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Volume CXXXIII, Number 11 |
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"Safe" and "Safer"
DR. JEFF BENSON
CONTRIBUTOR
Dear Dr. Jeff: What's the difference between "safe
sex" and "safer sex"? E.T.
Dear E.T.: "Safe sex" was promoted in the early
'80's in response to the outbreak of the HIV epidemic. The initial lists
of prescribed behaviors were discouragingly long, prohibitively broad,
and overly focused on gay men. They were also misleading. There is no
such thing as completely safe sex. "Safe" sex recommendations
were eventually replaced by "safer" sex recommendations, grounded
for many in a more balanced and acceptable understanding of the nature
of risk.
People have safer sex to protect themselves and their partners
from STD's, including HIV, and from unplanned pregnancies. They understand
that sex is more enjoyable if they are not afraid. Safer sex is about
what they do, or don't do, and not about who they are. It is about figuring
out their own "risk limits, ' and then avoiding sexual activities
that fall outside of them. Safer sex practices require self-reflection,
a great deal of communication between partners, and some familiarity with
the "tools of the trade," especially condoms.
Condoms greatly reduce the risk of contracting or spreading
many STD's, including HIV. They are available in a truly astonishing array
of styles, colors, sizes, shapes, and flavors. Most are made of latex.
For people allergic to latex (some 6 percent of the population), polyurethane
condoms are good alternatives. "Natural" lambskin condoms should
be avoided: they don't protect against viruses.
A good quality condom, properly used, is a birth control
method with a failure rate of about only 2 percent. In our real world,
however, this rate is more like 12 percent. Go Ask Alice! estimates that
2-5 percent of condoms tear during use. Causes include creating microscopic
tears with rings or fingernails, not using enough lube, or not using the
right lube (water- or glycerin-based like Astroglide or KY, not oil-based
like Vaseline or massage oil). The majority of condom failures are probably
due to inconsistent or incorrect use. Inconsistent condom use may mean
not using a new condom every time, or not putting it on soon enough. Incorrect
condom use may involve not fully unrolling the condom, or unrolling it
backwards, or not leaving space at the tip and squeezing the air out ("pinch
an inch!") Condoms should be stored in a cool, dry place, and not
carried around for long in a pocket or wallet.
That 12 percent user-failure rate is the reason condoms
should always be used with another contraceptive agent (such as foam,
jelly, or sponges). Many condoms are coated with a spermicide (usually
Nonoxynol-9), but this small amount is not considered adequate to prevent
pregnancy in the event of condom failure. Moreover, Nonoxynol-9 may have
been shown to facilitate HIV transmission. None of the condoms now distributed
by the Health Center contain N-9.
"Reality" brand condoms are placed into the vagina
or anus before sex. Although often called "female condoms,"
they can obviously used by men or women.
Dental dams, plastic wrap, and flavored or cut condoms can
all be used to make oral sex safer. The point is to avoid exchange of
body fluids.
Health educators at the Fenway Clinic in Boston have suggested we think
through the risks of sex and safer sex like we do other risks in life,
such as driving a car. There are people who choose not to drive for fear
of getting hurt in an accident. Most people seem willing to accept some
level of risk, and try to find ways to reduce it. They wear seat belts,
maintain their cars, drive defensively, and avoid driving after drinking
or in bad weather.
Practicing safer sex is really very similar.
You can, of course, choose abstinence. Obviously, that would
be the safest option. For some people, it's the best choice.
There is plenty of information readily available to help
you make your own best choices. Take a look at the Health Center web page.
Talk to someone at the Health Center, the Counseling Center, or the Women's
Resource Center. Talk to members of the Bowdoin Gay/Straight Alliance
or HIV/AIDS Peer Educators. Check out goaskalice.columbia.edu,
fenwayhealth.org, or ourbodiesourselves.org.
To your health!