Safer Sex

Reducing your risk of sexually transmitted infection

'Safer sex' usually refers to having sex in a way which reduces your risks of catching a sexually transmitted infection (STI). Although sex should be an enjoyable activity, it can put you at risk in several ways. Because it involves being very close (intimate) with another person, it may allow infections to pass from one person to another. Other risks to think about include pregnancy, emotional consequences and legal issues.

'Safe sex' guidelines often are called 'safer sex' guidelines because sex can never be completely without any risk at all. However, taking a few sensible precautions can reduce the risks greatly.

Listed below are various important ways in which you can reduce your risk of catching an STI.

Barrier methods

The most commonly used barrier method is the male condom. Other options are female condoms and dental dams. A dental dam is a sheet of latex (or similar material) used during oral sex to help stop STIs being spread.

Condoms have been shown to reduce the risk of passing on most STIs including:

• HIV and AIDS
• Chlamydia
• Gonorrhoea
• Syphilis
• Genital herpes

They are not completely guaranteed to prevent any risk but they do greatly reduce the risk. Latex condoms are the most effective but for those who are sensitive to latex, condoms made of polyurethane also help to reduce the risk.

Female condoms have also been shown to be effective in reducing the risk of catching an STI.

In the UK, condoms are available free of charge from family planning clinics. They are also available in some genitourinary medicine (GUM) clinics and some GP surgeries. They can also be bought from pharmacies. Consider always having a condom with you 'just in case'.

Tips to make condoms more effective:

• Ideally, use a condom every time you have vaginal, anal or oral sex. Even using a condom as often as possible is safer than not using one at all. If you forget to use a condom on one occasion, it is still worth using one on future occasions.
• Practise using a condom so you can reliably put one on even if it is dark or you are in a hurry.
• You can pass on an STI even if you don't come (ejaculate) so use a condom for all penetrative sex.
• Put the condom on before having sex.
• Remove all air from the condom before rolling it on.
• Do not unroll the condom before putting it on.
• Hold the condom on after having sex as you withdraw your penis.

Number of partners

It makes sense that the fewer sexual partners you have, the less chance you have of catching an STI. People who think of sex as something to enjoy in a committed relationship are less at risk of infections than people who think of it as a more casual activity.

Even people who have never been aware of having an STI may be carrying an infection. For example, you can pass on herpes without ever having any symptoms. Or you can pass it on many years after you had symptoms of an infection. This is why even in a regular committed relationship, it can be worth considering using a condom.

Sexual practices

Some kinds of sexual practices are higher-risk than others. If you are in no contact with another person whatsoever (for example, phone sex, self-masturbation) you are not at risk of catching an infection. Sex involving penetration (with a penis, sex toy, tongue, finger, fist, etc) involves more risk than sex without penetration. However, it is possible to catch some infections without penetration. For example, by rubbing genitals you can catch genital warts or genital herpes. You can catch genital herpes from having oral sex with somebody who has a cold sore. Other STIs which can be passed on during oral sex include HIV, gonorrhoea, syphilis, human papillomavirus (HPV), hepatitis B and hepatitis C.

Anal sex is particularly high-risk because the lining of the anus and rectum are very thin. This makes it easier for germs to enter the body. HIV and hepatitis B in particular are more likely to be passed on through anal sex.

STIs can be caught from infected sex toys. Therefore, to have safer sex, always wash and clean sex toys or use them with a barrier such as a condom.

Alcohol and recreational drugs

Alcohol and recreational drugs can loosen inhibitions. Therefore, they may make you more likely to have higher-risk sex (for example, with a stranger, without a condom, anal sex) than you might normally do. Consider this risk in advance of a situation where alcohol or drugs might be involved. You may then be able to make plans to reduce your risk.

Having tests for STIs

It is recommended that you think about having tests for STIs before having sex with somebody new, and also ask them to get tested.

In the UK, you can see your GP or make an appointment at GUM clinic without a GP referral - you can find details from the Family Planning Association's 'Find a Clinic' page.

Vaccinations

Vaccines are not available for most STIs. However, if you are at high risk, your GP or GUM clinic may advise you to consider vaccination against hepatitis B or hepatitis A. Teenage girls in the UK are now routinely vaccinated against HPV. This is expected to reduce rates of genital warts and cervical cancer drastically in the future.

There is no vaccine to protect against HIV. People with known HIV will be given specialist advice from those treating them about avoiding passing it on. Antiviral treatment and the use of condoms reduce the risk but cannot remove risk completely.

Reducing your risk of unwanted pregnancy: contraception

'Safer sex' usually refers to protecting yourself against STIs. However, if you do not wish to become pregnant, this is something else to consider before having sex. There are many ways of avoiding becoming pregnant when you have sex (contraception). These are discussed generally in the separate leaflet called Contraception Methods (Birth Control). There are also specific leaflets on the following forms of contraception:

• Combined oral contraceptive pill.
• Progestogen-only contraceptive pill.
• Contraceptive patch.
• Contraceptive vaginal ring.
• Barrier methods: male condom, female condom, diaphragms and caps.
• Contraceptive injections.
• Contraceptive implants.
• Coils (intrauterine contraceptive devices and the intrauterine system).
• Sterilisation - vasectomy and female sterilisation.
• Emergency contraception.

Most contraceptive methods do not protect you from STIs, so remember always to consider using a condom as well.

The Family Planning Association (FPA) website has a lot of information about contraception.

Sex and the law

Another part of having safer sex which you may need to think about is not breaking the law. Laws about sex and consent vary from country to country and may be confusing. In the UK the laws are broadly similar by country but have some slight differences.

Consent

Sex must always be consensual. That means both partners wish to have sex, without having been pressured in any way. This means the person has not been threatened or bullied or manipulated, or made to take alcohol or drugs which may influence their decision. Never assume consent - always ask first. Because a person has consented once does not mean they have consented for future times. Also, because a person has consented to one form of sexual activity, you cannot assume consent for any type of sexual activity. Make sure your partner is capable of giving consent - ie they are capable of understanding what is involved. They need to be old enough, conscious enough and have the intellectual capacity to make an informed choice.

Age of consent

In the UK, the age of consent for sex is 16. In other words, a person under the age of 16 is thought not old enough to give consent. It is therefore a crime (an offence) to have any type of sexual activity with a person under the age of 16. Potentially anyone having sex with a person under the age of 16 can be prosecuted, even if that person consents and even if both are under 16. This may result in a prison sentence. Usually, however, if both are under 16, and both consent, this is not enforced. The law is even stricter for anyone found guilty of sexual activity involving children aged 12 or younger, with possible life imprisonment sentences. It is also illegal for a person over 18 who holds a position of trust (for example, a teacher) to have sex with a person under the age of 18 who is under their influence as a result of that position.

Contraception for young people

Even though it is illegal for a person under the age of 16 to have sex, doctors and other health professionals can help keep them safe. This means if a doctor is satisfied that to provide advice on contraception or prevention of STIs is in your best interests, they can do so. They are under no obligation to tell your parents just because you are under 16. You will be treated with confidentiality, just as you are over the age of 16. However, if a health professional feels you have been forced or coerced into having sex, they would have to take this concern further.

Staying safe: emotions

Because sex is such a close experience, it will usually have an emotional effect. Many people connect sex with love. If you are thinking of sex as a more casual experience, check your partner feels the same first. You will both be safer if you can talk about where you are emotionally beforehand. In this way you can make sure you are both feeling the same way and one person will not get hurt. It may also be wise to talk about previous sexual experiences where possible. You may wish your partner to have tests for STIs before starting a sexual relationship if they have had many past sexual partners, or an STI in the past.

If you are a teenager thinking about having sex, make sure in your own mind this is something you want. Do not be pressured into it by your partner or because you think others of your age group are doing it. Think it through carefully first to be sure you are not going to get hurt, get pregnant or get an STI.

Summary: tips for safer sex

• Do not have lots of sexual partners. Get to know a person before having sex with them. Only have sex with somebody who is happy to practise safer sex and listen to your wishes.
• Make sure each partner consents and is happy with the consequences of having sex. Do not start a sexual relationship until both partners are ready for it.
• Always use a condom for all types of penetrative sex. Consider a barrier method for oral sex.
• Keep sex toys clean.
• Beware of having sex under the influence of alcohol or drugs. Make plans in advance to protect yourself.
• Think about getting yourself and your partner tested for STIs before you start having a sexual relationship. Always go to your GP or GUM clinic as soon as possible if you have any symptoms of an STI, such as soreness of, or discharge from, your vagina or penis. Don't have unprotected sex until you have been checked out.
• Consider contraception if needed.
• If you take steps to keep yourself safe, sex should be a pleasure and not a risk.