Safe sex

Overview
Safe sex (also called safer sex or protected sex) is a set of practices that are designed to reduce the risk of infection during sexual intercourse to avoid developing sexually transmitted diseases (STDs). Conversely, unsafe sex refers to engaging in sexual intercourse without the use of any barrier contraception or other preventive measures against STDs.

Safe sex practices became prominent in the late 1980s as a result of the AIDS epidemic. Promoting safe sex is now a principal aim of sex education. From the viewpoint of society, safer sex can be regarded as a harm reduction strategy. Safe sex is about risk reduction, not complete risk elimination.

Although safe sex practices can be used as a form of family planning, the term refers to efforts made to prevent infection rather than conception. Many effective forms of contraception do not offer protection against STDs.

Terminology
Recently, and mostly 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 mainly used by sex educators. Because these terms are virtually synonymous with each other, they are used interchangeably throughout this article.

Focus on HIV/AIDS
Much attention has focused on controlling HIV, the virus that causes AIDS, through the use of condoms, but each STD presents a different problem. However, sex educators recommend that some form of barrier protection as a harm reduction measure should be used for all sexual activities which might potentially result in the exchange of body fluids.

Sex by yourself
Known as Autoeroticism, solitary sexual activity (including "phone sex" and "cybersex") is relatively safe. However, some practices, such as self-bondage and autoerotic asphyxia, are made considerably more dangerous by the absence of people who can intervene if something goes wrong. Masturbation is safe, so long as contact is not made with other people's discharged bodily fluids.

Non-penetrative Sex
A range of sex acts, sometimes called outercourse can be enjoyed by lovers with significantly reduced risks of infection and no risk of pregnancy. U.S. President Bill Clinton's surgeon general, Dr. Joycelyn Elders, tried to encourage the use of these practices in the U.S.A. but criticism by the religious right forced her to resign.

Limiting fluid exchange
Various devices are used to avoid contact with blood, vaginal fluid, and semen during sexual activity:
 * 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.
 * 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 ersatz dental dam during oral sex, or to protect the hands during mutual masturbation. Hands may have invisible cuts on them that may admit pathogens that are found in the semen or the vaginal fluids of STD infectees. Although the risk of infection in this manner is thought to be low, gloves can be used as an extra precaution.
 * Another way to avoid contact with blood and semen is penetration, but not by the penis, such as using (properly cleaned) dildos or other sex toys. If a sex toy is to be used in more than one orifice, a condom can be used over it and changed when the toy is moved.  Fisting (penetration by the hand), has its own risks, but the risk of HIV transfer can be reduced by latex gloves or a condom. Pegging, female-to-male anal sex with a strap-on dildo, as promoted by sex educator Carol Queen does not involve fluid transfer.

If a latex barrier is being used, any lubrication must not be oil based, as this can break down the structure of the latex and undo the protection it gives.

Other Precautions
Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safer sex recommend that some of the following methods be used to minimize the risks of STD transmission and unwanted pregnancy.
 * Monogamy or polyfidelity, practiced faithfully, is very safe (as far as STDs 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 slightly 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 STDs. 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.
 * 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, it is important that they get regular check-ups from a doctor. Anyone noticing unusual symptoms should get medical advice quickly. Unfortunately HIV is almost symptom free until AIDS develops.

Ineffective methods
Note that most methods of contraception other than the barrier methods mentioned above are not effective at preventing the spread of STDs. This includes the "rhythm method", which is also commonly known as Natural Family Planning.

The spermicide Nonoxynol-9 has been claimed to reduce the likelihood of STD 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. As a result condoms with a Nonoxynol-9 lubricant are not to be promoted.

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 STD transmission. This is because of the formation of pre-ejaculate, a fluid that oozes from the urethra before actual ejaculation. In opposition to conventional wisdom, some recent studies awaiting confirmation suggest that pre-ejaculate may not contain sperm; it can, however, contain pathogens such as HIV. In addition, open sores on either partner can permit transmission, as can microscopic breaks in the skin which arise due to friction, or other irregularities in the skin of either partners genitalia or other body parts.

Dangers of anal sex
Unprotected anal sex is a high risk activity regardless of sexual orientation. Research suggests that although gay men are more likely to engage in anal sex, heterosexual couples are more likely not to use condoms when doing so.

Anal sex is more risky than vaginal, since being very thin tissues of anus and rectum can be easily damaged during such sex activities as anal intercourse or use of anal toys. Even slight injuries can become "open gates" for various bacteria and viruses, including HIV. This implies that anal sex does require some certain safety measures. First of all, any partners who practice anal sex should be aware of the necessity of using a condom. The condom must be put on properly, otherwise it does not provide reliable protection. Users should keep in mind that oil-based lubricants damage latex. For this reason water-based lubricants should be used for anal sex. Those who have allergy to latex should consider use of non-latex condoms, for instance polyurethane condoms that are compatible with both oil-based and water-based lubricants.

Condoms should also be used with sex toys. Through putting a condom on the sex toy a user provides better hygiene and prevents transmission of infections if the sex toy is shared. Cleaning of anal sex toys is also a very important matter as many anal sex toys are made of porous materials. Pores retain viruses and bacteria. For this reason users should clean anal toys (plugs, anal vibrators) thoroughly, preferably with use of special sex toy cleaners. Glass sex toys are more preferred for sexual uses because of their non-porus nature and ability to be sterilized between uses.

Abstinence as an alternative to safe sex
One way to avoid the risks associated with sexual contact is to abstain from sexual activity entirely, which nearly eliminates the chances of contracting STDs (the only alternative methods of infection being non-sexual as described below).

Some groups, notably some American 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 can place some teenagers at higher risk of unintended pregnancy and STDs, because up to 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 traditional sex education.

STDs may also be transmitted through non-sexual means. Thus, abstinence from sexual behavior does not guarantee complete protection against STDs. For example, 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.