HIV and Safer Sex

Oral Sex

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. 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 vagina with the lubed side facing away from your mouth. This gives you a thin barrier between your mouth and the vagina. 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 and B, 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, 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. If you have any of these, use a mint instead of brushing your teeth before sex.

Sex With Sex Toys

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.

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.

No-Risk Safer Sex Activities

These activities do not spread STDs because there is no person-to-person physical contact:

• Abstinence: not having sex
• Masturbation: touching yourself
• Phone sex, cybersex, talking dirty, and sharing sexual fantasies

Other Safer Sex Tips

It can be helpful to limit the time and frequency of penetrative 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 barrier to 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.

Thinking It Through

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:

• "We slipped once and forgot to use a condom, so it is too late now."
• New idea: It is never too late. Yes, even one time can be dangerous, but it is not as dangerous as many more times! If you slipped once, it is time to get back on the wagon.

• "Safer sex is such a drag. It is no fun."
• New idea: Here is a great chance to spice up your sex life. Why not take one of the workshops offered on "Eroticizing Safer Sex?" How about getting a book, video, or DVD about hot safer sex?

• "I can not feel anything through condoms!"
• New idea: Time to change brands! Getting free condoms at the health office or buying them at a drugstore may be cheap, but you are probably not getting the best around. Try some of the variety packs offered by mail-order sex supply catalogs or hit the "adult love" stores in your area for a better selection. The best condoms are thin but tough and transmit heat and sensation well.

• "My partner absolutely refuses to use a condom."
• New idea: How comfortable are you with someone who is willing to put your health and life at risk? This sounds like a serious issue, and it is probably not the only one in your relationship. Have you considered individual or couple counseling? Also see our info sheet on Negotiating for Condom Use.

• "I'm afraid that my partner will hurt me if I suggest that he use a condom.
• New idea: How about inserting a female condom before sex begins? Or perhaps you could offer to put a condom on his penis with your mouth. If you feel threatened, please read The Well Project's Domestic Violence info sheet.

• "I cannot suggest to my partner that we get an HIV test. We have been together so long that s/he would take it as an insult."
• New idea: How about presenting it as an act of love? "You know, I really love you. We have been together for a while, but we never got tested for HIV. I hate the thought that I could be putting you at risk, because I could not stand to hurt you. Why don't we go get tested together for our peace of mind?"