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Thursday, Nov. 19, 2009

The Balancing Act of Safer Oral Sex

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This week, we answer the first part of a two-part question (see last week’s column for the second part, which addressed common reasons that condoms might break):

 I am hanging out with a bunch of gay guys, and they have lots of oral sex. [Where we live], it’s estimated that 5% of the population is HIV positive. Their answer to being “safe” is: “If you're sucking a guy off, pre-cum is safer than cum, so as long as you don't let him cum in your mouth, that's better.” Is pre-cum really safer than cum? What is going on here? What would you suggest for them?

As regular readers of this column know, I get a lot of questions about oral sex and sexually transmitted infections. Since you seem to be specifically asking about HIV, I'll focus on HIV transmission during oral sex.

There's an interesting history behind your question. In the United States, the HIV epidemic was initially concentrated among men who had sex with men, and many public health programs were specifically aimed at getting these men to change their sexual behavior in ways that would reduce their HIV risk. Because HIV is a relatively new disease, research on how it is transmitted was rapidly producing new and conflicting information during the first decade of the epidemic. In the early 1990s, it was thought that the risk of HIV transmission during oral sex was essentially zero, and it was well known that unprotected anal sex carried a very high risk of transmission. This led to public health education campaigns in Boston and New York in the mid-’90s that proclaimed, "Oral Sex Is Safer Sex," and urged gay men to have oral sex rather than anal sex as a way to reduce their risk of contracting HIV.

Shortly thereafter, a number of studies and anecdotal reports from health care providers determined that while the risk of transmission from oral sex is much lower than from anal or vaginal sex, it still exists. HIV prevention campaigns began to emphasize using condoms during oral sex to reduce risk and to move away from stating that oral sex is "safe." The most recent guidelines from the Centers for Disease Control and Prevention, released in June 2009, state unequivocally that HIV can be transmitted through oral sex and that risk can be reduced through the use of latex barriers.

However, not everyone fancies the idea of licking latex. Many people choose to reduce their risk by not allowing their partner to ejaculate into their mouths, since semen is one of the body fluids that can transmit HIV. As your question implies, this may not be a 100% foolproof method, since pre-cum (also known as pre-seminal fluid) is secreted before a man ejaculates, and pre-seminal fluid does contain HIV. To my knowledge, there haven't been any studies that have looked at exactly how risky oral exposure to pre-cum is; in fact, I don't believe that we even have scientific agreement on how risky oral exposure to semen is, although it's generally agreed to be much less risky than anal or vaginal exposure.

From what we do know now, I would say that your friends are correct. Using a condom over the penis during oral sex would be the most effective way to reduce HIV transmission, but not letting a partner ejaculate into your mouth is also an effective risk reduction. Practically speaking, the risk of contracting HIV from oral exposure to pre-cum alone is very, very low. We can't say that there's no risk, but anyone who's sexually active performs a constant balancing act between pleasure, intimacy and safety, and I think your friends are finding a balance that is both pleasurable and responsible.

Want Laura to answer your questions in SEXpress? Send them to laura@shepex.com. Not all questions received will be answered in the column, and Laura cannot provide personal answers to questions that do not appear here. Questions sent to this address may be reproduced in this column, both in print and online, and may be edited for clarity and content.

Laura Anne Stuart has a master’s degree in public health and has worked as a sexuality educator for more than a decade. She owns the Tool Shed, an erotic boutique on Milwaukee’s East Side.