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(Created page with "{{Short description|Ways to reduce the risk of acquiring STDs}} {{For|the film|Safe Sex (film)}} {{Use dmy dates|date=February 2019}} thumb|250px|Male (or "external") [[condoms can be used to cover the penis (or fingers or other body parts) for safer sex when inserting into body cavities]] thumb|250px|[[Dental dams can be used to cover the vulva or anus when engaging in cunni...") |
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'''Safe sex''' is [[Human sexual activity|sexual activity]] using methods or contraceptive devices (such as [[condoms]]) to reduce the risk of transmitting or acquiring [[sexually transmitted infection]]s (STIs), especially [[HIV/AIDS|HIV]].<ref>[http://www.askoxford.com/concise_oed/safesex?view=uk Compact Oxford English Dictionary], Oxford University Press, 2009, Accessed 23 September 2009</ref> "Safe sex" is also sometimes referred to as '''safer sex''' or '''protected sex''' to indicate that some safe sex practices do not completely eliminate STI risks. It is also sometimes used colloquially to describe methods aimed at [[Birth control|preventing pregnancy]] that may or may not also lower STI risks. | '''Safe sex''' is [[Human sexual activity|sexual activity]] using methods or contraceptive devices (such as [[condoms]]) to reduce the risk of transmitting or acquiring [[sexually transmitted infection]]s (STIs), especially [[HIV/AIDS|HIV]].<ref>[http://www.askoxford.com/concise_oed/safesex?view=uk Compact Oxford English Dictionary], Oxford University Press, 2009, Accessed 23 September 2009</ref> "Safe sex" is also sometimes referred to as '''safer sex''' or '''protected sex''' to indicate that some safe sex practices do not completely eliminate STI risks. It is also sometimes used colloquially to describe methods aimed at [[Birth control|preventing pregnancy]] that may or may not also lower STI risks. | ||
The concept of "safe sex" emerged in the 1980s as a response to the global [[AIDS epidemic]], and possibly more specifically to the [[AIDS crisis]] in the | The concept of "safe sex" emerged in the 1980s as a response to the global [[AIDS epidemic]], and possibly more specifically to the [[AIDS crisis]] in the [[United States]]. Promoting safe sex is now one of the main aims of [[sex education]] and STI prevention, especially reducing new HIV infections. Safe sex is regarded as a [[harm reduction]] strategy aimed at reducing the risk of STI transmission.<ref name="Who">{{cite web| title = Global strategy for the prevention and control of sexually transmitted infections: 2006–2015. Breaking the chain of transmission| publisher = [[World Health Organization]]|year = 2007| access-date=26 November 2011|url=http://whqlibdoc.who.int/publications/2007/9789241563475_eng.pdf}}</ref><ref name="Mercer">{{cite journal | vauthors = Chin HB, Sipe TA, Elder R, Mercer SL, Chattopadhyay SK, Jacob V, Wethington HR, Kirby D, Elliston DB, Griffith M, Chuke SO, Briss SC, Ericksen I, Galbraith JS, Herbst JH, Johnson RL, Kraft JM, Noar SM, Romero LM, Santelli J | display-authors = 6 | title = The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services | journal = American Journal of Preventive Medicine | volume = 42 | issue = 3 | pages = 272–94 | date = March 2012 | pmid = 22341164 | doi = 10.1016/j.amepre.2011.11.006 | url = http://www.ajpmonline.org/article/S0749-3797(11)00906-8/abstract | author21 = Community Preventive Services Task Force }}</ref> | ||
Although some safe sex practices (like [[condoms]]) can also be used as [[birth control]] (''contraception''), most forms of contraception do not protect against STIs. Likewise, some safe sex practices, such as partner selection and low-risk sex behavior,{{Example needed|date=June 2019}} might not be effective forms of contraception. | Although some safe sex practices (like [[condoms]]) can also be used as [[birth control]] (''contraception''), most forms of contraception do not protect against STIs. Likewise, some safe sex practices, such as partner selection and low-risk sex behavior,{{Example needed|date=June 2019}} might not be effective forms of contraception. | ||
==History== | |||
{{More citations needed|section|date=March 2018}} | |||
Although strategies for avoiding STIs like [[syphilis]] and [[gonorrhea]] have existed for centuries and the term "safe sex" existed in English as early as the 1930s, the use of the term to refer to STI-risk reduction dates to the mid-1980s in the United States. It emerged in response to the [[AIDS crisis|HIV/AIDS crisis]].<ref>{{cite magazine | vauthors = Stephey MJ |title=A Brief History of Safe Sex |url=http://content.time.com/time/health/article/0,8599,1866044,00.html |magazine=Time |access-date=14 September 2018 |date=11 December 2008 |quote=In the 1540s, an Italian doctor named Gabriele Fallopius — the same man who discovered and subsequently named the Fallopian tubes of the female anatomy — wrote about syphilis, advocating the use of layered linen during intercourse for more "adventurous" (read: promiscuous) men. Legendary lover Casanova wrote about his pitfalls with medieval condoms made of dried sheep gut, referring to them as "dead skins" in his memoir. Even so, condoms made of animal intestine — known as "French letters" in England and la capote anglaise (English riding coats) in France — remained popular for centuries, though always expensive and never easy to obtain, meaning the devices were often reused.}}</ref><ref name="phrases.org.uk">{{cite web |title=The meaning and origin of the expression: Safe sex |url=https://www.phrases.org.uk/meanings/309375.html |website=The Phrase Finder |access-date=14 September 2018}}</ref> | |||
A year before the HIV virus was isolated and named, the San Francisco chapter of the [[Sisters of Perpetual Indulgence]] published a small pamphlet titled ''Play Fair!'' out of concern over widespread STIs among the city's gay male population. It specifically named illnesses (Kaposi's sarcoma and pneumocystis pneumonia) that would later be understood as symptoms of advanced HIV disease (or [[AIDS]]). The pamphlet advocated a range of safe-sex practices, including abstinence, condoms, personal hygiene, use of personal lubricants, and STI testing/treatment. It took a casual, sex-positive approach while also emphasizing personal and social responsibility. In May 1983—the same month HIV was isolated and named in France—the New York City-based HIV/AIDS activists Richard Berkowitz and Michael Callen published similar advice in their booklet, ''[[How to Have Sex in an Epidemic: One Approach]]''. Both publications included recommendations that are now standard advice for reducing STI (including HIV) risks.<ref>{{cite web |last1=Joseph |first1=Sonnabend | name-list-style = vanc |title=How to have sex in an epidemic: 30th anniversary |url=https://www.poz.com/blog/how-to-have-sex-in-a |website=POZ |access-date=14 September 2018|date=17 May 2013 }}</ref><ref>{{cite journal | vauthors = Merson MH, O'Malley J, Serwadda D, Apisuk C | title = The history and challenge of HIV prevention | journal = Lancet | volume = 372 | issue = 9637 | pages = 475–88 | date = August 2008 | pmid = 18687461 | doi = 10.1016/S0140-6736(08)60884-3 | url = https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60884-3 | s2cid = 26554589 }}</ref><ref name="Berkowitz 2">{{cite book |last1=Berkowitz |first1=Richard | name-list-style = vanc |title=Stayin' Alive: The Invention of Safe Sex |date=2003 |publisher=WestView |location=Boulder, CO |isbn=9780813340920}}</ref> | |||
[[File:A black woman with one hand on her arm looks directly at Wellcome L0052333.jpg|thumb|right|200px|A poster promotes condom use.]] | |||
Safe sex as a form of STI risk reduction appeared in journalism as early as 1984, in the British publication ''The Daily Intelligencer'': "The goal is to reach about 50 million people with messages about safe sex and AIDS education."<ref name="phrases.org.uk"/> | |||
Although ''safe sex'' is used by individuals to refer to protection against both [[pregnancy]] and HIV/AIDS or other STI transmissions, the term was born in response to the HIV/AIDS epidemic. It is believed that the term ''safe sex'' was used in the professional literature in 1984, in the content of a paper on the psychological effect that HIV/AIDS may have on gay and bisexual men.<ref>{{cite journal | vauthors = Blair TR | title = Safe Sex in the 1970s: Community Practitioners on the Eve of AIDS | journal = American Journal of Public Health | volume = 107 | issue = 6 | pages = 872–879 | date = June 2017 | pmid = 28426312 | pmc = 5425850 | doi = 10.2105/AJPH.2017.303704 }}</ref> | |||
[[File:Low risk isn't no risk. Wellcome L0052075.jpg|thumb|right|200px|A poster aimed at lesbians says "Low risk isn't no risk". It uses the expression "safer sex".]] | |||
A year later, the same term appeared in an article in ''[[The New York Times]].'' This article emphasized that most specialists advised their AIDS patients to practice safe sex. The concept included limiting the number of sexual partners, using prophylactics, avoiding bodily fluid exchange, and resisting the use of [[drug]]s that reduced inhibitions for high-risk sexual behavior.<ref name="A">{{cite web|url=http://www.csuchico.edu/cjhp/4/1/109-118-moskowitz.pdf|archive-url=https://web.archive.org/web/20060812073450/http://www.csuchico.edu/cjhp/4/1/109-118-moskowitz.pdf|url-status=dead|archive-date=12 August 2006|title=How Do Californians Define Safe Sex?|access-date=28 July 2010}}</ref> Moreover, in 1985, the first safe sex guidelines were established by the 'Coalition for Sexual Responsibilities'.{{Who|date=August 2010}} According to these guidelines, safe sex was practiced by using [[condom]]s also when engaging in [[Anal sex|anal]] or [[oral sex]].<ref>{{cite news |last1=Gross |first1=Jane |title=HOMOSEXUALS STEPPING UP AIDS EDUCATION |url=https://www.nytimes.com/1985/09/22/nyregion/homosexuals-stepping-up-aids-education.html |access-date=26 September 2021 |work=The New York Times |date=22 September 1985}}</ref> | |||
Although the term ''safe sex'' was primarily used in reference to sexual activity between men, in 1986 the concept was spread to the general population. Various programs were developed with the aim of promoting safe sex practices among college students. These programs were focused on promoting the use of the condom, a better knowledge about the partner's sexual history and limiting the number of [[sexual partner]]s. The first book on this subject appeared in the same year. The book was entitled "Safe Sex in the Age of AIDS", and had 88 pages that described both positive and negative approaches to sexual life.{{Citation needed|date=August 2010}} Sexual behavior could be safe ([[kiss]]ing, [[hug]]ging, [[massage]], [[Non-penetrative sex|body-to-body rubbing]], [[mutual masturbation]], [[exhibitionism]], [[phone sex]], and use of separate [[sex toy]]s); possibly safe (use of condoms); or unsafe.<ref name="A"/> | |||
In 1997, specialists in this matter promoted the use of condoms as the most accessible safe sex method (besides abstinence) and they called for [[TV commercials]] featuring condoms. During the same year, the [[Catholic Church]] in the United States issued their own "safer sex" guidelines on which condoms were listed, though two years later the [[Holy See|Vatican]] urged [[chastity]] and [[heterosexual]] marriage, attacking the American Catholic bishops' guidelines.{{citation needed|date=October 2020}} | |||
A study carried out in 2006 by Californian specialists showed that the most common definitions of safe sex are condom use (68% of the interviewed subjects), abstinence (31.1% of the interviewed subjects), monogamy (28.4% of the interviewed subjects) and safe partner (18.7% of the interviewed subjects).<ref name="A"/> | |||
The term ''safer sex'' in Canada and the United States has gained greater use by health workers, reflecting that risk of transmission of sexually transmitted infections in various [[Human sexual activity|sexual activities]] is a [[Continuum (theory)|continuum]]. The term ''safe sex'' is still in common use in the United Kingdom,<ref>{{cite web|url=https://www.nhs.uk/live-well/sexual-health/|title=Sexual Health|date=26 April 2018|publisher=[[NHS]]|access-date=2019-04-08}}</ref> Australia and New Zealand. | |||
"Safer sex" is thought to be a more aggressive term which may make it more obvious to individuals that any type of sexual activity carries a certain degree of risk. | |||
The term ''safe love'' has also been used, notably by the French [[Sidaction]] in the promotion of men's underpants incorporating a condom pocket and including the red ribbon symbol in the design, which were sold to support the charity. | |||
==Practices== | |||
A range of safe-sex practices are commonly recommended by sexual health educators and public health agencies. Many of these practices can reduce (but not eliminate) risk of transmitting or acquiring STIs.<ref>{{cite web |title=How You Can Prevent Sexually Transmitted Diseases |date=30 March 2020 |url=https://www.cdc.gov/std/prevention/default.htm |publisher=Centers for Disease Control |access-date=2 April 2021}}</ref> | |||
===Phone sex/cybersex/sexting=== | |||
Sexual activities, such as phone sex, [[cybersex]], and [[sexting]], that do not include direct contact with the skin or bodily fluids of sexual partners, carry no STI risks and, thus, are forms of safe sex.<ref name=plannedparenthood>{{cite web|url = http://www.plannedparenthood.org/health-topics/stds-hiv-safer-sex/safer-sex-4263.htm | title = Safer Sex ("Safe Sex") | access-date = 23 September 2009}}</ref> | |||
===Non-penetrative sex=== | |||
[[Image:PeterJohannNepomukGeigerEroticWatercolor04.jpg|thumb|right|[[Watercolor]] of [[Handjob|manual stimulation]] of the penis, [[Johann Nepomuk Geiger]], 1840]] | |||
{{Main|Non-penetrative sex}} | |||
A range of sex acts called "non-penetrative sex" or "outercourse" can significantly reduce STI risks. Non-penetrative sex includes practices such as kissing, mutual masturbation, rubbing or stroking.<ref name="LaRosa">{{cite book|first1=Judith|last1=LaRosa|first2=Helaine|last2=Bader|first3=Susan|last3=Garfield| title = New Dimensions In Women's Health| publisher =[[Jones & Bartlett Learning]]|year = 2009|page=91|access-date = 31 August 2013| isbn = 978-0763765927 |url =https://books.google.com/books?id=2X03PXd4JSoC&pg=PA91|quote=Outercourse is the sharing of sexual intimacy with behaviors such as private part kissing, petting, and mutual masturbation. The advantages of outercourse include no risk of pregnancy without penile-vaginal penetration and the behaviors permit emotional bonding and closeness.}}</ref><ref name="White">{{Cite book|first1=Lois|last1=White|first2=Gena|last2=Duncan|first3=Wendy|last3=Baumle|title=Medical Surgical Nursing: An Integrated Approach, 3rd ed| publisher = [[Cengage Learning]]|year = 2011|access-date=1 September 2013|page =1161| isbn = 978-1133707141|url=https://books.google.com/books?id=LWEJAAAAQBAJ&pg=PA1161|quote=Some people consider outercourse to mean sex play without vaginal intercourse, while others consider this to mean sex play with no penetration at all (vaginal, oral, or anal).}}</ref> According to the Health Department of Western Australia, this sexual practice may prevent pregnancy and most STIs. However, non-penetrative sex may not protect against infections that can be transmitted via skin-to-skin contact, such as [[herpes]] and [[HPV|human papilloma virus]].<ref>{{cite web|title=STDs (Sexually Transmitted Diseases)|url=http://www.mckinley.illinois.edu/handouts/sexually_transmitted_infections.html|access-date=23 January 2014|archive-date=2 February 2014|archive-url=https://web.archive.org/web/20140202144530/http://www.mckinley.illinois.edu/handouts/sexually_transmitted_infections.html|url-status=dead}}</ref> Mutual or partnered masturbation carries some STI risk, especially if there is skin contact or shared bodily fluids with sexual partners, although the risks are significantly lower than many other sexual activities.<ref name=plannedparenthood/> | |||
===Condoms, dental dams, gloves=== | |||
Barriers, such as condoms, dental dams, and medical gloves can prevent contact with body fluids (such as [[blood]], [[vaginal fluid]], [[semen]], rectal mucus), and other means of transmitting STIs (like skin, hair and shared objects) during sexual activity.{{citation needed|date=January 2021}} | |||
[[File:How To Put on a Condom graphic.png|thumb|How to put a male condom on a penis]] | |||
* External [[condom]]s can be used to cover the penis, hands, fingers, or other body parts during sexual penetration or stimulation.<ref name="Corinna" /> They are most frequently made of [[latex]], and can also be made out of synthetic materials including [[polyurethane]] and [[polyisoprene]]. | |||
* Internal condoms (also called [[female condom]]s) are inserted into the [[vagina]] or [[anus]] prior to sexual penetration. These condoms are made of either polyurethane or [[nitrile]]. If external and internal condoms are used at the same time, they may break due to friction between the materials during sexual activity. | |||
* 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 [[anal–oral sex]]. | |||
* [[Medical glove]]s made out of latex, vinyl, [[nitrile rubber|nitrile]], or polyurethane may be used as a makeshift dental dam during oral sex, or can cover hands, fingers, or other body parts during penetration or sexual stimulation, such as [[masturbation]].<ref name="Corinna">{{cite book |last1=Corinna |first1=Heather | name-list-style = vanc |title=S.E.X.: The All-You-Need-to-Know Sexuality Guide to Get You Through Your Teens and Twenties |date=2016 |publisher=Da Capo Lifelong Press |location=New York |isbn=978-0738218847 }}</ref><ref name="Moon">{{cite book |last1=Moon |first1=Allison | name-list-style = vanc |title=Girl Sex 101 |date=2018 |publisher=Lunatic Ink |isbn=978-0983830900 }}</ref> | |||
* Condoms, dental dams, and gloves can also be used to cover [[sex toys]] such as [[dildo]]s during sexual stimulation or penetration.<ref name="Corinna" /><ref name="Moon" /> If a sex toy is to be used in more than one orifice or partner, a condom/dental dam/glove can be used over it and changed when the toy is moved. | |||
Oil-based [[Personal lubricant|lubrication]] can break down the structure of latex condoms, dental dams or gloves, reducing their effectiveness for STI protection.<ref>{{cite book |last1=Corinna |first1=Heather | name-list-style = vanc |title=S.E.X.: The All-You-Need-to-Know Sexuality Guide to Get You Through Your Teens and Twenties |date=2016 |publisher=Da Capo Lifelong Press |location=New York |isbn=978-0738218847 |page=294 |edition=second }}</ref> | |||
While use of external condoms can reduce STI risks during sexual activity, they are not 100% effective. One study has suggested condoms might reduce HIV transmission by 85% to 95%; effectiveness beyond 95% was deemed unlikely because of slippage, breakage, and incorrect use.<ref name="Varghese">{{cite journal | vauthors = Varghese B, Maher JE, Peterman TA, Branson BM, Steketee RW | title = Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use | journal = Sexually Transmitted Diseases | volume = 29 | issue = 1 | pages = 38–43 | date = January 2002 | pmid = 11773877 | doi = 10.1097/00007435-200201000-00007 | url = http://ww2.aegis.org/files/AskDoc_refs/varghese2002-29-1.pdf | url-status = dead | s2cid = 45262002 | df = dmy-all | archive-url = https://web.archive.org/web/20110724224853/http://ww2.aegis.org/files/AskDoc_refs/varghese2002-29-1.pdf | archive-date = 24 July 2011 }}</ref> It also said, "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".<ref name="Varghese"/><sup>p. 40.</sup> | |||
===Pre-exposure prophylaxis (PrEP)=== | |||
{{Main|Pre-exposure prophylaxis}} | |||
[[Pre-exposure prophylaxis]] (often abbreviated as ''PrEP'') is the use of prescription drugs by those who do not have HIV to prevent HIV infection. PrEP drugs are taken ''prior'' to HIV exposure to prevent the transmission of the virus, usually between sexual partners. PrEP drugs do not prevent other STI infections or pregnancy.{{citation needed|date=April 2021}} | |||
As of 2018, the most-widely approved form of ''PrEP'' combines two drugs (tenofovir and emtricitabine) in one pill. That drug combination is sold under the brand name [[Truvada]] by Gilead Sciences. It is also sold in generic formulations worldwide. Other drugs and modalities are being studied for use as PrEP.<ref>{{Cite web |title=Pre-exposure Prophylaxis (PrEP) to Reduce HIV Risk {{!}} NIH: National Institute of Allergy and Infectious Diseases |url=https://www.niaid.nih.gov/diseases-conditions/pre-exposure-prophylaxis-prep |access-date=2022-06-27 |website=www.niaid.nih.gov |language=en}}</ref><ref>{{Cite journal |last=Beymer |first=Matthew |date=2019 |title="Current and Future PrEP Medications and Modalities: On-demand, Injectables, and Topicals." |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719717/ |journal=Current HIV/Aids Reports |volume=16 |issue=4 |pages=349-358 |pmid=31222499 |via=National Library of Medicine}}</ref> | |||
Different countries have approved different protocols for using the tenofovir/emtricitabine-combination drug as ''PrEP''. That two-drug combination has been shown to prevent HIV infection in different populations when taken daily, intermittently, and on demand. Numerous studies have found the tenofovir/emtricitabine combination to be over 90% effective at preventing HIV transmission between sexual partners.<ref>{{cite web |url=https://www.cdc.gov/hiv/risk/prep/ |title=Pre-Exposure Prophylaxis (PrEP) |date=19 September 2016 |publisher=Centers for Disease Control and Prevention |access-date=14 March 2017}}</ref> | |||
===Treatment as prevention=== | |||
{{Main|Treatment as prevention}} | |||
Treatment as Prevention (often abbreviated as ''TasP'') is the practice of testing for and treating HIV infection as a way to prevent further spread of the virus. Those having knowledge of their HIV-positive status can use safe-sex practices to protect themselves and their partners (such as using condoms, sero-sorting partners, or choosing less-risky sexual activities). And, because HIV-positive people with durably suppressed or undetectable amounts of HIV in their blood ''cannot transmit HIV to sexual partners'', sexual activity with HIV-positive partners on effective treatment is a form of safe sex (to prevent HIV infection). This fact has given rise to the concept of "U=U" ("Undetectable = Untransmittable").<ref>{{cite web |url=https://www.preventionaccess.org/ |title=U=U|date=2017|publisher=Prevention Access Campaign|access-date=11 September 2018}}</ref> | |||
===Other forms of safe sex=== | |||
Other methods proven effective at reducing STI risks during sexual activity are: | |||
* [[Immunization]] against certain sexually-transmitted viruses. The most common vaccines protect against [[Hepatitis B vaccine|hepatitis B]] and [[HPV vaccine|human papilloma virus (HPV)]], which can cause [[cervical cancer]], [[penile cancer]], [[oral cancer]], and [[genital warts]]. Immunization before initiation of sexual activity increases effectiveness of these vaccines. HPV vaccines are recommended for all teen girls and women as well as teen boys and men through age 26 and 21 respectively.<ref>{{Cite web|url=https://www.cdc.gov/std/prevention/default.htm|title=Prevention - STD Information from CDC|date=2019-05-28|website=www.cdc.gov|language=en-us|access-date=2019-08-05}}</ref> | |||
* Limiting numbers of sexual partners, particularly casual sexual partners, or restricting sexual activity to those who know and share their STI status, can also reduce STI risks. [[Monogamy]] or [[polyfidelity]], practiced faithfully, is very safe (as far as STIs are concerned) when all partners are non-infected. However, many monogamous people have been infected with sexually transmitted diseases by partners who are [[Adultery|sexually unfaithful]], have used injection drugs, or were infected by previous sexual partners. The same risks apply to polyfidelitous people, who face higher risks depending on how many people are in the polyfidelitous group. | |||
* [[Communication]] with sexual partners about sexual history and STI status, preferred safe sex practices, and acceptable risks for partnered sexual activities. | |||
* Engaging in less-risky sexual activities. In general, solo sexual activities are less risky than partnered activities. Sexual penetration of orifices (mouth, vagina, anus) and sharing body fluids (such as semen, blood, vaginal fluids, and rectal mucus) between sexual partners carry the most risk for STIs. | |||
* Regular STI testing and treatment, especially by those who are sexually active with more than one casual sexual partner.<ref name=Kahn>{{cite journal | vauthors = Kahn JO, Walker BD | title = Acute human immunodeficiency virus type 1 infection | journal = The New England Journal of Medicine | volume = 339 | issue = 1 | pages = 33–9 | date = July 1998 | pmid = 9647878 | doi = 10.1056/NEJM199807023390107 }}</ref><ref name="pmid11187417">{{cite journal | vauthors = Daar ES, Little S, Pitt J, Santangelo J, Ho P, Harawa N, Kerndt P, Glorgi JV, Bai J, Gaut P, Richman DD, Mandel S, Nichols S | display-authors = 6 | title = Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network | journal = Annals of Internal Medicine | volume = 134 | issue = 1 | pages = 25–9 | date = January 2001 | pmid = 11187417 | doi = 10.7326/0003-4819-134-1-200101020-00010 | s2cid = 34714025 | first14 = Network }}</ref> It is possible to attain and show proof of STD-free-verification through [[online dating services|online dating apps]] and websites.<ref>{{cite web| url = https://www.sheknows.com/health-and-wellness/articles/985207/app-for-finding-out-std-status/| title = Do you know his STD status? There's an app for that| date = 3 April 2013}}</ref><ref>{{cite web| url = https://medcitynews.com/2016/01/tinder-healthvana-std/| title = Tinder adds link to healthvana for STD-checking purposes| date = 22 January 2016}}</ref> | |||
* [[Circumcision and HIV|Penile circumcision]]. Some research suggests that circumcising (removing) the foreskin of the penis can reduce the risk of contracting HIV.<ref>{{cite web | title = Circumcision (male) | publisher = Mayo Clinic | url = https://www.mayoclinic.org/tests-procedures/circumcision/about/pac-20393550 | access-date = 10 May 2020}}</ref><ref>{{cite news |url=http://news.bbc.co.uk/2/hi/health/6502855.stm |title=WHO agrees HIV circumcision plan |access-date=12 July 2008 |work=BBC World News |publisher=BBC |date=3 March 2007 }}</ref> Some advocacy groups dispute these findings.<ref>{{cite web|url=http://www.circumstitions.com/HIV-SA.html|title=Circumcision and HIV - the Randomised Controlled Trials|website=www.circumstitions.com}}</ref><ref>{{cite web|url=http://mgmbill.org/aids.htm|title=Circumcision and AIDS<!-- Bot generated title -->|url-status=dead|archive-url=https://web.archive.org/web/20080723220755/http://mgmbill.org/aids.htm|archive-date=23 July 2008}}</ref> | |||
==Ineffective methods== | |||
===General=== | |||
Most methods of contraception are not effective at preventing the spread of [[Sexually transmitted disease|STI]]s. This includes [[birth control pills]], [[vasectomy]], [[tubal ligation]], [[Fertility awareness|periodic abstinence]], [[IUD]]s and many non-barrier methods of pregnancy prevention. However, [[condoms]], when used correctly, significantly reduces the risks of STI transmission and unwanted pregnancy.<ref>{{Cite web |title=Condom Effectiveness {{!}} CDC |author=Centers for Disease Control and Prevention |work=cdc.gov |date=2 February 2022 |access-date=13 April 2022 |url= https://www.cdc.gov/condomeffectiveness/index.html |quote=Correctly using male (also called external) condoms and other barriers like female (also called internal) condoms and dental dams, every time, can reduce (though not eliminate) the risk of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) and viral hepatitis. They can also provide protection against other diseases that may be transmitted through sex like Zika and Ebola. Using male (external) and female (internal) condoms correctly, every time, can also help prevent pregnancy. }}</ref> | |||
The [[spermicide]] [[nonoxynol-9]] has been claimed to reduce the likelihood of STI transmission. However, a technical report<ref name=":0">{{Cite web|url=http://apps.who.int/iris/bitstream/10665/68510/1/WHO_RHR_03.08.pdf|title=Technical Consultation on Nonoxynol-9 |date=October 2001|website=WHO|access-date=10 March 2018}}</ref> by the [[World Health Organization]] 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 [[pathogen]]s more easy points of entry into the system. They reported that nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness cautioned they should not be promoted. There is no evidence that spermicidal condoms are better at preventing STD transmission compared to condoms that do not have spermicide. If used properly, spermicidal condoms can prevent pregnancy, but there is still an increased risk that nonoxynyl-9 can irritate the skin, making it more susceptible for infections.<ref name=":0" /><ref>{{Cite web|url=https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/safer-sex/how-do-i-make-sex-safer|title=How Do I Make Sex Safer? {{!}} Common Questions and Answers|website=www.plannedparenthood.org|language=en|access-date=2019-08-02}}</ref> | |||
The use of a [[Diaphragm (contraceptive)|diaphragm]] or [[contraceptive sponge]] provides some women with better protection against certain sexually transmitted diseases,<ref name="TechInd">{{cite news|url=http://findarticles.com/p/articles/mi_m1200/is_n19_v141/ai_12248743/ |title=Diaphragm and sponge protect against STDs - sexually transmitted diseases |access-date=5 April 2010 |work=Science News |first=Kathy A. |last=Fackelmann | name-list-style = vanc |year=1992 |url-status=dead |archive-url=https://web.archive.org/web/20100404015828/http://findarticles.com/p/articles/mi_m1200/is_n19_v141/ai_12248743/ |archive-date=4 April 2010 }}</ref> but they are not effective for all STIs. | |||
Hormonal methods of preventing pregnancy (such as oral contraceptives [i.e. 'The pill'], depoprogesterone, hormonal IUDs, the vaginal ring, and the patch) offer no protection against STIs. The copper intrauterine device and the hormonal intrauterine device provide an up to 99% protection against pregnancies but no protection against STIs. Women with copper intrauterine device ''may'' be subject to greater risk of infection from bacterial infectious such as [[gonorrhea]] or [[Chlamydia infection|chlamydia]], although this is debated.<ref>{{cite journal | vauthors = Hubacher D | title = Intrauterine devices & infection: review of the literature | journal = The Indian Journal of Medical Research | volume = 140 Suppl | issue = Suppl 1 | pages = S53-7 | date = November 2014 | pmid = 25673543 | pmc = 4345753 }}</ref> | |||
[[Coitus interruptus]] (or "pulling out"), in which the penis is removed from the vagina, [[anus]], or [[mouth]] before [[ejaculation]], may reduce transmission of STIs but still carries significant risk. This is because [[pre-ejaculate]], a fluid that oozes from the penile [[urethra]] before ejaculation, may contain STI pathogens. Additionally, the microbes responsible for some diseases, including [[genital wart]]s and [[syphilis]], can be transmitted through skin-to-skin or mucous membrane contact.{{citation needed|date=April 2021}} | |||
===Anal sex=== | |||
Unprotected [[anal sex|anal penetration]] is considered a high-risk sexual activity because the thin tissues of the anus and [[rectum]] can be easily damaged.<ref name="Dean and Delvin">{{cite web|title=Anal sex|first1= John |last1=Dean |first2=David |last2=Delvin | name-list-style = vanc |publisher=Netdoctor.co.uk|access-date=29 April 2010| url=http://www.netdoctor.co.uk/sexandrelationships/analsex.htm}}</ref><ref>Voeller B. AIDS and heterosexual anal intercourse. ''Arch Sex Behav'' 1991; 20:233–276. as cited in Leichliter, Jami S. PhD, "Heterosexual Anal Sex: Part of an Expanding Sexual Repertoire?" in ''Sexually Transmitted Diseases:'' | |||
November 2008 – Volume 35 – Issue 11 – pp 910–911 [http://journals.lww.com/stdjournal/Fulltext/2008/11000/Heterosexual_Anal_Sex__Part_of_an_Expanding_Sexual.2.aspx#P12] Accessed 26 January 2010</ref> Slight injuries can allow the passage of bacteria and viruses, including HIV. This includes penetration of the anus by fingers, hands, or sex [[Sex toy|toys]] such as [[dildo]]s. Also, condoms may be more likely to break during anal sex than during vaginal sex, increasing the risk of STI transmission.<ref>{{cite web| title = Can I get HIV from anal sex? | url = http://aids.about.com/od/technicalquestions/f/oral.htm | access-date=19 August 2011}}</ref> | |||
The main risk which individuals are exposed to when performing anal sex is the transmission of [[HIV]]. Other possible infections include [[hepatitis A]], [[Hepatitis B|B]] and [[Hepatitis C|C]]; [[intestinal parasite infection]]s like ''[[Giardia]]''; and bacterial infections such as ''[[Escherichia coli]].''<ref>{{Cite web|url=https://www.cdc.gov/hiv/risk/analsex.html|title=Anal Sex |website=CDC|access-date=10 March 2018}}</ref> | |||
Anal sex should be avoided by couples in which one of the partners has been diagnosed with an STI until the treatment has proven to be effective. | |||
In order to make anal sex safer, the couple must ensure that the anal area is clean and the bowel empty and the partner on whom anal penetration occurs should be able to relax. Regardless of whether anal penetration occurs by using a finger or the penis, the condom is the best barrier method to prevent transmission of STI. [[Enema]]s should not be used as they can increase the risk of HIV infection<ref>{{cite journal | vauthors = Carballo-Diéguez A, Bauermeister JA, Ventuneac A, Dolezal C, Balan I, Remien RH | title = The use of rectal douches among HIV-uninfected and infected men who have unprotected receptive anal intercourse: implications for rectal microbicides | journal = AIDS and Behavior | volume = 12 | issue = 6 | pages = 860–6 | date = November 2008 | pmid = 17705033 | pmc = 2953367 | doi = 10.1007/s10461-007-9301-0 }}</ref> and [[lymphogranuloma venereum]] [[proctitis]].<ref>{{cite journal | vauthors = de Vries HJ, van der Bij AK, Fennema JS, Smit C, de Wolf F, Prins M, Coutinho RA, Morré SA | display-authors = 6 | title = Lymphogranuloma venereum proctitis in men who have sex with men is associated with anal enema use and high-risk behavior | journal = Sexually Transmitted Diseases | volume = 35 | issue = 2 | pages = 203–8 | date = February 2008 | pmid = 18091565 | doi = 10.1097/OLQ.0b013e31815abb08 | url = https://dare.uva.nl/personal/pure/en/publications/lymphogranuloma-venereum-proctitis-in-men-who-have-sex-with-men-is-associated-with-anal-enema-use-and-highrisk-behavior(6b9b21d8-9369-4f55-a0e5-c6804db29083).html | s2cid = 2065170 }}</ref> | |||
Since the rectum can be easily damaged, the use of lubricants is highly recommended even when penetration occurs by using the finger. Especially for beginners, using a condom on the finger is both a protection measure against STI and a lubricant source. Most condoms are lubricated and they allow less painful and easier penetration. Oil-based lubricants damage latex and should not be used with condoms;<ref>{{cite journal | vauthors = Steiner M, Piedrahita C, Glover L, Joanis C, Spruyt A, Foldesy R | title = The impact of lubricants on latex condoms during vaginal intercourse | journal = International Journal of STD & AIDS | volume = 5 | issue = 1 | pages = 29–36 | year = 1993 | pmid = 8142525 | doi = 10.1177/095646249400500108 | url = http://pdf.usaid.gov/pdf_docs/PNACA620.pdf | s2cid = 9271973 | citeseerx = 10.1.1.574.1501 }}</ref> water-based and silicone-based [[lubricant]]s are available instead. Non-latex condoms are available for people who are [[Latex allergy|allergic to latex]] made out of [[polyurethane]] or [[Synthetic rubber|polyisoprene]].<ref>{{Cite web|url=https://www.nhs.uk/conditions/contraception/male-condoms/|title=Condoms | date=21 December 2017|website=NHS|access-date=10 March 2018}}</ref> Polyurethane condoms can safely be used with oil-based lubricant.<ref>{{Cite web|url=https://www.cdc.gov/std/tg2015/clinical.htm|title=Clinical Prevention Guidance - 2015 STD Treatment Guidelines|date=10 October 2017|website=www.cdc.gov|access-date=10 March 2018}}</ref> The "[[female condom]]" may also be used effectively by the anal receiving partner. | |||
Anal stimulation with a sex toy requires similar safety measures to anal penetration with a penis, in this case using a condom on the sex toy in a similar way. | |||
It is important that the man washes and cleans his penis after anal intercourse if he intends to penetrate the vagina. Bacteria from the rectum are easily transferred to the vagina, which may cause [[Vaginal infection|vaginal]] and [[urinary tract infection]]s.<ref name="SHR">{{cite web |url=http://www.sexual-health-resource.org/anal_sex.htm#aidsanal |title=Anal Sex - Facts and Safe Sex Information |access-date=5 April 2010 |archive-url=https://web.archive.org/web/20100404055257/http://www.sexual-health-resource.org/anal_sex.htm#aidsanal |archive-date=4 April 2010 |url-status=dead }}</ref> | |||
When anal-oral contact occurs, protection is required since this is a [[risky sexual behavior]] in which illnesses as hepatitis A or STIs can be easily transmitted, as well as enteric infections. The dental dam or plastic wrap<ref>{{Cite book|title=HIVAIDS care & counselling : a multidisciplinary approach|last=Van Dyk |first=Alta C. | name-list-style = vanc | date=2008 |publisher=Pearson Education South Africa|isbn=9781770251717|edition=4th|location=Cape Town|oclc=225855360|page=157}}</ref> are effective protection means whenever anilingus is performed. | |||
==Sex toys== | |||
[[Image:Zwei unterschiedliche Butt-Plugs.jpg|right|thumb|Two [[butt plugs|sex toys intended for anal use]] (note the flared bases)]] | |||
Putting a condom on a [[sex toy]] provides better sexual hygiene and can help to prevent transmission of infections if the sex toy is shared, provided the condom is replaced when used by a different partner. Some [[sex toy]]s are made of porous materials, and pores retain viruses and bacteria, which makes it necessary to clean sex toys thoroughly, preferably with use of cleaners specifically for sex toys. Glass is non-porous and medical grade glass sex toys more easily sterilized between uses.<ref>{{Cite news|url=https://kinseyconfidential.org/safety-dance-sex-toy-safety-generation/|title=The Safety Dance: Sex Toy Safety for a New Generation|work=Kinsey Confidential|access-date=9 May 2017|archive-date=4 June 2017|archive-url=https://web.archive.org/web/20170604194306/https://kinseyconfidential.org/safety-dance-sex-toy-safety-generation/|url-status=dead}}</ref> | |||
In cases in which one of the partners is treated for an STI, it is recommended that the couple not use sex toys until the treatment has proved to be effective. | |||
All sex toys have to be properly cleaned after use. The way in which a sex toy is cleaned varies on the type of material it is made of. Some sex toys can be boiled or cleaned in a dishwasher. Most of the sex toys come with advice on the best way to clean and store them and these instructions should be carefully followed.<ref name="NHS">{{cite web|url=http://www.nhs.uk/chq/Pages/1690.aspx?CategoryID=118&SubCategoryID=122 |title=Are sex toys safe? |access-date=31 March 2010}}</ref> A sex toy should be cleaned not only when it is shared with other individuals but also when it is used on different parts of the body (such as mouth, vagina or anus). | |||
A sex toy should regularly be checked for scratches or breaks that can be breeding ground for [[bacteria]]. It is best if the damaged sex toy is replaced by a new undamaged one. Even more [[hygiene]] protection should be considered by pregnant women when using sex toys. Sharing any type of sex toy that may draw [[blood]], like whips or needles, is not recommended, and is not safe.<ref>{{cite web|url=http://www.nhs.uk/chq/pages/1690.aspx?categoryid=118&subcategoryid=122|title=Are sex toys safe? - Health questions - NHS Choices |date=27 June 2018}}</ref> | |||
When using sex toys in the anus, sex toys "...can easily get lost" as "rectal muscles contract and can suck an object up and up, potentially obstructing the colon"; to prevent this serious problem, sex toy users are advised to use sex "...toys with a flared base or a string".<ref>{{cite web|url=https://www.scientificamerican.com/article/good-vibrations-us-consumer-web-site-aims-to-enhance-sex-toy-safety/|title=Good Vibrations: U.S. Consumer Web Site Aims to Enhance Sex Toy Safety|first=Regina|last=Nuzzo |website=[[Scientific American]]| name-list-style = vanc |author-link= Regina Nuzzo}}</ref> | |||
==Abstinence== | |||
[[Sexual abstinence]] reduces STIs and pregnancy risks associated with [[Human sexual activity|sexual contact]], but STIs may also be transmitted through non-sexual means, or by [[rape]]. 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 | vauthors = 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 = Infection Control and Hospital Epidemiology | volume = 24 | issue = 2 | pages = 86–96 | date = February 2003 | pmid = 12602690 | doi = 10.1086/502178 | s2cid = 20112502 | url = https://zenodo.org/record/1235694 }}</ref> Evidence does not support the use of [[abstinence-only sex education]].<ref name=Obs07>{{cite journal | vauthors = Ott MA, Santelli JS | title = Abstinence and abstinence-only education | journal = Current Opinion in Obstetrics & Gynecology | volume = 19 | issue = 5 | pages = 446–52 | date = October 2007 | pmid = 17885460 | pmc = 5913747 | doi = 10.1097/GCO.0b013e3282efdc0b }}</ref> Abstinence-only sex education programs have been found to be ineffective in decreasing rates of [[HIV]] infection in the developed world<ref>{{cite journal | vauthors = Underhill K, Operario D, Montgomery P | title = Abstinence-only programs for HIV infection prevention in high-income countries | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD005421 | date = October 2007 | pmid = 17943855 | doi = 10.1002/14651858.CD005421.pub2 | veditors = Operario D }}</ref> and [[unintended pregnancy|unplanned pregnancy]].<ref name=Obs07/> Abstinence-only sex education primarily relies on the consequences of character and morality while health care professionals are concerned about matters regarding health outcomes and behaviors.<ref name=":1">{{cite journal | vauthors = Santelli JS, Kantor LM, Grilo SA, Speizer IS, Lindberg LD, Heitel J, Schalet AT, Lyon ME, Mason-Jones AJ, McGovern T, Heck CJ, Rogers J, Ott MA | display-authors = 6 | title = Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact | language = en | journal = The Journal of Adolescent Health | volume = 61 | issue = 3 | pages = 273–280 | date = September 2017 | pmid = 28842065 | doi = 10.1016/j.jadohealth.2017.05.031 | url = https://www.jahonline.org/article/S1054-139X(17)30260-4/abstract | doi-access = free }}</ref> Though abstinence is the best course to prevent pregnancy and STIs, in reality, it leaves young people without the information and skills they need to avoid unwanted pregnancies and STIs.<ref name=":1" /> | |||
== See also == | |||
{{Portal|Human sexuality}} | |||
* [[Bareback (sex)]] | |||
* [[Celibacy]] | |||
* [[Masturbation]] | |||
* [[Human sexual activity]] | |||
* [[Misconceptions about HIV/AIDS]] | |||
* [[Party and play]] | |||
* [[Post-exposure prophylaxis]] | |||
* [[Sisters of Perpetual Indulgence]] | |||
* [[Terrence Higgins Trust]] | |||
== References == | |||
{{Reflist|35em}} | |||
== External links == | |||
{{Commons category|Safer sex}} | |||
* [http://www.agum.org.uk/std/prevention-std.html "Prevention - Sexually Transmitted Disease, AGUM (Association of Genital Urinary Medicine)] | |||
* [http://www.bashh.org/guidelines "Guidelines", British Association for Sexual health and HIV (BASHH)] | |||
{{Reproductive health}} | |||
{{Human sexuality}} | |||
{{Sex}} | |||
{{condom}} | |||
{{AIDS|state=autocollapse}} | |||
{{STD/STI}} | |||
{{Public health}} | |||
{{Authority control}} | |||
[[Category:Birth control]] | |||
[[Category:HIV/AIDS]] | |||
[[Category:Prevention]] | |||
[[Category:Sexual health]] | |||
[[Category:Sex education]] | |||
[[Category:Prevention of HIV/AIDS]] | |||
[[Category:Harm reduction]] | |||