Start any potential sexual encounter with the “safe sex elevator speech”: Reid’s Safer Sex Elevator Speech

Contrary to what many people have been told, safe sex is real, and is practiced by hundreds of thousands of non-monogamous people every day. For the most part, it is simply a matter of getting tested, avoiding fluid exchange, proper hygiene after sex, and getting the right vaccines.

"Safer sex" is a term used by sex-negative people (people who are afraid of sex, for whatever reason) to scare people. The word "safer" isn't used in any other context: we talk about safe driving, safe swimming, safe biking, safe almost-anything-else-- and there is safe sex as well.

Safety is always relative--getting out of bed in the morning is dangerous, and staying in bed is even more dangerous! There is a level of risk we accept in everyday life. If we are in far more danger driving to the grocery store than in having sex with someone, then it is reasonable to call that "safe sex". The guidelines that I and other educated non-monogamous people use reduce the risk below that of driving or many other ordinary daily activities.

Condoms are a highly effective protection against most STI's, but *not* against herpes, HPV, MRSA, and molluscum.

Good safe sex practice includes not only using condoms, but also getting vaccines for Hepatitis A & B and HPV (even if you are over 45, a doctor can still prescribe it--but your insurance might not pay for it). The best HPV vaccine available is Gardasil-9. Recent research has shown that HPV is responsible for most or all cancers of the cervix, mouth, head, neck, throat, tongue, vagina, vulva, anus, and rectum, and some cases of cancer of the penis, larynx, and lungs. The vaccine, however, is systemic and protects all of these areas, and protects against genital warts as well. (There are dozens of strains of HPV, and the vaccine does not protect against all of them, but it does protect from all the most dangerous ones, and many of the others as well.)

(HPV can also cause genital warts, but the kind of HPV that causes cancer does *not* cause warts, and vice-versa; though it is entirely possible to have both infections. So if you have genital warts, they are a minor nuisance and not a major health threat; and they can be treated and/or removed.)

(If you have heard terrible things about vaccines, please ignore them. The hysteria over vaccines is based on *zero* hard evidence--but there is extensive evidence showing that they save lives and health.)

Even committed and faithful relationships often turn out not to be (surprise!). Infidelity is so common that it may be more the norm than the exception--and that's among people who have promised to be sexually exclusive. So my recommendation is to use barrier protection (condoms and other non-porous barriers that prevent fluid exchange) for at least a few years with any new partner.

There are tests for various STI's, but not for all of them. And the HPV test only tests the cervical area in women, but HPV can cause cancer in many parts of the body.

In the US at least, there is no "standard" list; it is whatever the doctor thinks to test for. So it is a good idea to have a specific written list of tests to hand to the doctor or nurse.  Our recommended list is here.

A word about Pap smears. They should be given along with HPV tests for all women who are sexually active, or who have been any time in the last couple of years. However, the "traditional" Pap smear has many false positives and false negatives--yet some places still use it, because it is cheaper. When a woman gets a Pap smear, she should insist on either ThinPrep or SurePath. ThinPrep is theoretically somewhat superior, but is easier to screw up. So they wind up about the same overall, and SurePath is what is most commonly available.

I strongly recommend the herpes test. Many doctors are highly resistant to giving them, because there is no cure for herpes, and the test doesn't tell *where* the herpes infection is. But knowing that you have herpes at all is important information, because half the people who have herpes have never had symptoms, but they can still transmit it to a partner. And if you know you have it, you can take steps to keep from spreading it.

Herpes is most infectious when someone has a visible outbreak. But even when there are no visible signs, herpes can also do "viral shedding"--having an area of the body that has no symptoms, yet is infectious. Ironically, these days herpes infections are more often transmilled by viral shedding rather than from an outbreak, because people know to avoid a visible sore, but aren't aware of the invisible viral shedding.

If a person has either herpes 1 or herpes 2, they can dramatically reduce the risk of transmitting it to another partner by taking valacyclovir (the best--brand name is Valtrex, but generic is just as good) or acyclovir (less convenient, slightly less expensive). It also eliminates outbreaks for way over 90% of people, and the vast majority of people who take it have *zero* side effects, even after taking it for years. Prices for generic valacyclovir vary wildly; a good way to find the best price on any medication that you have to pay for are sites like GoodRx.com

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They simply tell you the prices at pharmacies near you; they don't sell the medication themselves, and there is no charge for using their service. I usually buy a year's worth at a time, and it costs me *less* than my health plan's co-pay--about 20 cents a tablet (500 mg).

Valacyclovir also *might* have a protective effect against becoming infected with herpes; if you are having sex with someone who has herpes, and you do not, you may want to consider having *both* of you take the medicine—and if your partner won’t, you can still take it yourself. The research on this has been minimal so far, and no firm conclusions can be drawn.

Many couples in which one person has herpes have gone for years without infecting the other when safe sex practices are followed, so herpes is not inevitable.

Of course, if a person has a visible outbreak of *any* kind, that area and the area around it should be covered with a non-porous material during sex (bandaids don't work--think surgical tape and nonporous plastic wrap)--have them check with their doctor to get precise information. Visible outbreaks can be highly contagious, and could be MRSA, molluscum, herpes, or any of several other skin infections.

Avoiding transfer of fluids to the degree possible and practical is an important part of safe sex. Barriers are an effective way to minimize or eliminate fluid transfer. The most common barrier is a condom, of course, and many people are familiar with dental dams. But dental dams are expensive, hard to find, and small. A cheap and highly effective alternative barrier is generic "saran" wrap or plastic wrap. Be sure to get the cheap kind that does *not* have tiny holes in it. You can usually identify the wrong kind by seeing the pattern of holes if you hold some up to the light; you can also suck some air through it. Plastic wrap can be cut to any size you like, at a cost of a few pennies. Some women actually *prefer* the plastic wrap to direct oral sex; it eliminates the possibility of UTI's and other vaginal disruptions, and reduces the sensation just enough that the unpleasant "overwhelm" sensation doesn't happen.

Finally, it is a good idea to urinate, and to *wash* the entire genital region (waist to thighs) thoroughly as soon as is practical after having sex. This will help reduce the chance of transmitting HPV and herpes, which can be transmitted skin-to-skin.  The most effective wash technique is the “triple wash”.  This means soap up, rinse, soap up, rinse, soap up, rinse.  This can be done in about a minute, and is *far* more effective than even a lengthy single wash and rinse.  Kneeling in a bathtub facing the faucet, or using a shower-on-a-hose, can make this quick and simple,

The quick summary:  “safe sex” means vaccination, regular testing, barrier protection, and washing thoroughly and urinating afterwards.  This reduces your risks to “noise level”, below that of many risks we take every day without thinking twice about them.  Practice this, and enjoy your sexuality with safety!