This chapter discusses the importance of practicing safe sex to prevent the transmission of STIs. It provides tips for communicating with partners about sexual history and practicing barrier methods like condoms during vaginal, anal and oral sex. Specific advice is offered for using protection during various activities to minimize STI risk as much as possible without abstaining from sex entirely. While no method prevents transmission 100%, consistent and correct use of barriers can significantly reduce vulnerability to infection.

1. Chapter 14: SAFER SEX
Teachback by Michael Gould

2. Why practice safe sex?
• NEGATIVE influences:
• Approximately 65 million Americans are currently infected with an
incurable STI
• 18 million Americans can contract at least one STI every year
• There has been an increase in STIs that are viral and incurable 
protection today is more important than ever
• Treatable and curable STIs if not found early enough can result in
serious health problems
• If you currently have an STI and contract a second the symptoms may
be more serious
• POSITIVE influences:
• Talking with your partner about practicing safe sex can make you both
feel more relaxed, comfortable, and intimate
• Safe sex allows for new sexual possibilities When we are confident
that we will not get a STI, we are better able to explore and enjoy sex

3. Talk with your partner
• It is important to talk to your partner about STIs before having
sex
• Not always easy  try using humor
• If you or your partner feel uncomfortable with the subject, lightening
the mood can be a good way to ease into the topic and make way for a
more serious conversation
• IMPORTANT TOPICS:
• Has either partner ever had, or had a partner who has had, an STI?
• Does either partner have or have had any unusual bumps, sores,
discharge from the genitals, or other symptoms?
• Has either partner, or any previous partners, ever been exposed to an
STI, been tested for one, or had an abnormal Pap test?
• What does each partner typically do to practice safe sex?
• What is the best safe sex option for both partners to use in order to
prevent disease from this point forward?

4. Guideline for safer sex
• Safest sexual situation = one partner who is not infected
with an STI and is only having sex with you
• It can be hard to guarantee that your partner is having sex
with only you  can leave you vulnerable to STIs if you
partner is sleeping around an you are not using protection
• No prevention method is 100% effective but using safe
sex strategies can help you minimize your chances of
contracting an STI

5. SAFE SEX STRATEGIES

6. Barrier methods
• Use barrier methods during sex even when both partners
have no symptoms  you may not realize you have an
infection
• Latex condoms = safest and most well-known barrier
protection for vaginal, oral, and anal intercourse
• Other barriers  Dental dams and squares of latex
(dams) made especially for sexual activity can be used for
mouth-to-vagina and, mouth-to-anus, or for any other
area not covered by a condom
• But condoms and other barriers only protect the areas
that they cover

7. Use protection even if birth control is not
needed
• Women who can’t get pregnant (due to a tubal ligation or
hysterectomy, or menopause) still need to use protection
to minimize their risk of contracting a STI
• Use of a diaphragm, an IUD, or hormonal methods of birth
control alone do not protect against STIs  should be
used in combination with a barrier method for full
protection from both pregnancy and STIs

8. Washing and sexual hygiene
• It’s important to wash the genitals, anal area, and hands
both before and after sex, and in between anal and
vaginal contact
• It’s not only good hygiene but may also reduce your risk of a
urinary tract infection (UTI)
• But washing or douching will not prevent the transmission
of STIs
• Caution: Douching has the potential to push infections higher up in
the vagina which can affect other reproductive organs
• And always remember to reach for a condom or dental
dam after you wash

9. Avoid blood
• Be especially careful during sexual activity that involved
blood as direct contact, even with menstrual blood, of an
infected person can transmit infection (which includes HIV
and hepatitis)

10. It’s never too late to start!
• Even if you haven’t practiced safe sex in the past, it’s
never too late to start!
• If you don’t have an STI, you can protect yourself from
getting one
• If you do have an STI, safer sex not only protects your
partners but also prevents you from getting another one

11. Put foreplay in the spotlight
• Caressing, stroking, and touching each other can be very
fulfilling and erotic  And if you don’t have a condom this
is a safe way to get off while still being safe
• If you want to have intercourse, good foreplay helps
ensure the vagina is lubricated which results in a smaller
chance that the condom will break during intercourse

12. ACTIVITY-SPECIFIC
SAFE SEX TIPS

13. Vaginal Intercourse
• Only method conclusively proven to prevent HIV
transmission = lubricated latex or polyurethane male
condom or female condom
• With latex condoms use a water-based lubricant (K-Y jelly,
Astroglide, Probe etc.) as oil-based lubricant (like Vaseline
or lotion) will damage the condom
• During sex visually check the condom to ensure it is intact
and change the condom when changing activities
• Condoms are intended to last for approximately ten
minutes during sex  if intercourse lasts longer than 10
minutes, change the condom

14. Anal intercourse
• High-risk activity  tissue in the rectum is very fragile and
tears easily which may allow HIV or other infections
directly into the blodstream
• Lack of natural lubricant  for sufficient protection use a
strong latex condom (studies suggest polyeurthene
condoms are more likely to break) with a lot of lubricant
• Massaging the anus with a finger or sex toy is
recommended before having anal sex as it may help relax
the muscles  reduces the likelihood of condom
breakage during anal sex

15. Oral sex
• On a male:
• Less risky than vaginal or anal sex
• For maximum protection use a non-lubricated condom as soon as
the penis is erect (since pre-cum can contain HIV)
• On a female:
• Carries some risk, especially if the woman is on her period or has
an STI with open sores
• For maximum protection, cover your partner’s vulva and anus with
a dental dam, a cut-open latex glove, a non-lubricated condom, or
nonmicrowaveable plastic wrap (with no holes)

16. Fisting or finger play
• Fisting (putting the hand or fist into the rectum or vagina)
carries some risk due to easy bruising and tearing of
internal tissue
• Finger play is much less risky, although HIV can travel
into the bloodstream through cuts on your fingers or cuts
in his or her membranes
• For protection use latex gloves or finger cots and change
them with each use

17. Rimming
• Rimming (mouth-to-anus contact) has some risk of
transmitting HIV if there is blood in the partners feces or
saliva.
• It can also spread hepatitis A and internal parasites
• For protection, use nonmicrowaveable plastic wrap or a
dental dam

18. Sex toys
• If sex toys are shared they can transmit STIs from one
partner to another.
• Put a condom on a dildo before use, and if you plan on
sharing the dildo make sure to wash it thoroughly in hot
soapy after every use
• For maximum protection, you can also clean sex toys with
10% hydrogen peroxide or soak them for 20 minutes in a
bleach solution (1 part household bleach, 9 parts water)
 Make sure to rinse toys with water after cleaning and
let them dry completely before use

19. Fluid bonding
• Fluid bonding = sharing body fluid with only one person
and using condoms with all others
• Reduces risk only if both partners use protection
consistently and never have unprotected sex with other
partners
• Exposure to several partners, either your own or through
your partner’s partners increases your chances of
contracting an STI

20. Condoms 101 (Part 1)
• For sex with a man the condom has to be on his penis
when it’s erect and before it touches your body, especially
the volva, mouth, or anus
• When putting on the condom be careful to avoid rips, if
you put it on inside-out use a new condom as it might
have touched fluid, and pinch the reservoir tip while
rolling the condom onto the penis to allow room for the
semen
• Use a new condom each time you have sex
• Be aware of sensitivities due to spermicide and latex  if
irritation occurs try a new condom without spermicide
and/or without latex
• Save flavored condoms for oral sex as the flavoring may
contain sugar which could encourage bacterial infection in
the vagina if used during intercourse

21. Condoms 101 (Part 2)
• Use a lubricant if you are dry as it can cause the condom
to break  Lubricant can be put directly into the vagina or
a small amount can be put in the tip of the male’s condom
to provide extra pleasure
• Warning: too much lubricant added inside the condom may cause
the condom to slip off
• Only use water-soluble lubricants with latex condoms as oil-based
lubricants will damage the rubber and destroy the protection
• Female condoms can be useful if your male partner can’t
or won’t use other condoms  you can use small amount
of any lubricant (including oil-based) inside the pouch or
on the penis but don’t use a spermicide as a lunricant

22. Nonoxynol-9: Should I use it?
• Nonoxynol-9 (N-9) is a sperm-killing ingredient found in
most contraceptive creams, foams, jellies, films, and
sponges
• Although effective as a spermicide, it has not only been
proven to be ineffective in stopping HIV transmission but it
may even increase risk because it can cause irritation in
the vagina and rectal linings
• Even very low doses of N-9 can be very damaging to the
rectal lining
• It has been proven that spermicide condoms coated with
N-9 are no safer than condoms lubricated without N-9 
In result, condoms without spermicide lubrication are the
best type of condom for both vaginal and anal intercourse

23. Reasons why many don’t use protection
• Our own attitudes
• Such as “I’m afraid he’ll refuse” or “Talking about sex is too embarrassing” (p. 269)
• The attitudes of our partners
• Such as the belief that sex is less pleasurable with a condom
• Alcohol and drug use
• Being drunk or high compromises our judgment and weakens our power to protect
ourselves and if both partners are under the influences the likelihood that safe sex
will be practiced lessens
• Not enough information
• If we don’t know how to protect ourselves, we are more likely to practice unsafe sex
• If one partner has an STI they may think that safe sex is no longer helpful since
they assume the other partner has it as well  but this may not be the case, the
other partner may not be infected yet and by using protection they are preventing
themselves from being reinfected
• Other reasons
• May be trying to conceive and as a result don’t use a condom
• Supplies needed for safe sex may be too expensive or too difficult to obtain

24. Steps to take after unsafe sex
• If a condom broke, you engaged in unprotected sex with
someone who you think or know has HIV, or you were
raped you may be able to get medication from a doctor
that will help in protecting yourself from infection
• If you had unprotected sex and are worried about being
pregnant, you can take the morning-after pill
• The morning-after pill contains large concentrations of hormones
and is available from hospital emergency rooms and clinics  it is
best to take the morning-after pill within 72 hours of having
unprotected sex

25. Quote and Discussion Question
• Quote
• “With knowledge, communication, and just the right well-placed
piece of protection, we know we can avoid suffering a whole lot of
headaches tomorrow – and that makes sex a lot more fun today”
(p. 271)
• Discussion Question
• Do you think that the media portrays one gender as more
responsible than the other in terms of discussing safe sex? Do you
agree with this portrayal? Why or why not?