Safe sex

Although strategies for avoiding STIs like syphilis and gonorrhea have existed for centuries and the term safe sex existed in English as early as the 1930s, the use of the term to refer to STI-risk reduction dates to the mid-1980s in the United States. It emerged in response to the HIV/AIDS crisis. A year before the HIV virus was isolated and named, the San Francisco chapter of the Sisters of Perpetual Indulgence published a small pamphlet titled Play Fair! out of concern over widespread STIs among the city's gay male population. It specifically named illnesses (Kaposi's sarcoma and pneumocystis pneumonia) that would later be understood as symptoms of advanced HIV disease (AIDS). The pamphlet advocated a range of safe-sex practices, including abstinence, condoms, personal hygiene, use of personal lubricants, and STI testing/treatment. It took a casual, sex-positive approach while also emphasizing personal and social responsibility. In May 1983—the same month HIV was isolated and named in France—the New York City-based HIV/AIDS activists Richard Berkowitz and Michael Callen published similar advice in their booklet, How to Have Sex in an Epidemic: One Approach. Both publications included recommendations that are now standard advice for reducing STI (including HIV) risks. Safe sex as a form of STI risk reduction appeared in journalism as early as 1984, in the British publication The Daily Intelligencer: "The goal is to reach about 50 million people with messages about safe sex and AIDS education." A year later, the same term appeared in an article in The New York Times. This article emphasized that most specialists advised their AIDS patients to practice safe sex. The concept included limiting the number of sexual partners, using prophylactics, avoiding bodily fluid exchange, and resisting the use of drugs that reduced inhibitions for high-risk sexual behavior. Moreover, in 1985, the first safe sex guidelines were established by the 'Coalition for Sexual Responsibilities'. According to these guidelines, safe sex was practiced by using condoms also when engaging in anal or oral sex. Although the term safe sex was primarily used in reference to sexual activity between men, in 1986 the concept was spread to the general population. Various programs were developed to promote safe sex practices among college students. These programs were focused on promoting the use of the condom, a better knowledge about the partner's sexual history, and limiting the number of sexual partners. The first book on this subject, Safe Sex in the Age of AIDS, appeared in the same year. It had 88 pages that described both positive and negative approaches to sexual life. Sexual behavior was loosely sorted into safe (kissing, hugging, massage, body-to-body rubbing, mutual masturbation, exhibitionism, phone sex, and use of separate sex toys); possibly safe (use of condoms); or unsafe. Australia and New Zealand. The term safe love has also been used, notably by the French Sidaction in the promotion of men's underpants incorporating a condom pocket and including the red ribbon symbol in the design, which were sold to support the charity. ==Practices==

Sexual Health Educators and Public Health Agencies recommend a range of safe-sex practices. Many of these practices can reduce (but not eliminate) risk of transmitting or acquiring STIs. Phone sex/cybersex/sexting Sexual activities, such as phone sex, cybersex, and sexting, that do not include direct contact with the skin or bodily fluids of sexual partners, carry no STI risks and, thus, are forms of safe sex. Non-penetrative sex of manual stimulation of the penis, Johann Nepomuk Geiger, 1840A range of sex acts called non-penetrative sex or outercourse can significantly reduce STI risks. Non-penetrative sex includes practices such as kissing, mutual masturbation, circle jerks, manual sex, rubbing, or stroking. According to the Health Department of Western Australia, this sexual practice may prevent pregnancy and most STIs. However, non-penetrative sex may not protect against infections that can be transmitted via skin-to-skin contact, such as herpes and human papilloma virus. Mutual masturbation and manual sex carry some STI risk, especially if there is skin contact or shared bodily fluids with sexual partners; the risks are significantly lower than other sexual activities. • External condoms can be used to cover the penis, hands, fingers, or other body parts during sexual penetration or oral sex. • Medical gloves and finger cots made out of latex, vinyl, nitrile, or polyurethane can cover hands or fingers during manual sex or may be used as a makeshift dental dam during oral sex. • Condoms, dental dams, and gloves can also be used to cover sex toys such as dildos during sexual stimulation or penetration. Personal lubricants can also be water-based or silicone-based. While the use of external condoms can reduce STI risks during sexual activity, they are not 100% effective. 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 60–70%". As of 2018, the most widely approved form of PrEP combines two drugs (tenofovir and emtricitabine) in one pill. That drug combination is sold under the brand name Truvada by Gilead Sciences. It is also sold in generic formulations worldwide. Other drugs and modalities are being studied for use as PrEP. Different countries have approved different protocols for using the tenofovir/emtricitabine-combination drug as PrEP. That two-drug combination has been shown to prevent HIV infection in different populations when taken daily, intermittently, and on demand. Numerous studies have found the tenofovir/emtricitabine combination to be over 90% effective at preventing HIV transmission between sexual partners. AVAC has developed a tool to track trends in PrEP uptake across the globe. In 2025, Gilead announced approval for a PrEP shot that is effective for 6 months at a time, increasing the likelihood of adequate suppression. Treatment as prevention Treatment as Prevention (often abbreviated as TasP) is the practice of testing for and treating HIV infection as a way to prevent further spread of the virus. Those who know their HIV-positive status can use safe-sex practices to protect themselves and their partners (such as using condoms, sero-sorting partners, or choosing less-risky sexual activities). And, because HIV-positive people with durably suppressed or undetectable amounts of HIV in their blood cannot transmit HIV to sexual partners, sexual activity with HIV-positive partners on effective treatment is a form of safe sex (to prevent HIV infection). This fact has given rise to the concept of "U=U" ("Undetectable = Untransmittable"). Other forms of safe sex Other methods proven effective at reducing STI risks during sexual activity are: • Immunization against certain sexually transmitted viruses. The most common vaccines protect against hepatitis B and human papilloma virus (HPV), which can cause cervical cancer, penile cancer, oral cancer, and genital warts. Immunization before initiation of sexual activity increases the effectiveness of these vaccines. HPV vaccines are recommended for all teen girls and women, as well as teen boys and men, through age 26 and 21, respectively. • Limiting the number of sexual partners, particularly casual sexual partners, or restricting sexual activity to those who know and share their STI status, can also reduce STI risks. Monamory and Polyamory are safe when all partners are non-infected. However, several monogamous people have been infected with sexually transmitted infections by partners who engage in infidelity or use injection drugs. The same risks apply to polyamorous people, who face higher risks depending on how many people are in the polyamorous group. • Communication with sexual partners about sexual history and STI status, preferred safe sex practices, and acceptable risks for partnered sexual activities. • Engaging in less-risky sexual activities. In general, solo sexual activities are less risky than partnered activities. Sexual penetration of orifices (mouth, vagina, anus) and sharing body fluids (such as semen, blood, vaginal fluids, and rectal mucus) between sexual partners carry a higher risk for STIs. • Regular STI testing and treatment, especially for those who are sexually active with more than one casual sexual partner. It is possible to attain and show proof of STI status from lab results. Some online dating apps and websites allow this information to be shared. ==Ineffective methods==

Most methods of contraception are not effective at preventing the spread of STIs. This includes birth control pills, vasectomy, tubal ligation, periodic abstinence, IUDs and multiple non-barrier methods of pregnancy prevention. However, condoms, when used correctly, significantly reduce the risks of STI transmission and unwanted pregnancy. The spermicide nonoxynol-9 has been claimed to reduce the likelihood of STI transmission. However, a technical report from 2001 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. They reported that nonoxynol-9 lubricant does not have enough spermicide to increase contraceptive effectiveness, and cautioned that they should not be promoted. There is no evidence that spermicidal condoms are better at preventing STI transmission compared to condoms that do not have spermicide. If used properly, spermicidal condoms can prevent pregnancy, but there is still an increased risk that nonoxynyl-9 can irritate the skin, making it more susceptible to infections. The use of a diaphragm or contraceptive sponge provides some women with better protection against certain sexually transmitted infections, but they are not effective for all STIs. Hormonal methods of preventing pregnancy (such as oral contraceptives [i.e., 'The pill'], depoprogesterone, hormonal Intrauterine devices, the vaginal ring, and the patch) offer no protection against STIs. The copper IUD and the hormonal IUD provide up to 99% protection against pregnancy, but no protection against STIs. Women with a copper intrauterine device may be subject to greater risk of infection from bacterial infections such as gonorrhea or chlamydia, although this is debated. Coitus interruptus (or "pulling out"), in which the penis is removed from the vagina or mouth before ejaculation, may reduce transmission of STIs or rates of pregnancy but still carries significant risk. This is because pre-ejaculate, a fluid that oozes from the penile urethra before ejaculation, may contain STI pathogens. Additionally, the microbes responsible for some diseases, including genital warts and syphilis, can be transmitted through skin-to-skin or mucous membrane contact. ==Anal sex==

and Antinous engaging in anal sex based on ancient descriptions from De Figuris Veneris Unprotected anal penetration is considered a high-risk sexual activity because the thin tissues of the anus and rectum can be easily damaged. Slight injuries can allow the passage of bacteria and viruses, including HIV. This includes penetration of the anus by fingers, hands, or sex toys such as dildos. Condoms may be more likely to break during anal sex than during vaginal sex, increasing the risk of STI transmission. The main risk that individuals are exposed to when performing anal sex is the transmission of HIV. Other possible infections include hepatitis A, B and C; intestinal parasite infections like Giardia; and bacterial infections such as Escherichia coli. It is recommended that anal sex be avoided by couples in which one of the partners has been diagnosed with an STI until the treatment has proven to be effective. or anilingus can be made safer with a dental dam. To make anal sex safer, the couple can ensure that the anal area is clean and the bowel is empty, and the partner on whom anal penetration occurs should be able to relax. Regardless of whether anal penetration occurs by using a finger or the penis, the condom is the best barrier method to prevent transmission of STIs. Enemas can increase the risk of HIV infection and lymphogranuloma venereum proctitis. Since the rectum can be easily damaged, the use of lubricants is highly recommended even when penetration occurs by using the finger. Especially for beginners, using a condom on the finger is both a protection measure against STIs and a source of lubricant. Most condoms are lubricated, and they allow less painful and easier penetration. Oil-based lubricants can damage latex condoms, causing them to fail; water-based and silicone-based lubricants are available instead. Non-latex condoms are available for people who are allergic to latex made out of polyurethane or polyisoprene. Polyurethane condoms can safely be used with oil-based lubricant. The internal condom may also be used effectively by the anal receiving partner. Anal stimulation with a sex toy can be done with similar safety measures to anal penetration with a penis by using a condom on the sex toy if possible. Certain sex toys are easier to clean to a level of safety, and others are incapable of being cleaned thoroughly. In the 21st century, developments in sex technology have increased the availability of consumer devices intended for intimate use. Some manufacturers, such as Lovense, produce silicone-based products designed for compatibility with common safer-sex materials. Public-health guidance recommends using water- or silicone-based lubricants with latex and similar barriers, as oil-based lubricants can weaken these materials and increase the risk of condom failure. Sexual partners must wash and clean their penis after anal intercourse if they intend to penetrate the vagina. Bacteria from the rectum are easily transferred to the vagina, which may cause vaginal and urinary tract infections. When anal–oral contact occurs, protection is recommended since this is a risky sexual behavior in which illnesses such as hepatitis A or STIs can be easily transmitted, as well as enteric infections. The dental dam or non-vented plastic wrap are effective protection means whenever anilingus is performed. ==Sex toys==

(note the flared bases) Putting a condom on a sex toy provides better sexual hygiene and can help to prevent transmission of infections if the sex toy is shared, provided the condom is replaced when used by a different partner. Some sex toys are made of porous materials, and pores retain viruses and bacteria, which makes it necessary to clean sex toys thoroughly, preferably with the use of cleaners specifically for sex toys. Glass is non-porous, and medical-grade glass sex toys are more easily sterilized between uses. All sex toys should be properly cleaned after use. The way in which a sex toy is cleaned varies depending on the type of material it is made of. Some sex toys can be boiled or cleaned in a dishwasher. Most sex toys come with advice on the best way to clean and store them, and these instructions should be carefully followed. A sex toy should be cleaned not only when it is shared with other individuals but also when it is used on different parts of the body (such as the mouth, vagina, or anus). In cases in which one of the partners is treated for an STI, it is recommended that the couple not share sex toys until the treatment has proven to be effective. Toys should be made of body-safe materials. Only materials that can be safely placed in the mouth and safely placed on the skin are safe to use. Many toys are made of toxic materials and are impossible to clean properly. These cheap and poisonous materials often degrade quickly over time. Some soft toys are made of medical grade silicone, which is properly non-porous and non-reactive with the body. Toys from unreliable sellers may be mislabeled. Other commonly recognized as safe materials include glass and titanium. If the material has additives such as pigments or softeners, those may also be toxic. The list of safe materials often overlaps with Body piercing materials. A sex toy should regularly be checked for scratches or breaks that can be breeding grounds for bacteria. It is best if the damaged sex toy is replaced by a new, undamaged one. Even more hygiene protection should be considered by pregnant women when using sex toys. Sharing any sex toy that may draw blood, like whips or needles, is not recommended and is not safe. ==Abstinence==

Sexual abstinence reduces STIs and pregnancy risks associated with sexual contact, but STIs may also be transmitted through non-sexual means, or by rape. 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. Evidence does not support the use of abstinence-only sex education. Abstinence-only sex education programs have been found to be ineffective in decreasing rates of HIV infection in the developed world and unplanned pregnancy. == See also ==