Reprinted With Permission from Cuir Underground
Copyright (c) 1996 Cuir Underground
From Issue 2.6 - June/July 1996
Ask the Doctor of Perversity
by Beth Brown, MD
Rubber and Plastic are your Friends
Whether you've lived in San Francisco for years or are visiting for the first time this Gay Pride season, sexual safety is important for everyone's well-being. Eighteen years into the AIDS epidemic, we still don't have perfect information about every aspect of safer sex. There are areas nearly everyone agrees on (wear your rubbers!) and areas of incredible controversy (just what can you put in your mouth?). Since this is my column, I'll plunge in and tell you what I think.
Taking care of yourself emotionally is absolutely essential. People seldom fuck unsafely because they are ignorant of the risks. They do so because they are depressed and don't care. Or maybe they feel pressured because they think they won't get fucked if they insist on protection. Or maybe they're too drunk or high to drive a dick safely. If you're about to fuck or be fucked unsafely, ask yourself this: "Do I care enough about myself and my partner to protect our health? If not, what am I doing here?"
I concentrate on fucking because this it's one of the clearest risk factors for HIV infection, second only to direct blood contact. A condom should be worn every time a live organ penetrates a cunt or an ass. Latex condoms are the old standby, and now come in many different sizes, colors, textures, and flavors. The newer polyurethane Avanti condom is at least as hardy as latex and is safe to use with oil-based lubes. The Reality "female condom" is a completely new design; an enclosed ring allows the condom to be inserted into the vagina or anus, while and an external ring provides extra protection. Asslickers take note: the external part of Reality is much thinner than a dental dam, and it doesn't smell like rubber. For maximum safety, fingers or fists going into vaginas or butts should be covered with a latex glove.
Oral sex is the eye of a hurricane of controversy. Giving head without a condom is not risk-free, although it is certainly safer than unprotected fucking. There is less HIV in pre-cum than in semen, but nobody knows exactly how much is "too much." Menstrual blood, which may not be visible, and vaginal fluids also contain HIV. Oral sex can also spread diseases like gonorrhea, chlamydia, herpes, and genital warts. My recommendations: Use a condom for cocksucking. Use a dental dam, plastic wrap, or a Reality condom for asslicking. If you are going down on a woman, a dental dam or plastic wrap should cover the opening of the vagina. Unlike a penis, a clitoris cannot suddenly produce fluid; I think it's perfectly safe not to cover the clit at all, unless open sores are present. [Editrix note: several AIDS organization now regard oral sex as safer sex. You can make oral sex without a condom safer by not swallowing cum and by not brushing or flossing your teeth right before or after oral sex.]
There's more to kinky sex than just our genitals. Luckily for us, if we use common sense, most SM activities are safer than unsafe sex. We've all heard the warnings about sharing needles for injection drug use, but sharing needles, razors, knives, and other implements used for piercing, cutting, or shaving also presents a risk of HIV transmission; all such tools should be cleaned thoroughly with bleach or alcohol. Gloves should be worn for activities that involve blood. There is controversy about whether HIV can be transmitted via a whip that is used on more than one person in succession (researchers just don't study these things!). To be safest, use whips on only one person; a bottom can have a set of whips that are exclusively for use on them. Alternatively, whips can be cleaned thoroughly between uses.
I wish we had a device, like the tricorder on Star Trek, which could detect any contagious illnesses in our object of desire. But we don't. And we can play safely regardless of the status of our partners by observing a few simple precautions. The safest course is to keep body fluids -- especially blood, semen, and vaginal fluids -- off of broken skin and outside the body, no matter how healthy somebody looks. Only you can decide what is the appropriate level of safety for yourself. The less you have to worry about HIV and other sexually transmitted diseases, the more energy you will have to enjoy your fun and games.
Beth Brown, MD (DoctorBeth@aol.com) is a Bay Area family physician. She is a contributor to The Lesbian S/M Safety Manual (Pat Califia, editor; Alyson Press, 1988). Please send questions that you would like her to address in future issues to DoctorBeth@aol.com.
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