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Terminology Recently and mainly within Canada and 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 mostly used by sex educators Focus on condoms and HIV control Much attention has focused on controlling HIV the virus that causes AIDS through the use of barrier protection for the penis especially condoms However the HIV is a delicate virus so protections focused on HIV may not protect against other STIs which can also be transmitted through other areas of the body where the pathogen virus or bacteria has higher prevalence and resistance Thus some sex educators recommend the use of barrier protection for any sexual contact with anal or vaginal cavities or oral stimulation of those cavities or the penis Safe sex precautions It has been suggested that Dual protection be merged into this article or section Discuss Shunga print by Kunisada depicting masturbation 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 discharged 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 eliminating the risks involved with exchanging bodily fluids Non penetrative sex watercolor of manual stimulation of the penis Johann Nepomuk Geiger 1840 Main article Non penetrative sex A range of sex acts sometimes called outercourse can be enjoyed with significantly reduced risks of infection and 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 Barrier protection 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 Practice of sexual activity using this devices is called protected sex Condom machine Condoms cover the penis during sexual activity They are most frequently made of latex but can also be made out of polyurethane 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 Female condoms are inserted into the vagina prior to intercourse They may also be used for anal sex although they are less effective citation needed 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 anilingus Medical gloves made out of latex vinyl nitrile or polyurethane may be used as an makeshift dental dam during oral sex or to protect the hands during sexual stimulation like in masturbation Hands may have invisible cuts on them that may admit pathogens or more usually serve as vehicle for contamination of other body part or partner Another way to protect against pathogen transmission is the use of protected or properly cleaned dildos or 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 cleanness of surfaces of the barrier handling can pass contamination to and from surfaces the barrier unless care is taken Other precautions Acknowledging that it is usually impossible to have entirely risk free sex with another person proponents of safe sex recommend that some of the following methods be used to minimize the risks of STI transmission and unwanted pregnancy Immunization against various viral infections that can be transmitted sexually The most common vaccines are HPV vaccine which protects against the most common types of human papillomavirus that cause cervical cancer and the Hepatitis B vaccine Immunization before initiation of sexual activity increases effectiveness Male Circumcision and HIV Some recent research and advice from the World Health Organisation WHO has suggested that circumcision of males can be useful in preventing the spread of HIV infection in some countries Male circumcision is acknowledged by the WHO as a preventative measure against HIV transmission from women to men African studies have found that circumcision can reduce the rate of transmission of HIV to men by up to 60 Some advocacy groups dispute these findings However at least in sub Saharan Africa condom use is estimated to be much more cost effective Periodic STI testing has been used to reduce STIs in Cuba and among pornographic film actors Cuba implemented a program of mandatory testing and quarantine early in the AIDS epidemic In the US pornographic film industry in the US many production companies will not hire actors without tests for Chlamydia HIV and Gonorrhea that are no more than 30 days old and tests for other STIs no more than 6 months old AIM Medical foundation claims that program of testing has reduced the incidence of sexually transmitted infection to 20 of that of the general population Douching with soap and water has not been studied and it is thought that by disrupting the vaginal flora it might increase risk of infection 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 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 For those who are not monogamous reducing the number of one s sexual partners particularly anonymous sexual partners may also reduce one s potential exposure to STIs Similarly one may restrict one s sexual contact to a community of trusted individuals this is the approach taken by some pornographic actors and other non monogamous people When selecting a sexual parter some characteristics can increase the risks for contracting sexually transmitted diseases These include an age discordance of more than five years having an STI in the past year problems with alcohol having had sex with other people in the past year Communication with one s sexual partner s makes for greater safety Before initiating sexual activities partners may discuss what activities they will and will not engage in and what precautions they will take This can reduce the chance of risky decisions being made in the heat of passion Refraining from the use of recreational drugs including alcohol before and during sexual activity can protect against associated risks such as lowered inhibitions decreased immune response impaired judgment and loss of consciousness If a person is sexually active with a number of partners regular sexual health check ups from a doctor are a precaution taken and on noticing unusual symptoms seeking prompt medical advice HIV and other infectious agents can be either asymptomatic or involve nonspecific symptoms which on their own can be misdiagnosed Limitations While the use of condoms can reduce transmission of HIV and other infectious agents it does not do so completely 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 It also said In practice inconsistent use may reduce the overall effectiveness of condoms to as low as 6070 p 40 During each act of anal intercourse the risk of the receptive partner acquiring HIV from HIV seropositive partners not using condoms is about 1 in 120 Among people using condoms the receptive partner s risk declines to 1 in 550 a four to fivefold reduction Where the partner s HIV status is unknown Estimated per contact risk of protected receptive anal intercourse with HIV positive and unknown serostatus partners including episodes in which condoms failed was two thirds the risk of unprotected receptive anal intercourse with the comparable set of partners p 310 Using two or more forms of birth control concurrently Risk of accidental pregnancy BEST case scenario assuming PERFECT use Per Year assuming 100 sex acts Per Act No protection 8 in 10 1 in 1 25 1 in 125 Condoms 1 in 50 1 in 5 000 Birth Control 1 in 333 1 in 33 300 Condoms Birth Control 1 in 1 665 000 1 in 166 500 000 50 333 100 What the above figures mean is that in one year 80 out of 100 couples using no protection will get pregnant 2 out of 100 couples using just condoms will get pregnant 3 out of 100 couples using just hormonal birth control will get pregnant and 00006 out of 100 couples using both condoms and birth control will get pregnant Using 2 or more forms of birth control dramatically reduces the risk of unplanned pregnancy Use at least condoms and the pull out method together unless sure the female is on hormonal If sure use hormonal and condoms until sure there are no diseases Then hormonal and pull out is an option or hormonal and diaphragm or pull out and diaphragm Never use the pull out method by itself The typical success rate is 1 in 3 7 per year Always try to use at least two forms of birth control In 10 years the risk with just hormonal rises from 1 in 333 couples to 1 in 33 3 couples This is assuming perfect use of the contraceptive The typical use numbers are even riskier Risk of accidental pregnancy WORST case scenario assuming TYPICAL use Per Year assuming 80 sex acts Per Act No protection 8 in 10 1 in 1 25 1 in 125 Condoms 1 in 6 6 1 in 533 Birth Control 1 in 12 5 1 in 1 000 Condoms Birth Control 1 in 6 666 1 in 533 333 6 66 12 80 In typical use including forgetting to take the pill or not understanding instructions or things like that 8 in 100 1 in 12 5 couples using just hormonal birth control will get pregnant each year The true risk must be somewhere in between Perfect and Typical use If you care to ejaculate in the vagina for sexual bonding only do so infrequently In 10 years of typical use of only hormonal the risk rises from 8 in 100 1 in 12 5 to 80 in 100 1 in 1 25 couples See for reference on above tables Ineffective methods Most methods of contraception except for certain forms of outercourse and the barrier methods are not effective at preventing the spread of STIs This includes the birth control pills vasectomy tubal ligation periodic abstinence and all non barrier methods of pregnancy prevention The spermicide Nonoxynol 9 has been claimed to reduce the likelihood of STI transmission However a recent study 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 Condoms with Nonoxynol 9 lubricant do not have enough spermicide to increase contraceptive effectiveness and are not to be promoted citation needed 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 This is because of the formation of pre ejaculate a fluid that oozes from the urethra before actual ejaculation may contain pathogens such as HIV Additionally the microbes responsible for some diseases including genital warts and syphilis can be transmitted through skin to skin contact even if the partners never engage in oral vaginal or anal sexual intercourse Abstinence Sexual abstinence is sometimes promoted as a way to avoid the risks associated with sexual contact though STIs may also be transmitted through non sexual means 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 It is often recommended that those using abstinence have condoms available as a backup for protection against STIs and pregnancy Some groups notably some evangelical Christians and the Roman Catholic Church oppose sex outside marriage and object to safe sex education programs because they believe that providing such education promotes promiscuity Virginity pledges and sexual abstinence education programs are often promoted in lieu of contraceptives and safe sex education programs This may entail exposing some teenagers to increased risk of sexually transmitted infections because about 60 percent of teenagers who pledge virginity until marriage do engage in pre marital sex and are then one third less likely to use contraceptives than their peers who have received more conventional sex education Anal sex Unprotected anal penetration is
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