How to have safe sex

Condoms are the most effective way of having safe sex and are even easy on the pocket. In fact, one can even get a pack of condoms for free as per a new initiative by the Government of India. A condom is easy to carry, use and dispose of, and can be worn by both men and women. However, one should take note of the following points to ensure its maximum effectiveness:

• Always ensure that the condom is in place before the beginning of sexual activity. It should be firm on the penis, and must not be rolled down or have any space or air in between.
• While using a female condom, ensure that the vagina and its opening are completely covered, and the penis is inserted into the covered area. It should not get in the area between the vagina and the boundaries of the femidom.
• Ensure that the condom is correctly disposed of after sexual intercourse. It must also be taken off carefully to avoid spillage of the seminal contents on the intimate areas of your partner. Extra caution is required while using femidom to avoid spillage of the contents within the vagina.
• If you feel that the condom has broken or ruptured during sex, it is essential to discontinue and replace it before resuming.
• If one is having sex twice in a cycle, it is recommended that the condom is changed between the two cycles to reduce the risk of breakage.
• It is also important to note that the male condom and the female condom offer equal protection and they must be used alternatingly, but never together, Using them together can cause frictional breakage.
• Use of a spermicide (chemicals that prevent the sperm from reaching the egg, inserted into the vagina before sex to prevent pregnancy) along with condom is not recommended since it is found to increases the risk of HIV transmission. Further studies are still needed to understand the nature of this transmission. 
• The use of lubricants is recommended to minimise condom breakage, but only the ones which are water-based. This is because oil-based lubricants have a higher chance of a tear. Some experts also recommend the usage of polyurethane condoms over latex since they are more resistant to tear.
• It is also vital to ensure that a condom is used for all types of sexual contact, that is, vaginal sex, oral sex, anal sex or even during touching of genitals in other activities such as humping. In case of oral sex, flavoured condoms, which are available in a variety of synthetic flavours and fragrances can be opted for. 
• Additionally, it is essential to ensure that you use a good quality condom while having sex. Checking its expiry date and storing it at the required room temperature are some of the essentials that need to be checked before using a condom.

Using a condom regularly while having sex minimises the risk of STDs. Its effectiveness can be enhanced through its appropriate use. Condoms are claimed to be 98% effective which can be achieved by following the above-mentioned tips.

Condoms, essentially are a primary measure for having a safe sexual experience. In addition, there are certain other measures that one can take to have safe sex. In cases where one is looking forward to pregnancy, it makes the use of condoms impossible due to its contraceptive actions. It is, however, essential to ensure safety while having sex even if you want to get pregnant. The tips mentioned below might be helpful in doing so. 

• Hold a healthy conversation with your partner discussing their sexual experiences and history, which may help you in understanding if they have any history of infections.
• Get yourself and your partner tested, which will help in avoiding STDs in the two of you as well as in the infant.
• You can also consult your doctor and get yourself vaccinated for HPV (human papillomavirus), which is commonly associated with the risk of STDs and certain types of cancer in both men and women. It is recommended to take this vaccination before being sexually active or at least before pregnancy to ensure its best benefits. This vaccine, however, must be avoided by pregnant women. Read more: How to get pregnant
• Maintain good hygiene of the genital organs to avoid getting infected and transferring it to your partner.
• It is good to stick to one type of sex, whether vaginal or anal in one session. It is not recommended to have vaginal sex after having anal sex, especially without protection since it increases the risk of infections.
• In case any symptoms such as pain, dryness, excessive vaginal discharge are observed, it is advisable to visit a gynaecologist, before resuming your sex life.

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While sex primarily refers to vaginal penetration, it may involve other sexual activities of interest to the partners involved. Some of them are considered to be safer than others. Following is a list of safe and unsafe sexual practices that one needs to be aware of beforehand. 

The sexual activities mentioned here are generally considered safe. However, some precautions while indulging in any of these activities have mentioned which are essential to ensure full safety. 

• Kissing
  Kissing is generally regarded as safe but some STDs may spread through the oral route, especially in the presence of open wounds or cuts. So, it is advisable to be careful and refrain from kissing if your partner has any fresh or untreated oral wounds.

• Masturbation or mutual masturbation or touching each other
  This is the safest form of sexual activity for offering protection against STDs, but you must ensure that your hands are clean to avoid infections.
  It is recommended to wash hands after anal touching before touching the vagina. With mutual masturbation, it is recommended to wash your hands before touching your partner and then washing them again before touching yourself.

• Ejaculating on skin surfaces other than the reproductive organs
  While ejaculating as such, it must be ensured that the skin surface is intact and unbroken, that is, it does not possess any cuts or wounds. Any open wound may favour the spread of infection through the blood. It must also be ensured that the ejaculation is not made close to the vagina because this can increase the possibility of infections.

The sexual activities mentioned below have a very high risk of getting an individual infected with STDs. It is advised that one completely refrains from such activities while having sex. 

• Having sex without the use of a condom
  Many people believe that the withdrawal method (where the male withdraws his penis before ejaculation) may offer protection against STIs, but this is not at all true. Sometimes, the pre-ejaculation fluid may contain infectious agents and act as a source of STIs. So, it is important to use a condom at all times.

• Reusing a condom or continuing to have sex despite a broken condom
  This practice has the same risks comparable to not using a condom.

• Having oral sex without condoms
  According to the National Health Society (NHS), practising sex as such may increase the risk of STIs like gonorrhoea, herpes and syphilis.

• Having anal sex without condoms
  The mere fact that one cannot get pregnant via the anal route, does not imply that it can prevent STDs. It is essential to use a condom for all types of sexual practices.

• Having multiple sexual partners
  This increases the risk of STDs, particularly if you are not using any protection. The risk is further aggravated if you are having intercourse with a sex worker since they are exposed to a greater number of infectious agents.

• Homosexual sex without protection
  Research evidence put forward by ‘Centre for Disease Control and Prevention’ states that bisexual men are at a greater risk of getting infected with STDs, particularly HIV. A majority of the HIV cases have also been diagnosed in homosexuals. Such statistics could be due to lesser use of condoms among them because there is no risk of conception involved.

You can put yourself at a greater risk of STDs by:

• Not getting tested
• Assuming if someone is affected, and the symptoms will show- STDs have a very long incubation period before the symptoms actually begin to surface. You may be astounded to know that the symptoms of AIDS may actually appear 10 years after the individual is infected.
• Assuming that if someone has a good physical health and hygiene, he or she is not affected.
• Thinking if you pull out or just have sex once, it won't infect you: it does not take long to be infected.
• Having sex while you are drunk or on recreational drugs- this impairs your judgment, and you may forget to use a condom.
• Facing partner’s pressure to have unprotected sex- if you feel pressured by your partner to have sex as such, the decision to wear or not to wear a condom may lie with them. This can put you at a greater risk of STDs. In such situations, rational decision making is important and you must discuss these issues with your partner to reduce the risk for either of you.
• Assuming that you are protected against STDs while using oral contraceptives or any other form of contraceptives- Condoms are the only type of contraceptives that offer protection against STDs. No other contraceptives offer full protection against STDs.
• Thinking that lesbians don’t get STIs- any skin-to-skin contact in the genital area can cause STIs.
• Believing that condoms may reduce sexual pleasure-research evidence suggests that certain types of condoms, particularly dotted or ribbed may actually enhance sexual pleasure. Moreover, condoms allow you to focus on your partner and the act of sexual intercourse without being worried about its effects which may, in fact, enhance pleasure.
• Not taking your or your partner’s symptoms seriously- not all STIs are incurable. According to WHO, gonorrhoea, syphilis, chlamydia and trichomoniasis can be effectively managed with the help of antibiotics. However, if left untreated, they may increase the risk of HIV by up to 3 times. So, it is better to get yourself diagnosed and seek treatment before continuing with normal sexual activity.

In case you have had unsafe sex due to the failure of a barrier device or lack of precautions, there is a high risk of STDs involved. The risk though cannot be prevented but can be modified by taking the following measures:

• Visiting a doctor immediately and talking about the incidence along with its history. This may help them in forming a diagnosis before symptoms are actually visible. It is important to get tested at the earliest to reduce risks.
• Avoiding any home remedies or washing the genitals may lead to further spread of infections. Genital organs are very sensitive; washing, douching or urinating may not help to protect against STIs. In fact, some of the studies conducted on women found that washing with soap or water actually increases the risk of HIV infection, especially in women. However, wiping the penis with a gentle cloth and using a virucide (virus destroying chemicals) has been found to be preventive in some men. The use of soap and water is still not recommended.
• For the risk associated with syphilis, gonorrhoea and other treatable infections, prophylactic antibiotics may help.
• PEP (post-exposure prophylaxis) may be given to modify the risk of HIV following unsafe sex, but it is not 100% preventive. To reduce risk, it is essential to begin the treatment early since PEP has a window of 72 hours after which it is not effective.
• The use of topical vaginal estrogen has been suggested by some researchers but further research is required to establish this fact. 
• Vaccination and pre-exposure prophylaxis measures (before infection occurs) may help but it is important to visit your doctor.
• Some studies have also suggested that circumcised men are at a reduced risk of STDs but it is still essential to opt for preventive measures since a definite result has not yet been established.