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Safer sex 101

Our tips on how to prevent STIs

by Jen Bell, PhD, and Nicole Telfer Medically reviewed by Sarah Toler, DNP, CNM, Aubrey Bryan, and Amelie Eckersley
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What is “safer sex”? We often hear about tips and strategies for having ‘safe’ sex, but the reality is that having sex at all means there’s a risk of getting Sexually Transmitted Infections (STIs). We don’t shy from the facts! Thankfully, there are many ways to reduce your risk–that’s what we call having safer sex.

How do I have safer sex?

Safer sex is a way to reduce the risks of STIs, while still having sex. It’s not hard, but it’s important to keep these strategies in mind and be cautious, even when you’re getting caught up in the moment.

If you want to reduce your risks of catching or passing on an STI as much as possible, all three of these safer sex components are critical:

  1. Correct, consistent (always, not just some of the time) use of barriers (condoms and other barriers, like dental dams) on body parts or toys for any kind of vaginal, anal, or oral sex

  2. Being open and communicating with your partner about who you are having sex with

  3. Regular testing for all STIs, by you and your partner(s)

How are STIs transmitted?

Different types of sexual activities can put you at risk for different STIs. When anticipating different encounters you may have with people and how you want to keep yourself safe, it’s helpful to know what exactly you’re being cautious about.

The thing is, STIs are transferred through more than just semen. They can also travel through vaginal fluids, direct mucous membranes (your skin), blood, saliva, and feces (1). Ultimately, it's hard to know exactly which sex act is responsible for disease transmission, since people often engage in more than one type of sexual activity (like having both oral sex and penis-in-vagina sex during the same session). With that in mind, it’s best to practice safer sex no matter what.

Here's a list that can help you figure out which STIs you might be at risk for during different sexual activities (2, 3):

  • Kissing: Oral herpes (HSV-1)

  • Oral sex: Chlamydia, gonorrhea, HPV, herpes (HSV-1 and HSV-2), syphilis, HIV, trichomoniasis, Giardia, Shigella, Salmonella, Campylobacter, and E. coli (4)

  • Fingering and fisting (anal and vaginal): HIV, hepatitis B and C

  • Penis-in-vagina sex: HIV, gonorrhea, chlamydia, herpes, HPV, syphilis, chancroid, hepatitis B and C, trichomoniasis, genital warts

  • Anal sex: HIV, hepatitis B and C, HPV, syphilis, gonorrhea, chlamydia, herpes, genital warts 

  • Sex toys: Not much research has been dedicated to STI transmission via sex toys. It is possible that STIs transmission can occur from genital fluids on the sex toy.

  • Vulva-to-vulva sex (scissoring): HPV, HSV-1, HSV-2, syphilis, chancroid, chlamydia, gonorrhea, genital warts, HIV

How to prevent STIs

As we said above, having sex at all introduces risk of STIs.

It might sound bleak, but there are lots of ways you can be sexual and stay safe! Solo masturbation, dry-humping (rubbing genitals with clothes on), sexy talk, massage (without touching genitals) and cuddling are some of the things that you can do that won’t spread STIs. 

And if you do choose to engage in sexual activity, there are a few things you can do to reduce your risk. 

1. Get vaccinated 

Human papillomavirus (HPV), the most common STI in the USA, can have long-term consequences, like genital warts and cancers of the cervix, penis, and throat (5, 6). But the HPV vaccine can protect against the HPV virus. Routine vaccinations are offered to children around ages 11 and 12, and booster shots are available for people up to age 26, or some adults ages 27 to 45 who are not adequately vaccinated (7). If you’ve already had sex, don't worry! You can still get the vaccine (7).

2. Use barrier methods

Barrier methods like external condoms, internal condoms, gloves, or dental dams are protective during any type of sexual activity.

They do what their name suggests—they create a barrier between your genitals/mouth/anus and your partner’s genitals/mouth/anus. Keep in mind that these types of barriers reduce the risk of STI transmission during sex, but they don’t fully eliminate the risk altogether. The best way to be protected is to always consistently and correctly use a barrier method during every sex act (2).

External (male) condoms are a cheap, readily available (in many countries), and easy to use barrier method if you are having vaginal/oral/anal sex with a person with a penis. If you are having sex with a partner and are using sex toys (like vibrators, dildos, or anal inserts), an external condom should also be used over the sex toy to prevent the transmission of STIs between partners (2).

Latex external condoms are the most commonly researched and available methods for preventing STIs. If you or your partner have an allergy to latex, acceptable alternatives are readily available, though some data suggests non-latex condoms may break more easily (8, 9).

When it comes to condom efficacy, HIV is the most studied STI. Research suggests that  condoms prevent HIV transmission during penis-in-vagina sex by 70 to 95% of the time (10-13). Although less studied, consistent and correct condom use is also effective in reducing the spread of other STIs that are spread through genital secretions, like chlamydia, gonorrhea, and trichomoniasis (2). STIs that are spread through direct skin-to-skin contact, like genital herpes or genital ulcer diseases may not offer as much protection as a condom, as if the infected skin is exposed, then the condom can only offer limited protection (2).

To protect yourself during oral sex, use a dam, or a condom cut lengthwise to cover the vulva and/or anus. During oral sex on the vulva (cunnilingus) or anus (anilingus), infections—including HIV, syphilis, herpes, gonorrhea, HPV, trichomoniasis, and chlamydia—can be passed from mouth to genitals, or vice versa (14). 

To prevent STI transmission during touching, you can use latex or nitrile gloves.

If you’re touching your partner’s genitals, or they are touching yours, then there is a risk of transmitting some STIs (such as HPV, genital warts, chlamydia, herpes simplex virus (HSV) 1 and/or 2, syphilis). Infection risks increase when more fingers or a whole hand are inside the vagina or anus (sometimes called fisting), as this can cause small tears or trauma, which can increase STI transmission (14). 

3. Get tested for STIs

Whether it's a casual or serious relationship, it’s important to discuss your sexual health history with your partner, and ask them about theirs.

This gives both of you the chance to make an informed decision about what types of sex you want to have and what safer sex precautions you want to take.

This can feel like an awkward conversation at first, but you’ll get better at it with time. Plus, your partner’s reaction to discussing this subject will help you get to know them better. If they are really against getting tested, and talking about safer sex, this might affect your decision about having sex with them. They could also be completely open and excited that you initiated an honest conversation! When it comes to having safer sex, it’s important to look out for your health and well-being.

Safer sex is the best option if you want to have sex and also be protected against STIs, but it's up to each of us to decide what we want, and what level of risk we and our partners are comfortable with.

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This article was originally published July 4th, 2018.

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