This is a handout that was used for a presentation on safer sex in 1995. The attempt was to cover absolutely everything, frankly with mixed results, and the presentation wasn't repeated. We recommend reading the more concise and up-to-date guide to safer sex that's available on this site instead of this one. We're keeping this guide around just for historical reasons, as it reflects a lot of ideas that were popular at the time.
The goal of this guide is to give people of all genders, orientations, and preferences the information they need to perform a wide variety of sexual acts safely, pleasurably, and comfortably. It should be noted that this guide uses more sophisticated vocabulary and covers more material than most safer sex brochures; people who find this guide to be at all overwhelming might be better served by some of the simpler and more direct documents produced by mainstream STD prevention and public health organizations, or by the more concise version of this guide (written by the same authors).
As much as possible we try to avoid telling you what you "should" do. Think of this guide as a collection of techniques that can make whatever safer sex standards that you might choose to follow both graceful and effective. If you decide, for example, that you want to use barriers of some kind for oral sex, you'll find detailed information on how to do so in this guide; if you decide that this risk is low enough for you and choose not to use barriers for oral sex, then feel free to ignore that section of this guide. The choice of how much risk to assume is yours.
We actually do recommend that before reading this guide you first read the more concise version of it, which may help you both to put your choices in perspective and to see the bigger picture.
Material for this guide was compiled from a variety of sources, including first-hand experiences of STD counselors and educators, advice from a variety of highly sexually active people, and existing literature. For more rigorous documentation and referencing of various medical STD studies, see Choices: Sex in the Age of STD's by Jeffrey S. Nevid, or Our Sexuality by Robert Crooks and Karla Baur.
The authors of this guide accept no liability for any injury which may befall any individual as a result of performing activities described herein, and make no guarantees or warranties concerning this document. As safety recommendations often change based on new medical discoveries, we urge you to augment this guide with the best and most current information available to you.
Additionally, we should note that this document was created in 1996 to be the handout for a particular student-organized safer sex educational event, and will not generally be kept up to date: thus the information it contains will eventually go out of date, and if you have concerns or questions about your health your best bet is still talking to a qualified health care professional.
2. Comments on Contraception
The subject being dealt with in this document is STD prevention, not birth control. Of all of the STD-preventative supplies and techniques that will be discussed, only condoms and spermicidal products are also effective tools for contraception, and then only when they are used together and are used properly and consistently by male/female couples engaging in penile/vaginal intercourse. We urge you to see a health care provider, student health clinic, or Planned Parenthood clinic if you need an effective means of birth control.
Sex is any activity that one engages in for erotic pleasure or reproduction. Sex includes, but is not limited to, vaginal intercourse, anal intercourse, oral intercourse, manual manipulation of the anus or genitals, SM play, mutual masturbation, solo masturbation, fantasy, cunnilingus, analingus, penetration with dildos, etc. Sex is still sex whatever the gender, orientation, preferences, or number of the participants.
3.2 Safe, Safer, and Unsafe
For sex to be consensual, partners must heed each others' requests to slow down, back off, or stop. If you feel that your partner would not honor a direct request to stop doing something to your body, you might consider whether any sex with that person is "safe." Even when sex is consensual, it is important to be sufficiently sober, sane, communicative, and aware to effectively sense pain or danger and communicate that to a partner. There are a variety of excellent books and techniques available that are designed to help people communicate better about sexual matters, and we urge you to browse your local bookstore for one that suits you.
A barrier is any physical object which allows sex that would otherwise be unsafe to be safer or safe by preventing transmission of body fluids. Barriers discussed in this document include condoms, gloves, and oral barriers.
4. Positive Benefits of Safer Sex
5.1 Use of Sufficient Lubricant
Most penetrative sex or manual stimulation feels much better for both parties when sufficient lubricant is used. Lubricants also improve the efficacy rate of barriers. In general, water-based lubes are the most versatile.
5.2 Manual Stimulation
5.2.1 Women (the Clitoris and G-spot)
Many women experience orgasm and/or highly pleasurable sensations through intentional stimulation of the clitoris or G-spot (the G-spot is often located on the forward wall of the vagina, just beyond the pubic bone) more easily than they experience it through ordinary vaginal penetration by a penis or dildo. Ordinary "thrusting" sex, if that is desired, is often MUCH more enjoyable for women after arousal or orgasm. G-spot stimulation is usually easiest to accomplish with a (possibly gloved) hand, and clitoral stimulation is usually easiest to accomplish with either a (possibly gloved) hand, a vibrator, or a tongue (possbily with an oral barrier). Many women find that consistent, reliable, protracted clitoral stimulation best assists in achieving clitoral orgasm; as is also the case with G-spot stimulation, paying attention to your partner's body language and listening to her feedback will help more than anything else.
5.2.2 Men (the Prostate Gland)
Stimulation of the prostate gland can often cause an increase in the pleasure caused by penile stimulation, or can feel great even without penile stimulation. Prostate stimulation is usually easiest to accomplish with a gloved hand, exerting mild pressure against the forward wall of the anus. The prostate gland is typically more easily palpable than the G-spot, and often feels like a gentle dome. As is the case with the G-spot, one should listen to the feedback of one's partner when finding the prostate gland, as its location can vary from person to person. For additional pleasure for the recipient, one may stimulate the prostate gland at the same time one is masturbating the penis. In general, most men prefer a firmer touch on their genitals than many women assume would be comfortable, and many enjoy firm tugging on the scrotum.
5.3 Deep Breathing
Breathing rhythmically and deeply before and during sex can increase one's pleasure. See Annie Sprinkle's videotape Sluts and Goddesses for a humorous demonstration of this technique. In general, meditation and "focusing" techniques such as this are often used to great effect by Tantric sex practitioners, and by others who may have a purely secular viewpoint. Elements of atmosphere and ritual, such as turning off the telephone, putting good music on the CD player (on repeat play), engaging in rhythmic touching/caressing, keeping protracted eye contact, and lighting candles, are also helpful for many people.
5.4 PC Muscle Contraction
Contraction of a special muscle called the PC (Pubococcygeus) muscle can increase sexual pleasure, and is valuable for both women and men. See a text such as The New Good Vibrations Guide to Sex for details on how to identify this muscle, exercise it, and utilize it during sex. Briefly, though, the muscle of interest may be located when urinating, by noticing what muscle you contract to stop the flow of urine. This is the PC muscle, and it may be exercised by contracting it repeatedly and rhythmically, or by contracting/inhaling and relaxing/exhaling. It may be used during sex by contracting it when close to orgasm.
5.5 Good Communication
There isn't a substitute for being able to tell your partner during sex when something doesn't feel good, or when it does. There isn't a substitute for actually asking for what you want, and for learning over time what your partner likes. Higher levels of communication on sexual matters will tend to increase both the pleasure and the safety of all involved. Furthermore, knowledge of your partner's fantasies will allow one to construct verbal/theatrical fantasies and hot talk for them during sex to heighten their pleasure. Many people find that it is easier for them to reveal their fantasies to someone else while they are being sexually stimulated. "Tell me your deepest fantasy or I'll stop moving my hand" works wonders with many folks.
5.6 Learning More and Trying New Things
An EXCELLENT book on general sexuality is The New Good Vibrations Guide to Sex, by Cathy Winks and Anne Semans. This book will also provide details on all of the techniques mentioned above. You can also browse the Society for Human Sexuality web site for more information.
6. Safer Sex Supplies
6.1 Barriers (Condoms, Gloves, and Oral Barriers)
6.1.1 General Use Guidelines
To be most effective, barriers must be used from start to finish, correctly, every time you have sex. Use a new barrier with every partner, check the barrier periodically during sex, and discard used barriers immediately. One may also wish to set out before having sex all the barriers one might use and place them within easy reach; this can save one from fumbling later.
Also, there are occasions where one would wish to change barriers with the same partner. The classic example of this is having a fresh glove or condom when you switch from the anus to the vagina, as transferring bacteria found in the anus to the vagina can often cause vaginitis.
One general comment with barriers is that you should be careful removing them after use if possibly infected materials are present on them. If they cannot be removed without you coming into contact with possibly infected materials, then remove them with some sort of tissue paper or towelette between you and the barrier (this is especially effective for condoms), or have the partner who came into contact with the outside of that barrier remove it for you. If neither of these are options, then just avoid touching your eyes, urethra, or vagina with your hands before you have a chance to wash your hands.
Used latex materials should not be flushed down the toilet (as they tend to cause clogging), but rather should be discarded in a trash receptacle, preferably one with a disposable plactic liner.
6.1.2 Making Barriers More Pleasurable
18.104.22.168 General Comments
The use of any barrier can become more pleasant over time, as it becomes associated with pleasurable stimuli and one becomes more skilled with its use.
22.214.171.124 Things that Make Your Barrier Taste Better
When people complain about barriers tasting bad, it is usually because the barriers have been coated with something unpleasant. Plain latex, nitrile, polyurethane, etc. have no taste of their own. Common coating taste offenders are Nonoxynol-9 (HORRIBLE taste!) and the powder which is present on some non-lubed condoms and pre-powdered gloves (though note that you can rinse the powder off the outside of gloves with running water). The taste of pre-lubed condoms without N-9 depends on the type of lube used; Kimono MicroThin condoms, for example, taste fine to me.
Using flavored barriers (ala Sheik or Lifestyles mint condoms or Glyde "Lollyes"), using a flavored water-based lube on the barrier, or dipping the material in something more tasty (and fat free, in the case of latex barriers...) are also options.
6.1.3 Specific Barrier Materials
This is the most popular material for barriers. Latex condoms, gloves, and oral barriers have been shown to protect against the transmission of HIV and other STD's. Latex barriers are inexpensive and commonly available in a wide variety of different styles.
Any barrier made out of latex should not be exposed to anything with oil in it as oils will cause the latex to disintegrate. Thus, water-based and silicone-based lubes only should be used with latex. Latex can also be damaged by excessive exposure to air, sunlight, heat, or cold. The simplest storage solution is to keep latex condoms out of wallets/glove compartments and in their packages, and to keep latex oral barriers and latex gloves either in their boxes or in a plastic bag within one's toy bag. If latex appears sticky, marbled, discolored, brittle, or damaged, don't use it.
Some people are allergic to latex, or have developed latex sensitivity through continued exposure to it (generally in the medical field). Such folks will generally be more than aware of their sensitivity, and you will need to use barriers made of some other material when playing with them.
Polyurethane does not degrade when it comes into contact with oil, and it may transmit sensation better then latex. It may also be valuable for people with latex allergies.
According to lab tests, polyurethane should provide protection against transmission of HIV and other STD's. However, the only two barriers this substance has been formed into, the Avanti male condom and the Reality female condom, do not suit everybody in terms of construction and shape.
Nitrile does not degrade when it comes into contact with oil, and it may transmit sensation better than latex. According to lab tests, it provides protection against transmission of HIV and other STD's.
Currently, the only barrier this substance is formed into is nitrile gloves, which are definitely valuable in cases of latex allergy/sensitivity. Some people find the texture of these gloves to be unpleasant, while others prefer their texture to latex. Nitrile is more puncture-resistant than latex, but tears in it spread more rapidly.
126.96.36.199 Saran Wrap
Saran Wrap doesn't degrade in the presence of oil, and may transmit sensation better than latex. Lab tests indicate it can prevent transmission of Herpes, which is smaller than HIV. There is no reason to believe that "Microwaveable" Saran Wrap provides any less protection than regular Saran Wrap. Saran Wrap's STD prevention use is limited almost exclusively to forming a barrier for cunnilingus and analingus.
188.8.131.52 Lambskin, etc.
Barriers made of lambskin and similar materials are often too porous to dependably prevent transmission of viruses such as HIV, and are therefore not recommended by health organizations for STD prevention.
The only real safer sex purpose that comes to mind for a lambskin condom (which is the only type of barrier this material is made into) would be if a man was allergic to latex, and so he wore a latex condom over a lambskin one, or if his partner was allergic to latex, and so he wore a lambskin condom over a latex one. However, one could also use a polyurethane condom in this case and hence avoid having to wear any condom but that one (assuming that polyurethane condoms fit him properly). Although a lambskin condom is better than nothing, most people will have no need to purchase them.
Often, one finds gloves in medical or veterinary supply stores made of a substance called vinyl. Vinyl has not been tested as thoroughly as latex for its efficacy as an STD barrier, and most people find the feel of it to be less pleasant than latex. The use of vinyl gloves is not recommended.
6.2.1 Purpose and Use
Lubricants can protect barriers against friction that might otherwise tear them. The use of sufficient lube on the outside of a condom can help prevent condom slippage, as long as it is reapplied when necessary.
Lubricants can increase the pleasure and comfort of anally or vaginally penetrative sex and masturbation. Most experts recommend the use of lubricants for anal sex in all cases, and almost everyone reports that vaginal sex and masturbation feel much better when it is being used.
As most lubricants transmit thermal energy well, they can increase the sensation transmitted through a barrier; they can also cause the barrier to move in a stimulating way against the skin. These are the rationales behind putting a small drop of lube inside a condom at the tip or on the genital/anal side of an oral barrier. The hope is that it will increase sensitivity and pleasure. Lubes are available with and without Nonoxynol-9; however, see the portion of this document which discusses Nonoxynol-9 for information that will help you decide whether to use it or not.
One technique which experts at anal play sometimes use is to connect the syringe applicator that is packaged with the yeast infection product Miconazole to a tube of KY lube. One may then fill the syringe from the KY tube and inject it into the anus; this tends to release just the right amount, in just the right place. The same applicator should not be used with more than one person and should not be used for anal play purposes if it has already been used with Miconazole for medicinal purposes (similarly, one should not generally share the nozzles from enema equipment, etc.).
6.2.2 Common Lubricant Materials
184.108.40.206 Water-Based Lubes
These are safe to used with latex and any other barrier material. Currently popular brands include I-D, ForPlay, and Wet.
Water-based lubes tend to dry out during prolonged use. One may either reapply them, or spray the area with water from a spray bottle to reconstitute the lube.
If you find that irritations such as vaginitis are a persistent problem (and assuming you have eliminated the possibilities of being allergic to any spermicide being used and of being allergic to the barrier material itself), then try switching to a lube which does not contain glycerin, such as Liquid Silk. Glycerin irritation is rare, and I think I've only met one person in my life who had run into this as an issue, but in the interest of being thorough I thought it was worth mentioning...
220.127.116.11 Silicone-Based Lubes
These are safe to use with latex and any other barrier material. Popular brands are I-D "Millenium" and Wet "Platinum". The primary benefit of these lubes is that they will work underwater (which is valuable for sex in hot tubs) and that they don't need to be reapplied as often. As is the case with most sexual issues, whether one prefers water-based lube or silicone-based lube is a matter of personal preference; at this time water-based lube is still the most universally-accepted choice, so if you are sexually active and like silicone-based lube it would still be a good idea to own some water-based lube.
18.104.22.168 Oil-Based Lubes
No lube with oil in it should be used with a latex barriers. Oil causes latex to degrade and ultimately tear; many of the reported failures of latex condoms occur because an oil-based lube was used as a lubricant. Also, oil-based lubes used in the vagina may increase the probability of vaginitis. Note that many products such as hand and body lotions contain oils.
Since most barriers available are latex based (nitrile and polyurethane are rare), you should assume that a barrier is latex, and hence shouldn't come into contact with anything bearing oil, unless you KNOW otherwise.
If oil-based lubes are going to be used (and again, they should only be used with barriers made out of substances other than latex, such as nitrile or polyurethane), it is preferable from a health standpoint to select a vegetable-based product, such as sunflower oil or Crisco, instead of a petroleum based product, such as Vaseline.
6.3.1 As a Contraceptive
Nonoxynol-9 (N-9) is a substance which is commonly used as a spermicide; when placed in the vagina, and used in conjunction with another form of birth control such as condoms, it is a very effective contraceptive.
6.3.2 As an STD Preventative
There is plenty of evidence that N-9 is an effective contraceptive. However, there is less evidence from the field (as opposed to the laboratory) that it is nearly this effective in STD prevention. N-9 can be chemically harsh to the sensitive linings of the vagina, anus, and penile urethra, and in some cases it may cause microtears that could INCREASE the probability of pathogen transmission. If you are allergic to N-9 (evidenced by itching, burning, etc.) or experience ANY discomfort while using it which you do not experience when using comparable products without spermicides, then don't expose yourself to products containing N-9. Even mild discomfort may be a sign that any STD-preventative capabilities are being lost due to the mechanism described above. In addition, the fact that safer sex is being made uncomfortable for you will make you more likely to use safer sex precautions inconsistently; this is much worse than any theoretical benefit the N-9 could have provided.
If one is allergic or sensitive specifically to Nonoxynol-9, an alternative might be using products with Nonoxynol-15 or Octoxinol. As barriers, spermicides, and lubricants with these alternative spermicides are not nearly as commonly available as those with Nonoxynol-9, they will not be mentioned specifically in this document; however, you may substitute them for Nonoxynol-9 products if necessary. None of these spermicidal products should be used in the mouth, and most experts recommend that they not be used anally.
7. Dropping Safer Sex Precautions
7.1 General Comments
Some people elect not to use barriers with their long-term significant other(s), once they're convinced they are disease free and that they're not going to acquire any new diseases during the course of their relationship. They then use safer sex precautions only when they have sex with anyone else, or simply don't have sex with anyone else. As an aside, for those who wish to practice non-monogamy WITHOUT forming these "latex monogamy" groups, it should be pointed out that, according to a 1989 mathematical analysis, "Consistent and careful condom use is a far more effective method of reducing HIV infection than is reducing the number of sexual partners" [Reiss and Leik, 1989].
Of course, even when safer sex precautions may be dropped because STD's are no longer a concern, there are some practices that one may wish to retain for other reasons. For example, it is sometimes advisable to continue to use condoms for penile/anal intercourse, even if neither partner is infected with any STD, because bacteria in the anus can (occasionally) cause an infection in the urethra of the penis.
Test results should be interpreted with caution. Even if someone shows you a negative test result, all this tells you is that they weren't infected at some time BEFORE the test. They could have become infected after the test was taken, and they could have become infected too soon before the test for the test to properly discern infection (this "window period" is six months in the case of HIV).
7.2 Steps Involved in Dropping Safer Sex Precautions
Note: As used here, "Primary Partners" are the group of people who wish to drop safer sex procedures with each other.
If you're starting to find this guide overwhelming but are still interested in significantly reducing your risk of catching the most serious sexually transmitted diseases, then please keep in mind that consistently using latex condoms for vaginal or anal intercourse is the single most effective thing you can do to protect yourself. However, particularly if there are extenuating circumstances (i.e. your partner is HIV+ and you are HIV- but you still want to have an active and risk-free long-term sex life), or if accepting even a small amount of risk for any STD (including herpes) is not acceptable to you, or if you're unwilling to get the Hepatitis B vaccination but still want to have sex with various people who might have Hepatitis B, then you may wish to add other barriers to your personal set of safer sex habits. Here is the complete set of them which you have to choose from:
* HAND | MOUTH | ANUS | VULVA | PENIS ******************************************************* HAND * None | None | Glove | Glove | Glove ------*-------+----------+----------+----------+------- MOUTH * None | None | Oral Dam | Oral Dam | Condom ------*-------+----------+----------+----------+------- ANUS * Glove | Oral Dam | NA | NA | Condom ------*-------+----------+----------+----------+------- VULVA * Glove | Oral Dam | NA | Oral Dam | Condom ------*-------+----------+----------+----------+------- PENIS * Glove | Condom | Condom | Condom | CondomThere is definitely a hierarchy of risk. When barriers are NOT being used, many experts suggest that penile-anal intercourse is riskiest, followed (in decreasing order of estimated risk) by penile-vaginal intercourse, analingus (especially if you're not immunized against hepatitis), fellatio or cunnilingus, manual anal/vaginal penetration, and finally penile manipulation. Menstruation, ejaculation, recent (tooth) brushing and flossing, and the presence of small cuts in the skin can further increase risk for some unprotected activities. It should be noted that, if the skin is unbroken and healthy and no cum or pre-cum is present, that manual contact with the shaft of the penis is no different from manual contact with any other area of unbroken and healthy skin; however, washing your hands with anti-bacterial soap afterwards and avoiding touching your own genitals or eyes before doing so is still a good idea if you're doing any sort of penile, vaginal, or anal manipulation or penetration without gloves. Most experts agree that urinating on unbroken skin (keeping the urine away from the eyes) poses little or no health risk.
Sex toys which are applied to the head of the penis or to the vulva, or which are used to penetrate the vagina or anus, should be protected with some sort of barrier as well, so they may be kept clean and used easily and safely with a variety of people. Condoms work well for anal and vaginal dildos as well as cylindrical vibrators. For small butt plugs, the condom may be stretched so that it fits over the base of the plug. Gloves work well for larger (Hitachi-type) vibrators. Please see the portion of this document concerning SM gear for further reference on some toy-related issues.
9. Using Barriers
9.1.1 Selecting Condoms
Try a variety of condoms to find the brand that works for you. Often, some brands provide a better fit than others, and a good fit is important to the optimal operation of the condom.
Keep in mind the following:
9.1.2 Caring for Condoms
Throw them away if they're past the expiration (EXP) date or four years past the manufacturing (MFG) date. Don't let them get punctured, or get exposed to temperatures outside their specified range (in particular, don't keep latex condoms in your wallet, in a glove compartment where they can overheat, or in the same pocket of a purse where the safety pins and keys are kept...). Be aware that it is possible to damage a condom during use by scraping it with fingernails, jewelry, and teeth. Open condom packages carefully, by tearing the package vertically with your fingers at a corner. Don't try to test condoms yourself before use by unrolling them, filling them with water, or inflating them. This will only weaken them.
9.1.3 Making Condom Use Pleasurable Through Psychology
To eroticize condoms (or gloves, for that matter), masturbate with them. Select your favorite pornography, or pornography you suspect you are going to like, for this important process.
When you've found your favorite brand of condom, practice with it. Practice taking it out of the package without tearing it and practice putting it on (thinking about your favorite act of sex as you do so).
9.1.4 Instructions for Condom Use
Note: (+) indicates steps that are not applicable to dildos.
When the steps listed in "Instructions for Condom Use" are followed correctly, and the condom has been cared for properly, it will very rarely if ever slip or break for most people. However, if you do experience slippage or breakage, then in the interest of keeping things simple try the first six suggestions in "Practices that Can Help" section before trying the more extreme later suggestions.
22.214.171.124 Prevention of Condom Slippage
126.96.36.199.1 Condoms that Can Help
Note: (+) indicates steps that are not applicable to dildos. Also, some of these suggestions are a little extreme, so try the simpler ones first...
188.8.131.52.1 Condoms that Can Help
Any condom which is stronger than average, or stronger than the brand you experienced breakage with, should be of assistance (it should be noted, though, that condoms are rigorously tested by the FDA, and so there should be no condoms on the market which are patently and consistently unsafe). Sometimes breakage can be caused by using a condom which is much too small. It should also be noted that some of the same conditions which cause breakage can also cause slippage, so one should consider using a condom such as Mentor if breakage is a concern.
184.108.40.206.2 Practices that Can Help
Using more lube outside the condom and reapplying/reconstituting it often (possibly when you feel the condom start to get hot, or sooner), and replacing the condom every once in a while can help. Men who engage in intercourse that lasts for extended periods of time can especially benefit from this advice. As usual, it's a good idea to check condoms periodically during sex.
220.127.116.11 Recovery from a Condom Slipping Off or Tearing
Unless you are strongly allergic to N-9, apply a spermicide with N-9 liberally to/inside the affected genital areas of both partners, and let it remain there for at least fifteen minutes. Men may urinate and wash their genitals before applying the spermicide for substantial extra protection. Don't douche vaginally or anally following condom breakage; this will only push possibly infectious substances in further. In general, you may wish to always wash (possibly with Antimicrobial "Sani-Dex" Hand Wipes, Benzalkonium Chloride towelettes, or something similar) any areas of your body that come into contact with body fluids of another. If you believe that you have been exposed to an STD, see your health care provider as soon as possible.
9.1.6 Advanced Condom Use
18.104.22.168 Switching from Anal to Vaginal Penetration
If you plan to switch from anal to vaginal intercourse during sex, take care to avoid transmitting bacteria from one region to the other. Different barriers must be used to avoid increased risk of vaginitis. Basically, take off the old condom, and put on a new one.
22.214.171.124 Putting on a Condom with One's Mouth
The friction of latex on latex can cause problems for those who use more than one latex condom at once. The use of more than one latex condom at once is considered a last resort, after the suggestions in "Preventing Condom Breakage" have been followed and found to be insufficient.
126.96.36.199 Using Reality Condoms for Anal Sex
The instructions provided with Reality condoms explain how to use them for ordinary penis-in-vagina sex. Although they are not recommended for use in penis-in-anus sex, many people do use them this way with few difficulties. The remainder of this section consists of a brochure on using the Reality condom for anal sex which was provided by Northwest AIDS Foundation. [Editor's note: though in contrast to what is recommended below, most people who use the Reality condom for anal sex prefer to remove the condom's inner ring.]
188.8.131.52.2 Some Important Points to Know
Be careful of sharp objects, like rings or sharp fingernails.
184.108.40.206.4 Practice Putting Reality in Before You Plan to Actually Use It
Get familiar with Reality's unusual shape and looks. See how it hangs outside of the anus when in place, lining the anal cavity. Make sure you are comfortable inserting Reality before you use it in sex.
Take out Reality and look at is closely. Be sure the lubrication is evenly spread inside the pouch from the bottom to the top by rubbing the outside of the pouch together. If you need to, add more lubricant. Simply give one quick squeeze of the extra lubricant provided. You can decide how much more you and your partner would like once you try it on. You can also use oil-based lubricant.
220.127.116.11.5 To Insert Reality
Be sure the inner-ring is at the bottom, closed end of the pouch. If you wish, add extra lubricant to the outside of the pouch for extra comfort when you insert Reality.
18.104.22.168.6 How to Hold the Sheath
Now push the inner ring and the pouch the rest of the way up into the anal cavity with your index finger; for maximum protection, the inner ring should be inserted past the sphincter muscle. This step may be hard to do on the first or second try.
22.214.171.124.7 Before Anal Sex
When you are ready for sex, insert Reality, making sure the outside ring lies outside the anus. About one inch of the open end will stay outside. While this may look unusual, this part of Reality is protecting you and your partner during sex. You can add more lubricant either inside or outside Reality for extra comfort.
126.96.36.199.8 During Anal Sex
You may notice that Reality moves around during sex. Moving side-to-side of the outer ring is normal. It will not reduce your protection. Sometimes Reality may slip up and down in the anal cavity, riding on the penis. However the penis should remain covered by the pouch and any fluid stays inside the pouch. But, if either you or your partner notice the outer ring being pushed into the anal cavity, STOP. Pull the outer ring so that it lies outside the anus and add extra lubricant to the opening of the pouch or to the insertive penis. Make sure the outer ring lies outside the anus. If the penis starts to enter underneath or beside the sheath, STOP and reinsert within the covered anus.
188.8.131.52.9 After Anal Sex
To take out Reality, squeeze and twist the outer ring to keep any fluid inside the pouch. Pull out gently. Throw away in a trash can. Do not flush. Do not reuse.
184.108.40.206.10 Miscellaneous Advice
220.127.116.11 Myths About Condom Effectiveness Rates
Some myths persist about the preventative capability and functionality of condoms. Many commonly quoted statistics as to their effectiveness in preventing pregnancy, for example, include in the sample everyone who CLAIMED that they used condoms for contraception, whether they used the condoms consistently and correctly or not (in fact, many men who claim to be using condoms for contraception do not use them all the time). When used properly, the failure rate for pregnancy prevention of latex condoms can fall to 2% per year [Trussell, et. al., 1990]. An analogous argument may be made about condoms and STD prevention, and condom breakage.
The important thing to remember is that WHEN USED CORRECTLY AND CONSISTENTLY, latex condoms are VERY effective at reducing STD transmission and unwanted pregnancy. Furthermore, when used properly, they VERY rarely slip or break.
18.104.22.168 Useful Studies of the Effectiveness of the Condom
In one famous study of 123 couples where one partner was HIV+ and one was not, and the couples used condoms every time they had sex, none of the non-infected partners became infected; of 122 couples where one partner was HIV+ and one was not, but the couples used condoms inconsistently, 12 uninfected partners became infected [DeVincent, 1993]. In another study, only 1 condom out of 237 slipped off during sex [Trussell, et. al., 1992].
9.2.1 General Comments
Safer sex gloves are made of virus-impermeable materials and may be used to protect both partners when engaging in manual vulva, anus, or penile stimulation. Standard powdered latex examination gloves are commonly available at drug stores, and more exotic gloves (longer gloves, gloves made of nitrile rather than latex, unpowdered gloves, or x-large/x-small gloves) may be obtained through mail order from medical suppliers.
It is important for both comfort and effectiveness that your gloves fit correctly. Try different sizes on at a drug store which lets you buy them by the pair before you buy a whole box (but when you buy a box, buy an unopened box!).
Most latex gloves are lightly powdered with talc inside and out, which prevents them from sticking together in their box. If this is the case and either you or your partner find the feel or taste of the powder unappealing, you may rinse off the powder with running water or a wet sponge, or purchase powder-free gloves (see above). Powder-free gloves tend to be slightly thicker and significantly more expensive than ordinary gloves; the most common reason people give for choosing powder-free gloves is that they or one of their partners are allergic to the powder.
Be sure to remove any sharp objects (such as jewelry) from your hand before putting a glove on. You can wear more than one glove at a time (on the same hand) of different materials in cases where you or your partner are allergic to your prefered type of glove.
It is best to turn gloves inside out as you remove them; after one glove is turned inside out, you may optionally drop any used condoms and/or oral barriers inside it before placing it in the other gloved hand and turning the other glove inside out around it and discarding. This may sound complex, but it looks graceful and may cause you to feel very pleased with yourself.
Some people like to wear finger cots or condoms on the fingers they will be using in the place of gloves; it is not clear what the advantage of this approach is over the use of gloves, unless gloves are not available.
9.2.2 Basic Manual Anal Penetration Safety
For any manual anal penetration, be sure your fingernails are VERY short. If your fingernails are too long, you can puncture your glove and/or make penetration uncomfortable for your partner. Be sure you are using a glove of sufficient length to protect the entire surface that will be exposed. It is also valuable to insert your hand such that the fingers are pointing away from the walls of the anus, rather then pointing into the walls of the anus.
Some people who for fashion's sake prefer to keep long fingernails put cotton balls around their fingernails before putting on their gloves. The thought is that this will prevent any contact between the sharp fingernails and the inside of the glove. If you wish to use this approach, be sure to practice extensively before doing any significant penetrations (vaginally or anally) so you are confident none of the edges of your fingernails can exert direct pressure on the glove (and hence your partner).
Anal penetration is definitely a situation where an inch feels like a mile. As the anus does not provide its own lubrication, and as it is generally smaller and more fragile than the vagina, it is especially important to use sufficient lubrication. As was the case with penile/anal intercourse, this is a safer sex concern as well as a comfort concern. Finally, it is important to note that the natural curvature of the anal passageway is different from that of the vaginal passageway; one should proceed especially sensitively if one is accustomed to vaginal penetration rather than anal penetration. Examining a diagram is helpful. We suggest reading Anal Pleasure and Health by Jack Morin for more details on anal play.
9.2.3 Basic Manual Vaginal Penetration Safety
One should use a glove of sufficient length to protect the entire area that will be inserted into the vagina (i.e. don't use "finger cots" when a standard glove is needed), one should be sure that fingernails are not going to puncture the gloves or hurt the receptive partner (see earlier comments about cotton balls and long fashion nails), and one should apply lube WHENEVER it is necessary or desirable. Penetration should always stay within the comfort level of one's partner. Some women enjoy circular motions of the fingers while they are held at a constant depth in the vagina. Others like concentrated massage of the area on the forward wall of the vagina, just beyond the pubic bone. A few enjoy having an entire hand in their vagina - a practice referred to as "vaginal fisting" (a book on this subject called A Hand in the Bush: The Fine Art of Vaginal Fisting was published quite recently).
The basic technique for vaginal fisting is to insert the hand slowly, always staying within the comfort level of the person being penetrated. The insertion is done with the fingers and thumb folded together, to form what looks like a duck bill. The farther in one goes, the more the hand has a tendency to naturally close into a fist; this is perfectly fine, and protects the hand from being hurt during the strong contractions that often accompany orgasm. Many people find that they "get stuck" when their hand is in to about the depth of halfway down the thumb; an advanced trick that may be used at this point is to slightly splay open the fingers and thumb; this may cause the hand to naturally slide in past the "sticking point." Of course, the depth of vaginal penetration is limited by the cervix, which may be found about six inches into the vagina. Vaginal fisting is much easier to perform if you have small hands; this is also the case for handballing. If you "get stuck", inserting an extra finger can break the suction.
If your partner is a post-operative male-to-female transsexual with a surgically constructed vagina, then you shouldn't engage in any sort of vaginal fisting without first consulting his or her doctor together about whether this sort of thing would be safe.
9.2.4 Advanced Glove Use
22.214.171.124 Special Tricks and Techniques
The basic technique is to insert the hand slowly, always staying within the comfort level of the person being penetrated. The insertion is done with the fingers and thumb folded together, to form what looks like a duck bill. The farther in one goes, the more the hand has a tendency to naturally close into a fist; this is perfectly fine, and allows depth of penetration. Many people find that they "get stuck" when their hand is in to about the depth of halfway down the thumb; an advanced trick that may be used at this point is to slightly splay open the fingers and thumb; this may cause the hand to naturally slide in past the "sticking point." In general, it is better to go inward while the receptive partner is exhaling rather than inhaling, and to let their interior muscles "pull you in" as they are ready for more.
Breathing deeply, relaxing, and being still are important for the receptive partner (especially at the beginning), and the receptive partner should also have flushed his or her lower GI tract out beforehand with a gentle solution so that any feces are not caused to abrade against the walls of the rectum. For details on this cleansing procedure, and for much more information which is necessary to perform handballing safely, we strongly urge you to read TRUST/The Hand Book by Bert Herrman. Deep anal penetration can be dangerous if done carelessly, and this book discusses safety concerns relevant to everything from basic handballing to transverse-colon-depth fisting.
The primary danger involved in handballing other than disease transmission is potential damage to the anal/rectal tissues. It is very important not to push the receiving partner faster or harder than he or she wishes. Sharp pain is a bad sign. Sensitivity, caution, and the liberal use of lube is necessary to avoid damage. Also, the use of mind-altering substances is to be avoided in handballing; they can block pain sensations for the receiving partner which might be a signal that the inserting partner needs to back off.
As a handballing session may require an hour or more for the anal sphincters to dilate to the point necessary to accommodate an entire hand, it is important that the anal passageway be well lubricated for long periods of time. As water-based lubes need to be reapplied or reconstituted often, oil-based lubes such as Crisco (regular, not butter-flavored) have traditionally been popular among handballers. Of course, the difficulty with oil-based lubes is that they break down latex.
There are a number of potential solutions to this problem. Some handballers note that latex examination gloves are thicker than latex condoms and insist that for moderate amounts of time they CAN be used with oil-based lubes (perhaps changing them periodically during VERY lengthy play). Indeed, from Mr. S. Leathers one can obtain special thick latex handballing gloves (imported from Holland) which go to either the elbow or to the shoulder.
You might be able to avoid the whole issue by using gloves made of a substance called Nitrile, which does not degrade in the presence of oils. Nitrile gloves are available from Conney and may be purchased in 9", 11", and 18" lengths. It should be noted that many players may not end up having their hand in their partner long enough for the oils to degrade the latex gloves; if Nitrile is (for some reason) uncomfortable for you or your partner, then switch back to latex and while playing be sure to change gloves before their integrity can be seriously compromised (i.e. ANYTHING is better than nothing). Of course, another option is to use silicone-based lubes with regular latex gloves; it's a matter of personal taste.
A small number of advanced handballers have been known to penetrate through the rectum to near the transverse colon, which means that the person doing the penetration may have their arm inserted to near the elbow. There are some health care professionals who say that unless there are visible cuts on the arm, that it is OK to penetrate to beyond the base of the glove. Obviously, this is the sort of thing that formal studies have not been done on, so they may be right but we don't really know. Washing your hands and arms afterwards with hot water and anti-bacterial soap is always a good idea, of course.
You may be tempted to try to use calving gloves, which may obtained from veterinary shops. The only comments that should be made is that many calving gloves are made of vinyl, which has not been tested for safer sex as completely latex has been and which has a texture that many people find very uncomfortable; furthermore, the latex calving gloves are often nearly as expensive as the specially-designed latex handballing gloves mentioned above, which makes them much less attractive as an option.
Since deep handballing may require longer gloves, and longer gloves are typically thicker, it is especially critical in such cases to listen carefully to comments about comfort from the receiving partner, and to apply and reapply lube OUTSIDE the glove liberally.
Be very cautious about engaging in penile/anal intercourse after handballing. After a deep handballing session, it can take up to two or three days for the anal/rectal membranes to fully recover; this means that they are more likely to allow transmission of an STD. Also, since the most commonly used lube for handballing is oil-based (regular Crisco), the presence of oil in the anus and rectum can degrade any latex condom that comes into contact with them. Thus, if one is going to follow a handballing session with anal intercourse, a polyurethane condom such as Avanti should be used, and EXTREME care should be taken that the integrity of this barrier is maintained (you might try wearing an Avanti condom over a thin latex condom, and practicing with this combination beforehand to be sure that it works well for you).
9.3 Oral Barriers
9.3.1 General Comments
Oral barriers are some manner of flat, virus-impermeable material which may be used to protect both partners when engaging in analingus and cunnilingus.
Here are a few general tips on their use:
126.96.36.199 Dental Dam
This is a small, thick square of material which was traditionally used in the dentist's office. In the early days of AIDS education, these were recommended exclusively. People found them so difficult to use and so ineffective at transmitting sensation that many folks rejected the use of oral barriers entirely. Fortunately, there are other oral barriers available today which transmit sensation MUCH better than dental dams, if you decide that your personal standards include using barriers for oral sex. All of the barriers mentioned below are thinner then dental dams, and transmit sensation much better.
188.8.131.52 Saran Wrap
The primary advantage of Saran Wrap as an oral barrier (in comparison to the other popular option, the Glyde barrier mentioned below) is that it allows you to perform barriered oral sex without as much need for anyone to hold anything in place. Here's how:
Some people like anal or vaginal penetration while receiving oral sex; in this case, their partner can simply slip his or her (typically gloved) fingers around the side of the wrap and in.
One advanced technique which may be used on men is to make a series of wraps around the whole pelvis horizontally with the Saran Wrap, after adjusting the penis so it is pointing downwards. This serves as a type of bondage technique for the genitals, and allows a fun and frustrating level of manual and oral stimulation to be performed on it through the Saran Wrap.
184.108.40.206 Glyde Dams
These portable rectangular barriers are thinner than dental dams and have a mild vanilla taste. They're a favorite with many people, and are the only oral sex barrier with FDA approval to make claims about their protective abilities.
220.127.116.11 Modified Condoms
One may partially unroll a condom, cut off the tip, slit it up the side, stretch it out, and use that as a barrier. Some people like to cut off the base as well. Be sure that you have selected an good-tasting condom without N-9 if you're going to do this. Using Modified Condoms is a good option if you don't have any Glyde barriers around.
18.104.22.168 Modified Gloves
One may snip the fingers off of a glove (leaving the thumb in place), and slit it up the pinkie side. Then, you have a barrier with a depression (where the thumb used to be) where your tongue may go. This works well for some people. If you don't like the thumb indentation, you can slit it up the thumb side, and remove the thumb as well as the fingers. Some people like to snip off the base as well. As it is difficult to remove any powder from the inside of a glove, unpowdered gloves are preferable if this technique is going to be used. Some people like to keep the fingers that they snipped off the glove for use as finger cots, but if you had gloves in the first place you might as well just wear a glove instead of using these extra finger cots. Since gloves are thicker than condoms, this "Modified Gloves" approach might not be the best approach unless you really like the thumb indendation.
22.214.171.124 Combination Glove and Dental Dam
If you like performing cunnilingus or analingus at the same time you are performing manual vaginal penetration, then here is an idea you might try. Put on a glove (possibly one which is longer than normal), slit the glove up both sides (stopping as you get to the wrist), and fold the resulting flap up to serve as the oral barrier while your gloved hand is free to penetrate. This technique works well with latex gloves, and poorly with nitrile gloves. As it is difficult to remove any powder from the inside of a glove, unpowdered gloves are preferable if this technique is going to be used.
126.96.36.199 Eros Veil
This is a product which is essentially Saran Wrap shaped to fit the human pelvis and designed to "bunch up" less. I haven't seen these for sale anywhere for quite some time, and they may be off the market.
188.8.131.52 Face Shield
This is a barrier (which I've only seen once or twice) that the person performing the cunnilingus or analingus puts over his or her head, like a ski mask. It has an indentation where the tongue may go and move about. It isn't commonly available, and may be uncomfortable for people with facial hair. One can improvise a face shield which is perhaps more comfortable in the following way: take a square piece of Saran Wrap, fold it once from corner to corner (so it looks like a triangle), and wrap it around your face in such a way that you can tie the two ends together at the back of your head and the flat part is just below your nose and the body of the triangle covers your mouth; then, you may perform cunnilingus or analingus on your partner through the Saran Wrap triangle which is draped over your mouth.
10. Special Notes on SM Safety
If you break the skin with a toy, or if it comes into contact with possibly infected vaginal fluids or semen, then you shouldn't use that toy on someone else until it has been cleaned adequately. To disinfect many types of toys (especially ones made of metal, plastic, or some other nonporous material), one may soak them for two or three minutes in a 10% bleach/90% water solution, possibly preceded by washing with hot soapy water but definitely followed by rinsing well with hot water and allowing to air-dry.
For items made of leather or suede, which could be damaged by bleach, you should refer to the excellent book Leather and Latex Care by Kelly J. Thibault. On the subjects of cleaning and disinfection, Kelly Thibault offers the following suggestions:
"Don't submerge the part of a battery vibe that holds the batteries. Do not submerge electric vibes at all.If cleaning seems like too much of a chore and you still want to use your toy with more than one person, it may be possible (depending on the toy) for you to put a latex condom or latex glove over it, which you discard when you're done. Rubber dildos are porous and it isn't really practical to completely sterilize them, so you should either put condoms on them if you're going to use them with multiple people or switch to silicone dildos (which can be boiled to disinfect them, as mentioned above).
Silicone dils and plugs can be boiled up to 3 minutes, cleaned with a bleach solution, or run through your dishwasher. For more delicate polymers stick to warm water and soap, and replace them every so often, as they are impossible to keep perfectly clean."
For play piercing, needles should be purchased sterile (from a medical supply shop such as Choice Medical, or from a scientific supply shop such as Fisher Scientific) and discarded in a sharps container after use. One should not dispose of sharps containers in the trash, but rather should drop the sealed container off at either a pharmacy or a hospital emergency room. Be sure to first clean the area that will be pierced with one of more of the following: Betadine, Benzalkonium Chloride, or 70% rubbing alcohol; these substances can be most easily applied by using pre-packaged cleansing towelettes. It is recommended that you wear gloves when performing blood-letting activities such as cuttings. If a metal cutting/piercing instrument is not disposable, immerse it in a solution of 50% bleach/50% water for for 10 minutes, and then rinse thoroughly; it is preferable, however, that non-disposable cutting/piercing instruments be reserved for only one person if possible. Note that the legality of private needle ownership varies by jurisdiction; do not order or purchase needles if you are in a jurisdiction which outlaws private ownership of them, or which classifies them as drug periphenalia.
There are safety procedures for these and a variety of other SM techniques which are more stringent than the ones described above, and which many people choose to follow. Please consult a modern text on BDSM, such as (but not limited to):
Despite these precautions, however, it should be pointed out that many common BDSM practices (such as floggings that don't break the skin, psychological domination and submission, bondage, nipple pinching, spanking, use of hot wax or clothespins, etc.) offer absolutely no potential for STD transmission. In fact, part of the current surge of interest in BDSM practices such as these may be caused by their relative safety from STD risks.
11. Forming a Toy Bag
11.1 General Comments
Depending on your preferences, you may use and wish to have on hand a variety of different equipment when you go to play with someone. For that reason, it can be useful to put together a safer sex/sex toy bag. Your toy bag can be as simple as a small hip pack containing the different items you use. If you have some small items or easily confused items (i.e. different sizes of gloves) you can arrange them in labeled little zip-lock bags, which can prevent unnecessary awkward fumbling in the heat of passion.
11.2 Basic Contents of a Toy Bag
12.1 The Basic Principle for Prevention
Avoid the exchange of infectious body fluids, and avoid unprotected contact with infectious surface regions.
12.2 General Comments
Microtears in the gums (perhaps aggravated by recent brushing or flossing), finger cuticles, penis, vagina, or anus can cause a breach where a virus or bacterium may enter, even if the tears are not visible or noticeable. Pathogens can also enter the body after landing on the eyes. Basically, one should avoid any situation in which the body fluids of another might make their way into one's bloodstream or contact one's mucous membranes.
Some diseases show no symptoms, and the people carrying them may not know they are infected or show any noticeable signs for years, though they can still transmit the disease to you. When symptoms are observed, common ones are pain when urinating, discharge or odd smell from genitals, itching, burning, or pain in genitals (and sometime lower abdomen), warts, sores, or discolorations on genitals, and flu-like symptoms. There are other symptoms as well; see your health care provider if you have any questions.
Some STD's (such as Herpes) may be spread by contact with the general areas of the genitals, anus, or mouth. Rashes or outbreaks are often a sign of infection and contagiousness, though it is possible for some of these diseases to be transmitted when there are no visible symptoms.
It is a myth that one may acquire "immunity" to STDs. Two other myths are that one cannot have more than one STD at once (you can have many at once), and that one needs to have multiple partners to acquire an STD (one is sufficient).
HIV and hepatitis may be spread through sharing drug or steroid needles with someone who is infected. In many cities, such as Seattle, one may go to a needle exchange program for clean needles. However, the best approach to the needle problem if you're an injecting drug or steroid user is to obtain a supply of sterile syringes and needles for yourself, and NEVER use a rig that has been used by somebody else. It is true that you can clean somebody else's works, but if you need a fix you may not be willing to sit through the sterilization procedure, which takes time.
However, if using clean equipment is not an option, the following procedure may be used. Pour 100% bleach (i.e. Clorox) into a container and repeatedly (3-4 times) draw the bleach into the needle up to the top of the plunger, keep it there for a few minutes, and then eject it down a drain (you can alternatively just take your rig apart and soak it in 100% bleach for about 10 minutes). After this step, rinse everything in cold running water fora few minutes. If a cooker is used, wipe it with a bleach-soaked cotton ball, and then rinse the cooker with cold water and discard the cotton. Never share any of the water, bleach, or cotton once it has been used during this procedure with someone else.
12.3 Comments on Specific Diseases
HIV can be found in four body fluids: blood, semen (and precum), vaginal fluids, and breast milk. An incident of transmission through deep kissing or casual contact has not yet been confirmed, and there have been no documented cases of HIV being transmitted through casual contact in the schools or workplace.
Some people assume that HIV/AIDS is a disease limited to gay males. The facts are that worldwide, heterosexual transmission accounts for 75% of AIDS cases [Novello, 1991], and that women may transmit the virus to other women.
The fact that someone looks healthy gives you no information as to their disease status; people may carry HIV and infect others with it before they exhibit a single symptom or know they are infected. Also, the fact that someone was HIV negative a while ago means little if their behavior has not been safe since that time, and the fact that someone just passed an HIV test may not guarantee that they are not infected and not contagious (generally, it can take up to six months from the time of initial HIV infection for the presence of the virus to be detectable by the HIV tests). For these reasons and others, most STD prevention organizations are now emphasizing the widespread use of safer sex rather than widespread disease testing.
At the time this document was originally written, HIV infection was ultimately causing death in almost all cases. However, new drugs are currently being employed which may prove to assist those living with AIDS in staying healthy longer. Despite this, it must be strongly emphasized that these new drugs are NOT A CURE, and their long-term efficacy is completely unknown.
There is a permanent vaccine against Hepatitis-B (as well as for Hepatitis-A), which you might consider getting. The vaccine consists of a series of three shots over a period of six months, and costs around $130 total (though insurance or your employer may cover it under certain circumstances). The vaccine is effective only if the series of three shots was completed a period of time before you are exposed to the virus. This vaccine may be obtained at most hospitals and student health clinics.
12.4 Common STD's
In parentheses after each STD is the estimated number of new cases of that STD in the United States during 1995.
Note: Although these are curable, they may cause damage if they go untreated for lengths of time. They are all bacteria-based unless otherwise noted. In women, some of these may lead to Pelvic Inflammatory Disease if left untreated.
Note: Although these are incurable, medications are available which may ease some of the symptoms. They are all virus-based.
13.3.2 Local (Seattle)
184.108.40.206 Education/Health Care
Note: Basic safe sex supplies are available at 24 hour Bartell Drug Stores and 24 hour supermarkets. CostCo typically has the best prices on boxes of latex gloves.
14. Medical Studies Cited
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