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Safe sex issexual activity using protective methods orcontraceptive devices (such ascondoms) to reduce the risk of transmitting or acquiringsexually transmitted infections (STIs), especiallyHIV.[1] The termssafer sex andprotected sex are sometimes preferred, to indicate that even highly effective prevention practices do not completely eliminate all possible risks. It is also sometimes used colloquially to describe methods aimed atpreventing pregnancy that may or may not also lower STI risks.
The concept of safe sex emerged in the 1980s as a response to the globalAIDS epidemic, and possibly more specifically to theAIDS crisis in theUnited States. Promoting safe sex is now one of the main aims ofsex education and STI prevention, especially reducing new HIV infections. Safe sex is regarded as aharm reduction strategy aimed at reducing the risk of STI transmission.[2][3]
Although some safe sex practices (likecondoms) can also be used asbirth control (contraception), most forms of contraception do not protect against STIs. Likewise, some safe sex practices, such as partner selection and low-risk sex behavior, might not be effective forms of contraception.
Although strategies for avoiding STIs likesyphilis andgonorrhea have existed for centuries and the termsafe sex existed in English as early as the 1930s, the use of the term to refer to STI-risk reduction dates to the mid-1980s in the United States. It emerged in response to theHIV/AIDS crisis.[4][5]
A year before the HIV virus was isolated and named, the San Francisco chapter of theSisters of Perpetual Indulgence published a small pamphlet titledPlay Fair! out of concern over widespread STIs among the city's gay male population. It specifically named illnesses (Kaposi's sarcoma andpneumocystis pneumonia) that would later be understood as symptoms of advanced HIV disease (AIDS). The pamphlet advocated a range of safe-sex practices, includingabstinence, condoms, personalhygiene, use ofpersonal lubricants, andSTI testing/treatment. It took a casual,sex-positive approach while also emphasizing personal and social responsibility. In May 1983—the same month HIV was isolated and named in France—the New York City-based HIV/AIDS activistsRichard Berkowitz andMichael Callen published similar advice in their booklet,How to Have Sex in an Epidemic: One Approach. Both publications included recommendations that are now standard advice for reducing STI (including HIV) risks.[6][7][8]
Safe sex as a form of STI risk reduction appeared in journalism as early as 1984, in the British publicationThe Daily Intelligencer: "The goal is to reach about 50 million people with messages about safe sex and AIDS education."[5]
Althoughsafe sex is used by individuals to refer to protection against bothpregnancy and HIV/AIDS or other STI transmissions, the term was born in response to the HIV/AIDS epidemic. It is believed that the termsafe sex was used in the professional literature in 1984, in the content of a paper on the psychological effect that HIV/AIDS may have on gay and bisexual men.[9]
A year later, the same term appeared in an article inThe New York Times. This article emphasized that most specialists advised their AIDS patients to practice safe sex. The concept included limiting the number of sexual partners, using prophylactics, avoiding bodily fluid exchange, and resisting the use ofdrugs that reduced inhibitions for high-risksexual behavior.[10] Moreover, in 1985, the first safe sex guidelines were established by the 'Coalition for Sexual Responsibilities'.[who?] According to these guidelines, safe sex was practiced by usingcondoms also when engaging inanal ororal sex.[11]
Although the termsafe sex was primarily used in reference to sexual activity between men, in 1986 the concept was spread to the general population. Various programs were developed with the aim of promoting safe sex practices among college students. These programs were focused on promoting the use of the condom, a better knowledge about the partner's sexual history and limiting the number ofsexual partners. The first book on this subject,Safe Sex in the Age of AIDS, appeared in the same year. It had 88 pages that described both positive and negative approaches to sexual life.[citation needed] Sexual behavior was loosely sorted into safe (kissing,hugging,massage,body-to-body rubbing,mutual masturbation,exhibitionism,phone sex, and use of separatesex toys); possibly safe (use of condoms); or unsafe.[10]
In 1997, specialists in this matter promoted the use of condoms as the most accessible safe sex method (besides abstinence) and they called forTV commercials featuring condoms. During the same year, theCatholic Church in the United States issued their own safer sex guidelines on which condoms were listed, though two years later theVatican urgedchastity andheterosexual marriage, attacking the American Catholic bishops' guidelines.[citation needed]
A 2006 survey found that the most common definitions of safe sex are condom use (68% of the interviewed subjects), abstinence (31.1% of the interviewed subjects), monogamy (28.4% of the interviewed subjects), and safe partner (18.7% of the interviewed subjects).[10]
The termsafer sex in Canada and the United States has gained greater use by health workers, reflecting that risk of transmission of sexually transmitted infections in varioussexual activities is acontinuum.Safer sex is thought to make it more obvious to individuals that any type of sexual activity carries a certain degree of risk. The termsafe sex is still in common use in the United Kingdom,[12] Australia and New Zealand.
The termsafe love has also been used, notably by the FrenchSidaction in the promotion of men's underpants incorporating a condom pocket and including thered ribbon symbol in the design, which were sold to support the charity.
A range of safe-sex practices are commonly recommended by Sexual Health Educators and Public Health Agencies. Many of these practices can reduce (but not eliminate) risk of transmitting or acquiring STIs.[13]
Sexual activities, such asphone sex,cybersex, andsexting, that do not include direct contact with the skin orbodily fluids of sexual partners, carry no STI risks and, thus, are forms of safe sex.[14]
A range of sex acts callednon-penetrative sex oroutercourse can significantly reduce STI risks. Non-penetrative sex includes practices such askissing, mutual masturbation,circle jerks, manual sex, rubbing or stroking.[15][16] According to the Health Department of Western Australia, this sexual practice may prevent pregnancy and most STIs. However, non-penetrative sex may not protect against infections that can be transmitted via skin-to-skin contact, such asherpes andhuman papilloma virus.[17] Mutual masturbation and manual sex carry some STI risk, especially if there is skin contact or shared bodily fluids with sexual partners, although the risks are significantly lower than other sexual activities.[14]
Barriers, such as condoms, dental dams, and medical gloves can prevent contact with body fluids (such asblood,vaginal fluid,semen, rectal mucus), and other means of transmitting STIs (like skin, hair and shared objects) during sexual activity.[18][19]
Oil-basedlubrication can break down the structure of latex condoms, dental dams or gloves, reducing their effectiveness for STI protection.[25] Personal lubricants can also be water-based or silicone-based.
While use of external condoms can reduce STI risks during sexual activity, they are not 100% effective. One study has suggested condoms might reduce HIV transmission by 85% to 95%; effectiveness beyond 95% was deemed unlikely because of slippage, breakage, and incorrect use.[26] It also said, "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".[26]p. 40.
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Pre-exposure prophylaxis (often abbreviated asPrEP) is the use of prescription drugs by those who do not have HIV to prevent HIV infection. PrEP drugs are takenprior to HIV exposure to prevent the transmission of the virus, usually between sexual partners. PrEP drugs do not prevent other STI infections or pregnancy.[27]
As of 2018, the most-widely approved form ofPrEP combines two drugs (tenofovir and emtricitabine) in one pill. That drug combination is sold under the brand nameTruvada by Gilead Sciences. It is also sold in generic formulations worldwide. Other drugs and modalities are being studied for use as PrEP.[28][29]
Different countries have approved different protocols for using the tenofovir/emtricitabine-combination drug asPrEP. That two-drug combination has been shown to prevent HIV infection in different populations when taken daily, intermittently, and on demand. Numerous studies have found the tenofovir/emtricitabine combination to be over 90% effective at preventing HIV transmission between sexual partners.[30] AVAC has developed a tool to track trends in PrEP uptake across the globe.[31] In 2025, Gilead announced approval for a PrEP shot that is effective for 6 months at a time, increasing the likelihood of adequate suppression.[32]
Treatment as Prevention (often abbreviated asTasP) is the practice of testing for and treating HIV infection as a way to prevent further spread of the virus. Those having knowledge of their HIV-positive status can use safe-sex practices to protect themselves and their partners (such as using condoms, sero-sorting partners, or choosing less-risky sexual activities). And, because HIV-positive people with durably suppressed or undetectable amounts of HIV in their bloodcannot transmit HIV to sexual partners, sexual activity with HIV-positive partners on effective treatment is a form of safe sex (to prevent HIV infection). This fact has given rise to the concept of "U=U" ("Undetectable = Untransmittable").[33]
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Other methods proven effective at reducing STI risks during sexual activity are:
Most methods of contraception are not effective at preventing the spread ofSTIs. This includesbirth control pills,vasectomy,tubal ligation,periodic abstinence,IUDs and multiple non-barrier methods of pregnancy prevention. However,condoms, when used correctly, significantly reduces the risks of STI transmission and unwanted pregnancy.[39]
Thespermicidenonoxynol-9 has been claimed to reduce the likelihood of STI transmission. However, a technical report from 2001[40] by theWorld Health Organization has shown that nonoxynol-9 is an irritant and can produce tiny tears in mucous membranes, which may increase the risk of transmission by offeringpathogens more easy points of entry into the system. They reported that nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness cautioned they should not be promoted. There is no evidence that spermicidal condoms are better at preventing STI transmission compared to condoms that do not have spermicide. If used properly, spermicidal condoms can prevent pregnancy, but there is still an increased risk that nonoxynyl-9 can irritate the skin, making it more susceptible for infections.[40][41]
The use of adiaphragm orcontraceptive sponge provides some women with better protection against certain sexually transmitted infections,[42] but they are not effective for all STIs.
Hormonal methods of preventing pregnancy (such as oral contraceptives [i.e. 'The pill'], depoprogesterone, hormonalIntrauterine devices, thevaginal ring, andthe patch) offer no protection against STIs. The copper IUD and the hormonal IUD provide an up to 99% protection against pregnancies but no protection against STIs. Women with copper intrauterine devicemay be subject to greater risk of infection from bacterial infectious such asgonorrhea orchlamydia, although this is debated.[43]
Coitus interruptus (or "pulling out"), in which the penis is removed from thevagina ormouth beforeejaculation, may reduce transmission of STIs or rates of pregnancy but still carries significant risk. This is becausepre-ejaculate, a fluid that oozes from the penileurethra before ejaculation, may contain STI pathogens. Additionally, the microbes responsible for some diseases, includinggenital warts andsyphilis, can be transmitted through skin-to-skin ormucous membrane contact.[44]
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Unprotectedanal penetration is considered a high-risk sexual activity because the thin tissues of theanus andrectum can be easily damaged.[45][46] Slight injuries can allow the passage of bacteria and viruses, including HIV. This includes penetration of the anus by fingers, hands, or sextoys such asdildos. Condoms may be more likely to break during anal sex than during vaginal sex, increasing the risk of STI transmission.[47]
The main risk that individuals are exposed to when performing anal sex is the transmission ofHIV. Other possible infections includehepatitis A,B andC;intestinal parasite infections likeGiardia; and bacterial infections such asEscherichia coli.[48]
It's recommended anal sex be avoided by couples in which one of the partners has been diagnosed with an STI until the treatment has proven to be effective.
To make anal sex safer, the couple can ensure that the anal area is clean and the bowel empty and the partner on whom anal penetration occurs should be able to relax. Regardless of whether anal penetration occurs by using a finger or the penis, the condom is the best barrier method to prevent transmission of STI.Enemas can increase the risk of HIV infection[49] andlymphogranuloma venereumproctitis.[50]
Since the rectum can be easily damaged, the use of lubricants is highly recommended even when penetration occurs by using the finger. Especially for beginners, using a condom on the finger is both a protection measure against STI and a lubricant source. Most condoms are lubricated and they allow less painful and easier penetration. Oil-based lubricants can damage latex condoms, causing them to fail;[51] water-based and silicone-basedlubricants are available instead. Non-latex condoms are available for people who areallergic to latex made out ofpolyurethane orpolyisoprene.[52] Polyurethane condoms can safely be used with oil-based lubricant.[53] Theinternal condom may also be used effectively by the anal receiving partner.
Anal stimulation with a sex toy can be done with similar safety measures to anal penetration with a penis by using a condom on the sex toy if possible. Certain sex toys are easier to clean to a level of safety, and others are incapable of being cleaned thoroughly. In the 21st century, developments in sex technology have increased the availability of consumer devices intended for intimate use. Some manufacturers, such asLovense, produce silicone-based products designed for compatibility with common safer-sex materials. Public-health guidance recommends using water- orsilicone-basedlubricants withlatex and similar barriers, as oil-based lubricants can weaken these materials and increase the risk of condom failure.[54]
It is important that sexual partners wash and clean their penis after anal intercourse if they intend to penetrate the vagina. Bacteria from the rectum are easily transferred to the vagina, which may causevaginal andurinary tract infections.[55]
When anal–oral contact occurs, protection is recommended since this is arisky sexual behavior in which illnesses such as hepatitis A or STIs can be easily transmitted, as well as enteric infections. The dental dam or non-vented plastic wrap[56] are effective protection means whenever anilingus is performed.
Putting a condom on asex toy provides better sexual hygiene and can help to prevent transmission of infections if the sex toy is shared, provided the condom is replaced when used by a different partner. Somesex toys are made of porous materials, and pores retain viruses and bacteria, which makes it necessary to clean sex toys thoroughly, preferably with use of cleaners specifically for sex toys. Glass is non-porous and medical grade glass sex toys are more easily sterilized between uses.[57]
All sex toys should be properly cleaned after use. The way in which a sex toy is cleaned varies on the type of material it is made of. Some sex toys can be boiled or cleaned in a dishwasher. Most sex toys come with advice on the best way to clean and store them and these instructions should be carefully followed.[58] A sex toy should be cleaned not only when it is shared with other individuals but also when it is used on different parts of the body (such as mouth, vagina or anus). In cases in which one of the partners is treated for an STI, it is recommended that the couple not share sex toys until the treatment has proved to be effective.
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Toys should be made of body-safe materials. Only materials that can be safely placed in the mouth and safely placed on the skin are safe to use. A number of toys are made of materials that are toxic and impossible to properly clean. These cheap and poisonous materials often degrade quickly over time. Some soft toys are made ofmedical grade silicone which is properlynon-porous and non-reactive with the body. Toys from unreputable sellers may be mis-labeled. Other commonly recognized as safe materials includeglass andtitanium. If the material has additives such aspigments or softeners, those may also be toxic. The list of safe materials often overlaps withBody piercing materials.
A sex toy should regularly be checked for scratches or breaks that can be breeding grounds forbacteria. It is best if the damaged sex toy is replaced by a new undamaged one. Even morehygiene protection should be considered by pregnant women when using sex toys. Sharing any type of sex toy that may drawblood, likewhips or needles, is not recommended, and is not safe.[58]
Sexual abstinence reduces STIs and pregnancy risks associated withsexual contact, but STIs may also be transmitted through non-sexual means, or byrape. HIV may be transmitted through contaminated needles used intattooing,body piercing, orinjections. Medical or dental procedures using contaminated instruments can also spread HIV, while some health-care workers have acquired HIV through occupational exposure to accidental injuries with needles.[59] Evidence does not support the use ofabstinence-only sex education.[60] Abstinence-only sex education programs have been found to be ineffective in decreasing rates ofHIV infection in the developed world[61] andunplanned pregnancy.[60] Abstinence-only sex education primarily relies on the consequences of character and morality while health care professionals are concerned about matters regarding health outcomes and behaviors.[62]
In the 1540s, an Italian doctor named Gabriele Fallopius — the same man who discovered and subsequently named the Fallopian tubes of the female anatomy — wrote about syphilis, advocating the use of layered linen during intercourse for more "adventurous" (read: promiscuous) men. Legendary lover Casanova wrote about his pitfalls with medieval condoms made of dried sheep gut, referring to them as "dead skins" in his memoir. Even so, condoms made of animal intestine — known as "French letters" in England and la capote anglaise (English riding coats) in France — remained popular for centuries, though always expensive and never easy to obtain, meaning the devices were often reused.
Outercourse is the sharing of sexual intimacy with behaviors such as private part kissing, petting, and mutual masturbation. The advantages of outercourse include no risk of pregnancy without penile-vaginal penetration and the behaviors permit emotional bonding and closeness.
Some people consider outercourse to mean sex play without vaginal intercourse, while others consider this to mean sex play with no penetration at all (vaginal, oral, or anal).
Correctly using male (also called external) condoms and other barriers like female (also called internal) condoms and dental dams, every time, can reduce (though not eliminate) the risk of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) and viral hepatitis. They can also provide protection against other diseases that may be transmitted through sex like Zika and Ebola. Using male (external) and female (internal) condoms correctly, every time, can also help prevent pregnancy.
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