Safe sex, also called safer sex, is a set of practices designed to reduce the risk of sustaining or imparting sexually-transmitted infections (STIs) (also known as sexually-transmitted diseases or STDs). Conversely, unsafe sex refers to the participation in a sexual relationship without the benefit or use of any contraceptive or preventive measures against STIs.
Safer sex practices became prominent in the late 1980s as a result of the AIDS epidemic. From the viewpoint of society, safer sex can be regarded as a harm reduction strategy. Safe sex is about risk reduction, not complete risk elimination.
Recently, and mostly within 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. Because these terms are virtually synonymous with each other, they will be used interchangeably throughout this article.
Focus on AIDS
Much attention has focused on controlling HIV, which causes AIDS, through the use of condoms, but each STI presents a different predicament. However, sex educators recommend that some form of barrier protection as a harm reduction measure should be used for all sexual activities which might potentially result in the exchange of body fluids.
Safe sex precautions
(also see Unsafe sexual practices)
Sexual abstinence, while it virtually eliminates the risk of STIs or pregnancy, is technically not a method of pursuing "safer sex". Solitary masturbation (including so-called "phone sex" and "cybersex") is also completely safe.
Outside of total abstinence and masturbation, proponents of safer sex recommend that some of the following methods can minimize the risks of STI transmission and pregnancy during sexual activity.
- Monogamy. However, be aware that many monogamous people have been infected with sexually-transmitted diseases by non-monogamous partners, partners who use injection drugs, or previously infected partners.
- Knowing your partner(s), especially their STI status.
- Treating existing STIs and infections of the genitals or mouth (which may increase the chance of transmission).
- Communicating with your partner. Being assertive in saying what you want and don't want. This includes discussing beforehand what is acceptable and what is not to avoid "heat of passion" decisions.
- For those who are not monogamous, reducing your number of sexual partners, particularly anonymous sexual partners, will also reduce your potential exposure to STIs.
- Not using recreational drugs, including alcohol, in a way that increases the likelihood you will be negligent of other safer sex guidelines.
Preventing fluid exchange
Avoiding any contact with blood, vaginal fluid, and semen of the partner:
- Use condoms. Condoms cover the penis during sexual activity. They are most frequently made of latex, but can also be made out of polyurethane for those who have a latex allergy, or they can be made out of animal intestine. 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. Any condoms made out of animal skin or intestine, such as Trojan NaturaLamb, are not thought to be safe because they are porous and viruses such as HIV can pass through them.
- Female condom. This condom is inserted into the vagina prior to intercourse. It is also sometimes used for anal sex.
- Dental dam. A sheet of latex (originally used for dentistry) for protection when engaging in oral sex. It is typically used as a barrier between the mouth and the vagina during cunnilingus or between the mouth and the anus during anilingus. A piece of plastic wrap (such as Saran™ wrap) may also be used as a dental dam; Saran™ wrap has been tested by the FDA and CDC and found effective in preventing the transmission of virus-sized particles, although "microwave-safe" wrap may be ineffective. Latex condoms may also be cut to form an improvised dental dam.
- Medical gloves. Gloves made out of latex, PVC, nitrile or polyurethane may be used as dental dams 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 semen or vaginal fluid. Although the risk of infection in this manner is thought to be low, some people use gloves as an extra precaution. Gloves also make mutual masturbation more comfortable by preventing sharp fingernails from accidentally scratching the genitalia.
- Another way to avoid contact with blood and semen is outercourse (non-penetrative sex), or forms of penetration that do not involve a penis, such as the use of dildos (when cleaned or covered with condoms).
Note that most methods of contraception (birth control) other than the barrier methods mentioned above are not effective at preventing the spread of STIs.
The spermicide Nonoxynol-9 has been claimed to reduce the likelihood of STI transmission. However a recent study by the World Health Organisation  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. However it is better to use a condom with Nonoxynol-9 than no condom at all.
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 STI transmission or pregnancy. This is because of the formation of pre-ejaculate, a fluid (which may contain sperm) that oozes from the urethra before actual ejaculation. In addition, open sores on either partner can permit transmission.
- "Guide to Safer Sex" from the Society for Human Sexuality's sexuality.org site. Very explicit information on making various sexual practices safer:
- Tiny Nibbles Safer Sex Chart. Presents risk levels of a variety of sexual activities and most major STIs.
- The Strategy. Get tested together before you have sex for sexually transmitted infections.
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