Why did the dental dam become a joke?

Notisha Massaquoi used to brag about her fancy, high-femme way of fashioning dental dams out of condoms with her pinky fingernail: carefully open the package, cut the condom’s tip off, then slice it down the middle. It was a quick and effective way to create a safe-sex product for lesbians like her who were having trouble finding options for their own sexual health. Massaquoi, now the executive director of Women’s Health in Women’s Hands (WHIWH) community health centre in Toronto, remembers the angry conversations among lesbian and queer women about dental dams during the AIDS epidemic of the 1980s. While condoms and lube were being distributed for free in every gay bar and bathhouse, there was little information about safer sex for people with vaginas who have sex with other people with vaginas, including oral sex. They wanted their own options for protection, and it wasn’t happening fast enough. So, nearly 20 years ago, Massaquoi began running workshops for women like her, to teach them how to fashion a dental dam out of a condom — and to show off her own latex-slicing skills. “It was like this really cool, sexy thing, to make it entertaining,” she tells me. “But I think that it spoke to the larger question of why are we, as women, always forced to make do with male things and transform them into things that work for us?” Two decades later, she’s still asking that question. “Dams weren’t easy to access, but they were part of the conversation. And now all of a sudden, [protection for women is no longer] part of that conversation.” Dental dams, a thin piece of latex meant to cover the pubic or anal area for added protection during oral sex or rimming, have never received a warm reception as a safe-sex option, especially for queer women and other folks who have vaginas. They’ve effectively disappeared from drugstore and sex store shelves, as well as from our collective conscious — some people don’t even know what they are. For those of us who do, the complaints are often the same: they taste bad, they’re hard to find, they’re expensive and just generally awkward. Stories and videos of queer women grimacing at dams circulate the internet. When I told people I was writing about dental dams, they either laughed outright, or gave me a squeamish grin. With so little information and resources available to protect the health of women and folks with vaginas who have sex with other people with vaginas, you’d think we would want to take the use of dams seriously. Instead, it’s become laughable. So why did the dental dam become such a joke?

Dental dams have always been meant for oral — hygiene, that is. Invented in 1864 by Sanford Barnum, the dam is used to isolate a tooth during dental work. The dental dam’s use during sex became more commonplace at the height of AIDS epidemic, when queer and lesbian women wanted their own sexual health protection. Fearful they might also be at risk of the virus, they started to rally information for their own safer sex practices — in 1986, the New York Times even published a piece on “discussing precautions” when it came to women and AIDS. The piece included dental dams as an option, advising that they could be picked up at surgical and dental supply warehouses. But Katie Batza, author of Before AIDS: Gay Health Politics in the 1970s, says queer and lesbian women were already concerned about their sexual health prior to this period. “Even in the 1970s, there was a lot of movement around gay and lesbian health, and women’s health in general,” Batza says. “And lesbians were trying to find their footing and where they fit, both within the women’s health movement, which focused largely on abortion rights, access to quality care and sterilization misuse, and within the gay health movement, which was largely dominated by often sexist gay men who were very concerned about extraordinarily high rates of venereal disease among gay men.” One of the most critical resources available at the time was Our Bodies, Ourselves, which was considered revolutionary when it was published in 1970 for the way it talked about abortion and sexuality. But queer women wanted to know more about STIs and their modes of transmission, a thirst for knowledge which, Batza says, ramped up with the emergence of the AIDS crisis in the 1980s. The use of the dental dam came out of “a little bit of a freak out around AIDS,” says Batza, but also out of a desire to create a space for lesbians and queer women in the changing conversations around sexual health. Despite STI transmission being extremely low among women who have sex with women, Batza says, “the dental dam market provided this option for lesbians who were worried.” But the zeal for — and appeal of — dams didn’t last long. “As lesbians realized that people weren’t getting these diseases with dental dams or without them, it kind of became defunct,” Batza explains. As HIV/AIDS prevention and treatment options improved and the focus centred on men who have sex with men, lesbians and queer women were essentially shut out of STI and HIV research. This exclusion of their sexual health practices has had a lasting impact on prevention research and available methods for anyone who has a vagina or has sex with a partner who has a vagina. Studies focusing on the average rate of STI transmission between women who have sex with women are hard to come by — and those that do exist often don’t only include data on sexual risk. Only six cases of HIV transmission between women partners has been documented, and they all involved other risk factors such as sharing sex toys, one partner having had sex with someone with a penis, intravenous drug use, exposure to blood or less common modes of HIV transmission, like tattooing or blood transfusion. STI rates also depend on the group of women studied. Some studies indicate up to 20 percent of lesbian, bisexual and queer women have been diagnosed with an STI in their lifetime. According to the Centers for Disease Control and Prevention (CDC), people with vaginas who have sex with other people with vaginas are at risk of bacterial, viral and protozoal STIs, which can be spread through skin-to-skin contact, mucosal contact, vaginal fluids, menstrual blood and the sharing of sex toys. The most common STIs that people with vaginas can pass to each other is human papillomavirus (HPV), which is transmitted through skin-to-skin contact. Syphilis has also been reported, likely through oral sex, and so has chlamydia — though both can also be acquired from a partner who has a penis and then spread to a current partner with a vagina. While not classified as an STI, bacterial vaginosis (BV) is common among couples who both have vaginas (although BV rarely affects people with vaginas who have never had sex, which can also suggest that it is passed on from a partner with a penis). Despite the levels of STI transmission being pretty low, it’s still possible, when you consider all the other risk factors. And yet, even though the dental dam is the only thing available for people with vaginas who have sex with other people with vaginas, its usage is extremely low.

While studies on dental dam usage are sparse, the few that have been published confirm its lack of use among queer women. Queer feminist media company Autostraddle did its own research into the sexual practices of its readers with the 2015 Lesbian Sex Survey. In it, 5.5 percent said they used dental dams for protection, 9.2 percent used nitrile or latex gloves and 72.9 percent reported not using any protection at all. Juliet Richters and a team of researchers in Australia led another, earlier 2010 study in Sydney of women who have sex with women, which found that 9.7 percent of respondents had ever used a dam, and only 2.1 percent used them regularly. Richters’s team conducted another study that year of Australian women prisoners; 36 percent of inmates said they had sex with other female inmates, with most encounters including oral sex. While dental dams have been made available to Australian prisons for years, just 4 percent of inmates surveyed used them. In the decade since the studies have been done, not much has changed in terms of dental dam usage among queer women. When I ask Ritchers why this is the case, she says it’s because “there’s no problem” when it comes to HIV transmission among women who have sex with women. But that’s not entirely true. The research department of WHIWH community health centre, which serves racialized women and trans people, has conducted more than 30 studies in partnership with academic institutions across the country, focusing on racialized heterosexual and queer women’s health. Massaquoi says the myth that women who have sex with women have a low risk of HIV and STI transmission doesn’t take into account the population that WHIWH works with. Its research has found that racialized women who have sex with women have the same 9 percent rate of HIV transmission and STI transmission as women who identify as heterosexual. “So I don’t take the use of dams lightly with the population that we’re serving,” she says. Dental dams are a pretty good option for everyone, regardless of sexual orientation, and especially when we look at the rise in STI transmissions across the world. The World Health Organization (WHO) estimates that more than one million people are diagnosed with an STI every day — with no signs of slowing down. STIs, including those like herpes or genital warts which are passed through skin-to-skin contact, are also on the rise in Canada. Rates of oral cancers caused by HPV have also increased: a 2016 study in the medical journal JAMA Oncology found that the presence of an HPV strain in the mouth makes the development of throat cancers 22 times more likely. One phase of the study showed that the strain was more likely associated with oral sex on vaginas — which also suggests that dams should be promoted more significantly to anyone who has sex with someone with a vagina. Many of the experts I spoke to noted that, although heterosexual people have higher rates of STIs, dental dams are often targeted to women who have sex with women. Since Richters’ studies on dam use among Australian women were published, the way we talk about gender identities and sexual practices have shifted significantly. The past 40 years of research into women who have sex with women has mostly included women who identify as lesbian, not necessarily the sexual practices or partners of female-identified people. According to the Human Rights Campaign’s report, Health Disparities Among Bisexual People, bisexual women report “higher rates of behaviours that can increase the likelihood of HIV transmission such as having anal sex and condomless sex with a non-steady partner.” Multiple studies show that bisexual women are also more likely than lesbian or heterosexual women to engage in sexual behaviours that can increase their risk of STIs. And like lesbians, bisexual women have lower rates of HPV screening and STI testing due to ingrained societal beliefs that they aren’t at risk. Trans men also face high rates of inadequate pap testing, and, according to Dr Jen Gunter, are ten times more likely to have an abnormal pap smear than cis women. Given that people are now more likely than ever to identify as bisexual — especially those who identify as women — the scope of conversations about STI transmission among women who have sex with women has broadened. Despite this, people who have vaginas but who don’t identify as female are still left out of studies almost entirely, even though millennials are more likely to openly identify as gender fluid or non-binary, and are less likely than boomers or gen-Xers to use terms such as “gay” and “lesbian.” “That’s really the myth, actually,” Massaquoi says. “People focus on the identity being the thing that reduces your risk, as opposed to your sexual practices or sexual behaviour.”

I can understand why no one is a fan of dental dams. First, they’re hard to find — I scoured Shoppers Drug Mart and Walmart on a mission to taste one, with no luck. (Shoppers Drug Mart did not respond to my request for comment.) Felicia Fefer, manager of corporate affairs at Walmart Canada, confirmed that they do not carry dams in store. “These products are available on walmart.ca as part of our extended aisle assortment. In the category of family planning/sexual health, items like condoms, lubricants and pregnancy tests are more popular with customers and sold in-store.” When I checked online I found one near sold-out vanilla-flavoured dam that sells for a whopping $38.02 (at the time of publication, the product was no longer available on the site). The US Walmart’s prices ranged from $6 to $20. I managed to find a few in person at the Stag Shop — a single dam cost me close to $4 with tax, while the five-pack flavour assortment set me back $14.99 (there were no options for unflavoured). Having the ability to access dams is important, but they can be costly to stock for sexual health clinics and queer women’s events. Massaquoi says that WHIWH receives only 500 dental dams a year from Toronto Public Health, but between 12,000 and 20,000 condoms. She says it’s the cost that limits access — about $3.25 a dam, compared to $0.50 for a condom. And despite news articles and research that find that women generally aren’t using dental dams, Massaquoi says clients come to the centre actively asking for them. “We can’t keep enough here,” she says. “I mean, you put a basket of dams out in our waiting area and by the end of the day, they’re gone.” Although WHIWH would like to give out more dams, Massaquoi’s team has to ration enough for specific events and LGBTQ2 programs. With recent cuts to public health by Premier Doug Ford’s provincial Ontario government, which trickles down to the municipal level, Maasaquoi isn’t expecting a new shipment of dams this fall. “I want to be able to say to these young people walking in and asking for a dam that I have one to give,” she says. “I don’t want to say the city didn’t give me enough this year, or we can’t afford to give you one, because that sends a message: you don’t matter enough for us to make this available to you.” Even event nights for queer, lesbian and female-identified people are struggling to supply enough dental dams. Oasis Aqualounge, a sex club in Toronto that hosts a bi-monthly event for women and trans folks called Sapphic Aquatica, doesn’t carry dental dams — though they do have condoms, lube and non-latex/latex gloves. “We have only ever carried dental dams that were donated to us on the rare occasion,” says co-owner Fatima Mechtab. “Unfortunately, dental dams are very expensive. A pack of 10 is $25 and, considering we are a sex club that is open seven days a week, that would barely last a few days.” JL Cotter, communications coordinator at Planned Parenthood Toronto (PPT), says accessibility is a big issue. Many of the organization’s safe sex supplies are provided by donations or through free public health programs, but dams aren’t usually available through either. “We generally don’t see dental dams or other safer sex supplies as readily as we see condoms,” she says. Instead, PPT buys a bulk order of dams through a distributor. “I can say with certainty that [the demand for dams] is relatively low. People definitely do come in specifically asking for them, but the demand is low enough that we only order about 300 per year.” Cotter says PPT hands out the most dams around Pride month for folks hosting sex parties, as well as to folks involved in sex work.

In 2015, PPT’s main distributor stopped making non-latex dental dams, and one of the only suppliers to produce non-latex and unflavoured dental dams went out of business. “It’s a problem of availability and barriers to access in terms of those who have allergies,” Cotter says. Only a few brands of dental dam are FDA-approved for safe sex, like Line One Labs from California, and Sheer GLYDE Dams, founded in 1993 by Glyde USA’s parent company, Glyde Health Australia. (According to managing director Clive Woodworth, he was approached by a woman who asked why the condom manufacturers only made products for men.) But even these dams are still made out of latex and are flavoured. In addition to being hard to get a hold of, they taste awful. I opted for grape, which tasted like a latex glove and a grape magic marker made a baby. It had a powder residue that left my tongue feeling filmy for hours. In my search for dental dams, I couldn’t find any unflavoured ones, like condoms, which seems to underscore the societal belief about vaginas smelling or tasting unpleasant. “There’s this long-standing, intractable idea that vulvas or vaginas are smelly and gross and taste bad. And that’s so deeply internalized by a lot of people who have a vagina,” says Chris Barcelos, an assistant professor of gender and women’s studies at the University of Wisconsin–Madison, who specializes in LGBTQ2 health and politics. “So manufacturers are like, here, we can help people get over this idea that vaginas are gross by using a flavour — which is wrong because a lot of people like the taste.” Vaginas and their potential for pleasure have long been treated with fear and disgust in our culture. There are stories about the toothed vagina — vagina dentata — in nearly every culture. Labiaplasty — a cosmetic surgery that reduces the size of the skin, or “lips,” around the vaginal opening — as well as hymen-repairing surgery, are on the rise. Products to make your vagina smell better, look better, feel better and be “cleaner” are everywhere: douches, scented tampons, washes and wipes, yoni eggs and kegel balls. So are DIY-insertion methods to combat odour or change the vagina’s pH balance, like borax, garlic, yogurt and tampons dipped in apple cider vinegar, often targeted toward heterosexual women and lesbian women, not those who are non-binary, trans or not cisgender. By taking vaginas as far away as possible from normal and healthy functions, these products and procedures attempt to make them more attractive to straight men, but very few actually support and promote sexual pleasure. After all, our choices for sexual health protection are a female condom that is terribly frightening looking, and a dental dam that is, well, incredibly awkward. A dam is just a flimsy, medium-sized square of bright coloured latex that is supposed to sit across your vagina and that smells like artificial sweeteners. It’s shifty, and needs to be held in place. I can’t imagine anyone wanting to lick it, or not laughing while licking a vagina covered with a large Barney-purple sheet.

BuzzFeed and Mashable have made videos of queer and lesbian women reacting to trying a dental dam for the first time, and of them trying to explain the product. Their stories mainly reference awkwardness as a reason that dams aren’t used — even the New York Times talked about the “unimaginably awkward dental dam” in a 2007 review of the TV show Life Support. Our culture’s discomfort and misunderstandings about the purposes of dental dams also extends to pop culture. They have rarely appeared in films, and when they do, they’re used as a punchline in heterosexual encounters, highlighting just how little men know about sex. In J Stanford Parker’s 1997 comedy, Booty Call, Rushon (Tommy Davidson) doesn’t know what a dental dam is and wraps himself entirely in plastic wrap, almost suffocating to death. In a scene in Judd Apatow’s 2007 rom-com, Knocked Up, Alison (Katherine Heigl) tells Ben (Seth Rogen) over dinner that she’s pregnant because they didn’t use protection. In response, Ben says, “I assumed you were wearing a patch or, like, a dental dam.” But there are young innovators who don’t see the dental dam as a joke — they want to bring it back from safe-sex purgatory and create new options for women’s sexual health and pleasure. After all, people with vaginas shouldn’t have to resort to DIY condom slicing (though the CDC has a diagram on how to do it). In 2017, Vice profiled two dental students looking to turn the dam into a textured face mask for oral sex and rimming, making it hands-free and more pleasurable. Lorals (shortened from Love Oral, Always) is a line of disposable underwear for oral sex, which founder Melanie Cristol invented after wanting (but feeling too uncomfortable) to use a dental dam with her then-wife. Though the campaign was initially targeted to people who felt too self-conscious about their vaginas to recieve skin-to-skin contact during oral sex (Lorals’ data found that 80 percent of women have said no to oral sex when they want to say yes), Cristol shifted its focus to include the underwear as a safe sex option for women. But for creators who are trying to change the market, the process to get approval is expensive, running up to $100,000 — Lorals still isn’t FDA approved. Larger manufacturers of dental dams have profited from their safe-sex supplies but haven’t created more innovative options for women’s pleasure; meanwhile, young innovators who are trying to reimagine an improved, modern dam can’t afford the costs. For the time being, we’re stuck with the dam’s current form. But is that such a bad thing? The belief that no one is using dental dams and that STI transmission is low among queer women and people who have vaginas doesn’t take away from the truth that dams are in demand, that they’re effective at preventing STIs and that people want to use them, though costs and accessibility remain obstacles. While we wait for sexier versions of dental dams, we’ll have to make do with what we have. In the meantime, creating ways to make dams more accessible, available and cost-effective to people of all gender identities and sexual practices should be a priority. Including dental dams alongside condoms in sex-ed conversations needs to happen now; less gendered marketing and greater size, taste and texture options could open up more interest. The dental dam may elicit a case of the giggles, but it’s about time we get serious and see it in a new light — not as a punchline, but as a genuine option for safer sex.

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