Safe sex

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The condom - the best known and most important protective measure for safe sex.

The term safer sex ( German  , safer sex ' ) came in the course of the discussion about HIV and AIDS and describes a set of behaviors and precautions individually or adapted in its entirety to the risk of infection with sexually transmitted diseases significantly to reduce. The comparative safer to to raise awareness that there is no absolute "safe" ( safe can be) protection against infection, but the risk can be significantly reduced, the sexual contact is "safe" ( safer ). In the German-speaking world, the term protected sex is also common.

Compliance with the principles of safer sex provides effective protection against pregnancy ( contraception ).

Safer sex means behaving in such a way that no body fluids get into the partner's body and, conversely, no body fluids from the partner get into your own body.

Development and history

The first approaches to "safer sex" - in the form of using condoms made from animal membranes - are more than 3000 years old, but were primarily used for contraception , as the concept of the pathogen in particular was unknown for a long time.

A few other significant discoveries were made in the period after World War II through the 1968s Cultural Revolution , notably penicillin and birth control pills . Among other things, penicillin was effective against syphilis , one of the most feared sexually transmitted diseases until then . The birth control pill promised effective protection against unwanted pregnancies. These developments enabled young people of the 1968 years (see also '68 ), a time of sexual freedom of movement usher, among other things, of an increased level of promiscuity ( " Free Love ") was coined.

This changed suddenly and radically when the deadly immune deficiency disease AIDS spread like an epidemic worldwide . Your pathogen HIV was not vulnerable to drugs; AIDS turned out to be incurable. Avoiding infection came to the fore and the concept of safe sex found its way into the consciousness of the general public. Since then, major advertising campaigns have attempted to encourage people to observe the guidelines for “safer sex” and, in particular, to use condoms regularly and as a matter of course , in order to counteract the spread of AIDS and other sexually transmitted diseases.

The development of life-prolonging drugs for HIV-positive people and the agitation of politically or religiously motivated groups, who mostly promote abstinence as an alternative (see e.g. True Love Waits ), have stalled education about safe sex since 2000. The Catholic Church in particular, with a few exceptions, explicitly forbids its members to use condoms.

functionality

Condom machine

Safer sex means always behaving in such a way that your own semen, vaginal fluid, blood or traces of blood do not get into the partner's body and, conversely, that such bodily fluids do not get into your own body.

Disease-causing germs ( fungi , bacteria , viruses, etc.) are found in different concentrations in various body fluids ( blood , sperm , vaginal secretions , saliva, etc.) and are usually highest in the blood, but there are also often high levels in sperm and vaginal fluid Concentrations of pathogens. In other liquids, the concentration is not zero, but so low that it is assumed that the risk of infection on contact is negligible.

The aim of "safer sex" is therefore to avoid contact with infectious body fluids. Since many germs can be absorbed through the mucous membranes ( vagina , anus , glans , mouth, eyes, nose), it is particularly important to avoid contact of body fluids with mucous membranes.

Different safer sex guidelines apply to different sexual practices. In general, the greater the stress on the tissue (hard sex), the easier it is for the viruses to penetrate the tissue. In general, when using condoms, care should be taken to ensure adequate moistening (lubricant gel) in order to reduce the risk of a defect and to limit the stress on the tissue.

Avoiding penetration

Many sexual practices get by without " penetration " into the partner's body, these are usually assigned to petting . If the man's penis does not penetrate the partner's vagina, mouth or anus, no seminal fluid can get there. Petting is therefore considered safe as long as body fluids are not carried into the partner or onto open wounds. Sperm on uninjured skin (not on the mucous membranes) is considered safe.

It should be noted that although petting is considered safe with regard to most diseases , it can lead to pregnancies due to the fact that sperm are more motile than most germs. It may be enough for a pregnancy if traces of sperm get near the vagina.

Protective measures for vaginal intercourse

The most important protective measure is the use of condoms or femidomes , which on the one hand avoid contact of the penis with the vaginal secretion or blood and on the other hand prevent the penetration of sperm or pre-ejaculate into the vagina.

Protective measures for oral sex

In fellatio , the introduction of semen into the mouth and throat area should be avoided (no ejaculation in the mouth), especially swallowing semen carries a high risk of infection. Fellatio should not be used on sores or inflamed mucous membranes in the mouth or throat, as this also increases the risk of infection.

During cunnilingus , contact with menstrual blood , which is also highly infectious, should be avoided. During menstruation, protective measures such as femidom or licking cloth should be taken or cunnilingus should be avoided entirely.

Apart from these restrictions, oral sex only represents a comparatively low risk. The risk of infection is very low, especially for the partner who can be satisfied orally - that is, the passive partner. It is believed that saliva has a virus-inhibiting effect. The residual risk can be further reduced by using a condom for fellatio, or a femidom or licking sheet for cunnilingus.

Protective measures for anal intercourse

The anal sex is generally considered a sexual practice considered at very high risk of infection, particularly infection with HIV . Inappropriately performed anal intercourse often leads to injuries from which blood leaks, which then comes into contact with the penis of the active partner. Condoms prevent the mutual contact of body fluids with mucous membranes. In addition, the use of lubricants can further reduce the risk of injury and thus the risk of contact with blood. In particular, the condom prevents sperm from coming into contact with the intestinal mucosa, through which germs can be absorbed even if the mucous membrane is intact. Since the mechanical stress on the condom during anal intercourse is often higher than with vaginal intercourse, the use of particularly tear-resistant condoms with thicker walls is recommended.

Protective measures when fisting

The Fisting is a sexual practice, in which the tissue, both of the active partner (hand) as is also heavily burdened the passive partner (intestine, vagina) and stretched. This creates a high risk of injury and therefore an increased risk of contact with blood. The risk of injury can be reduced by using lubricants . Neatly cut fingernails are also recommended . In addition, latex gloves recommended to prevent direct contact with blood at wound sites or mucous membranes.

Dealing with "bloody" sexual practices

Bloody sexual practices, as they are occasionally practiced in the field of BDSM , should be avoided in order to comply with safer sex standards if it cannot be ruled out that pathogens could be transmitted between the sexual partners from wound to wound or wound to mucous membranes. The risk of contact with infectious blood is extremely high with such sexual practices.

Securing sex toys

Many people use toys such as dildos during sex . If these are introduced into the body, residues of body fluids can remain on them, which pose a risk of infection. The sharing of such toys by several people should therefore be avoided or the toy should be secured by putting on a fresh condom for each person. The toy should always be cleaned before and after use.

Dealing with group sex

In group sex , even when using a condom, there is a particular risk that body fluids will remain on the outside of the condom and be transferred from one passive partner to another. This risk can be avoided if a new, fresh condom is used every time you change partners. This requires a high level of discipline, which, however, is often not observed to the necessary extent. Group sex therefore offers a higher residual risk even if the safer sex guidelines are observed and should therefore be avoided or restricted if possible (as few partner changes as possible during a group game).

Handling condoms, gloves and lubricants

Latex condoms and gloves should be used with lubricant . The lubricant drastically reduces the mechanical stress on the condom or glove. One of the most common causes of condom tearing is not using lubricant. When choosing the lubricant, it is essential to ensure that it is suitable and approved for use with a condom or glove. Fat-free lubricants (e.g. glycerine or silicone based) are suitable. Fatty substances (such as oils) break down the latex, making it permeable to pathogens or causing it to tear. However, condoms made of polyethylene (PE) and polyurethane (PUR) are suitable for use with fatty substances . Condoms that have passed their expiration date should no longer be used. Condoms from vending machines that are outside age faster due to temperature fluctuations.

Alcohol and other drugs

People who are alcoholized or under the influence of other drugs often make irrational and unreasonable decisions. As a result, inhibition thresholds are usually reduced and the willingness to take risks is greatly increased, which increases the willingness of those concerned to behave insecure. Occasionally, sex even occurs while one of the partners is unconscious and can no longer observe safe sex himself. Excessive alcohol consumption and the use of other drugs is therefore not recommended in terms of safer sex.

Education and knowledge

An important and useful addition to following the guidelines for safer sex is an extensive knowledge of the infection routes and symptoms of various diseases. Many “manual” mistakes can be avoided if one is well informed about the meaning and effectiveness of the various protective measures.

First aid

Safe sex is not perfect, and there are various risks associated with observing safe sex. Particularly in a state of sexual arousal, in which rationality is often reduced, important precautionary measures are occasionally neglected. Sometimes it can also happen that the partner does not respect the desire for safe sex (up to and including rape) or the condom can simply fail and tear (this can happen even if used properly).

If for any reason one of the above-described contacts with potentially infectious body fluids should occur, it is advisable to wash the affected area immediately and thoroughly, ideally using a suitable disinfectant , e.g. high-percentage alcohol, tincture of iodine or 3% hydrogen peroxide solution.

If semen is absorbed into the vagina or rectum, external showering can help reduce the risk. An attempt can be made to partially remove ingested sperm from the vagina or rectum by pressing or having a bowel movement and thus to reduce the viral load. It is not advisable to rinse the vagina or rectum internally, as this increases rather than decreases the risk of infection through possible injuries and deeper flushing of the pathogens.

If the partner belongs to a high-risk group or is known to be HIV-positive, ideally you should consult a doctor within 2, but no more than 48 hours. This is especially true in the case of rape, if the victim may be delayed in seeking help out of shame. With a rapid assay , within about 30 minutes which can be provided that the consent of the partner, serostatus determined and optionally a so-called post-exposure prophylaxis be initiated. This reduces the risk of infection by around 80 percent.

Special features of certain diseases

syphilis

Syphilis is a deadly infectious disease that is widespread worldwide and is caused by the Treponema pallidum bacterium . The pathogen is found in all body fluids, including saliva. Even a kiss can therefore be contagious. Condoms reduce the risk of infection, but do not exclude it. Typical of syphilis are one or more coin-sized weeping ulcers at the point of entry of the bacterium. The secretion from this ulcer is highly contagious. Syphilis infection can make HIV infection more likely.

Since syphilis is treatable and curable in the early stages of the disease with high-dose intramuscular penicillin , but treatment becomes more and more difficult as the disease progresses, early diagnosis of the disease is extremely important. If a syphilis infection is found, abstinence for several weeks is mandatory.

Most of the safer sex rules that provide effective protection against HIV have only limited protection against infection with syphilis. Diagnosis and treatment are all the more important . It is therefore advisable to know the symptoms of syphilis precisely in order to be able to start therapy quickly and in a targeted manner in the event of infection. Typical of syphilis is an onset with painless mucosal ulcers and swelling of the lymph nodes.

HIV and AIDS

HI-virus from an immune cell dissolves

Oral sex is largely considered safe for HIV, both fellatio and cunnilingus . However, only if fellatio does not result in ejaculation in the mouth and cunnilingus is not performed during menstruation. During this time, there may be contact with infectious menstrual blood.

It is worth noting that the risk of infection is greatest immediately after infection with HIV, because this is when the viral load in the blood is greatest. Since the HIV antibody test has a diagnostic window of six weeks, the time with the greatest risk of infection is precisely the time in which no clear statements can be made even with a test. Consequently, in spite of the presence of a current negative HIV test, no statement about the current infection status of the person concerned can be derived from this alone .

hepatitis

Hepatitis is a highly contagious and, depending on the pathogen, fatal disease. The infectiousness of hepatitis is significantly higher than that of HIV. A much smaller viral load is sufficient for an infection. Compared to HIV, hepatitis has a significantly higher risk of being transmitted through, for example, oral practices such as cunnilingus or fellatio. The risk of infection can be drastically reduced by using barrier methods ( condom , licking sheet ) and by vaccination , which in many cases is covered by health insurance companies. Sharing sex toys or toothbrushes, for example, can also transmit the virus and must therefore be avoided.

Vaccinations against hepatitis A and hepatitis B are possible and recommended; there is currently no vaccine in sight for hepatitis C.

More diseases

Other risks include gonorrhea , chlamydia , papillomaviruses and the genital form of herpes . With a prevalence of 5 to 10%, an infection with chlamydia is very common in Germany, which remains undetected in up to 75% of cases, but can lead to infertility in women and is highly contagious.

criticism

Again and again there is criticism of safe sex. The motivation for this criticism is very different.

Rejection of condoms by the Catholic Church

The Vatican has taken as a spokesman for the Catholic Church a clear position and explicitly prohibits members of the Catholic Church safer sex. The reason given for this prohibition was that only those sexual activities are permitted which take place within a valid marriage and which are directly aimed at the conception of children or in which the conception of children is possible. This is not possible with safer sex, therefore safer sex is forbidden for Catholics. It is further argued that this does not encourage the spread of STDs, as abstinence and marital fidelity offer more reliable protection against infection and thus represent an alternative to safer sex.

In December 2003 the Vatican published its criticism of the state's safer sex campaigns in the form of a treatise entitled Family Values ​​Versus Safe Sex . In the text, Cardinal Alfonso López Trujillo criticizes the unreserved recommendation of condoms , as they protect even less against infection with sexually transmitted diseases than against unwanted pregnancies.

Under Pope Benedict XVI. Cardinal Baragàn spoke out in favor of an exception to the general condom ban if one of the spouses in a marriage is infected with HIV.

In contrast, the Evangelical Church in Germany (EKD) is promoting the use of condoms to combat the immunodeficiency disease. In July 2007, the EKD Chamber for Sustainable Development stated in a study for a life in dignity that fighting HIV “requires the use of condoms and renunciation of promiscuity ”. The word “condom” is used 22 times in the 58-page text.

Promote immoral behavior

Another form of criticism is directed against the promotion of “immoral behavior”. This line of reasoning is particularly common in the United States. It is argued that the ability to reduce the risk of contagion would reduce the fear of engaging in sexuality and thus encourage immoral behavior, which in turn would increase the risk of contagion.

This observation of risk compensation is supported by a study according to which homosexuals put the protection gained by condoms back on the line by changing partners more frequently.

Campaigns in Africa

In Uganda, on the other hand, a campaign for marital fidelity or against promiscuity has led to a significant decrease in new HIV infections.

Success in Uganda was based on an ABC program. It also relied on chastity (abstinence) and loyalty (Be faithful), but safer sex (condoms) was an integral part. The move away from safe sex has only happened recently and threatens to undo what has been achieved so far.

Legal Aspects

In Germany, intentionally infecting another person with the HI virus and other illnesses is punishable as bodily harm ( §§ 223 ff. StGB ) or homicide ( §§ 211 ff. StGB).

In Austria there are laws against the intentional ( § 178 ÖStGB ) and negligent ( § 179 ÖStGB) endangerment of people by communicable diseases. In this case, the endangerment would be classified as a publicly dangerous criminal act.

In Switzerland, both negligent and willful spreading of human diseases is punishable under Article 231 of the Criminal Code .

Related topics

  • Safer Use - measures to prevent virus transmission between drug users.

literature

Web links

Individual evidence

  1. ↑ What is safe sex? Retrieved on July 14, 2019 (German).
  2. ↑ profamilia.de: Safer Sex. Retrieved July 14, 2019 .
  3. ^ History of the condom ( Memento from October 7, 2010 in the Internet Archive )
  4. ↑ spiegel.de: November 20, 2011: Pope loosens the strict condom ban , In Africa resistance against Benedict XVI stirs.
  5. ↑ ( page no longer available , search in web archives: risk of infection during oral sex )@1@ 2Template: Toter Link / www.aids-aufklaerung.de
  6. ↑ Deutsche AIDS-Hilfe eV: HIVreport 2015/3 ( memento of the original from September 24, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 2.4 MB) @1@ 2Template: Webachiv / IABot / www.hivreport.de
  7. ↑ Vaccinations against hepatitis AB
  8. ↑ Cardinal ALTrujillo: Family Values ​​Versus Safe Sex "
  9. ↑ dpa: Vatican wants to allow AIDS sufferers condoms ( memento of October 19, 2007 in the Internet Archive ). Der Tagesspiegel (April 24, 2006)
  10. ↑ News from the Tagesschau: Relaxation of the condom ban ( Memento from July 10, 2010 in the Internet Archive )
  11. ↑ Report from the star: Easing of the condom ban
  12. ↑ EKD: For a dignified life - The global threat from HIV / AIDS and the Church's options for action (PDF; 696 kB)
  13. ↑ Article in Spiegel Online: Man seeks danger
  14. ↑ Stoneburner R. and Low-Beer, D .: Population-level HIV declines and behavior risk avoidance in Uganda. ( Memento of February 25, 2006 in the Internet Archive ) . Science 2004 Apr 30; 304: 714-8 "
  15. ↑ Uganda AIDS Commission: Frequently Asked Questions ( Memento of October 4, 2006 in the Internet Archive )
  16. ↑ Practice Psychosocial Counseling Frankfurt am Main: Turning away from the condom ( Memento from February 13, 2009 in the Internet Archive )
  17. ↑ Walter Scheuerl : AIDS and criminal law: The criminal liability of HIV-infected persons when making sexual contacts , dissertation, Hamburg-Münster, 1992, 364 pages, ISBN 3-89473-287-3 .
  18. ↑ Switzerland: Art. 231 StGB.