Safe sex is defined as "Sexual activity engaged in by people who have taken precautions to protect themselves against sexually transmitted diseases such as AIDS." This is also referred to as safer sex, or protected sex, while unsafe sex or unprotected sex is sexual activity engaged in by people who have not taken precautions to protect themselves against sexually transmitted infections. Some sources suggest the use of safer sex is preferable to safe sex, as this reflects that risk is reduced, not avoided.
Safe sex practices became more prominent in the late 1980s as a result of the AIDS epidemic. Promoting safe sex is now a principal aim of sex education. From the viewpoint of society, safe sex can be regarded as a harm reduction strategy aimed at reducing risks.
The risk reduction of safe sex is not absolute; for example the reduced risk to the receptive partner of acquiring HIV from HIV seropositive partners not wearing condoms to compared to when they wear them is estimated to be about a four- to fivefold.
Although some safe sex practices can be used as contraception, most forms of contraception don't protect against all or any STIs; likewise, some safe sex practices, like partner selection and low risk sex behavior, aren't effective forms of contraception.
Recently, and mainly within Canada and the United States, the use of the term safer sex rather than safe sex has gained greater use by health workers, with the realization the grounds that risk of transmission of sexually transmitted infections in various sexual activities is a continuum rather than a simple dichotomy between risky and safe. However, in most other countries, including the United Kingdom and Australia, the term safe sex is still mostly used by sex educators.
Much attention has focused on controlling HIV, the virus that causes AIDS, through the use of barrier protection for the penis, especially condoms. However, the HIV is a delicate virus, so protections focused on HIV may not protect against other STIs, which can also be transmitted through other areas of the body where the pathogen (virus or bacteria) has higher prevalence and resistance. Thus some sex educators recommend the use of barrier protection for any sexual contact with anal or vaginal cavities, or oral stimulation of those cavities or the penis.
Known as autoeroticism, solitary sexual activity is relatively safe. Masturbation, the simple act of stimulating one's own genitalia, is safe so long as contact is not made with other people's discharged bodily fluids. Some activities, such as "phone sex" and "cybersex", that allow for partners to engage in sexual activity without being in the same room, eliminating the risks involved with exchanging bodily fluids.
A range of sex acts, sometimes called "outercourse", can be enjoyed with significantly reduced risks of infection and pregnancy. U.S. President Bill Clinton's surgeon general, Dr. Joycelyn Elders, tried to encourage the use of these practices among young people, but her position encountered opposition from a number of outlets, including the White House itself, and resulted in her being fired by President Clinton in December 1994.
Various protective devices are used to avoid contact with blood, vaginal fluid, semen or other contaminant agents (like skin, hair and shared objects) during sexual activity. Practice of sexual activity using this devices is called protected sex.
When latex barriers are used, oil-based lubrication can break down the structure of the latex and remove the protection it provides.
Condoms (male or female) are used to protect against STIs, and used with other forms of contraception to improve contraceptive effectiveness. For example, simultaneously using both the male condom and spermicide (applied separately, not pre-lubricated) is believed to reduce perfect-use pregnancy rates to those seen among implant users. However, if two condoms are used simultaneously (male condom on top of male condom, or male condom inside female condom), this increases the chance of condom failure.
Proper use of barriers, such as condoms, depends on the cleanness of surfaces of the barrier, handling can pass contamination to and from surfaces the barrier unless care is taken.
Acknowledging that it is usually impossible to have entirely risk-free sex with another person, proponents of safe sex recommend that some of the following methods be used to minimize the risks of STI transmission and unwanted pregnancy.
While the use of condoms can reduce transmission of HIV and other infectious agents, it does not do so completely. 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. It also said, "In practice, inconsistent use may reduce the overall effectiveness of condoms to as low as 60–70%".p. 40.
During each act of anal intercourse, the risk of the receptive partner acquiring HIV from HIV seropositive partners not using condoms is about 1 in 120. Among people using condoms, the receptive partner's risk declines to 1 in 550, a four- to fivefold reduction. Where the partner's HIV status is unknown, "Estimated per-contact risk of protected receptive anal intercourse with HIV-positive and unknown serostatus partners, including episodes in which condoms failed, was two thirds the risk of unprotected receptive anal intercourse with the comparable set of partners."p. 310.
|Risk of accidental pregnancy||BEST case scenario assuming PERFECT use|
|Per Year (assuming 100 sex acts)||Per Act|
|No protection||8 in 10 (1 in 1.25)||1 in 125|
|Condoms||1 in 50||1 in 5,000|
|Birth Control||1 in 333||1 in 33,300|
|Condoms & Birth Control||1 in 1,665,000*||1 in 166,500,000|
What the above figures mean is that in one year, 80 out of 100 couples using no protection will get pregnant. 2 out of 100 couples using just condoms will get pregnant, .3 out of 100 couples using just hormonal birth control will get pregnant, and .00006 out of 100 couples using both condoms and birth control will get pregnant.
Using 2 or more forms of birth control dramatically reduces the risk of unplanned pregnancy. Use at least condoms and the pull-out method together unless sure the female is on hormonal. If sure, use hormonal and condoms until sure there are no diseases. Then hormonal and pull-out is an option (or hormonal and diaphragm, or pull-out and diaphragm). Never use the pull-out method by itself. The typical success rate is 1 in 3.7 per year. Always try to use at least two forms of birth control. In 10 years, the risk with just hormonal rises from 1 in 333 couples to 1 in 33.3 couples. This is assuming perfect use of the contraceptive. The typical use numbers are even riskier:
|Risk of accidental pregnancy||WORST case scenario assuming TYPICAL use|
|Per Year (assuming 80 sex acts)||Per Act|
|No protection||8 in 10 (1 in 1.25)||1 in 125|
|Condoms||1 in 6.6||1 in 533|
|Birth Control||1 in 12.5||1 in 1,000|
|Condoms & Birth Control||1 in 6,666*||1 in 533,333|
In typical use (including forgetting to take the pill or not understanding instructions or things like that) 8 in 100 (1 in 12.5) couples using just hormonal birth control will get pregnant each year. The true risk must be somewhere in between Perfect, and Typical use.
If you care to ejaculate in the vagina for sexual bonding, only do so infrequently. In 10 years of typical use of only hormonal, the risk rises from 8 in 100 (1 in 12.5) to 80 in 100 (1 in 1.25) couples. See  for reference on above tables.
Most methods of contraception, except for certain forms of "outercourse" and the barrier methods, are not effective at preventing the spread of STIs. This includes the birth control pills, vasectomy, tubal ligation, periodic abstinence and all non-barrier methods of pregnancy prevention.
The spermicide Nonoxynol-9 has been claimed to reduce the likelihood of STI transmission. However a recent study by the World 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 offering pathogens more easy points of entry into the system. Condoms with Nonoxynol-9 lubricant do not have enough spermicide to increase contraceptive effectiveness and are not to be promoted.
Coitus interruptus (or "pulling out"), in which the penis is removed from the vagina, anus, or mouth before ejaculation, is not safe sex and can result in STI transmission. This is because of the formation of pre-ejaculate, a fluid that oozes from the urethra before actual ejaculation, may contain pathogens such as HIV. Additionally, the microbes responsible for some diseases, including genital warts and syphilis, can be transmitted through skin-to-skin contact, even if the partners never engage in oral, vaginal, or anal sexual intercourse.
Sexual abstinence is sometimes promoted as a way to avoid the risks associated with sexual contact, though STIs may also be transmitted through non-sexual means. HIV may be transmitted through contaminated needles used in tattooing, body piercing, or injections. 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.
It is often recommended that those using abstinence have condoms available as a backup for protection against STIs and pregnancy.
Some groups, notably some evangelical Christians and the Roman Catholic Church oppose sex outside marriage, and object to safe-sex education programs because they believe that providing such education promotes promiscuity. Virginity pledges and sexual abstinence education programs are often promoted in lieu of contraceptives and safe-sex education programs. This may entail exposing some teenagers to increased risk of sexually transmitted infections, because about 60 percent of teenagers who pledge virginity until marriage do engage in pre-marital sex and are then one-third less likely to use contraceptives than their peers who have received more conventional sex education.
Unprotected anal penetration is a high risk activity regardless of sexual orientation. Research suggests that although gay men are more likely to engage in anal sex, heterosexual couples are more likely not to use condoms when doing so.
Anal sex is a higher risk activity than vaginal intercourse, because the thin tissues of the anus and rectum can be easily damaged; this includes by the use of anal toys. Slight injuries can allow the passage of bacteria and viruses, including HIV. Anal stimulation with a sex toy requires similar safety measures to anal penetration with a penis, in this case using a condom on the sex toy in a similar way. Oil-based lubricants damage latex, and water-based lubricants are available instead, and non-latex condoms are available for people who are allergic to latex (e.g., polyurethane condoms that are compatible with both oil-based and water-based lubricants).
Putting a condom on a sex toy provides better sexual hygiene and prevents transmission of infections if the sex toy is shared, provided the condom is replaced when used by a different partner. Some sex toys are made of porous materials, and pores retain viruses and bacteria, which makes it necessary to clean sex toys (plugs, anal vibrators) thoroughly, preferably with use of cleaners specifically for sex toys. Glass sex toys are non-porous and more easily sterilized between uses.
Safe sex (also called Safer sex or protected sex) is to have sex in a safe way. There are many dangers with having sex. Perhaps the most well-known are: