Safer sex. Why all the confusion?

Safe sex, safer sex, risk reduction, how did something so natural get so complicated?

Some would suggest that nothing is safe and the only way to protect ourselves is to abstain from sex completely. Others would have us believe that the risks are overblown (pardon the pun) and that we should be less uptight and more adventurous. As is often the case, reality lies somewhere between the extremes.

Each of us needs to develop our own approach to safer sex. That approach should be based partly on what each of us does and what gives us pleasure, partly on how much risk we are each willing to live with, and partly on knowing what it is we are being “safe” about.

If we are going to talk about safer sex, we should probably take a step back for a moment and first think about sex. Masturbation, blow jobs, anal sex, dildos, toys, one partner, multiple partners, groups is what makes sex as varied as we are. Furthermore, not only do we each have our individual preferences, but our preferences are also likely to vary from time to time and partner to partner. It all makes sex exciting and fun, but it also makes giving a single prescription for “safer sex” next to impossible.

Anal sex and blow jobs, for example, each come with their own pleasures and their own risks. Knowing that different infections can be passed by different routes should help us define and reduce our risks when enjoying our favourite ways to have sex.

When the subject of safer sex comes up, for most of us our thoughts jump to HIV. That is not surprising since safer-sex education really developed around our attempts to reduce the transmission of this virus. HIV is passed from person to person through bodily fluids, specifically pre-cum, cum, blood and vaginal fluids. The bottom line when it comes to HIV is condoms. Condoms for anal sex are a must, the risk without them is high.

When it comes to other sexually transmitted diseases such as gonorrhea, syphilis, herpes or warts, the story is somewhat different. These are not dependent on exposure to body fluids like cum, but instead are transmitted by direct contact. Condoms may or may not be protective. Giardia on the other hand is transmitted most commonly by rimming. Because these infections are transmitted differently, the ways to best avoid them differ. We will talk more about HIV and other infections in more detail in coming months. It is important to keep in mind, though, that staying safe is partially dependent on knowing what you are staying safe from.

Safer sex is also dependent on knowing your own limits and how much risk you are willing to live with. Abstinence or a mutually monogamous relationship are the only ways to eliminate risk. If you enjoy having different partners, you will have to accept some level of risk associated with sex. But how much risk? The risk of getting HIV from sucking someone off is low and less than the risk associated with anal sex, but there is still a risk. Some people are not comfortable even with low risk and so prefer to have a condom in place when they give head. Others accept some degree of risk and are okay blowing someone without a condom. Safer sex then is partly defined by you. It is important, though, that your decisions are based on accurate information. It is also important that your decisions are your own and that you never feel pressured or obligated to take risks you are not comfortable with.

So, safe sex. Why all the confusion? It is confusing because it is not just one set of guidelines.

First, if you enjoy sex with different guys, accept that there is a risk that you may encounter a sexually transmitted disease.

Second, find out what infections you need to know about, how they are transmitted and how to reduce your exposure to them. Know what condoms will help protect you from and what they may not.

Third, be aware of the risks as they relate to what you do. If you use condoms for anal sex or do not have anal sex at all, that does not mean sexually transmitted infections are not in your ball park. Know what infections you may encounter from blow jobs, during anal sex or from rimming.

Finally, if something doesn’t seem right, a sore on your anus, a rash on your chest, persistent diarrhea, go see your doctor or drop by the Sexual Health Clinic at 179 Clarence St in the Market. Being safe is about being informed and being aware.

* Dr MacPherson is an assistant professor of medicine at the University of Ottawa, a specialist in the Division of Infectious Diseases at the Ottawa Hospital General Campus, and a staff scientist at the Ottawa Health Research Institute. He is also a member of the Gay Men’s Wellness Initiative of Ottawa.