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STIs and Safer Sex

Practicing safer sex is a good way to lower your chances of preventing unwanted pregnancy or a sexually transmitted infection (STI or STD). Learn about STIs and ways they can be prevented to help you and your partners make informed choices.

What is a sexually transmitted infection?

Sexually transmitted infections (STI or STIs) are infections that spread during sexual activity, including genital, anal, or oral sex. They are also sometimes called sexually transmitted diseases (STD or STDs)

There are different types of STIs, and they can spread and affect the body in different ways.

It is possible to have an STI without having symptoms, so the only way to confirm an STI is through testing. Getting or having an STI is not related to someone’s personal character, values, beliefs, education, or morality.

STIs are very common, but there is often stigma and shame around them. This comes from fear, confusion and incorrect information. Having open, non-judgmental conversations can help improve understanding.

There are ways to prevent and treat STIs.

Safer sex basics

How do you get an STI?

For someone to pass an STI to someone else, they must already have it. Different infections pass in different ways.

Ways that some STIs can pass

  • Genital fluids (fluids from the penis or vagina, ejaculate or ‘cum’),
    • Example: when you have sex where a penis goes inside a vagina, the fluid from the penis can mix with the fluid that’s inside the vagina and STIs can pass this way.
  • Rectal fluids (mucus from the anus) or the tissue lining in the anus,
    • Example: when you have sex where a penis goes inside the anus (bum), fluids from the penis can mix with fluids that are inside the anus, and STIs can pass this way.
  • Skin-to-skin contact,
  • Blood,
  • Breast milk, during pregnancy or birth.

Some STIs such as Hepatitis B, C, or HIV can also pass through contact with blood from a person that has the infection, such as sharing needles.

Ways that STIs can not be passed

  • Body fluids like sweat, tears, saliva,
  • Activities like hugging, kissing, holding hands,
  • Sharing personal objects, or
  • Being in the same spaces like busses, classrooms, offices.

STIs can be treated

Treatments are available to manage or cure STIs and their symptoms. Some STIs have no symptoms, some get better on their own, and some lead to serious health issues if left untreated.

Common questions about STIs

Preventing STIs

To reduce your chances of getting an STI, here are some steps you can take:

  • Get informed: Understand different STIs, how to prevent them, and which sexual activities are more or less likely to pass them.
  • Get tested: Get tested regularly with your partner(s) for STIs so that you know and can take action as soon as possible. Learn more about testing in the next section.
  • Have safer sex: Use condoms, barriers, or lube to make sex safer.
  • Get vaccinated: There are vaccines you can get for some infections, including HPV, Hepatitis A, or Hepatitis B.

Talk to your partner(s): Discuss consent, safer sex, sexual activities or preferences, and STI testing. Communication can help protect the health of you, your partners and can help you have positive sexual relationships and experiences. 

Condoms

There are external condoms (sometimes called “male” condoms) and internal condoms (sometimes called “female” condoms). When used properly, they can prevent many sexually transmitted infections (STIs) and pregnancy.

A new condom should be used every time you have sex, with each new partner, and when switching from anal to oral or genital penetration. The condom should be applied before sexual contact occurs.  Condoms can be used with sex toys. 

External Condom

The external condom is made of thin latex that fits snugly over the penis/external genitals. There is a tip at the top to hold ejaculate (cum).

Condoms made of latex or non-latex (ie nitrile, polyurethane and polyisoprene) are highly protective against many STIs. Do not use condoms with the spermicide nonoxynol-9 as it can cause irritation and increase the chance of getting HIV. Lambskin or sheepskin condoms protect against pregnancy, but are not effective for preventing STIs, including HIV. Novelty condoms, such as “edible” condoms, do not offer protection against either STIs or pregnancy.

Some STIs, such as herpes and HPV (which causes genital warts), are passed by skin-to-skin contact. While external condoms provide good protection, they don’t cover all areas, and therefore may not always prevent infection. Dental dams and internal condoms can cover a larger area. 

You can buy condoms at most drug stores, corner stores and grocery stores. Sexual health clinics often have free external condoms available to the public.

Internal condom

The internal condom is made from synthetic nitrile, a type of material that is thinner than latex but stronger so less likely to break. It fits inside the vagina/internal genitals or inside the rectum. The internal condom is a good option for people who are sensitive or allergic to latex. It can be useful for those with a sexual partner who has difficulty maintaining erections or have soft erections. It can also be useful for those who need to rest during sex because of long sex sessions, ability, or stamina.

Reasons some people prefer the internal condom:

  • It gives more STI protection than the external condom because part of the condom stays outside the body and covers more of the skin around the genitals.
  • It can be put into place up to 2 hours before intercourse and it does not need to be taken out immediately after intercourse.
  • It can be used for both genital and anal sex. Note that it has not been approved for anal sex (this is considered “off label” use).
  • It can be used with any type of lubrication.
  • It is not affected by temperature or humidity and has a shelf life of 5 years.

Internal condoms are not widely available at drug stores or grocery stores, but are sold at some specialty sex shops. Internal condoms are more expensive than external condoms, but can be available for free at some sexual health clinics.

How to use an external condom

  • Check the expiry date on the package. Be careful not to tear the condom when taking it out of the packet.
  • Add a drop of water-soluble or silicone lubricant to the inside of the condom if you like.
  • Check to see which way the condom rolls and put the condom on the end of the erect penis/external genitals.
  • Pinch the tip of the condom to remove the air in the tip.
  • Unroll the condom down to the base of the penis/external genitals.
  • After intercourse, withdraw the penis/external genitals before it becomes soft; hold the condom to make sure that semen does not spill out.
  • Slide the condom off the penis/external genitals, tie the open end in a knot and throw it in the garbage.

Condoms that fit well will feel better and are less likely to fall off or break. There are many styles and sizes of condoms, so it’s a good idea to try different ones to decide what works for you. Keep condoms in a cool, dry, dark place. Heat, light and moisture break down condoms and increase the risk of breakage. Find out what to do if a condom breaks.

Video on how to put on an external condom

Condoms and oral sex

Condoms are recommended for oral sex because some STIs, including herpes, gonorrhea, chlamydia and syphilis, are easily passed during oral sex. An external condom can be used when performing oral sex on the penis/external genitals. To make a condom into a dental dam (for cunnilingus or rimming), cut it lengthwise and hold it against the vagina/external genitals or anus. 

Flavored condoms

Flavoured external condoms are colorful latex condoms that come in a variety of flavours. They are popular for oral sex because some people do not like the taste of regular condoms.

It is safe to use flavoured condoms for oral sex. The flavoring and colors added to these condoms are the same additives that are used in food products and are safe to swallow.

The safety of using flavoured condoms for genital or anal sex is not well studied. It is possible that some ingredients used in flavored condoms may cause vaginal irritation, yeast infections or bacterial vaginosis.

Tips for pleasure and condoms

Condoms come in different styles and textures to increase sensation and pleasure. For example, condoms can be part of foreplay when you have partners put it on or in. Studies show that with regular use, you will notice the condom less and the pleasure more. Keep condoms nearby so that they are easy to use when you need them.

Sometimes, people lose their erections or find they are not able to ejaculate when using external condoms. Here are some things you can try:

  • Masturbate with a condom to get used to the sensation.
  • Masturbate until close to ejaculation (cumming), then put the condom on and finish.
  • Do all the things you like to do sexually, but with a condom on; focus on what feels good.
  • Use water-soluble lubricant (lube) on the inside and outside to improve sensation.
  • Use an internal condom.

Dental Dams

A dental dam is a piece of thin latex that is placed over the vagina/internal genitals or anus during oral sex. It can also be called a latex barrier/sheet, latex dam, oral dam or sheet.

Dental dams are a good way to lower the chance of getting or passing sexually transmitted infections (STIs). 

They are usually available in pharmacies, medical supply stores, sex shops and sexual health clinics. Supplies can also be ordered online. An external condom cut length-ways can be used in the same way as a dental dam.

How to use a dental dam

  • Before you use the dam, hold it up to light and check for holes
  • Rinse it gently with warm water to remove powder
  • Hold the dam over the vagina/internal genitals or anus
  • Be sure that only one side of the dam touches the vagina/internal genitals or anus
  • Use a new dam each time you have oral sex
  • Use a different dam for the anal area and the vagina/internal genital area
  • Use lubricant on the vagina/internal genitals or anus to improve sensation
  • Dispose of the dam in the garbage.

Non-microwaveable plastic food wrap is sometimes used in place of a dental dam. These products have not been tested for STI protection.

Medication to prevent HIV

In BC, the number of HIV infections is low because there are great testing, treatment, and community efforts. People living with HIV can control HIV with these medications:

  • Highly Active Antiretroviral Therapy (HAART). This type of medication lowers the amount of the virus in the body. When taken as directed, this medication can make the amount of virus in the body so low that it can not transmit to anyone. This is called an undetectable viral load. You may have also seen U=U (undetectable means un-transmittable).
  • Pre-exposure prophylaxis (PrEP): This is a medication that is taken everyday to prevent HIV.
  • Post-exposure prophylaxis (PEP): This is a medication people can take within 3 days after potential contact with someone living with HIV, that could lead to transmission.

Vaccines

Hepatitis A and B and some types of Human Papillomavirus (HPV) can be prevented by vaccines. Vaccines for some other STIs, including HIV and Herpes Simplex Virus (HSV) are being developed.

Vaccines are made from weakened or killed bacteria or virus. When a person is given a vaccine, the body’s immune system responds to the ‘invading’ germs. The body creates anti-bodies to the bacteria or virus which protect the person against that infection in the future. For vaccines to be effective they must be given before exposure to the virus or bacteria.

There are vaccines for some sexually transmitted infections, including hepatitis A, hepatitis B, and HPV.

Hepatitis A vaccine

In British Columbia, the hepatitis A vaccine is free for:

  • Men who have sex with other men, or are not yet sexually active but are questioning their sexual orientation
  • Individuals who are living with HIV
  • Inmates of provincial correctional facilities
  • People who use intravenous drugs or share drug equipment
  • Indigenous people age 6 month to 18 years

Hepatitis B vaccine

In British Columbia, the hepatitis B vaccine is free for:

  • Infants as part of routine immunizations
  • Children in Grade 6
  • People born in 1980 or later
  • Individuals who are living with HIV
  • Inmates of provincial correctional facilities
  • People who use intravenous drugs or share drug equipment
  • People at higher risk of hepatitis B infection 

HPV vaccine

In British Columbia, the HPV vaccine is provided free to: 

  • Children in Grade 6
  • Those who did not start a vaccine series in Grade 6 are eligible to initiate a series prior to age 19 (for males born in 2006 or later) but not thereafter.
  • People aged 9-26 years who are living with HIV
  • Transgender individuals aged 9-26 years
  • Men 9 to 26 years who self-identify as having sex with other men, or are not yet sexually active but are questioning their sexual orientation, or are street-involved
  • Boys aged 9-18 who are in the care of the Ministry of Children and Family Development
  • Males in youth custody services centres

There are two HPV vaccines available in Canada: Cervarix (HPV2) and Gardasil9 (HPV9). The HPV9 vaccine is approved for use in all genders. The HPV2 vaccine is only approved for use in females.

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