Oral sex – is the getting still good? September 10, 2013

Besides Human Papillomavirus (HPV), there are other issues that should be raised following Michael Douglas’ oral sex and throat cancer theory.

Who’s giving, who’s getting, who’s at risk and who cares?

Let’s start with cunnilingus (a very good place to start, some would say). There have always been negative attitudes about oral sex on women because of repugnance towards female genitals. Apparently, we smell, we’re dirty; and we don’t look the way we should. Feminine hygiene products included Lysol in the early days of making women feel bad about their genital scent. Female genital cosmetic cutting and anal bleaching are the contemporary equivalents. However, it would appear that some people have gotten over that prejudice, because in films and on TV, men are going down on women in droves, not to mention woman on woman action as well. However, I’ve met many young men who gave their female partners oral sex, but didn’t want their male friends to know; it was considered unmanly.

Interestingly, there are also prejudices against oral sex on a man. I worked with young women who said they could never kiss their baby after they had put their mouth on a man’s penis.

Oral sex has been on the menu for a long time, soon to be replaced in popularity, at least according to the media, by anal sex, even though statistics do not bear this out. We have some statistics regarding oral sex for adolescents. They mirror age-related statistics on vaginal intercourse—about half of the teen population are having vaginal and oral sex by age 17. The “epidemic” of teen oral sex never did materialize since the first hysterical media stories more than 15 years ago. Unfortunately, we can only guess at who’s giving and who’s getting. As sexualityandu.ca suggests, “It is sometimes assumed that with respect to teen oral sex there is a gender discrepancy in which females are more likely to be giving (fellatio) rather than receiving (cunnilingus) oral sex from their male partners.”

It is a fair assumption that for young women, oral sex on a young male partner is one way of preventing pregnancy and postponing vaginal intercourse. A lot of ink has been spilled over whether young women find it enjoyable and/or empowering to give oral sex to a male partner. I’d like to see a good study on that.

These days, adults are seeing oral sex in a different light: will it give me cancer?

Oddly, there has not been much discussion about a risk that is much more common: genital herpes. A person with a history of cold sores (even when no sore is present) can pass herpes simplex virus 1 (HSV-1) to a partner’s genitals. Part of my health promotion message has been that is it a courtesy to tell a person you have a history of cold sores, offering to cover your partner’s genitals before oral sex. Part of someone’s decision might include the fact that HSV-1 tends to recur less frequently than HSV- 2 on the genitals and tends to be less painful. I was recently called “sexist” for suggesting that men would tend to dismiss such protection in a nanosecond. A propos, I have never met a woman, no matter with whom she had sex, who used an oral latex barrier to receive oral sex.

Men having unprotected oral sex with multiple male partners are at risk for syphilis. My clinic experience tells me that, like heterosexuals and women who have sex with women, they are not likely to use protection for oral sex. They need to be tested more frequently, since untreated syphilis puts them at higher risk for HIV.

But Iet’s get back to Michael Douglas and throat cancer.

I have been following the HPV and oral sex story for several years. Although there has been speculation that the increase in HPV-related mouth and throat cancers (which is on the rise) may be related to the increase in oral sex in earlier decades, there has been no definitive proof. The non-HPV-related head and neck cancers are related to alcohol and tobacco abuse.

HPV is only a problem when it is persistent. Most people clear the virus in the first or second year after infection.

This information leaves people with some decisions to make.

The Public Health message, which I consider unrealistic, has always been to use a latex barrier for oral sex. People don’t, and then they feel guilty.

Unfortunately, there are no screening tests for HPV in Canada; i.e., although a Pap test may indicate the presence of HPV, it does not test for it. Genital warts are generally diagnosed on visual examination. The overwhelming majority of adults will have been infected with some strain or other of HPV in their lifetime. Most of them will have gotten rid of it.

So here are your homework questions:

If you always use condoms with a male partner for intercourse (or at least, until you’ve both been tested), does that also apply for oral sex?

If someone tells you they have a history of cold sores, are you going to politely decline oral sex, use a latex barrier or say, just do it?

Will fear of cancer mean you’re going to cover your next lover’s genitals with latex before you give them oral sex, even though the numbers of these cancers are still relatively low?

If you’ve ever had a bout of genital warts, do you need to tell a partner before they put their lips on yours (the other ones) even though genital warts are more a nuisance than a danger?

Bottom line, we need to decide on the level of risk we are willing to take.

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