HEALTH EDUCATION

Sex - safer and satisfying

Enjoying sex
We are all sexual — from birth to death. When we decide to have sex, we want it to be satisfying — whether we are women or men, married or single, young or old, straight, lesbian, gay, or bisexual. Enjoying our sexuality is a normal, natural part of life.

Most of us have taken risks when we have had sex — risks that include getting sexually transmitted infections. We take so many risks, that at least one out of four of us gets an infection some time in our lives.

The risks we take can be dangerous. Many sexually transmitted infections can:

• Last a lifetime

• Put stress on relationships

• Cause sterility

• Cause birth defects

• Lead to major illness and death

We know that safer sex reduces our risks. But many of us don’t make the effort, because we think safer sex will be less satisfying. It does not have to be. Safer sex is about protection and sexual pleasure.
Exploring safer sex can make sex more satisfying. It can:

• Improve partner communication

• Increase intimacy and trust

• Prolong sex play

• Enhance orgasm

• Add variety to sexual pleasure

• Relieve anxiety

• Strengthen relationships

"My love life actually improved when I started having safer sex." — 41-year-old Latino man

What is safer sex?
Safer sex is anything we do to lower our risk of getting a sexually transmitted infection. It’s about getting more pleasure with less risk.

Three Steps to Safer Sex:

1. Become honest with ourselves about the risks we take.

2. Decide which risks we are willing to take — and which ones we aren’t willing to take.

3. Find ways to make our sex play as safe and satisfying as possible.

The most important ways to reduce your risk are:

• Keep your partner’s body fluids out of your body — vagina, anus, or mouth. The body — fluids to be most careful about are blood, cum, pre-cum, vaginal fluids, and the discharge from sores caused by sexually transmitted infections.

• Don’t touch sores or growths that are caused by sexually transmitted infections.

• Safer sex also means protecting your partner.

• Don’t allow your body fluids to get into your partner’s body.

• Don’t have sex if you have sores or other symptoms of infection.

• Have routine checkups for infections.

• Get the correct treatment if you become infected.

"I like sex a lot — some people would call me promiscuous. But I know how to handle myself.I don’t do anything to let anyone’s body fluids inside my body. And I get tested every year to be sure I don’t pass anything along to someone else. Except for a case of crabs two years ago, I haven’t had a sexually transmitted infection in 10 years. I can tell you from experience — safer sex works."
— 35-year-old white woman

Your relationships
Is it safe to have sex with only one partner?

Maybe. The ideal for many people is to have sex with only one partner. Women and men don’t need to worry about getting sexually transmitted infections:

• If neither partner ever had sex with anyone else

• If neither partner has ever shared needles

• If neither partner currently has or ever had an infection

Most of us have more than one sex partner during our lives. We may not plan it that way, but it happens. We may also get an infection from one partner and carry it to another. The partners who gave it to us:

• May not have known they had an infection

• May have hoped they wouldn’t pass the infection to us

• May not have been totally honest about their sexual history

Most women who got HIV from having sex thought that they were their sex partners’ only sex partner.

You and your sex partner may want to give up safer sex because you’ve decided to have sex with no one else. Before you do, be sure that neither of you has an infection. Some infections, like HIV, may take years to develop symptoms. You may not even know they are there. Visit your local Planned Parenthood center or health care provider to get yourself checked out for sexually transmitted infections.

"I always hoped that someday I’d be able to share my life and enjoy sex with only one special partner. In the meantime, I insisted on safer sex with the partners I had. Now that I’ve found my partner for life, I’m really glad I played it safe."
— 27-year-old African-American man

Trust
Many of us know how it feels to discover that a sex partner has been dishonest with us.More than one out of three people will lie about their feelings to have sex with someone else. A similar number will lie about their sexual history. The same number will lie about whether or not they have HIV!

When it comes to safer sex, rely on yourself. Believing you are your sex partner’s only partner will not make it true. Answer the Yes or No questions below to think it over.

Do I know how my partner spends time away from me?

Is my partner always open about everything with me?

Does my partner get upset if I want to have a "serious" talk about our relationship?

Does my partner keep secrets from me?

Does my partner ever say, "I’m just going out" or "It’s none of your business"?

Is my partner always respectful of me?

We all want partners we can trust. The key is to make sure that our partners earn our trust. We should never just give it away.

"Whether or not my partners have HIV isn’t important. I know it’s up to me to protect myself. I don’t take anyone’s word for it until we’ve been through an awful lot together, and even then, I’m careful. They have to be careful, too, or they get no loving from me." — 25-year-old white woman

How infections get passed along
Not all sexually transmitted infections are transmitted the same way. Here are the basics about how infections can be passed through sex play:

Unprotected vaginal or anal intercourse — high risk for:

• Trichomoniasis

• Gonorrhea

• Chlamydia

• Syphilis

• Chancroid

• Pubic lice

• Scabies

• Hepatitis B virus (HBV)

• Cytomegalovirus (CMV)

• Human Papilloma viruses (HPVs)
some HPVs can cause genital warts
some can cause cancer

• Herpes simplex virus (HSV)
can cause oral and genital herpes

• Pelvic Inflammatory Disease (PID)
can cause sterility

• Human Immunodeficiency Virus (HIV)
can cause AIDS

Unprotected oral sex — high risk for:

• Gonorrhea

• Syphilis

• Chancroid

• HSV

• HBV

• CMV

Sex play without sexual intercourse — risk for:

• HSV

• CMV

• HPV

• Pubic lice

• Scabies

Lots of other diseases, from the flu to mononucleosis, can also be transmitted during sex play.

Unprotected vaginal and anal intercourse have the highest risks for the most dangerous sexually transmitted infections.

Lower-risk sex play includes:

• Masturbation

• Mutual masturbation

• Erotic massage

• Body rubbing

• Cybersex

• Kissing

• Deep kissing

• Oral sex

• Vaginal intercourse with a male or female condom

• Anal intercourse with a male or female condom

"I got hepatitis B years ago. I’m still a carrier and can’t drink wine anymore. These days there’s a vaccine so no one has to get this disease."
— 52-year-old white man

If you are a woman...
Your risk of getting an infection is greater than a man’s. Your vagina and rectum are more easily infected than his penis. A woman’s chance of being infected by a man with HIV is twice as great as a man’s chance of being infected by a woman with HIV.

Women generally have fewer symptoms than men. You are less likely to know if you are infected. Lots of damage can be done — even if you have no symptoms.

Many women develop pelvic inflammatory disease (PID) because they don’t know they are infected. Especially if untreated, PID increases the risk of sterility and ectopic pregnancy.

If you are a man...
Sexually transmitted infections do not only affect women. You can also have an infection and not know it. And if an infection is left untreated, it can cause damage.

For example, chlamydia can spread from the urethra to the testicles and cause sterility.

If untreated, chlamydia infections in the testicles can cause reactive arthritis, which can lead to permanent disability.

When You Have a Checkup...

Don’t assume you’re getting tested for sexually transmitted infections. You need to ask your clinician to do it. Otherwise, it probably won’t happen.

"Everybody is different. Everyone has to decide what risks they are prepared to take — then decide what to do."
— a 26-year-old African-American woman

Outercourse
Sex can be very satisfying without intercourse. Great sex is about a lot more than penetration with a penis. It’s about exploring the many ways you can turn your partner on. It’s exploring the many ways that you can be turned on.

Don’t be shy about your sexual pleasure. Partners who explore safer sex through outercourse may discover new sexual excitements. They can be clear about how and where they like to be caressed. They help each other enjoy sex even more.

For some people, outercourse is sex play without vaginal intercourse. For others, it is sex play with no penetration at all — oral, anal, or vaginal. Some people also believe that any kind of penetrative sex play is too risky to be called "safer sex." But many people do have oral and anal sex — sometimes to avoid pregnancy or to "preserve their virginity" — so we include them here.

For many years, women and men were taught that "good sex" only meant having an orgasm during vaginal intercourse. Nothing could be less true. Most women don’t have orgasms from vaginal
stimulation. Most women have them when the clitoris is stimulated — whether or not they are being penetrated by a penis. Men also enjoy outercourse — even if they’re shy about letting their partners know.

"At first, I put off intercourse with new partners by having sex without penetration. I wouldn’t have intercourse until I knew them better and could be sure they would use a condom right. Now, I’m really into sex without intercourse. It’s hot."
— a 35-year-old African-American woman

Alternatives to intercourse
Kissing — Many people explore different ways of kissing. They may also explore kissing different body parts.

Masturbation — Many people enjoy masturbating — touching their own sex organs for pleasure. It’s the most common way we are sexual. Partners can masturbate alone or together.

Erotic Massage — Many couples touch and rub each other’s sex organs with their hands, bodies, or mouths.

Body-to-body Rubbing/Frottage — Many couples rub their bodies together — especially their sex organs — for pleasure and orgasm.

Fantasy — Couples can read or watch sexy stories or pictures together. It can also be exciting to share sexy fantasies. People do it in person, on the phone or Internet, or through e-mail.

Sex Toys — Vibrators, dildos, and other toys can be used to explore and caress the body. Condoms need to be used if partners share the same toy. Follow the cleaning instructions that come with toys.

Oral Sex Play — Many people like to use their mouths on each other’s sex organs. On a woman it is called cunnilingus. On a man, it’s called fellatio. It cannot cause pregnancy. But it can pass infection. Latex or plastic barriers reduce the risks.

Anal Sex Play — Many people enjoy exploring each other’s buttocks, anus, or rectum with their hands, mouths, sex organs, or with toys. Anal sex play cannot cause pregnancy — but it can easily pass infection. Latex or plastic barriers reduce the risks.

"Safer sex taught me how to be more erotic — how to enjoy my body and my partner’s body without worry or embarrassment."
— 21-year-old Asian man

Condoms
Condoms are the best protection when enjoying sexual intercourse. Condoms help make sex last longer. Condoms help prevent premature ejaculation.

Latex and female condoms reduce the risk of:

• Vaginitis caused by trichomoniasis

• Chlamydia

• Syphilis

• PID

• Chancroid

• Gonorrhea

• HIV/AIDS

Latex and female condoms may offer more limited protection against:

• Bacterial vaginosis

• CMV

•Genital warts

• Herpes

• Hepatitis B

• Cervical cancer

But do not use male and female condoms together.

The female condom

• Stays in place even if a guy loses his erection

• Has an external ring that may stimulate the clitoris

• Can be used for anal sex

• Can be used by people who are allergic to latex

Follow the instructions on the package insert to learn how to use condoms.

"The woman I love has herpes — she told me on our first date — so we deal with it. I always wear a condom, and if she has an outbreak, we catch up on the latest movies."
— 37-year-old Latino man

Sex, drugs, and mixed feelings
As much as we like sex, it embarrasses a lot of us. Sometimes we can’t admit we enjoy it. Some of us use alcohol or other drugs to feel less self-conscious about enjoying ourselves.

But drugs also encourage us to take risks we wouldn’t take if we weren’t high. These drugs include:

• Alcohol

• Cocaine

• Ecstasy

• Crystal Meth

• Poppers

• Speed

• Downers

• Crack

• Acid

• Heroin

• Marijuana

The more we use drugs when we have sex, the more we are likely to take risks. We also have a lot of feelings that encourage taking risks with sex.

They include:

• Passion

• Shame

• Embarrassment

• Desire to be swept away

• Insecurity

• Fear of losing a partner

• Anger

• Desire to be attractive

• Shyness

• Low self-esteem

• Grief

• Need to be wanted

Women and men who are comfortable with their sexuality are more likely to enjoy safer sex. If drug use, shame, or other feelings block your safer sex plans, make an appointment to talk with a sexual health counselor. A counselor can help you work through the feelings that keep you from having safer sex — for confidential counseling or referral, call your nearest Planned Parenthood center at (1-800) 230-PLAN.

"It was when I realized that I didn’t have to get high to have sex that I really began to enjoy myself. I realized I didn’t need to take the risks I was taking to have a good time. Feeling better about sex makes me feel better about myself."
— 65-year-old white woman

Am I ready for safer sex?
Answer these true or false questions to find out how ready you are.

I want to be able to let my partner know where and how I like to be touched.

I want to be able to buy condoms, whether I’m embarrassed or not.

If I decide I want to use erotic materials, I want to be able to buy them myself — whether I’m embarrassed or not.

I want to be able to let my partner know my limits when it comes to taking risks.

I want to be able to say no to sex when I don’t want to have it.

I want to have regular physical exams and checkups for infections.

I want to be able to talk with my clinician about my sex life.

I want to be able to enjoy sex without having to get high.

If you answered "true" to more than half of these questions, you are well on your way to becoming assertive enough for safer sex. Congratulations!

"For me, the scariest sexually transmitted infection is HIV. I volunteered for my local AIDS service organization to get over my fear. Being a buddy for someone with AIDS taught me a lot. One of the things it taught me was how important safer sex is. I started being very careful after my first client died. I hope other people don’t wait as long as I did."
— 30-year-old Latina woman

Guidelines for sex partners

• Have each other’s consent.

• Never use pressure to get consent.

• Be honest with each other.

• Treat each other as equals.

• Be attentive to each other’s pleasure.

• Protect each other against physical and emotional harm.

• Guard against unintended pregnancy and sexually transmitted infection.

• Be clear with each other about what you want to do and don’t want to do.

• Respect each other’s limits.

• Accept responsibility for your actions.

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