This guide focuses on the basics of safer sex, and on how to make whatever precautions you choose feel as pleasurable as possible. Safer sex precautions are obviously not necessary when neither you nor your partner(s) have anything you could transmit to each other (and will be completely safe in your interactions with anyone else during the course of your relationship, etc.), but in all other cases your peace of mind can be enhanced by making good choices about safer sex ahead of time and sticking to them.
Please note that safer sex is about dramatic risk reduction against the most serious sexually-transmitted ailments, not complete risk elimination for every possible condition (for example: the virii for cold sores and warts can be spread through unbarriered contact with any infected area, including healthy-looking skin that a condom would not cover).
The single most effective thing you can do to stay healthy while being sexually active is to use latex condoms for intercourse (whether vaginal or anal). All condoms are not made alike; men should experiment with different brands until they find the one they like best (many men prefer Kimono Microthins, which are commonly available in drug stores, and which also taste fine for fellatio if you get them without Nonoxynol-9). When you put on a condom, pinch its tip as you unroll it (all the way down!) to prevent an air bubble from forming in the reservoir tip. For intercourse, you should then put some water-based lube (of the brands commonly available in drug stores Astroglide probably being the best bet) on the outside of the condom for comfort, mutual pleasure, and to keep the condom from tearing during sex. Note that some men find that more sensation is transmitted to them if they put a drop or two of water-based lube INSIDE the tip of their condom before putting it on. Also, it's very important for men to hold onto the base of their condom as they withdraw (i.e. after becoming soft) so it doesn't slip off.
For a while, health experts were recommending that people choose safer sex products with Nonoxynol-9 to protect against HIV transmission: scientific evidence resulted in this advice being formally retracted by public health officials in the year 2000, and unless you are using Nonoxynol-9 as a contraceptive rather than for HIV prevention it may be wise to cease using it entirely.
If a condom fails during vaginal or anal intercourse, the receptive partner shouldn't douche; if any Nonoxynol-9 contraceptive foam is handy it MIGHT help for him or her to insert it and leave it in for about 15 minutes, and it would certainly help to immediately remove the condom from inside the vagina or anus if it was left there. Some sex educators have suggested that men might be able to give themselves a little extra protection after a condom failure by immediately visiting the restroom and urinating, though other experts have questioned this advice. If unwanted pregnancy is a possible outcome of the condom failure, you should visit http://ec.princeton.edu to find out about emergency contraception in your area.
It should be obvious that a new condom needs to be used for each new partner, and that condoms should not be reused. Also, if you're going to switch from anal intercourse to vaginal intercourse, you should put on a new condom to avoid causing vaginal infections.
Opinions differ on the use of safer-sex barriers for oral sex. It's clear that herpes can be transmitted from genitals to mouth or mouth to genitals during unprotected oral sex. It is also very possible to pick up a bacterial infection of the mouth or throat by going down on someone who currently has a bacterial STD (typically Gonorrhea, Syphillis, or Chlamydia), but these can usually be cured with antibiotics once they're identified.
At the time of this guide's writing, the available evidence strongly suggested that the risk of transmitting HIV was much, MUCH lower for unprotected oral sex than for unprotected anal or vaginal intercourse, and conventional wisdom amongst sex educators was that the risk is much lower for the person being sucked or licked than for the person doing the sucking or licking. For the person doing the sucking or licking, it seemed physically plausible that: the risk of transmission could be lower if your gums (and lips/mouth/throat) are healthy, if you don't let men come in your mouth, and if you don't perform cunnilingus on a woman while she is menstruating.
Some sex educators recommend NOT flossing or brushing your teeth for an hour before giving unprotected oral sex (use an anti-bacterial mouthwash if you're concerned about bad breath or just want to freshen up), and others recommend quickly looking over the genitals you're about to go down on for obvious signs of contagious STDs (including genital warts, which can potentially be transmitted from genitals to mouth). If your policy for performing unprotected fellatio is to not let your partner come in your mouth and he does so anyway, it's probably better to immediately spit than to either wait or swallow, and it may help (especially for bacterial STDs) to then go use an anti-bacterial or peroxide mouthwash. Pre-cum can contain HIV, and although not letting men come in your mouth SIGNIFICANTLY reduces your already low risk to even lower levels, if you are concerned about becoming infected via pre-cum while performing fellatio you have two risk-reduction options: not taking the head of his penis in your mouth or using barriers for oral sex.
If after getting all the current facts you decide that your personal safety standards include barriers for oral sex, then you'll need to use latex condoms (without Nonoxynol-9) for fellatio, and either regular saran wrap or one of those "Glyde" dams for cunnilingus (for cunnilingus, put a little water-based lube on your partner's side of the barrier to increase the sensation transmitted to her). The same barrier techniques used for cunnilingus can also be used for analingus (rimming), where they should be considered essential if the person doing the licking isn't immunized against hepatitis A or if the person being licked may have a bacterial infection.
If you've had your fingers in someone's vagina, or had someone come on your hands, then it's a good idea to wash your hands with hot water and anti-bacterial soap before touching your eyes or anyone else's genitals (individually-packaged anti-bacterial towlettes might be useful if you're outdoors). If your skin is compromised in any way, if you want to avoid needing to leave the scene to wash your hands, if you're going to be engaging in anal fisting or exposing yourself to any blood, or if you just want to be extra-safe and/or extra-tidy, then try using disposable latex "examination" gloves (available at most drug stores).
If you're not going to use gloves, then just as a hygiene matter washing your hands before putting them in someone is a good idea.
Of course, if you've just had your ungloved fingers in somebody's ass, then you'll want to be sure to clean your hands particularly thoroughly (especially under your fingernails) before putting your them in or near anyone's mouth.
It's helpful to get a little hip pack for your safer-sex supplies, your smaller bottle of water-based lube, and anything else you commonly use. You might also want to pack a portable toothbrush and a travel-sized toothpaste tube in case you end up staying overnight somewhere.
Permanent vaccines are available for hepatitis B and hepatitis A. Hepatitis B can be spread easily through intercourse and (less easily) through oral sex or rimming, and hepatitis A is easily spread through rimming. Getting these two vaccinations (which you can do at the same time) would be an excellent idea if you don't always use barriers for these activities. By contrast, there is currently NO vaccine against Hepatitis C (though Hep C is spread primarily through direct contact with human blood, e.g. through sharing needles, and only rarely through sexual contact - see http://www.cdc.gov/hepatitis/ for more details).
More recently, in June 2006 a vaccine against several specific types of human papillomavirus (HPV) was approved for use by girls/women (see http://www.cdc.gov/hpv/ for details). Although this vaccine does not protect against every type of HPV, the types it protects against cause the majority of cervical cancers and the overwhelming majority of genital warts. Ideally, if one is to get the full benefit of this vaccine, the vaccination series should be complete before one becomes sexually active: at this time it's recommended for 11-12 year old girls, and can be given to girls as young as nine.
If you're going to be engaging in intercourse with someone of the opposite sex, birth control may be an issue. If the birth control that latex condoms offer is good enough for you, then you're set. If you want more protection than this, contact Planned Parenthood at 1-800-230-PLAN to discuss the options. Special doses of particular birth control pills can reduce the chance of pregnancy by 75% if taken within 72 hours of contraceptive failure; the Emergency Contraception Website at http://ec.princeton.edu can tell you where to go to get them.
If you have additional questions about STDs or HIV, call the CDC hotline at 1-800-232-4636 or visit http://www.thebody.com. Information about testing clinics is available by calling the aforementioned hotline, and since bacterial STDs are almost always curable with appropriate antibiotics and the incurable viral STDs (such as HIV, herpes, hepatitis, and HPV) are now more easily managed than ever, it's definitely in your best interest to get tested if you think you might have been exposed to anything.
Please keep in mind that, for standard HIV testing, a minimum of three months needs to go by since your last potential exposure for the test to be reliable: in other words, if you and your partner would like to drop safer sex precautions with each other and are primarily concerned about HIV, you'll need to go through a period of time where you're completely safe with each other and everyone else before you'll be able to get a meaningful test result (you'll also be advised on this matter when you go in for testing).
If you require more detailed information on STD/HIV treatments, the best online document is the CDC's Sexually Transmitted Diseases Treatment Guidelines at http://www.cdc.gov/std/treatment/.
We've prepared guides to the different lubes and safer sex barriers currently available, which may help you make your selections.
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