Safe sex is sexual activity engaged in by people who have taken precautions to protect themselves against sexually transmitted diseases (STDs) such as HIV/AIDS. It is also referred to as safer sex or protected sex, while unsafe or unprotected sex is sexual activity engaged in without precautions. Some sources prefer the term safer sex to more precisely reflect the fact that these practices reduce, but do not completely eliminate, the risk of disease transmission. In recent years, the term “sexually transmitted infections” (STIs) has been preferred over “STDs”, as it has a broader range of meaning; a person may be infected, and may potentially infect others, without showing signs of disease.
Safe sex practices became more prominent in the late 1980s as a result of the AIDS epidemic. Promoting safe sex is now one of the aims of sex education. Safe sex is regarded as a harm reduction strategy aimed at reducing risks. The risk reduction of safe sex is not absolute; for example the reduced risk to the receptive partner of acquiring HIV from HIV seropositive partners not wearing condoms to compared to when they wear them is estimated to be about a four- to fivefold. Although some safe sex practices can be used as contraception, most forms of contraception do not protect against all or any STIs; likewise, some safe sex practices, like partner selection and low risk sex behavior, are not effective forms of contraception.
Safe sex is effective on avoiding STDs if only both parties involved in sexual intercourse agreed on doing so and stick to it. During sexual intercourse using condoms, for example, the male might intentionally pull off the condom and continue penetrating without the female (or male receptive partner)’s consent and notice. This is a high risk behavior that betrays trust as well as spreading the disease.
Although “safe sex” is used by individuals to refer to protection against both pregnancy and HIV/AIDS or other STI transmissions, the term was primarily derived in response to the HIV/AIDS epidemic. It is believed that the term of “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 homosexual men. The term was related with the need to develop educational programs for the group considered at risk, homosexual men. 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 drugs that reduced inhibitions for high-risk sexual behavior. Moreover, in 1985, the first safe sex guidelines were established by the ‘Coalition for Sexual Responsibilities’. According to these guidelines, safe sex was practiced by using condoms also when engaging in anal or oral sex.
Avoiding physical contact
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 bodily fluids. Some activities, such as “phone sex” and “cybersex”, that allow for partners to engage in sexual activity without being in the same room, eliminate the risks involved with exchanging bodily fluids.
A range of sex acts, sometimes called “outercourse”, can be enjoyed with significantly reduced risks of infection or 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 1994.
Non-penetrative sex includes practices such as kissing, mutual masturbation, rubbing or stroking and, 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 skin-to-skin such as herpes and genital warts.
Various protective devices are used to avoid contact with blood, vaginal fluid, semen or other contaminant agents (like skin, hair and shared objects) during sexual activity. Sexual activity using these devices is called protected sex.
Condoms cover the penis during sexual activity. They are most frequently made of latex, and can also be made out of synthetic materials including polyurethane.
Female condoms are inserted into the vagina prior to intercourse.
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 gloves made out of latex, vinyl, nitrile, or polyurethane may be used as a makeshift dental dam during oral sex, or to protect the hands during sexual stimulation, such as masturbation. Hands may have invisible cuts on them that may admit pathogens or contaminate the other body part or partner.
Another way to protect against pathogen transmission is the use of protected or properly cleaned dildos and other sex toys. If a sex toy is to be used in more than one orifice or partner, a condom can be used over it and changed when the toy is moved.
When latex barriers are used, oil-based lubrication can break down the structure of the latex and remove the protection it provides.
Condoms (male or female) are used to protect against STIs, and used with other forms of contraception to improve contraceptive effectiveness. For example, simultaneously using both the male condom and spermicide (applied separately, not pre-lubricated) is believed to reduce perfect-use pregnancy rates to those seen among implant users. However, if two condoms are used simultaneously (male condom on top of male condom, or male condom inside female condom), this increases the chance of condom failure.
Proper use of barriers, such as condoms, depends on the cleanliness of surfaces of the barrier, handling can pass contamination to and from surfaces of the barrier unless care is taken.
Studies of latex condom performance during use reported breakage and slippage rates varying from 1.46% to 18.60%. Condoms must be put on before any bodily fluid could be exchanged, and they must be used also during oral sex.
Female condoms are made of two flexible polyurethane rings and a loose-fitting polyurethane sheath. According to laboratory testing, female condoms are effective in preventing the leakage of body fluids and therefore the transmission of STIs and HIV. Several studies show that between 50% and 73% of women who have used this type of condoms during intercourse find them as or more comfortable than male condoms. On the other hand, acceptability of these condoms among the male population is somewhat less, at approximately 40%. Because the cost of female condoms is higher than male condoms, there have been studies carried out with the aim of detecting whether they can be reused. Research has shown that structural integrity of polyurethane female condoms is not damaged during up to five uses if it is disinfected with water and household bleach. However, regardless of this study, specialists still recommend that female condoms are used only once and then discarded.