Safe sex
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2008-07-14T04:08:59Z
AlphaEta
2368277
The AFAO simply states that the results of the African RCTs can't be extrapolated to the Australian epidemic. It does not contradict their findings.
[[Image:Laos AIDS education campaign.jpg|thumb|Poster for AIDS education campaign in Laos]]
'''Safe sex''' (also called '''safer sex''' or '''protected sex''') is the practice of [[sexual activity]] in a manner that reduces the risk of [[infection]] with [[sexually transmitted diseases]] (STDs). Conversely, '''unsafe sex''' is the practice of sexual intercourse without regard for prevention of STDs.
Safe sex practices became prominent in the late [[1980]]s as a result of the [[AIDS]] epidemic. Promoting safe sex is now a principal aim of [[sex education]]. From the viewpoint of society, safe sex can be regarded as a [[harm reduction]] strategy. The goal of safer sex is education and risk reduction.
In contrast to protected sex is '''unprotected sex''', which can refer to:
*The practice of sex without protection from pregnancy
*The practice of sex without protection from STDs
Although safe sex practices can be used as a form of [[family planning]], the term refers to efforts made to prevent [[STD|infection]] as well as [[conception]]. Many effective forms of [[contraception]] do not offer protection against STDs.
==Terminology==
Recently, and mostly within [[Canada]] and the [[United States]], the use of the term ''safer sex'' rather than ''safe sex'' has gained greater use by health workers, with the realization the grounds that risk of transmission of sexually transmitted infections in various [[sexual activities]] is a continuum rather than a simple dichotomy between risky and safe. However, in most other countries, including the [[United Kingdom]] and [[Australia]], the term ''safe sex'' is still mainly used by sex educators.
==Focus on HIV/AIDS==
Much attention has focused on controlling [[HIV]], the [[virus]] that causes AIDS, through the use of [[condoms]]. However, as many STDs can be transmitted through other activities, some [[sex educator]]s recommend that barrier protection be used for all sexual activities which have the potential for disease transmission, such as manual penetration of the anal or vaginal cavities, or oral stimulation of the genitals.
==Safe sex precautions==
[[Image:Kunisada surimono.jpg|thumb|right|[[Shunga]] print by [[Kunisada]] depicting masturbation]]
===Sex by yourself===
Known as ''[[autoeroticism]]'', solitary sexual activity is relatively safe. [[Masturbation]], the simple act of stimulating one's own genitalia, is safe so long as contact is not made with other people's discharged bodily fluids. However, some practices, such as [[self-bondage]] and [[autoerotic asphyxia]], are made considerably more dangerous by the absence of people who can intervene if something goes wrong.
Modern technology does permit some activities, such as "[[phone sex]]" and "[[cybersex]]", that allow for partners to engage in sexual activity without being in the same room, eliminating the risks involved with exchanging bodily fluids.
=== Non-penetrative sex ===
{{main|Non-penetrative sex}}
A range of sex acts, sometimes called "outercourse", can be enjoyed by lovers with significantly reduced risks of infection and pregnancy. U.S. President [[Bill Clinton]]'s surgeon general, Dr. [[Joycelyn Elders]], tried to encourage the use of these practices among young people, but her position encountered opposition from a number of outlets, including the White House itself, and resulted in her being fired by President Clinton in December of 1994.<ref>[http://www.time.com/time/magazine/article/0,9171,982008,00.html Getting Out the Wrecking Ball - TIME<!-- Bot generated title -->]</ref><ref>[http://findarticles.com/p/articles/mi_m1316/is_n1-2_v29/ai_19034244 Joycelyn Elders: From Sharecropper's Daughter to Surgeon General of the United States of America. - book reviews | Washington Monthly | Find Articles at BNET.com<!-- Bot generated title -->]</ref><ref>[http://query.nytimes.com/gst/fullpage.html?res=9C02E0D81038F935A35752C1A960958260 President Clinton Makes a Celebratory Return to His Starting Point in Arkansas - New York Times<!-- Bot generated title -->]</ref>
=== Limiting fluid exchange ===
[[Image:Tysk kondomautomat.jpg|thumb|right|[[Condom machine]]]]
Various devices are used to avoid contact with [[blood]], [[vaginal fluid]], and [[semen]] during sexual activity:
*[[Condom]]s cover the penis during sexual activity. They are most frequently made of [[latex]], but can also be made out of [[polyurethane]]<!-- removed animal intestine condoms from the list, because they "have larger microscopic openings and may allow the organisms that cause STDs to pass through and infect either partner". Also just you don't need to say "for those with latex allergies". If someone has a latex allergy they will naturally use polyurethane and not latex... -->. Polyurethane is thought to be a safe material for use in condoms, since it is nonporous and viruses cannot pass through it. However, there is less research on its effectiveness than there is on latex. <!-- the same reasoning as the above statement. -->
*[[Female condom]]s are inserted into the [[vagina]] prior to intercourse. They may also be used for [[anal sex]], although they are less effective.
*A [[dental dam]] (originally used in dentistry) is a sheet of latex used for protection when engaging in [[oral sex]]. It is typically used as a barrier between the mouth and the [[vulva]] during [[cunnilingus]] or between the mouth and the anus during [[anilingus]].
*[[Medical gloves]] made out of latex, vinyl, [[nitrile rubber|nitrile]], or polyurethane may be used as an makeshift dental dam during oral sex, or to protect the hands during [[mutual masturbation]]. Hands may have invisible cuts on them that may admit pathogens that are found in the semen or the [[vaginal fluids]] of STD infectees. Although the risk of infection in this manner is thought to be low {{Fact|date=February 2007}}, gloves can be used as an extra precaution.
*Another way to avoid contact with blood and semen is penetration, but not by the [[penis]], such as using (properly cleaned) [[dildo]]s or other [[sex toy]]s. If a sex toy is to be used in more than one orifice, a condom can be used over it and changed when the toy is moved. [[Fisting]] (penetration by the hand), has its own risks, but the risk of HIV transfer can be reduced by latex gloves or a condom. [[Pegging (sexual practice)|Pegging]], female-to-male anal sex with a [[strap-on dildo]], as promoted by sex educator [[Carol Queen]] does not involve fluid transfer.
If a latex barrier is being used, any [[Personal lubricant|lubrication]] must not be oil based, as this can break down the structure of the latex and undo the protection it gives.
=== Other Precautions ===
Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safe sex recommend that some of the following methods be used to minimize the risks of STD transmission and unwanted pregnancy.
* [[Circumcision]] is now backed by the [[World Health Organization]] as a preventative measure against HIV. African studies have found that circumcision can reduce the transmission rate of HIV by 50%<ref>{{cite web |url=http://news.bbc.co.uk/2/hi/health/6502855.stm |title=WHO agrees HIV circumcision plan |accessdate=2008-07-12 |work=BBC World News |publisher=BBC |date=2007-03-03 }}</ref>. Some advocacy groups dispute these findings.<ref>http://www.circumstitions.com/HIV-SA.html</ref><ref>http://mgmbill.org/aids.htm</ref>
* [[Monogamy]] or [[polyfidelity]], practiced faithfully, is very safe (as far as STDs are concerned) when all partners are non-infected. However, many monogamous people have been infected with sexually transmitted diseases by partners who are [[sexual infidelity|sexually unfaithful]], have used injection drugs, or were infected by previous sexual partners; the same risks apply to polyfidelitous people, who face slightly higher risks depending on how many people are in the polyfidelitous group.
* For those who are not monogamous, reducing the number of one's sexual partners, particularly anonymous sexual partners, may also reduce one's potential exposure to STDs. Similarly, one may restrict one's sexual contact to a community of trusted individuals - this is the approach taken by some [[pornographic actor]]s and other [[Forms of nonmonogamy|non-monogamous]] people.
* [[Communication]] with one's sexual partner(s) makes for greater safety. Before initiating sexual activities, partners may discuss what activities they will and will not engage in, and what precautions they will take. This can reduce the chance of risky decisions being made "in the heat of passion".
* Refraining from the use of [[recreational drug]]s, including [[alcoholic beverage|alcohol]], before and during sexual activity can protect against associated risks such as lowered inhibitions, decreased immune response, impaired judgment, and loss of consciousness.
* If a person is sexually active with a number of partners, it is important that they get regular [[sexual health clinic|sexual health]] check-ups from a doctor. Anyone noticing unusual symptoms should get medical advice quickly as [[HIV]] is sometimes [[asymptomatic]] or symptoms will have a nonspecific nature and can even be misdiagnosed.<ref name=Kahn>{{cite journal
| author=Kahn, J. O. and Walker, B. D. | title=Acute Human Immunodeficiency Virus type 1 infection | journal=N. Engl. J. Med. | year=1998 | pages=33–39 | volume=331 | issue=1 | pmid=9647878 | doi=10.1056/NEJM199807023390107}}</ref><ref name="pmid11187417">{{cite journal |author=Daar ES, Little S, Pitt J, ''et al'' |title=Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network |journal=Ann. Intern. Med. |volume=134 |issue=1 |pages=25–9 |year=2001 |pmid=11187417 |doi=}}</ref>
== Ineffective methods ==
Note that most methods of contraception<!-- removed (birth control) because unless I'm wrong - which I may well be - contraception is a specific type of birth control barrier methods not falling under this category --> other than the barrier methods mentioned above are ''not'' effective at preventing the spread of STDs. This includes the "rhythm method", which is also commonly known as Natural Family Planning.
The [[spermicide]] [[Nonoxynol-9]] has been claimed to reduce the likelihood of STD transmission. However a recent study by the [[World Health Organization]] [http://www.who.int/reproductive-health/publications/rhr_03_8/Nonoxynol_9.pdf] has shown that Nonoxynol-9 is an irritant and can produce tiny tears in mucous membranes, which may increase the risk of transmission by offering [[pathogens]] more easy points of entry into the system. As a result condoms with a Nonoxynol-9 lubricant are not to be promoted. <!-- removed a blatant pov statement, please do not re-add without serious changes and a source -->
[[Coitus interruptus]] (or "pulling out"), in which the penis is removed from the vagina, [[anus]], or [[mouth]] before [[ejaculation]], is not safe sex and can result in STD transmission. This is because of the formation of [[pre-ejaculate]], a fluid that oozes from the [[urethra]] before actual ejaculation. In opposition to conventional wisdom, some recent studies awaiting confirmation suggest that pre-ejaculate may not contain sperm; it ''can'', however, contain pathogens such as HIV.<!--
--><ref name="HIV study">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12286905&query_hl=1&itool=pubmed_docsum Researchers find no sperm in pre-ejaculate fluid]. ''Contraceptive Technology Update''. Volume 14, Number 10, October 1993, pp.154-6.</ref><!--
--><ref>Zukerman, Z. et al. [http://www.ingentaconnect.com/content/klu/jarg/2003/00000020/00000004/00461193 Short Communication: Does Preejaculatory Penile Secretion Originating from Cowper's Gland Contain Sperm?] ''Journal of Assisted Reproduction and Genetics''. Volume 20, Number 4, April 2003, pp. 157-159(3).</ref> However when combined with a second form of birth control, the risk of pregnancy falls to near zero, as the risk both fail is small. For typical and perfect use, from 1 in 3.7 to 1 in 25 per year for the pull-out method and 1 in 12 to 1 in 333 for hormonal birth control, when the two are combined the risk of pregnancy falls to 1 in 3,700 to 1 in 832,500. Using any two birth control methods concurrently increases your safety. If you keep ejaculate fluid out of any orifices this will do a great deal to help protect pregnancy and diseases. Especially important to note if you have cuts in your mouth. In addition, open sores on either partner can permit transmission, as can microscopic breaks in the skin which arise due to friction, or other irregularities in the skin of either partners genitalia or other body parts.
==Dangers of anal sex==
Unprotected anal sex is a high risk activity regardless of sexual orientation. Research suggests that although gay men are more likely to engage in anal sex, heterosexual couples are more likely not to use condoms when doing so.<ref>"Gay men's dream: A 'magic' lube: Researchers discuss rectal microbicide development at NIAID workshop", Bob Roehr, (June 15, 2001) ''Bay Area Reporter'' [http://www.aegis.com/news/bar/2001/BR010617.html http://www.aegis.com/news/bar/2001/BR010617.html]</ref>
Anal sex is more risky than vaginal, since being very thin tissues of anus and [[rectum]] can be easily damaged during such sex activities as anal intercourse or use of anal [[sex toys|toys]]. Even slight injuries can become "open gates" for various bacteria and viruses, including HIV. This implies that anal sex does require some certain safety measures. First of all, any partners who practice anal sex should be aware of the necessity of using a condom. The condom must be put on properly, otherwise it does not provide reliable protection. Users should keep in mind that oil-based lubricants damage latex. For this reason water-based [[lubricant]]s should be used for anal sex. Those who have allergy to latex should consider use of non-latex condoms, for instance polyurethane condoms that are compatible with both oil-based and water-based lubricants.
Condoms should also be used with sex toys. Through putting a condom on the sex toy a user provides better hygiene and prevents transmission of infections if the sex toy is shared. Cleaning of anal sex toys is also a very important matter as many anal sex toys are made of porous materials. Pores retain viruses and bacteria. For this reason users should clean anal toys (plugs, anal vibrators) thoroughly, preferably with use of special sex toy cleaners. Glass sex toys are more preferred for sexual uses because of their non-porus nature and ability to be sterilized between uses.
== Abstinence as an alternative to safe sex==
One way to avoid the risks associated with [[sexual contact]] is to abstain from sexual activity entirely, which nearly eliminates the chances of contracting [[STDs]] (the only alternative methods of infection being non-sexual as described below).
Some groups, notably some American [[evangelical Christians]] and the [[Roman Catholic Church]] oppose sex outside [[marriage]], and object to safe-sex education programs because they believe that providing such education promotes [[promiscuity]]. [[Virginity pledge]]s and [[sexual abstinence]] education programs are often promoted in lieu of contraceptives and safe-sex education programs. This can place some [[teenagers]] at higher risk of unintended [[pregnancy]] and STDs, because up to 60 percent of teenagers who pledge [[virginity]] until marriage do engage in pre-marital sex and are then one-third less likely to use contraceptives than their peers who have received more conventional [[sex]] education.<ref>[http://www.guttmacher.org/pubs/tgr/04/4/gr040401.html Recent Findings from The 'Add Health' Survey: Teens and Sexual Activity]</ref>
STDs may also be transmitted through non-sexual means. Thus, [[abstinence]] from sexual behavior does not guarantee complete protection against STDs. For example, HIV may be transmitted through contaminated needles used in [[tattoo]]ing, [[body piercing]], or [[Injection (medicine)|injections]]. Medical or dental procedures using contaminated instruments can also spread HIV, while some health-care workers have acquired HIV through occupational exposure to accidental injuries with needles.<!--
--><ref name="HIV">{{cite journal | author=Do AN, Ciesielski CA, Metler RP, Hammett TA, Li J, Fleming PL | title=Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States | journal=Infect Control Hosp Epidemiol | year=2003 | pages=86–96 | volume=24 | issue=2 | pmid=12602690 | doi = 10.1086/502178 <!--Retrieved from CrossRef by DOI bot-->}}
</ref>
==References==
{{reflist}}
==See also==
* [[Bareback sex]]
* [[Birth control]]
* [[Condom fatigue]]
* [[HIV and AIDS misconceptions]]
* [[Human sexual behavior]]
* [[Safe sex makespan]]
* [[Sisters of Perpetual Indulgence]]
* [[Terrence Higgins Trust]]
==External links==
*[http://www.bcsviet.com/tuvan/10_bi_mat_ve_bao_cao_su_3/3.aspx Advise safer sex] - 10 articles about condoms.
* "Guide to Safer Sex" from the [[Society for Human Sexuality]]'s sexuality.org site. Very explicit information on making various sexual practices safer:
**[http://www.sexuality.org/concise.html Concise version (20k)]
**[http://www.sexuality.org/safesex.html Long version (97k)]
*[http://hivinsite.ucsf.edu/InSite?page=kb-07-02-02 Safer-Sex Methods] from HIV InSite
*[http://www.soc.ucsb.edu/sexinfo/?article=contraception&refid=003menu SexInfo's Methods of Contraception For Men and Women] - Detailed information on contraception (also includes a step-by-step guide with pictures on how to make a dental dam out of a condom)
* [http://www.tinynibbles.com/safesexchart.html Tiny Nibbles Safer Sex Chart] - Presents risk levels of a variety of sexual activities and most major STDs.
*[http://www.condoms4life.org/ Condoms4Life]
*[http://www.epigee.org/health/stds.html Epigee Women's Health - Comprehensive STD info]
*[http://www.stdadvice.co.uk STD Advice]
*[http://groups.google.com/group/soc.men/browse_thread/thread/97ef720ac38c69d8/b366c06819d0b471?lnk=st&q=#b366c06819d0b471 Safe SEX Guide on Google Groups]
*[http://groups.google.com/group/alt.religion.christian.catholic/browse_thread/thread/b94a937474c2fa76/0bc6f16ece00b864? more safe sex info from Google Groups]
*{{fr icon}} [http://preservatif.maisonx.com/index.htm Condom use] — with many pictures.
{{AIDS}}
{{STD/STI}}
[[Category:Birth control]]
[[Category:HIV/AIDS]]
[[Category:Prevention]]
[[Category:Sexual health]]
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