Safer Sex

A Sexually Transmitted Infection (STI) is an infection passed on between people during sexual activities such as vaginal, anal and oral sex and through sharing sex toys. There are several viruses, bacteria and fungi which cause a range of infections such as HIV, Hepatitis B, Herpes, Chlamydia, Gonorrhoea and Genital Warts. Some infections such as Genital Warts (HPV) and Herpes (HSV1 and 2) can spread through skin to skin contact as well.

Some sexually transmitted infections can be transmitted through the sharing of needles, tattooing with unsterilised equipment and blood transfusions where the blood has not been properly screened. In the UK, all blood and blood products are screened for HIV, Hepatitis B, Hepatitis C and Syphilis.

How do we make sex safer?

By having safer sex we aim to reduce the transmission of sexually transmitted infections and unplanned pregnancy.

Barrier methods - especially condoms remain the most effective method of reducing the risk of catching STIs. Common barrier methods include male and female condoms, dental dams and gloves. Sex toys can also be covered with condoms and it is important to change condoms or wash devices before it is used by another partner. Oil based lubricants and oils used during foreplay and sex can break down some condoms and reduce their protective properties.

Non-penetrative activities such as mutual masturbation, kissing, hugging and massage carry a reduced, but not zero risk of catching or transmitting an STI and causing pregnancy. 

At risk groups may benefit from vaccination to protect against Hepatitis B and in some cases Hepatitis A (such as sex workers, men who have sex with men and individuals who frequently change sexual partners). HPV vaccination may also protect against certain strains of the virus linked to genital warts and cervical abnormalities. The vaccination is most successful when given before someone becomes sexually active.

You can reduce your risk of catching an STI if you have sex with fewer partners.

Regular testing for STIs reduces the incidence of infection. It is important to be tested before starting a sexual relationship with someone new and to encourage all parties to be tested.

Risky sexual behaviour such as unprotected sex is more likely to occur under the influence of alcohol or drugs and it is important to be prepared if you expect to be in such a position so that you can protect yourself and others.

Preventing pregnancy

Contraception such as the birth control pill, vasectomy, tubal ligation, implants and contraceptive coils offer good protection against unplanned pregnancy. Diaphragms, contraceptive foams and gels, sponges and other methods such as the rhythm method and early withdrawal are less safe. None of the above methods of contraception offer any protection against catching STIs and condoms should still be used.

Anal sex

Anal sex remains the most risky of sexual activities. The skin and lining of the anus and rectum are delicate and easily torn, allowing bacteria and viruses including the Human Immunodeficiency Virus (HIV) to pass between those engaging in unprotected anal sex. There is also less natural lubrication which makes condoms more likely to break.

To reduce the risk of infection:

• Make sure the anal area is clean and the bowel is empty
• If any pain occurs at any point, stop and withdraw
• A condom is always the best method to reduce the risk of infection and should be used to cover sex toys as well
• There is no evidence that stronger or thicker condoms are better or safer for anal sex
• Use generous amounts of a water based lubricant
• If a man has performed anal sex on his partner, it is important that he cleans his penis before penetrating the vagina or mouth of his partner. Bacteria from the rectum are easily transferred to the partner causing infections.
• Anal to oral contact (“rimming”) can transmit infections including Hepatitis A as well as other infections caused by bacteria present in the bowel. A dental dam can help to reduce the risk.

Oral sex

Oral sex carries less risk of transmitting STIs than unprotected vaginal and anal sex, with the person receiving oral sex at the lowest risk (except for Herpes). Oral sex includes activities such as cunnilingus (stimulation of the female genitals), fellatio (stimulation of the male genitals) and “rimming” (stimulating the anus).  

The most commonly transmitted infections during oral sex are Herpes, Gonorrhoea and syphilis.  Transmission of chlamydia, HIV, Hepatitis A, Hepatitis B, Hepatitis C, Genital warts and Pubic lice is also possible, but rare.

To reduce the risk of infection:, 

• Avoid oral sex if you or a partner have an STI, have sores, blisters, warts or rashes around the genitals, anus or mouth, have inflamed piercings in the mouth or genitals or have a throat infection.
• Use condoms and dental dams.
• Avoid brushing or flossing your teeth before or after giving someone oral sex.

Sex toys

If you and your partner use a sex toy, it is a good idea to cover it with a condom. Replace the condom each time the toy is shared between you and your partner. Some toys are made of materials which can trap and hold bacteria and viruses. It is very important that all sex toys are thoroughly washed and disinfected prior and after use by each person. It’s a good idea to use cleaners that are specifically made for cleaning sex toys. Sex toys made out of glass and other non-porous materials are more easily cleaned and sterilised between uses than some other materials. 

Some sex toys such as whips, needles, restraints and other similar devices can draw blood and allow transmission of certain infections.

Condoms

When used correctly, condoms offer nearly complete protection (98%) against pregnancy and certain sexually transmitted infections. There is no evidence that stronger or thicker condoms are better for anal sex, but extra lubrication is recommended to reduce the risk of the condom breaking. Female condoms offer nearly the same protection as male condoms against infection and approximately 95% protection against pregnancy.

The condom should be put on when the penis is erect and before it comes into contact with the vagina, mouth or anus.

• Condom packaging should be kite marked (a mark of safety and quality) and within date.
• Use male condoms that easily fit the erect penis – tight condoms are more likely to tear.
• Examine the packaging and condom itself for tears before use.
• There is no evidence that stronger or thicker condoms are better or safer for anal sex.
• Polyurethane condoms are an alternative for latex allergy sufferers.
• Condoms should be discarded after sex and not reused.
• Condoms should be stored where they cannot be damaged by strong heat, sharp objects, light or damp.

More information can be found on the Family Planning Association (FPA) website: www.fpa.org.uk.