June 29, 2015
Table of Contents
Serious, even life-threatening infections like HIV, syphilis, and other sexually transmitted diseases (STDs, or sexually transmitted infections) can be passed from one person to another through sex. Safer sex is sex that reduces the chances of spreading or getting sexually transmitted infections. It involves certain actions (e.g., using a condom) that prevent person-to-person sharing of the bodily fluids that can spread STDs. Choosing to have safer sex shows that you care about the pleasure and health of yourself and your sexual partner(s).
Safer sex is not only for the prevention of new HIV infections. For people living with HIV (HIV+), safer sex is important because it can prevent infection with other STDs that can weaken the immune system. If both people are living with HIV, safer sex can also reduce the possibility of getting infected with another strain of HIV that is resistant to the HIV drugs you are taking.
Safer sex can be fun, exciting, and very pleasurable. It can decrease your worry about getting or spreading STDs, which can in turn make your sex more relaxed and satisfying. It is also a great chance to add variety to your sex life and to build trust and intimacy with your partner by talking about each other's desires.
Practicing safer sex involves knowing what bodily fluids can spread STDs, what sexual activities are risky for each person, and how you can make that activity less risky. Bodily fluids that can spread STDs include blood (including menstrual blood), vaginal secretions, and semen (cum and pre-cum).
Since every sexual act that involves sexual fluids or blood has some risk, safer sex means using barriers to prevent passing fluids into another's body. Barriers include condoms (male and female), dental dams (thin squares of latex), and latex or nitrile gloves. Barriers can help reduce the risk of spreading or getting STDs by keeping one partner's fluids from getting into or onto the other partner. There are also several sexual activities that do not pass sexual fluids or blood between bodies and therefore have very little risk.
For people who do not wish to use condoms or whose partners will not use condoms, there are now a few more options to protect against getting or spreading HIV during sex. Treatment as prevention, or TasP, refers to ways in which we can use HIV drugs, or HIV treatment, to lower the risk of spreading HIV. For people living with HIV, taking HIV drugs can reduce their viral load, thus making their blood, vaginal fluids, and semen (cum), much less likely to spread HIV to others. For people who are HIV-negative, taking HIV drugs can protect against becoming infected if they are exposed to HIV.
Treatment as prevention for HIV-negative people includes both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP means taking HIV drugs before being exposed to HIV to prevent yourself from getting it. Research has shown that PrEP is a promising tool that women can use to prevent HIV infection without their partners' cooperation. Post-exposure prophylaxis refers to taking HIV drugs for about a month immediately after possible exposure to HIV (e.g., unprotected sex) to prevent infection.
Whether you choose to use a barrier (e.g., condom), or a form of HIV treatment as prevention, it can be helpful to know which sexual acts are more risky than others for HIV. The risk for a specific sexual act is determined by what bodily fluids are being exchanged and what part of the body is involved. Below is a list of common sexual activities, their risks, and tips for making them safer:
Receptive vaginal-penile sex, or heterosexual intercourse, refers to sex in which the penis goes into the vagina. It is considered a high-risk activity and the most common way that HIV is spread worldwide. While it is high risk for both women and men, men living with HIV are much more likely to spread infection to women than women living with HIV are to infect men.
The best way to make vaginal-penile sex safer is to use a condom (rubber). There are two main types of condoms: male condoms and female condoms. Most male condoms are made of latex; some are made of polyisoprene (a type of plastic) or lambskin. Lambskin condoms can prevent pregnancy; however, they do NOT prevent the spread of HIV. Only latex and plastic condoms prevent the spread of HIV.
Male condoms come in a variety of shapes, sizes, colors, textures, and even tastes. They are generally inexpensive and can be found at pharmacies, grocery stores, and sex stores. Sometimes they are available for free at certain health clinics and AIDS-service organizations. They are also quite small and easy to carry with you so that you can always be prepared to protect yourself.
Female condoms are made of latex or polyurethane and can be put inside the vagina before you begin sexual activity. They usually cost a bit more than male condoms and are often available at pharmacies, grocery stores, and sex stores. They are also available for free at certain health clinics and AIDS service organizations.
To make vaginal-penile sex even safer, consider using lubricant ('lube'). Lube can prevent the condom from breaking and also helps prevent small cuts or tears in the vagina and on the penis during penetration. Lube is good for un-lubricated condoms as well as ones that come already lubricated; sometimes the lubrication on the condoms is not enough. Condoms lubricated with the spermicide Nonoxynol-9 (N-9) are no longer recommended. They have a shorter shelf life, do not decrease pregnancy more than other lubricated condoms, and may cause irritation of the vagina or rectum (which increases HIV risk).
When using latex condoms, use only water- or silicone-based lube. Do not use oil-based lubes like Vaseline, Crisco, shea butter, or baby oil with latex condoms because they weaken the condom and make it more likely to break. Silicone-based lube will last longer than water-based lube. Lube can also make the condom feel better. There are several types and brands of lubes, with a variety of different feels and tastes. Some also contain substances that 'warm' or enhance sensation. For more information on using condoms, see our article on Talking to Your Partner about Condoms.
If you are not using a condom, you can avoid getting semen in the vagina by having a man pull out before ejaculating (cumming, reaching orgasm). It is important to know, however, that HIV can be in pre-cum, the fluid that comes out of the penis before orgasm or ejaculation. Therefore, having a man pull out before he comes is not a guarantee that you will not get HIV or other STDs spread through male sexual fluids.
Receptive anal-penile sex refers to sex in which the penis enters the anus or butt-hole. It is a high-risk activity. While the risk for the insertive male partner is lower than for the receptive partner, it is still risky. As with vaginal-penile sex, the best way to make anal-penile sex safer is to use a condom and lube.
When using latex condoms, use only water- or silicone-based lubricant to prevent the condom from breaking and help the condom feel better. Lube will also help prevent small cuts or tears to the rectum, anus, or penis during penetration. Do not use oil-based lubes like Vaseline, Crisco, shea butter, or baby oil with latex condoms because they weaken the condom and make it more likely to break. There are several types and brands of lubes, with a variety of different feels and tastes. Currently, there is research going on to look at which type of lube is best for anal sex. However, there is not enough evidence yet to make recommendations about which lube is safest.
If you are not using a condom, you can avoid getting semen in the anus by having a man pull out before ejaculating (cumming, reaching orgasm). It is important to know, however, that HIV can be in pre-cum, the fluid that comes out of the penis before orgasm. Therefore, having a man pull out before he comes is not a guarantee that you will not get HIV or other STDs spread through male sexual fluids.
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 article 'Oral Sex: 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, or spit semen out and rinse with mouthwash rather than swallowing.
There have been 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.
It is also possible to spread or get STDs by 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 STDs 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.
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 STDs because there is no person-to-person physical contact:
It can be helpful to limit the time and frequency of insertive sex. 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 STDs, damaging or tearing them will increase the chance that being exposed to an infected bodily fluid of another will result in infection.
Try non-insertive sex. For example, consider hugging, touching, massage, or mutual masturbation (touching each other's genitals). Also get 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 are more likely to make bad decisions and have unsafe sex. It is also a good idea to plan ahead: get your safer sex items (condoms, dental dams, gloves, lube, etc.) before you find yourself in a sexual situation. That way, you have what you need to protect yourself whenever the need arises.
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: