...
using methods or contraceptive devices (such as
condoms A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both male and female condoms. With proper use—and use at every act of inte ...
) to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
. "Safe sex" is also sometimes referred to as safer sex or protected sex to indicate that some safe sex practices do not eliminate STI risks. It is also sometimes used colloquially to describe methods aimed at preventing pregnancy that may or may not also lower STI risks. The concept of "safe sex" emerged in the 1980s as a response to the global AIDS epidemic, and possibly more specifically to the
AIDS crisis The AIDS epidemic, caused by HIV (Human Immunodeficiency Virus), found its way to the United States between the 1970s and 1980s, but was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in homosexual ...
in the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
. Promoting safe sex is now one of the main aims of
sex education Sex education, also known as sexual education, sexuality education or sex ed, is the instruction of issues relating to human sexuality, including emotional relations and responsibilities, human sexual anatomy, sexual activity, sexual reproduc ...
and STI prevention, especially reducing new HIV infections. Safe sex is regarded as a
harm reduction Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to d ...
strategy aimed at reducing the risk of STI transmission. Although some safe sex practices (like
condoms A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both male and female condoms. With proper use—and use at every act of inte ...
) can also be used as birth control (''contraception''), most forms of contraception do not protect against STIs. Likewise, some safe sex practices, such as partner selection and low-risk sex behavior, might not be effective forms of contraception.


History

Although strategies for avoiding STIs like syphilis and
gonorrhea Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium ''Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with u ...
have existed for centuries and the term "safe sex" existed in English as early as the 1930s, the use of the term to refer to STI-risk reduction dates to the mid-1980s in the United States. It emerged in response to the HIV/AIDS crisis. A year before the HIV virus was isolated and named, the San Francisco chapter of the Sisters of Perpetual Indulgence published a small pamphlet titled ''Play Fair!'' out of concern over widespread STIs among the city's gay male population. It specifically named illnesses (Kaposi's sarcoma and pneumocystis pneumonia) that would later be understood as symptoms of advanced HIV disease (or AIDS). The pamphlet advocated a range of safe-sex practices, including abstinence, condoms, personal hygiene, use of personal lubricants, and STI testing/treatment. It took a casual, sex-positive approach while also emphasizing personal and social responsibility. In May 1983—the same month HIV was isolated and named in France—the New York City-based HIV/AIDS activists Richard Berkowitz and Michael Callen published similar advice in their booklet, '' How to Have Sex in an Epidemic: One Approach''. Both publications included recommendations that are now standard advice for reducing STI (including HIV) risks. Safe sex as a form of STI risk reduction appeared in journalism as early as 1984, in the British publication ''The Daily Intelligencer'': "The goal is to reach about 50 million people with messages about safe sex and AIDS education." Although ''safe sex'' is used by individuals to refer to protection against both
pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...
and HIV/AIDS or other STI transmissions, the term was born in response to the HIV/AIDS epidemic. It is believed that the term ''safe sex'' was used in the professional literature in 1984, in the content of a paper on the psychological effect that HIV/AIDS may have on gay and bisexual men. A year later, the same term appeared in an article in ''
The New York Times ''The New York Times'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid ...
.'' 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 fluid exchange, and resisting the use of
drug A drug is any chemical substance that causes a change in an organism's physiology or psychology when consumed. Drugs are typically distinguished from food and substances that provide nutritional support. Consumption of drugs can be via insuffla ...
s that reduced inhibitions for high-risk sexual behavior. Moreover, in 1985, the first 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 Anal may refer to: Related to the anus *Related to the anus of animals: ** Anal fin, in fish anatomy ** Anal vein, in insect anatomy ** Anal scale, in reptile anatomy *Related to the human anus: ** Anal sex, a type of sexual activity involving s ...
or
oral sex Oral sex, sometimes referred to as oral intercourse, is sexual activity involving the stimulation of the genitalia of a person by another person using the mouth (including the lips, tongue, or teeth) and the throat. Cunnilingus is oral sex p ...
. Although the term ''safe sex'' was primarily used in reference to sexual activity between men, 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 partner's sexual history and limiting the number of
sexual partner Sexual partners are people who engage in sexual activity together. The sexual partners may be in a committed relationship, either on an exclusive basis or not, or engage in the sexual activity on a casual basis. They may be on intimate terms ...
s. The first book on this subject appeared in the same year. The book was entitled "Safe Sex in the Age of AIDS", and had 88 pages that described both positive and negative approaches to sexual life. Sexual behavior could be safe (
kiss A kiss is the touch or pressing of one's lips against another person or an object. Cultural connotations of kissing vary widely. Depending on the culture and context, a kiss can express sentiments of love, passion, romance, sexual attraction, ...
ing,
hug A hug is a form of endearment, universal in most human communities, in which two or more people put their arms around the neck, back, or waist of one another and hold each other closely. If more than two people are involved, it may be referre ...
ging,
massage Massage is the manipulation of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In E ...
, body-to-body rubbing,
mutual masturbation Non-penetrative sex or outercourse is sexual activity that usually does not include sexual penetration. It generally excludes the penetrative aspects of vaginal, anal, or oral sexual activity, but includes various forms of sexual and non-sex ...
, exhibitionism, phone sex, and use of separate
sex toy A sex toy is an object or device that is primarily used to facilitate human sexual pleasure, such as a dildo, artificial vagina or vibrator. Many popular sex toys are designed to resemble human genitals, and may be vibrating or non-vibratin ...
s); possibly safe (use of condoms); or unsafe. 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 A television advertisement (also called a television commercial, TV commercial, commercial, spot, television spot, TV spot, advert, television advert, TV advert, television ad, TV ad or simply an ad) is a span of television programming produce ...
featuring condoms. During the same year, the
Catholic Church The Catholic Church, also known as the Roman Catholic Church, is the largest Christian church, with 1.3 billion baptized Catholics worldwide . It is among the world's oldest and largest international institutions, and has played a ...
in the United States issued their own "safer sex" guidelines on which condoms were listed, though two years later the
Vatican Vatican may refer to: Vatican City, the city-state ruled by the pope in Rome, including St. Peter's Basilica, Sistine Chapel, Vatican Museum The Holy See * The Holy See, the governing body of the Catholic Church and sovereign entity recognized ...
urged
chastity Chastity, also known as purity, is a virtue related to temperance. Someone who is ''chaste'' refrains either from sexual activity considered immoral or any sexual activity, according to their state of life. In some contexts, for example when ma ...
and
heterosexual Heterosexuality is romantic attraction, sexual attraction or sexual behavior between people of the opposite sex or gender. As a sexual orientation, heterosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" ...
marriage, attacking the American Catholic bishops' guidelines. A study carried out in 2006 by Californian specialists showed that the most common definitions 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). The term ''safer sex'' in Canada and the United States has gained greater use by health workers, reflecting that risk of transmission of sexually transmitted infections in various
sexual activities Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts, ranging from activities done alone (e.g., masturbation) t ...
is a
continuum Continuum may refer to: * Continuum (measurement), theories or models that explain gradual transitions from one condition to another without abrupt changes Mathematics * Continuum (set theory), the real line or the corresponding cardinal number ...
. The term ''safe sex'' is still in common use in the United Kingdom, Australia and New Zealand. "Safer sex" is thought to be a more aggressive term which may make it more obvious to individuals that any type of sexual activity carries a certain degree of risk. The term ''safe love'' has also been used, notably by the French
Sidaction Sidaction is a major French public event that started in 1994 in France for raising awareness and collecting charitable funds for AIDS. It donates important sums to various AIDS charities, HIV/AIDS research, institutions specializing in medical c ...
in the promotion of men's underpants incorporating a condom pocket and including the red ribbon symbol in the design, which were sold to support the charity.


Practices

A range of safe-sex practices are commonly recommended by sexual health educators and public health agencies. Many of these practices can reduce (but not eliminate) risk of transmitting or acquiring STIs.


Phone sex/cybersex/sexting

Sexual activities, such as phone sex,
cybersex Cybersex, also called computer sex, Internet sex, netsex and, colloquially, cyber or cybering, is a virtual sex encounter in which two or more people have long distance sex via electronic video communication (webcams, VR headsets, etc) and other e ...
, and
sexting Sexting is sending, receiving, or forwarding sexually explicit messages, photographs, or videos, primarily between mobile phones. It may also include the use of a computer or any digital device. The term was first popularized early in the 21st ...
, that do not include direct contact with the skin or bodily fluids of sexual partners, carry no STI risks and, thus, are forms of safe sex.


Non-penetrative sex

A range of sex acts called "non-penetrative sex" or "outercourse" can significantly reduce STI risks. Non-penetrative sex includes practices such as kissing, mutual masturbation, rubbing or stroking. 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 via skin-to-skin contact, such as
herpes Herpes simplex is a viral infection caused by the herpes simplex virus. Infections are categorized based on the part of the body infected. Oral herpes involves the face or mouth. It may result in small blisters in groups often called cold ...
and
human papilloma virus Human papillomavirus infection (HPV infection) is caused by a DNA virus from the '' Papillomaviridae'' family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and r ...
. Mutual or partnered masturbation carries some STI risk, especially if there is skin contact or shared bodily fluids with sexual partners, although the risks are significantly lower than many other sexual activities.


Condoms, dental dams, gloves

Barriers, such as condoms, dental dams, and medical gloves can prevent contact with body fluids (such as
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
,
vaginal fluid Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amo ...
,
semen Semen, also known as seminal fluid, is an organic bodily fluid created to contain spermatozoa. It is secreted by the gonads (sexual glands) and other sexual organs of male or hermaphroditic animals and can fertilize the female ovum. Sem ...
, rectal mucus), and other means of transmitting STIs (like skin, hair and shared objects) during sexual activity. * External condoms can be used to cover the penis, hands, fingers, or other body parts during sexual penetration or stimulation. They are most frequently made of
latex Latex is an emulsion (stable dispersion) of polymer microparticles in water. Latexes are found in nature, but synthetic latexes are common as well. In nature, latex is found as a milky fluid found in 10% of all flowering plants (angiosperms ...
, and can also be made out of synthetic materials including
polyurethane Polyurethane (; often abbreviated PUR and PU) refers to a class of polymers composed of organic units joined by carbamate (urethane) links. In contrast to other common polymers such as polyethylene and polystyrene, polyurethane is produced from ...
and
polyisoprene Polyisoprene is strictly speaking a collective name for polymers that are produced by polymerization of isoprene. In practice polyisoprene is commonly used to refer to synthetic ''cis''-1,4-polyisoprene, made by the industrial polymerisation of i ...
. * Internal condoms (also called
female condom An internal condom (also known as a femidom or female condom) is a barrier device that is used during sexual intercourse as a barrier contraceptive to reduce the probability of pregnancy or a sexually transmitted infection (STI). Meant as an al ...
s) are inserted into the
vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
or anus prior to sexual penetration. These condoms are made of either polyurethane or nitrile. If external and internal condoms are used at the same time, they may break due to friction between the materials during sexual activity. * A
dental dam A dental dam or rubber dam is a thin, square sheet, usually latex or nitrile, used in dentistry to isolate the operative site (one or more teeth) from the rest of the mouth. Sometimes termed "Kofferdam" (from German), it was designed in the U ...
(originally used in dentistry) is a sheet of latex used for protection when engaging in
oral sex Oral sex, sometimes referred to as oral intercourse, is sexual activity involving the stimulation of the genitalia of a person by another person using the mouth (including the lips, tongue, or teeth) and the throat. Cunnilingus is oral sex p ...
. It is typically used as a barrier between the mouth and the
vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, vestibular bulbs, vulv ...
during
cunnilingus Cunnilingus is an oral sex act performed by a person on the vulva or vagina of another person. The clitoris is the most sexually sensitive part of the human female genitalia, and its stimulation may result in a woman becoming sexually aroused ...
or between the mouth and the anus during
anal–oral sex Anilingus (from the Latin ''anus'' + ''-lingus'', from ''lingere'', "to lick", variantly spelled "analingus") is the oral and anal sex act in which a person stimulates the anus of another by using the mouth, including lips, tongue, or teeth. ...
. *
Medical glove Medical gloves are disposable gloves used during medical examinations and procedures to help prevent cross-contamination between caregivers and patients. Medical gloves are made of different polymers including latex, nitrile rubber, polyvinyl ...
s made out of latex, vinyl, nitrile, or polyurethane may be used as a makeshift dental dam during oral sex, or can cover hands, fingers, or other body parts during penetration or sexual stimulation, such as masturbation. * Condoms, dental dams, and gloves can also be used to cover
sex toys A sex toy is an object or device that is primarily used to facilitate human sexual pleasure, such as a dildo, artificial vagina or vibrator. Many popular sex toys are designed to resemble human genitals, and may be vibrating or non-vibratin ...
such as
dildo A dildo is a sex toy, often explicitly phallic in appearance, intended for sexual penetration or other sexual activity during masturbation or with sex partners. Dildos can be made from a number of materials and shaped like an erect human p ...
s during sexual stimulation or penetration. If a sex toy is to be used in more than one orifice or partner, a condom/dental dam/glove can be used over it and changed when the toy is moved. Oil-based
lubrication Lubrication is the process or technique of using a lubricant to reduce friction and wear and tear in a contact between two surfaces. The study of lubrication is a discipline in the field of tribology. Lubrication mechanisms such as fluid-lubric ...
can break down the structure of latex condoms, dental dams or gloves, reducing their effectiveness for STI protection. While use of external condoms can reduce STI risks during sexual activity, they are not 100% effective. One study has suggested condoms might reduce HIV transmission by 85% to 95%; effectiveness beyond 95% was deemed unlikely because of slippage, breakage, and incorrect use. It also said, "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".p. 40.


Pre-exposure prophylaxis (PrEP)

Pre-exposure prophylaxis Pre-exposure prophylaxis (PrEP) is the use of medications to prevent the spread of disease in people who have not yet been exposed to a disease-causing agent, usually a virus. The term typically refers to the use of antiviral drugs as a strateg ...
(often abbreviated as ''PrEP'') is the use of prescription drugs by those who do not have HIV to prevent HIV infection. PrEP drugs are taken ''prior'' to HIV exposure to prevent the transmission of the virus, usually between sexual partners. PrEP drugs do not prevent other STI infections or pregnancy. As of 2018, the most-widely approved form of ''PrEP'' combines two drugs (tenofovir and emtricitabine) in one pill. That drug combination is sold under the brand name
Truvada Emtricitabine/tenofovir, sold under the brand name Truvada among others, is a fixed-dose combination antiretroviral medication used to treat and prevent HIV/AIDS. It contains the antiretroviral medications emtricitabine and tenofovir disoprox ...
by Gilead Sciences. It is also sold in generic formulations worldwide. Other drugs and modalities are being studied for use as PrEP. Different countries have approved different protocols for using the tenofovir/emtricitabine-combination drug as ''PrEP''. That two-drug combination has been shown to prevent HIV infection in different populations when taken daily, intermittently, and on demand. Numerous studies have found the tenofovir/emtricitabine combination to be over 90% effective at preventing HIV transmission between sexual partners.


Treatment as prevention

Treatment as Prevention (often abbreviated as ''TasP'') is the practice of testing for and treating HIV infection as a way to prevent further spread of the virus. Those having knowledge of their HIV-positive status can use safe-sex practices to protect themselves and their partners (such as using condoms, sero-sorting partners, or choosing less-risky sexual activities). And, because HIV-positive people with durably suppressed or undetectable amounts of HIV in their blood ''cannot transmit HIV to sexual partners'', sexual activity with HIV-positive partners on effective treatment is a form of safe sex (to prevent HIV infection). This fact has given rise to the concept of "U=U" ("Undetectable = Untransmittable").


Other forms of safe sex

Other methods proven effective at reducing STI risks during sexual activity are: *
Immunization Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an infectious agent (known as the immunogen). When this system is exposed to molecules that are foreign to the body, called ''non-se ...
against certain sexually-transmitted viruses. The most common vaccines protect against
hepatitis B Hepatitis B is an infectious disease caused by the '' Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no symptoms during an initial infection. ...
and human papilloma virus (HPV), which can cause cervical cancer,
penile cancer Penile cancer is cancer that develops in the skin or tissues of the penis. Symptoms may include abnormal growth, an ulcer or sore on the skin of the penis, and bleeding or foul smelling discharge. Risk factors include phimosis (inability to retr ...
,
oral cancer Oral cancer, also known as mouth cancer, is cancer of the lining of the lips, mouth, or upper throat. In the mouth, it most commonly starts as a painless white patch, that thickens, develops red patches, an ulcer, and continues to grow. When on ...
, and
genital warts Genital warts are a sexually transmitted infection caused by certain types of human papillomavirus (HPV). They are generally pink in color and project out from the surface of the skin. Usually they cause few symptoms, but can occasionally be pai ...
. Immunization before initiation of sexual activity increases effectiveness of these vaccines. HPV vaccines are recommended for all teen girls and women as well as teen boys and men through age 26 and 21 respectively. * Limiting numbers of sexual partners, particularly casual sexual partners, or restricting sexual activity to those who know and share their STI status, can also reduce STI risks.
Monogamy Monogamy ( ) is a form of dyadic relationship in which an individual has only one partner during their lifetime. Alternately, only one partner at any one time (serial monogamy) — as compared to the various forms of non-monogamy (e.g., polyga ...
or
polyfidelity Polyfidelity is a form of non-monogamy, a romantic relationship structure in which all members are considered equal partners and agree to restrict sexual and/or romantic activity only to other members of the group. Origin The practices and b ...
, 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 polyfidelitous people, who face higher risks depending on how many people are in the polyfidelitous group. *
Communication Communication (from la, communicare, meaning "to share" or "to be in relation with") is usually defined as the transmission of information. The term may also refer to the message communicated through such transmissions or the field of inquir ...
with sexual partners about sexual history and STI status, preferred safe sex practices, and acceptable risks for partnered sexual activities. * Engaging in less-risky sexual activities. In general, solo sexual activities are less risky than partnered activities. Sexual penetration of orifices (mouth, vagina, anus) and sharing body fluids (such as semen, blood, vaginal fluids, and rectal mucus) between sexual partners carry the most risk for STIs. * Regular STI testing and treatment, especially by those who are sexually active with more than one casual sexual partner. It is possible to attain and show proof of STD-free-verification through online dating apps and websites. * Penile circumcision. Some research suggests that circumcising (removing) the foreskin of the penis can reduce the risk of contracting HIV. Some advocacy groups dispute these findings.


Ineffective methods


General

Most methods of contraception are not effective at preventing the spread of STIs. This includes birth control pills,
vasectomy Vasectomy, or vasoligation, is an elective surgical procedure for male sterilization or permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into the urethra and ...
,
tubal ligation Tubal ligation (commonly known as having one's "tubes tied") is a surgical procedure for female sterilization in which the fallopian tubes are permanently blocked, clipped or removed. This prevents the fertilization of eggs by sperm and thus th ...
, periodic abstinence,
IUD An intrauterine device (IUD), also known as intrauterine contraceptive device (IUCD or ICD) or coil, is a small, often T-shaped birth control device that is inserted into the uterus to prevent pregnancy. IUDs are one form of long-acting rever ...
s and many non-barrier methods of pregnancy prevention. However,
condoms A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both male and female condoms. With proper use—and use at every act of inte ...
, when used correctly, significantly reduces the risks of STI transmission and unwanted pregnancy. The
spermicide Spermicide is a contraceptive substance that destroys sperm, inserted vaginally prior to intercourse to prevent pregnancy. As a contraceptive, spermicide may be used alone. However, the pregnancy rate experienced by couples using only spermicid ...
nonoxynol-9 Nonoxynol-9, sometimes abbreviated as N-9, is an organic compound that is used as a surfactant. It is a member of the nonoxynol family of nonionic surfactants. N-9 and related compounds are ingredients in various cleaning and cosmetic products ...
has been claimed to reduce the likelihood of STI transmission. However, a technical report by the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
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
pathogen In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...
s more easy points of entry into the system. They reported that nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness cautioned they should not be promoted. There is no evidence that spermicidal condoms are better at preventing STD transmission compared to condoms that do not have spermicide. If used properly, spermicidal condoms can prevent pregnancy, but there is still an increased risk that nonoxynyl-9 can irritate the skin, making it more susceptible for infections. The use of a diaphragm or
contraceptive sponge The contraceptive sponge combines barrier and spermicidal methods to prevent conception. Sponges work in two ways. First, the sponge is inserted into the vagina, so it can cover the cervix and prevent any sperm from entering the uterus. Secondly ...
provides some women with better protection against certain sexually transmitted diseases, but they are not effective for all STIs. Hormonal methods of preventing pregnancy (such as oral contraceptives .e. 'The pill' depoprogesterone, hormonal IUDs, the vaginal ring, and the patch) offer no protection against STIs. The copper intrauterine device and the hormonal intrauterine device provide an up to 99% protection against pregnancies but no protection against STIs. Women with copper intrauterine device ''may'' be subject to greater risk of infection from bacterial infectious such as
gonorrhea Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium ''Neisseria gonorrhoeae''. Infection may involve the genitals, mouth, or rectum. Infected men may experience pain or burning with u ...
or
chlamydia Chlamydia, or more specifically a chlamydia infection, is a sexually transmitted infection caused by the bacterium '' Chlamydia trachomatis''. Most people who are infected have no symptoms. When symptoms do appear they may occur only several we ...
, although this is debated.
Coitus interruptus ''Coitus interruptus'', also known as withdrawal, pulling out or the pull-out method, is a method of birth control in which a man, during sexual intercourse, withdraws his penis from a woman's vagina prior to ejaculation and then directs his ej ...
(or "pulling out"), in which the penis is removed from the vagina, anus, or mouth before
ejaculation Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the male reproductory tract as a result of an orgasm. It is the final stage and natural objective of male sexual stimulation, and an essential componen ...
, may reduce transmission of STIs but still carries significant risk. This is because
pre-ejaculate Pre-ejaculate (also known as pre-ejaculatory fluid, pre-seminal fluid or Cowper's fluid, and colloquially as ''pre-cum'') is a clear, colorless, viscous fluid that is emitted from the urethra of the penis during sexual arousal. It is similar in c ...
, a fluid that oozes from the penile
urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra c ...
before ejaculation, may contain STI pathogens. Additionally, the microbes responsible for some diseases, including
genital wart Genital warts are a sexually transmitted infection caused by certain types of human papillomavirus (HPV). They are generally pink in color and project out from the surface of the skin. Usually they cause few symptoms, but can occasionally be pai ...
s and syphilis, can be transmitted through skin-to-skin or mucous membrane contact.


Anal sex

Unprotected
anal penetration Anal sex or anal intercourse is generally the insertion and thrusting of the erect penis into a person's anus, or anus and rectum, for sexual pleasure.Sepages 270–271for anal sex information, anpage 118for information about the clitoris. Ot ...
is considered a high-risk sexual activity because the thin tissues of the anus and rectum can be easily damaged. Slight injuries can allow the passage of bacteria and viruses, including HIV. This includes penetration of the anus by fingers, hands, or sex
toys A toy or plaything is an object that is used primarily to provide entertainment. Simple examples include toy blocks, board games, and dolls. Toys are often designed for use by children, although many are designed specifically for adults and pe ...
such as
dildo A dildo is a sex toy, often explicitly phallic in appearance, intended for sexual penetration or other sexual activity during masturbation or with sex partners. Dildos can be made from a number of materials and shaped like an erect human p ...
s. Also, condoms may be more likely to break during anal sex than during vaginal sex, increasing the risk of STI transmission. The main risk which individuals are exposed to when performing anal sex is the transmission of
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
. Other possible infections include
hepatitis A Hepatitis A is an infectious disease of the liver caused by ''Hepatovirus A'' (HAV); it is a type of viral hepatitis. Many cases have few or no symptoms, especially in the young. The time between infection and symptoms, in those who develop them ...
, B and C;
intestinal parasite infection An intestinal parasite infection is a condition in which a parasite infects the gastro-intestinal tract of humans and other animals. Such parasites can live anywhere in the body, but most prefer the intestinal wall. Routes of exposure and infe ...
s like '' Giardia''; and bacterial infections such as ''
Escherichia coli ''Escherichia coli'' (),Wells, J. C. (2000) Longman Pronunciation Dictionary. Harlow ngland Pearson Education Ltd. also known as ''E. coli'' (), is a Gram-negative, facultative anaerobic, rod-shaped, coliform bacterium of the genus ''Escher ...
.'' Anal sex should be avoided by couples in which one of the partners has been diagnosed with an STI until the treatment has proven to be effective. In order to make anal sex safer, the couple must ensure that the anal area is clean and the bowel empty and the partner on whom anal penetration occurs should be able to relax. Regardless of whether anal penetration occurs by using a finger or the penis, the condom is the best barrier method to prevent transmission of STI.
Enema An enema, also known as a clyster, is an injection of fluid into the lower bowel by way of the rectum.Cullingworth, ''A Manual of Nursing, Medical and Surgical'':155 The word enema can also refer to the liquid injected, as well as to a device ...
s should not be used as they can increase the risk of HIV infection and
lymphogranuloma venereum Lymphogranuloma venereum (LGV; also known as climatic bubo, Durand–Nicolas–Favre disease, poradenitis inguinale, lymphogranuloma inguinale, and strumous bubo) is a sexually transmitted disease caused by the invasive serovars L1, L2, L2a, L2 ...
proctitis. Since the rectum can be easily damaged, the use of lubricants is highly recommended even when penetration occurs by using the finger. Especially for beginners, using a condom on the finger is both a protection measure against STI and a lubricant source. Most condoms are lubricated and they allow less painful and easier penetration. Oil-based lubricants damage latex and should not be used with condoms; water-based and silicone-based lubricants are available instead. Non-latex condoms are available for people who are allergic to latex made out of
polyurethane Polyurethane (; often abbreviated PUR and PU) refers to a class of polymers composed of organic units joined by carbamate (urethane) links. In contrast to other common polymers such as polyethylene and polystyrene, polyurethane is produced from ...
or
polyisoprene Polyisoprene is strictly speaking a collective name for polymers that are produced by polymerization of isoprene. In practice polyisoprene is commonly used to refer to synthetic ''cis''-1,4-polyisoprene, made by the industrial polymerisation of i ...
. Polyurethane condoms can safely be used with oil-based lubricant. The "
female condom An internal condom (also known as a femidom or female condom) is a barrier device that is used during sexual intercourse as a barrier contraceptive to reduce the probability of pregnancy or a sexually transmitted infection (STI). Meant as an al ...
" may also be used effectively by the anal receiving partner. Anal stimulation with a sex toy requires similar safety measures to anal penetration with a penis, in this case using a condom on the sex toy in a similar way. It is important that the man washes and cleans his penis after anal intercourse if he intends to penetrate the vagina. Bacteria from the rectum are easily transferred to the vagina, which may cause
vaginal In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hyme ...
and
urinary tract infection A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidne ...
s. When anal-oral contact occurs, protection is required since this is a
risky sexual behavior Risky sexual behavior is the description of the activity that will increase the probability that a person engaging in sexual activity with another person infected with a sexually transmitted infection will be infected or become pregnant, or make ...
in which illnesses as hepatitis A or STIs can be easily transmitted, as well as enteric infections. The dental dam or plastic wrap are effective protection means whenever anilingus is performed.


Sex toys

Putting a condom on a
sex toy A sex toy is an object or device that is primarily used to facilitate human sexual pleasure, such as a dildo, artificial vagina or vibrator. Many popular sex toys are designed to resemble human genitals, and may be vibrating or non-vibratin ...
provides better sexual hygiene and can help to prevent transmission of infections if the sex toy is shared, provided the condom is replaced when used by a different partner. Some
sex toy A sex toy is an object or device that is primarily used to facilitate human sexual pleasure, such as a dildo, artificial vagina or vibrator. Many popular sex toys are designed to resemble human genitals, and may be vibrating or non-vibratin ...
s 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 specifically for sex toys. Glass is non-porous and medical grade glass sex toys more easily sterilized between uses. In cases in which one of the partners is treated for an STI, it is recommended that the couple not use sex toys until the treatment has proved to be effective. 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. A sex toy should be cleaned not only when it is shared with other individuals but also when it is used on different 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 Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
. It is best if the damaged sex toy is replaced by a new undamaged one. Even more
hygiene Hygiene is a series of practices performed to preserve health. According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...
protection should be considered by pregnant women when using sex toys. Sharing any type of sex toy that may draw
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
, 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 flared base or a string".


Abstinence

Sexual abstinence Sexual abstinence or sexual restraint is the practice of refraining from some or all aspects of sexual activity for medical, psychological, legal, social, financial, philosophical, moral, or religious reasons. Sexual abstinence is distinct from ...
reduces STIs and pregnancy risks associated with
sexual contact Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express their Human sexuality, sexuality. People engage in a variety of sexual acts, ranging from activities done alone (e.g. ...
, but STIs may also be transmitted through non-sexual means, or by
rape Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration carried out against a person without their consent. The act may be carried out by physical force, coercion, abuse of authority, or ag ...
. HIV may be transmitted through contaminated needles used in
tattoo A tattoo is a form of body modification made by inserting tattoo ink, dyes, and/or pigments, either indelible or temporary, into the dermis layer of the skin to form a design. Tattoo artists create these designs using several Process of tatt ...
ing, body piercing, or injections. Medical or dental procedures using contaminated instruments can also spread HIV, while some health-care workers have acquired HIV through occupational exposure to accidental injuries with needles. Evidence does not support the use of
abstinence-only sex education Abstinence-only sex education is a form of sex education that teaches not having sex outside of marriage. It often excludes other types of sexual and reproductive health education, such as birth control and safe sex. Comprehensive sex education ...
. Abstinence-only sex education programs have been found to be ineffective in decreasing rates of
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
infection in the developed world and
unplanned pregnancy Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception. Sexual activity without the use of effective contraception through choice or coercion is the predominant cause of unintended pregnancy. W ...
. Abstinence-only sex education primarily relies on the consequences of character and morality while health care professionals are concerned about matters regarding health outcomes and behaviors. Though abstinence is the best course to prevent pregnancy and STIs, in reality, it leaves young people without the information and skills they need to avoid unwanted pregnancies and STIs.


See also

*
Bareback (sex) Bareback sex is physical sexual activity, especially sexual penetration, without the use of a condom. The topic primarily concerns anal sex between men who have sex with men without the use of a condom, and may be distinguished from unprotected s ...
* Celibacy * Masturbation *
Human sexual activity Human sexual activity, human sexual practice or human sexual behaviour is the manner in which humans experience and express their sexuality. People engage in a variety of sexual acts, ranging from activities done alone (e.g., masturbation) ...
* Misconceptions about HIV/AIDS * Party and play * Post-exposure prophylaxis * Sisters of Perpetual Indulgence *
Terrence Higgins Trust Terrence Higgins Trust is a British charity that campaigns about and provides services relating to HIV and sexual health. In particular, the charity aims to end the transmission of HIV in the UK; to support and empower people living with HIV, to ...


References


External links


"Prevention - Sexually Transmitted Disease, AGUM (Association of Genital Urinary Medicine)

"Guidelines", British Association for Sexual health and HIV (BASHH)
{{Authority control Birth control HIV/AIDS Prevention Sexual health Sex education Prevention of HIV/AIDS Harm reduction