HIV and Safer Sex
November 7, 2017
Oral sex involves contact between the mouth and the genitals. It includes giving or receiving licking, sucking, or biting of the vulva (vagina, clitoris, and labia, or "lips"), penis, or anus. A number of studies have demonstrated a low but definite level of risk associated with both giving and receiving oral-penile sex. For more information, see our fact sheet on Oral Sex and HIV: What's the Real Risk?
To make it safer, use an unlubricated latex condom (one that does not have lube on it). If you perform oral-penile sex without a condom, finish up with your hand (mutual masturbation), or spit semen out and rinse with mouthwash rather than swallowing.
There have been very rare, but documented cases of HIV being spread from female-to-male and female-to-female during oral-vaginal sex. To make oral sex on a woman safer, use a dental dam or a condom that has been cut open. Dental dams are squares made from latex. Put some water- or silicone-based lube on one side of the dental dam or cut-open condom. Then stretch the dam or condom over the vulva with the lubed side facing away from your mouth. This gives you a thin barrier between your mouth and the vulva. Some people use plastic food wrap instead of dental dams or cut-open condoms. Plastic food wrap may prevent the transmission of herpes infections, but there is no proof that it can prevent the transmission of HIV.
Oral-anal sex has been shown to spread hepatitis A, hepatitis B, and hepatitis C, as well as other infections. To make oral-anal sex on a man or woman safer, use a dental dam or a condom that has been cut open. Put some water- or silicone-based lube on one side of the dental dam or cut-open condom. Then stretch the dam or condom over the anus with the lubed side facing away from your mouth. This gives you a thin barrier between your mouth and the anus.
If you do not use a barrier during oral sex, avoid getting pre-cum, semen, menstrual blood, or vaginal fluids in your mouth. Avoid oral sex on a woman who is menstruating (having her period) to prevent contact with blood. Bleeding gums, ulcers, or gum disease can make oral sex much riskier. Also, do not floss or brush your teeth just before oral sex; use a breath mint instead.
Sex With Sex Toys
It is also possible to spread or get sexually transmitted infections while using sex toys. Many people like to use vibrators, dildos, butt plugs, and strap-ons as part of sex play. Sex toys need to be kept clean, whether they are used alone or with partners. If they are not cleaned after each use, they can grow bacteria and cause an infection. Because sex toys are made of different materials -- silicone, rubber, vinyl, metal, etc. -- they must be cleaned in different ways. Be sure to read the instructions on the package insert to see how to clean your toy properly.
As with other forms of sex, making sex toy play safer involves using a barrier to prevent each person's bodily fluids from touching the other person. The best way to keep dildos, vibrators, and butt plugs clean is to use them with a latex condom. Be sure to use a fresh condom whenever the toy is used by a different person or in a different location (e.g., moves from vagina to anus or vice-versa). Having sex toys that are not shared and only used by one person can reduce the chances of passing STIs between partners. However, it is still important to clean the toy after each use and to use a fresh condom whenever the toy is used in a different location.
It also helps to use lube with sex toys, both to enhance pleasure and to reduce damage to the tissues that line the vagina, mouth, anus, and rectum. Do not use oil-based lubes like Vaseline, Crisco, shea butter, or baby oil with latex condoms because they weaken condoms and make them more likely to break. Also, do not use silicone-based lube with silicone sex toys, as it will destroy the sex toy.
Fisting, Handballing or Fingering
Paper cuts and other openings in the skin can make your hands vulnerable to infection. Wearing latex or nitrile gloves keeps you protected during hand-vagina, hand-penis, or hand-anus sex. Adding water- or silicone-based lube to the outside of the gloves can increase your partner's pleasure.
These activities do not spread STIs because there is no physical contact with another person's bodily fluids:
Repeated or rough vaginal, anal, and oral sex play can cause damage to the linings of these areas. Since these linings are the body's protection against STIs, damaging or tearing them can increase the chance of being exposed to an infected bodily fluid. Seek medical attention for any infections or health problems in the genital area.
Sometimes the safest thing you can do in sex is have a clear head. When you are under the influence of drugs or alcohol, you may be more likely to have unsafe sex. It is also a good idea to plan ahead: get your safer sex items (condoms, dental dams, gloves, lube, prescription for daily PrEP, etc.) before you find yourself in a sexual situation where you may need them.
It can be helpful to think through things that make it difficult for you to practice safer sex. Doing this can help you be safer when you find yourself in a sexual situation. Because our thoughts affect how we act, it can also be helpful to think about things in new ways. Here are some examples:
[Note from TheBody.com: This article was created by The Well Project, who last updated it on Nov. 7, 2017. We have cross-posted it with their permission.]
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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