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Let’s talk sex: Safe sex

Let’s talk sex: Safe sex

At LOLA, we’re dedicated to providing you with trusted products and candid information so you can make the right decisions for your reproductive health and wellness. And when it comes to your sexual wellness specifically, education is key to making these deliberate and purposeful decisions.

A crucial aspect of a healthy sex life is to learn how to protect yourself from sexually transmitted infections (STIs), sometimes also referred to as sexually transmitted diseases (STDs) or sexually transmissible infectious diseases (STIDs). Understanding what they are, how they’re contracted and manifest, and proactive ways to prevent contracting them is essential for your own sexual health, as well as the health of your sexual partner.

Let’s start with some baseline terminology. “STI,” “STD,” and “STID” all represent the same broad group of infections that can be passed between individuals through various types of intimate contact, including oral, vaginal, and anal sex, as well as through the use of fingers and sex toys (if shared between partners). While used interchangeably, the medical and public health community has not yet reached a consensus on the STI versus STD terminology debate. This is because medically, infections are only called “diseases” when they cause symptoms, but many sexually transmitted infections can be contracted and manifest without any symptoms. For example, most people who have a high-risk type of human papillomavirus (HPV) will never show any signs of infection until it has already caused serious, and sometimes deadly, health problems. For the purposes of simplicity, we’ll stick to the term STI.

Common STIs include chlamydia, gonorrhea, trichomonas, syphilis, HIV, hepatitis, HPV, mycoplasma genitalium, and the herpes simplex virus (HSV, but most commonly just referred to as herpes), types 1 and 2.16 Most — but not all — STIs require an exchange of bodily fluids; some, like herpes,17 can be spread through skin-to-skin contact.

HPV is the most common STI. The CDC estimates that nearly 80 million Americans currently have HPV.18 Different strains of HPV can cause different symptoms: some can cause genital warts, while others can cause cancers (including cancers of the cervix, vulva, vagina, penis, anus, and throat).19 It’s also possible to have HPV without any visible symptoms. Knowing your partner’s HPV status20 and regularly using condoms and dental dams can help reduce your risk of contracting the virus. However, since HPV can be passed through skin-to-skin contact, using condoms and dental dams aren’t a foolproof solution.21

All STIs can impact your overall health, and while some are curable with treatment, like chlamydia and gonorrhea, others, like HIV and herpes, are not.22 While it’s not a vaccine, but rather a prescription drug regimen, pre-exposure prophylaxis (or PrEP) has been shown to be highly effective for preventing HIV if it is used as prescribed.23 Currently, the only STI you can be vaccinated against is HPV (more on this in our Q&A section). 

As with any vaccination or prescription medication, it is important to openly talk to your doctor about your sex life, medical history, and any other medications or dietary supplements you are currently taking to ensure your doctor can accurately assess any potential risks. 

If you have a regular annual checkup with your gynecologist or primary care physician, you can request STI testing to ensure you’re consistently and proactively getting tested. If you ever notice any STI symptoms, however, see a medical professional or head to a free, low-cost, or sliding-scale clinic to get tested. Just remember, since not all STIs cause symptoms, it’s possible that you and your partner could have an infection without knowing it, so make sure you’ve both been tested before becoming intimate. Also make sure you’re using condoms or dental dams to reduce the risk of contracting an STI.

Talking about sexually transmitted infections with your partner isn’t always an easy conversation to have, but remember that it’s your body, and it’s important to just come right out and ask if they’ve had recent STI testing. It’s also important to know when testing occurred in relation to their last sexual partner (for example, if your prospective partner was tested and then had unprotected sex, it’s recommended that they get tested again).24  

In the event that you are diagnosed with an incurable STI, there may be ways to manage it and reduce the risk of spreading it to others.25 Talk to your doctor to learn more about how widespread the infection is and the health risks associated with it. And there’s no reason to be embarrassed! They talk about this stuff every day.

STI testing

STI testing doesn’t always include all possible STIs, and the range of tests varies depending upon the clinic or doctor you see. But you always have a right to ask your healthcare provider for additional testing if you’re concerned about your risk. For example, HSV types 1 and 2 aren’t commonly included in routine testing, but if you think you may have been exposed or just want to cover all your bases, you can request that it be added. It’s your body, so don’t be afraid to ask for everything you’d like included.

There are a range of different treatment options for each STI, and the only way to know which is right for you is to talk to your doctor. Factors like the severity of the infection, a patient’s dosage tolerance, medical history, and allergies all factor into how an STI is treated.

Condoms and dental dams

While they can be highly effective when used properly, condoms do not completely eliminate the risk of contracting an STI. Because condoms only cover the penis from the head to the base of the shaft, they offer less protection against STIs that can be spread from skin-to-skin contact,27 like HPV, herpes, and syphilis. Each condom is different (for example, in material, size, and effectiveness), and you should carefully review the specific condom’s labeling and instructions for applicable safety and usage information.

Latex condoms are the best condoms to use for STI prevention because they reduce the risk of transmitting STIs that are passed through bodily fluids, like chlamydia and gonorrhea, by providing a barrier against the source of the infection.28 Polyurethane, polyisoprene, and nitrile options are good alternatives if you’re allergic to latex, but they have a higher breakage rate compared to latex. Natural membrane (or lambskin) condoms can reduce your risk of unwanted pregnancy, but they do not adequately protect against STIs.29

Be sure to refer to the instructional pamphlet within the box before using the condom. Use a new condom (and check its expiration date) for each act of sex. Lesions, pre-ejaculate secretions, semen, vaginal secretions, and blood can all transmit infectious organisms. Tear open the package carefully. Do not use fingernails, teeth, or anything that could damage the condom. 

Before any sexual contact, place the condom on the head of the erect penis. Be sure the rolled-up ring is on the outside. Squeeze the top gently so no air is trapped inside. There should be some space at the tip to hold semen when you or your partner come.

Hold the tip while you unroll the condom all the way to the base of the erect penis. If the condom doesn’t unroll easily, it may be on backwards, damaged, or too old. Throw it away and start over with a new condom.

Do not use any oil-based lubricants with condoms — such as those made with petroleum jelly, mineral oil, vegetable oil, or cold cream — as they can cause damage. Only use a water-based or silicone personal lubricant with a condom.30

If you’re sharing penetrative sex toys, such as a dildo or a strap-on, you can apply a condom exactly as you would on a penis. Make sure to use a new condom for each partner and for each sex act. And if you’re sharing non-penetrative sex toys, be sure to clean them in between use if condoms aren’t logistically possible.31

Dental dams can be used for STI protection during oral sex. They’re made of latex or polyurethane and are placed over the vulva (including the vaginal opening) or anus before oral sex.32 For oral sex performed on a penis, use a condom, not a dental dam.33

Just like condoms, it’s important to make sure that your dental dam isn’t expired. Consult the instructional pamphlet before using a dental dam, and carefully remove it from its wrapper to make sure that you don’t rip it on the way out. You can also use a water- or silicone-based lubricant in between the dental dam and your partner’s genitals to prevent any friction or breakage.32

Preventing unplanned pregnancy

Of course, contracting an STI isn’t the only physical risk associated with having sex. There is also the possibility of vaginal penetrative intercouse resulting in an unplanned pregnancy.

To help reduce the risk of unplanned pregnancy, there are four broad classifications of birth control methods — behavioral, barrier, reversible, and permanent. A “failure rate” is used to describe the percentage of the time a particular method of birth control results in pregnancy. Failure rates are associated with “typical use” — meaning they are averages that include human error. Consistent and correct use may further decrease the risk of pregnancy, but no method of birth control is 100% effective in every case.

Behavioral birth control methods include withdrawal and fertility awareness. These have the highest failure rates out of all the options. 

Withdrawal, or the practice of removing the penis from the vagina before ejaculation (colloquially known as the “pull-out method”), has a failure rate of 22 percent. 

Fertility awareness, or planning when you have unprotected sex based off of a female partner’s ovulation window, has a failure rate of 24 percent.34

Barrier birth control methods like diaphragms, cervical caps, sponges, and condoms (female and male) work by blocking the sperm cells from reaching the egg. They have a higher failure rate than reversible methods because there’s a greater possibility for user error. 

Diaphragms and cervical caps are dome-shaped silicone cups with a flexible rim. Typically used in conjunction with spermicide, they are placed into the vagina over the cervix to prevent semen ejaculate from reaching an egg. These forms typically require the user to leave the device in for a period of time after intercourse. Some are one-size-fits-most, while others need to be fitted by a healthcare provider. They have a failure rate of 12 percent when used with spermicidal cream or jelly. 

Sponges are made of a soft foam containing spermicide and are typically about two inches in diameter. They are placed into the vagina over the cervix to block sperm from entering the uterus and release spermicide to immobilize the sperm. Like diaphragms and cervical caps, most sponges require the user to leave the sponge in for a period of time after intercourse. Unlike diaphragms and cervical caps, sponges must be discarded after a single use. They have a failure rate of 24 percent among women who have previously given birth and 12 percent among women who have never given birth before.

Female condoms are a tube-shaped barrier placed inside the vagina with the opening resting just outside of the body. Typically they feature flexible rings on either end to aid with insertion. They have a failure rate of 21 percent with typical use and 5 percent if perfectly used as directed every time.

Male condoms are designed to stop the semen from entering into the vagina. They have a failure rate of 18 percent with typical use and 2 percent if perfectly used as directed every time.

Reversible birth control methods are those that do not permanently affect your ability to conceive. There are many different types of reversible birth control methods and there is a lot to consider when choosing a reversible birth control like, “Is an IUD right for me?” or, “Should I be on hormonal or non-hormonal birth control?” Knowing your options, understanding potential side effects, and being in tune with your body’s response to a reversible birth control method are all critical to maintain your reproductive and mental health and wellness.

Intrauterine birth control includes both hormonal (or progestin) and non-hormonal (or copper) IUDs, which are small T-shaped devices made of flexible plastic. They are inserted into the uterus by a health care provider and sit inside the uterus for the duration of use, which can range from three to twelve years. IUDs work by altering the uterine environment such that the sperm are no longer able to swim, thus preventing egg fertilization. A hormonal IUD releases a low dose of progestin, which thickens cervical mucus to create a barrier to sperm entering the uterus. Progestin can also suppress ovulation in some users. A non-hormonal IUD features copper, which has additional spermicidal effects. IUDs have a failure rate of 0.2 percent to 0.8 percent.

Combination hormonal birth control options contain both progestin and estrogen and come in three forms: the pill, the patch, and the vaginal ring. They all work by preventing ovulation and thickening cervical mucus to create a barrier to sperm entering the uterus. The main difference between the three is the manner by which the hormones are administered. There are many combination pills on the market with varying amounts of each hormone, but most are taken daily with sugar pills for “off” weeks when menstruation occurs. The patch is worn on the skin — usually on the upper arm, upper torso, buttocks, or back. The ring is inserted into the vagina. Both are worn for three consecutive weeks and, like most pills, you’ll have an “off” week. The failure rate for these is 9 percent.      

Progestin-only hormonal birth control options do not contain estrogen and come in three forms: the mini pill, an injection, and an implant. Like the hormonal IUD, they work by releasing a low dose of progestin, which thickens cervical mucus to create a barrier to sperm entering the uterus. Progestin can also suppress ovulation in some users. For the mini pill to be effective, it must be taken at the exact same time each day and has failure rate of 9 percent. Since both the injection and implant are administered by a healthcare provider, they have much lower failure rates ranging from 0.05 to 6 percent.

Permanent birth control methods include vasectomies and tubal sterilization (colloquially known as “getting your tubes tied”).

Keep in mind that even though condoms are not 100 percent effective and do not prevent against all STIs, they are the only type of contraception that also reduces your risk of STIs. For maximum coverage, you might want to consider a dual method,36 such as condoms and an IUD, or condoms and the pill.

In the event that your birth control method fails — for example, if a condom rips or you improperly inserted a diaphragm — there are over-the-counter medications you can take afterward to prevent pregnancy. Levonorgestrel-containing emergency contraceptives can be taken within 72 hours of contraceptive failure. The sooner you take it, the more effective it can be;35 however, before running to the nearest drugstore, make sure to speak with a medical professional or pharmacist to understand the potential side effects.

Figuring out which birth control method is right for you is a very personal decision. If you’re curious about your contraceptive options or want to learn more about the pros and cons of each method, talk to your healthcare provider or medical representative at a healthcare clinic.

LOLA’s Guide to Sexual Wellness

If you found this article helpful, we recommend downloading our full Sexual Wellness Guide. The guide features tips on safe sex, solo sex, sex with a partner, and how to talk to your doctor, all written by experts.

This chapter was written with contributions from Corina Dunlap, ND, MS. All statistics, material definitions, and instructions for use included in this section are sourced from the FDA and CDC.