Safer Sex: Risk Reduction for STDs

Methods of protecting yourself from STDs range from abstaining to practicing safer sexual behaviors. Outlined below are a number of ways in which you can protect yourself from STDs.

What behaviors can transmit a sexually transmitted disease?

We're really talking about four different behaviors here, listed below.

• Vaginal intercourse: the insertion of a man's penis into a woman's vagina.
• Anal intercourse: the insertion of a man's penis into another person's rectum/anus.
• Oral sex on a man: oral contact with a man's penis or testicles.
• Oral sex on a woman: oral contact with a woman's labia, vagina, clitoris.

These four behaviors can all transmit an STD to an uninfected partner, in either direction. In other words, it is possible to become infected with an STD whether you are receiving or performing oral sex, on anyone, or if you are the insertive or receptive partner in either act of intercourse.

What is safer sex?

Safer sex entails a wide range of sexual activities. Some sexual activities carry no risk of infection. Others have limited risk. If you do choose to have sexual intercourse it is important to practice responsible sexual behavior, often referred to as 'safer sex'.

Again, we're talking about a series of behaviors.

• Communication
• Abstinence
• Monogamy
• Condoms
• Latex Dams

Communication

Honest, open communication is a must these days for any kind of responsible (and enjoyable!) sexual experience. Not only do you find out about what risks you might be at, you can also find out what your partner likes and dislikes, how they prefer to be touched, where the limits of sexual expression are for a given encounter, and increase trust between people (never a bad thing).

Most men and women find erotic talk, as well as risk reduction, to be not only helpful in pleasing their partners, but also in pleasing themselves. You can share how you want to be touched and sexual as well!

What is abstinence?

Abstinence is when you voluntarily refrain from engaging in the above four acts, at the least. For some individuals this may mean not having sexual intercourse. To others it may mean not having any genital contact. NO genital contact is the best protection against STDs. Abstinence is a positive, healthy choice many people make. By the middle of their first year at college, almost 60% (females 58%, males 48%) of first year students have not had sexual intercourse. Even by the fourth year many seniors have not had vaginal intercourse (females 37%, males 30%). Many Duke students enjoy sexual activities without sexual intercourse. (See "Safer Sex Menu Ways " for some ideas from Duke Students.)

Monogamy

This clinically means:

• the engaging of the four behaviors above
• exclusively with one person
• for the rest of your life
• and after you've both either tested negative for all testable STDs, or
• if both of you have never shared these behaviors before with anyone else.

We have many people at Duke who come to Student Health and tell us they are monogamous, then wonder why they've been diagnosed with an STD. Upon further investigation, we find (more often than not) that they don't meet the above definition, and many, in fact, state that they've had several 'monogamous' sexual relations in the past semester or year.

Serial monogamy is not clinical monogamy. A series of supposedly safe sexual experiences where a person has sexual behaviors with 'only one person at a time' and calls it 'monogamy' doesn't protect anyone from anything.

By contrast, the clinical version of monogamy above does do a good job of reducing your risks of STDs, and can also bring a level of intimacy and sexual pleasure to a relationship that is difficult to find elsewhere.

This also means that, with testing, a person may very well have several clinically monogamous relationships in his or her lifetime. In addition, people who have not engaged in the above four behaviors with anyone in their life, and who choose each other as sexual partners, have a lower risk for STDs.

Condoms

Always use a latex condom for anal and vaginal intercourse, regardless of the need for contraception. The condom is the best protection currently available against STDs for sexually active people. While not 100% effective in prevention of all STDs (for example, the condom offers little protection from HPV or herpes on the external genitalia), it does greatly lower risk for chlamydia, gonorrhea, hepatitis B, and HIV.

Always use a latex barrier (condom, dental dam) for oral-genital sex. There is risk of transmitting many sexually transmitted diseases from the mouth to the genital area or from the genital area to the mouth.

For the record, use only a lubricated, latex or polyurethane condom for vaginal or anal intercourse, and either a flavored or nonlubricated condom for oral sex on men.

Latex Dams

For oral sex on women, you can cut a flavored or nonlubricated condom for use as a latex dam, or obtain a latex dam from the Healthy Devil .

A dental dam is a six-inch square piece of latex, sometime flavored, used during oral-vaginal sex or oral-anal sex to prevent the transmission of STDs from the anus or vagina to the mouth or the mouth to the vagina or anus. For information on their use, see below .

Other Risk Reduction (Safer Sex) Techniques

Avoid sexual contact (genital to genital or mouth to genital) until you and your partner(s) have been tested for pre-existing STDs. However, be aware that some STD infections may not be detected by testing or visual exam.

Limit your number of sexual partners. Restricting your sexual activities to a committed relationship in which you and your partner make an agreement to be faithful sexually makes good emotional as well as disease prevention sense.

Do not rely upon your partner to tell the truth because studies indicate that some college men and women do not reveal everything about their sexual history. Also, your partner may not know the sexual history of their partners.

Before you have sex, look closely for any signs of an STD: a rash, a sore, redness or discharge on your partner's genitals. If you notice anything unusual, refrain from any sexual contact and insist your partner(s) get a medical checkup.

If you or a partner was ever infected with a viral STD like herpes, HPV (genital warts), hepatitis B, or HIV, avoid unprotected sex. Even if no symptoms are present, the virus is still there and can be transmitted.

If you are infected with an STD, notify your partner(s) so they can be evaluated and treated and will not infect or reinfect others.

If you have an STD, refrain from sexual activity until you and your partner(s) have completed the entire treatment, even if your symptoms disappear before the treatment is finished.

If you are using oral contraceptives, Depo-Provera, Norplant, a diaphragm, or an IUD, protect yourself from STDs by using a condom.

Know the signs and symptoms of STDs. If you notice a symptom that worries you, get medical attention. Do not wait.

Get checked for STDs every time you have an annual health maintenance exam, especially if you have changed partners or if you have more than one partner. This is very important for women who often have no symptoms of an STD. If you have more than one partner, you should have a regular STD checkup one to two times a year.

Tell your health care provider if you have ever had an STD. Do not rely upon your provider to read through your chart (which may have your STD history) if you only come in for an annul Pap test. You may be putting yourself at risk by not telling your health care provider all the facts.

Should I use a barrier for oral sex?

Health professionals often recommend using a barrier during oral sex (oral-vaginal sex, oral-penile sex or oral-anal sex) to reduce the possible transmission of STDs. Barrier options include non-spermicidal latex condoms and latex dams. Though no testing has been done on plastic wrap (non-microwavable), some people choose to use it as a barrier for oral sex.

Oral sex on a female

Because STDs can be transmitted from the vaginal and anal area to the mouth, use a latex dam between the mouth and the vagina or anus.

To use the dam, first rinse it to remove the powdery talc. Pat it dry with a low-lint towel or let it air-dry. During oral-vaginal sex, spread the dam over the entire vaginal opening and clitoris, holding the edges of the dam with your hands. In oral-anal contact use the dam to cover your partner's anus.

Remember to use a new dental dam each time you have oral sex and use only one side. Always use separate dams if you are practicing both oral-vaginal and oral-anal sex because anal organisms can be harmful to the vagina.

Latex dams are available free at the Office of Health Promotion, located in the new Student Health Center in the Duke Clinic complex. You may also purchase dental dams at Planned Parenthood, 820 Broad St., Durham, and at dental and medical supply stores.

If you do not have a dental dam you can make a latex barrier by cutting a rolled non-spermicidal latex condom with a pair of scissors form the edge to the center. Unroll the resulting sheet of latex. This can be used just like a dental dam. Some people prefer this method because the latex is thinner.

Oral sex on a male:

Reduce your risk by using a non-spermicidal latex condom on the penis from start to finish if you decide to have anal, vaginal or oral sex. Flavored condoms are available at the Office of Health Promotion and drug stores to help disguise the latex smell and taste.

What do drugs and alcohol have to do with STDs?

Being under the influence of drugs and alcohol can drastically reduce your ability to make self-protecting decisions. Alcohol and other drugs may cloud your judgment and lead you to engage in unsafe sexual practices, therefore placing you at risk of infection.

If you shoot drugs and share needles you are putting yourself at risk of infection. When you share needles, you inject someone else's blood directly into your blood stream. Both Hepatitis B and HIV are transmitted in this manner. If you use drugs, we urge you to stop, or seek help if you find that you cannot. Never share needles. If you do share "works", clean them with a solution of bleach (1 part) and water (9 parts) before each use. Boiling does not guarantee sterility of needles or syringes.

Where can I go for more information, testing, and support?

On campus:

Duke Student Health Center in the Duke Clinics (Duke South), 681-WELL: provides confidential health information, confidential counseling, testing options, treatment and follow-up services.

The Healthy Devils Peer Educators are also available at 681-WELL: they provide confidential health information, confidential counseling and referral resources.

Off Campus:

AIDS Hotline 1-800-342-AIDS

STD Hotline 1-800-227-8922

Herpes Hotline 361-8488

Durham County Health Dept. 560-7600

Planned Parenthood of Orange/Durham 286-2872

HPV Hotline 361-4848