By: Jennifer McMillen Smith, MSSA, LISW-S, Division of Infectious Disease and medically reviewed by Ann Avery, Infectious Disease Physician at Metrohealth Medical Center
Safer, smarter sex starts in the most powerful sex organ: your brain. You have to make up your mind ahead of time that you want to protect yourself and your partner(s) from HIV and other sexually transmitted infections (STIs).
HIV isn’t a death sentence like it used to be, thanks to modern anti-retroviral meds, but getting infected will complicate your life. You’ll have to take meds every day and potentially deal with the stigma that still hasn’t gone away, unfortunately.
So, the best route is to be thoughtful and proactive about protecting and caring for yourself and others— which also reduces the risk of HIV spreading. That’s a true win-win.
It’s also crucial to think about all the other STIs: gonorrhea, syphilis, genital herpes and HPV (Human papillomavirus), which causes genital warts and cervical cancer.
If you’re living with HIV, other STIs pose substantial risks to your health. So you really have to protect yourself from all STIs — not just HIV.
The Science of STIs: A Quick Review
Before we talk about safer, smarter sex practices, let’s review the main ways HIV and other STIs get into the body:
- Mucous membranes in the anus and vagina
- Cuts and open sores in the anus, vagina, penis, and mouth
- Injections with used needles
The tissues of the anus and vagina are very porous, so any potentially infected bodily fluid that comes in contact with them — blood, semen (cum) or anal/vaginal fluids — can pass viruses and bacterial infections directly into the bloodstream. Anal tissue is especially vulnerable to STIs because it’s more porous and thinner than the vagina. Plus,the rectal region can carry a host of bacteria from potentially lingering poo.
Herpes and HPV are a bit different because they are spread by skin-to- skin contact, so they require slightly different protection strategies.
Knowing these infection pathways can help you understand the safest, smartest ways to have a great sex life.
Safer, Smarter sex: The Fundamentals
Condoms still provide the most reliable way to prevent STIs that travel in bodily fluids into the bloodstream. They’re cheap, plentiful and even available in flavored and glow-in-the-dark varieties. For oral sex, you can cut the tip off a condom and cut it all the way down one side to create a rectangular-shaped protector you can spread across the vagina or anus before going down on your partner in those areas.
You can also buy dental dams that are already cut into a rectangular shape and also come in a variety of scrumptious flavors.
Perhaps the most important factor about condoms is that they are available when you need them. That means carrying a few in your wallet or purse and having a supply in your nightstand at home, or where-ever else you might find yourself hot and ready. Just be sure to keep the condoms protected from extreme temperatures, free of tears, and not expired. Expired condoms should always be tossed out.
Insertive (Top) vs. Receptive (bottom.) The receptive partner, or the bottom, faces the most risk because the lining of the rectum is very vulnerable to a STI infection such as HIV. The insertive partner, or top, faces a much lower risk — but the risk is not zero because the virus can pass through the urethra (pee hole) of the penis. If there are open sores or cuts on the penis or inside the vagina or anus, this drastically increases the risk of infection for both the insertive and receptive partners.
In the case of anal sex, the one essential to a pleasurable and safer experience is extra lubrication. Lots and lots of lube! You can use lubricated condoms and external lubricants that are water-based or silicon-based to achieve the best results. They make everything feel better and reduce the risk of the condom breaking or falling off.Note oil-based lubricants will weaken and break a latex condom..Oils can also mess with the acidity of an anus or vagina which can lead to a yucky and painful yeast infection. Moral of the story, we recommend avoiding oil-based lubes.
Oral. It’s best to protect your mouth from the tissues and fluids of the penis, anus and vagina. You can do that with a condom or a dental dam — whether you are licking or sucking. There’s basically no risk of your saliva infecting somebody else, but any fluid carrying an STI that touches any open sores in your mouth or bleeding gums could infect you.
What about PrEP and PEP? PrEP and PEP are anti-retroviral treatments that you can take if you’re HIV negative either before or after a potential exposure to HIV. While these treatments reduce the risk of HIV infection by up to 99%, they offer no protections against other STIs. That limits their usefulness in avoiding all STI risks, but they are still a great tool for those at risk for HIV.
A quick note about alcohol. If you’re on anti-retroviral meds, your doctor will warn you that drinking too much alcohol can cloud your judgment and cause you to forget to take your meds.
The same idea is true for sex in general: a few drinks will help you relax and enjoy yourself, but too many drinks might cause you to make an oops.
Mixing Safety with Pleasure
Sex is pure feel-good fun. It is a natural and intimate human activity. The key to protecting yourself and preventing the spread of HIV and other STIs is to integrate your protection into your lovemaking. Just use your imagination and pay attention to what your partner enjoys.
Smart sex is not just safer, it's fun! As long as you’re getting tested every few months and protecting yourself against infections in your own way, there’s no reason why you can’t have great sex and stay safe.
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