To cover or not to cover: that is the dam question

True confession: I have always been ambivalent about safer oro-genital sex.

Although we talked a good line about it at Toronto Public Health (TPH) where I worked as a sexual health educator for 30 years, no one was listening.  As did other health units, we even suggested cutting up a condom to use over the vulva or anus if they didn’t have a dental dam.  Maybe they still do.  But I felt we were asking people to take a step they were unlikely to follow; and I was afraid they would dismiss all of our risk reduction strategies.  For that reason, I tried – and failed – to take barrier protection for oro-genital contact out of our print materials.

At the TPH sexual health clinic where I worked as a counsellor, sex workers were the only people protecting themselves and their clients by using condoms for oral sex on a penis.

I recently posted an article about dental dams and some 40 year olds of my acquaintance said – and I quote – “A what”?  They had never heard of dental dams.

“…about 30 years after dams hit the market, awareness of and demand for them remains shockingly low.”

Nope.  Not shocking at all.  Practically no one asked for dams at clinic during those 30 years.

When I read the article, I did think they could have specified exactly which Sexually Transmitted Infections (STIs) one could contract through unprotected mouth to genital contact.  This can be critical information for some.  We know, for example, that men having unprotected oral sex with multiple male partners are at a higher risk for HIV if they are already infected with syphilis.  But when I broached condom use to these men at clinic, they said their risk reduction strategy was more frequent testing.  So we tested them more frequently.  There was no way they were going to use condoms for oral sex.

So here we go…

Oro-genital sex and STIs – the facts

Syphilis.  Not a common STI but on the rise, including congenital syphilis  Syphilis is known as the great imitator because the symptoms may mimic other STIs.  The first symptom is a chancre (pronounced “shanker”) which may appear at the point of contact.  However, if you have a chancre in your mouth or just inside the anus, you may not be aware of it because it is a painless sore.  If untreated, syphilis may advance to a second or a third stage, eventually damaging internal organs and causing death.  As I said above, it also increases the risk for the transmission of HIV because the virus can enter the bloodstream more easily if there is a chancre.  Syphilis is cured by antibiotics.

Otherwise, unprotected oro-genital sex is considered low risk for HIV.  For a person who is HIV positive and taking medication, it is almost impossible to transmit.

Gonorrhea and chlamydia are both transmissible through unprotected oro-genital sex – and they are both curable with antibiotics.

Hepatitis A virus, Shigella and intestinal parasites (amebiasis) can be spread through giving unprotected oral sex on the anus.

HSV-1 (herpes 1) causes cold sores.  Like genital herpes (HSV-2), it is easy to transmit even when there are no sores.  During workshops on STIs, I used to tell people that getting HSV-1 wasn’t the end of the world.  It tends not to be as painful as genital herpes and recurs less frequently.  It is also more difficult to transmit from one person’s genitals to another’s.

If you have a history of cold sores, it is only fair to tell a partner before using your mouth on their vulva, penis or anus.  They need to know about the possibility of transmission even when there is no cold sore present.  The next step is to ask if they want to use barrier protection or not.  It’s their decision.  (Here is more  information)

HPV (Human Papillomavirus).  You have heard about this virus in its relation to cervical cancer.  More recently, there has been a lot of discussion about HPV and “head and neck cancers” which may start in the mouth, nose, throat, larynx, sinuses, or salivary glands.

“Alcohol and tobacco are known risk factors for most head and neck cancers, and incidence rates are found to be higher in regions with high rates of alcohol and tobacco consumption.  During the past few decades, several countries have witnessed a decline in oral cavity cancer incidence correlating to a decline in tobacco use. However, Canada, Denmark, the Netherlands, Norway, Sweden, the United States, and the United Kingdom, have seen an increasing rate of oropharyngeal and oral cavity cancers despite declines in smoking rates since the 1980s. This has led to theories that human papillomavirus (HPV) infection might be an additional risk factor for developing certain head and neck cancers.”

Current research is focusing on the relationship between the increasing inclusion of oral sex in people’s sexual repertoire and the spread of HPV to the oral cavity.  Before you panic and head for the dams, it should be pointed out that most people clear HPV infection with a good immune system; and that the number of oral sex partners tends to increase risk.

Bottom line…

We know that we need to negotiate safer sex when it comes to genital to genital contact.  For some, that means we get tested for the usual suspects (chlamydia, gonorrhea and HIV) and then decide if we are going to use barrier protection.  In the same way, we need to talk about our oro-genital behaviours.  In the end, it’s up to you.

 

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