Safe sex

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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 Condom unrolled durex.jpg
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
Dental dams can be used to cover the vulva or anus when engaging in cunnilingus or anilingus, respectively, for safer sex Latex Dental Dam far (cropped).jpg
Dental dams can be used to cover the vulva or anus when engaging in cunnilingus or anilingus, respectively, for safer sex
Female condoms ("internal" condoms) can be used by receptive partners for safer sex Female condom.jpg
Female condoms ("internal" condoms) can be used by receptive partners for safer sex

Safe sex is sexual activity using methods or devices (such as condoms) to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. [1] "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 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 US. 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. [2] [3]

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 ] might not be effective forms of contraception.


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 HIV/AIDS crisis. [4] [5]

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 . Neither publication used the term "safe sex" but both included recommendations that are now standard advice for reducing STI (including HIV) risks. [6] [7] [8]

A poster promotes condom use. A black woman with one hand on her arm looks directly at Wellcome L0052333.jpg
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 Intelligencer': ""The goal is to reach about 50 million people with messages about safe sex and AIDS education." [5]

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. [9]

A poster aimed at lesbians says "Low risk isn't no risk". It uses the expression "safer sex". Low risk isn't no risk. Wellcome L0052075.jpg
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 drugs that reduced inhibitions for high-risk sexual behavior. [10] Moreover, in 1985, the first safe sex guidelines were established by the 'Coalition for Sexual Responsibilities'.[ who? ] According to these guidelines, safe sex was practiced by using condoms also when engaging in anal or oral sex.[ citation needed ]

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 partners. The first book on this subject appeared in the same year. The book was entitled "Safe Sex in the Age of AIDS", it had 88 pages and it described both positive and negative approaches to sexual life.[ citation needed ] Sexual behavior could be either safe (kissing, hugging, massage, body-to-body rubbing, mutual masturbation, exhibitionism, phone sex, and use of separate sex toys); possibly safe (use of condoms); and unsafe. [10]

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 Vatican urged chastity and heterosexual marriage, attacking the American Catholic bishops' guidelines.[ citation needed ]

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). [10]

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 sexual activities is a continuum. The term safe sex is still in common use in the United Kingdom, [11] 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.


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 completely eliminate) risk of transmitting or acquiring STIs.

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. [12]

Non-penetrative sex

Watercolor of manual stimulation of the penis, Johann Nepomuk Geiger, 1840 PeterJohannNepomukGeigerEroticWatercolor04.jpg
Watercolor of manual stimulation of the penis, Johann Nepomuk Geiger, 1840

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. [13] [14] 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 human papilloma virus. [15] 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. [12]

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.

How to put a male condom on a penis How To Put on a Condom graphic.png
How to put a male condom on a penis

Oil-based lubrication can break down the structure of latex condoms, dental dams or gloves, reducing their effectiveness for STI protection. [18]

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. [19] It also said, "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%". [19] p. 40.

Pre-exposure prophylaxis (PrEP)

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.

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 are also being studied for use as PrEP.

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. [20]

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"). [21]

Other forms of safe sex

Other methods proven effective at reducing STI risks during sexual activity are:

Ineffective methods


Most methods of contraception are not effective at preventing the spread of STIs. This includes birth control pills, vasectomy, tubal ligation, periodic abstinence, IUDs and many non-barrier methods of pregnancy prevention. However, condoms are highly effective for birth control and STI prevention.

The spermicide Nonoxynol-9 has been claimed to reduce the likelihood of STI transmission. However, a technical report [31] 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 pathogens 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. [31] [32]

The use of a diaphragm or contraceptive sponge provides some women with better protection against certain sexually transmitted diseases, [33] 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, although this is debated. [34]

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 warts and syphilis, can be transmitted through skin-to-skin or mucous membrane contact.

Anal sex

Unprotected anal penetration is considered a high-risk sexual activity because the thin tissues of the anus and rectum can be easily damaged. [35] [36] Slight injuries can allow the passage of bacteria and viruses, including HIV. This includes penetration of the anus by fingers, hands, or sex toys such as dildos. Also, condoms may be more likely to break during anal sex than during vaginal sex, increasing the risk of STI transmission. [37]

The main risk which individuals are exposed to when performing anal sex is the transmission of HIV. Other possible infections include Hepatitis A, B and C; intestinal parasite infections like Giardia ; and bacterial infections such as Escherichia coli. [38]

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. Enemas should not be used as they can increase the risk of HIV infection [39] and lymphogranuloma venereum proctitis. [40]

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; [41] water-based and silicone-based lubricants are available instead. Non-latex condoms are available for people who are allergic to latex made out of polyurethane or polyisoprene. [42] Polyurethane condoms can safely be used with oil-based lubricant. [43] 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 and urinary tract infections. [44]

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 the plastic wrap [45] are effective protection means whenever anilingus is performed.

Sex toys

Two sex toys intended for anal use (note the flared bases) Zwei unterschiedliche Butt-Plugs.jpg
Two 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 toys 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. [46]

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. [47] 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. [48]

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 " with a flared base or a string". [49]


Sexual abstinence reduces STIs and pregnancy risks associated with sexual contact, but STIs may also be transmitted through non-sexual means, or by rape. HIV may be transmitted through contaminated needles used in tattooing, body piercing, or 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. [50] Evidence does not support the use of abstinence-only sex education. [51] Abstinence-only sex education programs have been found to be ineffective in decreasing rates of HIV infection in the developed world [52] and unplanned pregnancy. [51] 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. [53] Though abstinence is the best course to prevent pregnancy and STIs, in reality, it is unrealistic so intentions to abstain from sexual activity are often unsuccessful. It leaves young people without the information and skills they need to avoid unwanted pregnancies and STIs. [53]

See also

Related Research Articles

Fellatio Oral sex on the penis by a sexual partner

Fellatio is an oral sex act involving a person stimulating the penis of another person by using the mouth, throat, or both. Oral stimulation of the scrotum may also be termed fellatio, or colloquially as teabagging. If fellatio is performed on oneself, the act is called autofellatio.

Microbicides for sexually transmitted diseases Pharmacologic agents and chemical substances

Microbicides for sexually transmitted diseases are pharmacologic agents and chemical substances that are capable of killing or destroying certain microorganisms that commonly cause human infection.

Men who have sex with men (MSM), also known as males who have sex with males, are male persons who engage in sexual activity with members of the same sex, regardless of how they identify themselves. They may identify as gay, homosexual, bisexual, pansexual, or heterosexual; or dispense with sexual identification altogether.

Bareback sex is physical sexual activity, especially sexual penetration, without the use of a condom. The topic primarily concerns anal sex between men who have sex with men without the use of a condom, and may be distinguished from unprotected sex because bareback sex denotes the deliberate act of forgoing condom use.

Dry sex is the sexual practice of having sexual intercourse without vaginal lubrication. Vaginal lubrication can be removed by using herbal aphrodisiacs, household detergents, antiseptics, by wiping out the vagina, or by placing leaves in the vagina besides other methods. Dry sex is associated with increased health risks.

Oral sex Sexual activity involving the stimulation of the genitalia by the use of the mouth

Oral sex, sometimes referred to as oral intercourse, is sexual activity involving the stimulation of the genitalia of a person by another person using the mouth and the throat. Cunnilingus is oral sex performed on the vulva or vagina, while fellatio is oral sex performed on the penis. Anilingus, another form of oral sex, is oral stimulation of the anus. Oral stimulation of other parts of the body, such as by kissing or licking, is not considered oral sex.

Serosorting, also known as serodiscrimination is the practice of using HIV status as a decision-making point in choosing sexual behavior. Frequently the term is used to describe the behavior of a person who chooses a sexual partner assumed to be of the same HIV serostatus in order to engage in unprotected sex with them for a reduced risk of acquiring or transmitting HIV/AIDS.

Abstinence-only sex education

Abstinence-only sex education is a form of sex education that teaches not having sex outside of marriage. It often excludes other types of sexual and reproductive health education, such as birth control and safe sex. Comprehensive sex education, by contrast, covers the use of birth control and sexual abstinence.

Abstinence, be faithful, use a condom, also known as the ABC strategy or abstinence-plus sex education, also known as abstinence-based sex education, is a sex education policy based on a combination of "risk avoidance" and harm reduction which modifies the approach of abstinence-only sex education by including education about the value of partner reduction safe sex and birth control methods. Abstinence-only sex education is strictly to promote the sexual abstinence until marriage, and does not teach about safe sex or contraceptives. The abstinence-based sex education program is meant to stress abstinence and include information on safe sex practices. In general terms, this strategy of sex education is a compromise between abstinence-only education and comprehensive sex education. The ABC approach was developed in response to the growing epidemic of HIV/AIDS in Africa, and to prevent the spread of other sexually transmitted diseases. This approach has been credited by some with the falling numbers of those infected with AIDS in Uganda, Kenya and Zimbabwe, among others. From 1990 to 2001 the percentage of Ugandans living with AIDS fell from 15% to between 5 and 6%. This fall is believed to result from the employment of the ABC approach, especially reduction in the number of sex partners, called "Zero-Grazing" in Uganda.

Women who have sex with women (WSW) are women who engage in sexual activities with other women, whether or not they identify themselves as lesbian, bisexual, heterosexual, or dispense with sexual identification altogether. The term WSW is often used in medical literature to describe such women as a group for clinical study, without needing to consider sexual self-identity.

Non-penetrative sex Sexual activity that usually does not include sexual penetration

Non-penetrative sex or outercourse is sexual activity that usually does not include sexual penetration. It generally excludes the penetrative aspects of vaginal, anal, or oral sexual activity, but includes various forms of sexual and non-sexual activity, such as frottage, mutual masturbation, kissing, or cuddling. Some forms of non-penetrative sex, particularly when termed outercourse, include penetrative aspects, such as penetration that may result from forms of fingering or oral sex.

Lesbian sexual practices Sexual practices between women

Lesbian sexual practices are sexual activities involving women who have sex with women, regardless of their sexual orientation. A woman who has sex with another woman may identify as a lesbian if she is sexually attracted to women, or bisexual if she is not exclusively sexually attracted to women, or dispense with sexual identification altogether. The term may also be applied to a heterosexual or asexual woman who is unsure of or is exploring her sexuality.

Condom effectiveness

Condom effectiveness is how effective condoms are at preventing STDs and pregnancy. Correctly using male condoms and other barriers like female condoms and dental dams, every time, can reduce 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 or female condoms correctly, every time, can also help prevent pregnancy.

Sexually transmitted infection Infection transmitted through human sexual behavior

Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs), are infections that are commonly spread by sexual activity, especially vaginal intercourse, anal sex and oral sex. STIs often do not initially cause symptoms, which results in a greater risk of passing the disease on to others. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. STIs can be transmitted to an infant before or during childbirth, which may result in poor outcomes for the infant. Some STIs can cause infertility.

HIV prevention refers to practices that aim to prevent the spread of the Human Immunodeficiency Virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

<i>How to Have Sex in an Epidemic</i> 1983 book by Richard Berkowitz and Michael Callen

How to Have Sex in an Epidemic: One Approach is a 1983 manual by Richard Berkowitz and Michael Callen, under the direction of Joseph Sonnabend, to advise men who have sex with men (MSM) about how to avoid contracting the infecting agent which causes AIDS. It was among the first publications to recommend the use of condoms to prevent the transmission of STDs in men having sex with men, and has even been named, along with Play Fair!, as one of the foundational publications in the advent of modern safe sex.

A rectal microbicide is a microbicide for rectal use. Most commonly such a product would be a topical gel inserted into the anus so that it make act as protection against the contract of a sexually transmitted infection during anal sex.

Since reports of the human immunodeficiency virus (HIV) began to emerge in the United States in the 1980s, the HIV epidemic has frequently been linked to gay, bisexual, and other men who have sex with men (MSM) by epidemiologists and medical professionals. The first official report on the virus was published by the Center for Disease Control (CDC) on June 5, 1981 and detailed the cases of five young gay men who were hospitalized with serious infections. A month later, The New York Times reported that 41 homosexuals had been diagnosed with Kaposi’s Sarcoma, and eight had died less than 24 months after the diagnosis was made. By 1982, the condition was referred to in the medical community as Gay-related immune deficiency (GRID), "gay cancer," and "gay compromise syndrome." It was not until July 1982 that the term Acquired Immune Deficiency Syndrome (AIDS) was suggested to replace GRID, and even then it was not until September that the CDC first used the AIDS acronym in an official report.

Uganda is one of the few Sub-Saharan African countries that has adopted abstinence-only sex education as an approach of sexual education that emphasizes abstinence from sexual intercourse until marriage as the only option. Abstinence-only sex education does not include joint curriculum covering other options including safe sex practices, family planning, and is espoused as the only sure way to avoid pregnancy and sexually transmitted infections. Uganda is commonly recognized as an exemplary case of lowering the rate of HIV prevalence Prevalence figures may have also been distorted by the lack of treatment, meaning that the percentage of infected is decreased by disproportionately early deaths. Abstinence-only sex education has been implemented and supported for this cause to a large degree in Uganda, to some controversy. Critics have questioned its effectiveness in lowering HIV/AIDS transmission. They have also highlighted discrimination, gender inequality and social stigma as the outcomes of the program in Uganda.

Risky sexual behavior is the description of the activity that will increase the probability that a person engaging in sexual activity with another person infected with a sexually transmitted infection will be infected or become pregnant, or make a partner pregnant. It can mean two similar things: the behavior itself, the description of the partner's behavior. The behavior could be unprotected vaginal, oral, or anal intercourse. The partner could be a nonexclusive partner, HIV-positive, or an intravenous drug user. Drug use is associated with risky sexual behaviors.


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