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Chapter 14: SAFER SEX
Teachback by Michael Gould
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
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?
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
SAFE SEX STRATEGIES
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
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
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
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)
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
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
ACTIVITY-SPECIFIC
SAFE SEX TIPS
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
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
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)
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
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
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
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
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
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
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
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
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
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?

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Safe Sex Teachback

  • 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
  • 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
  • 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?