Safe practices

Oral sex

This post was originally published on Ferne Health.

Oral sex involves the use of mouth and tongue to stimulate a partner’s genital area, such as the vagina (cunnilingus), penis and testicles (fellatio) and anus (anilingus). It is a common sex practice and can be enjoyable with consent from both partners.

 

Oral sex without appropriate barrier protection comes with risks of sexually transmitted diseases (STDs). These diseases are transmitted through fluids or faeces secreted from the genitals or anus respectively, and you are even more likely to be at risk if you have a cut or sore in your mouth and are giving oral sex.

 

It is therefore important to discuss with your partners about the use of protection as well as history of sexual partners and getting tested for STDs on a regular basis.

 

STDs

The types of STDs that one may get through oral sex includes but are not limited to:

  • Human immunodeficiency (HIV)

  • Human papillomavirus (HPV) (see below for risks of oral and throat cancer)

  • Chlamydia

  • Gonorrhoea

  • Herpes Simplex

  • Syphilis

  • Hepatitis A

  • Parasitic infections such as shigellosis, giardia

  • Scabies

 

Please also note it is possible for one to contract STDs even if he/she/they has had just oral sex. It is not required to have other forms of sex for one to get STDs.

 

Tips on reducing risks of STDs when having oral sex

You can minimise the risks of STDs by using a condom for fellatio or using a dental dam for cunnilingus and anilingus. Also refrain from having oral sex if the receiving partner has sores in the mouth or bleeding gums, or if the giving partner has sores on the genitals (refer to the previous series on lumps and bumps of the vulva).

 

Infections associated with oral sex

While STDs can be transmitted through any forms of sexual contact as the infections are passed through fluids (such as blood and genital fluids), some infections are more specific to oral sex.

 

Anilingus or Rimming

Anilingus, commonly known as rimming, refers to oral-anal sex. With consent, it can be pleasurable for both partners. It is possible for one to not only get STDs from rimming, but also parasitic infections. These infections, such as giardia and entamoeba histolytica, are spread from the faeces of an infected person to another person’s mouth. Parasitic infections are initially transmitted through ingestion of static bodies of water (such as lakes or rivers contaminated with sewage), uncooked food or food that has not been prepared properly. It can occur to anyone of all ages, and is common in day care centres and food places with poor hygiene.

 

Symptoms include persistent diarrhoea and flu-like symptoms such as fever and fatigue. Treatment includes oral medications to kill the parasites. 

 

While parasitic infections are more common amongst men who have sex with men (MSM), it can occur to any straight or bisexual couples too. To reduce the risks of getting these infections, avoid having anilingus with a partner who has recently had diarrhoea. Please note that it may take a few weeks after the diarrhoea has stopped for the infection to clear from the body. Other ways to reduce the risk of transmission include showering and washing the genital area thoroughly prior to oral-anal sex and using dental dams.

 

Cunnilingus and fellatio

Oral-vaginal sex and oral-penile sex, also known as cunnilingus and fellatio respectively, carries similar risks of STDs to other forms of penetrative sex.

 

While it is commonly known that HPV can lead to cervical cancer through vaginal-penile penetration, fewer have heard of the associations between HPV and oral and throat cancer. Also known as oropharyngeal cancer, other known risk factors include smoking, alcohol, and some preserved foods like salted fish. Like cervical cancer, some high-risk strains of HPV will infect the surface of the skin - in this case the mouth and throat - and sometimes remain inactive for many years. At times it may cause growths on the tongue or mouth.

 

HPV vaccination is effective in reducing the risks of HPV-related oropharyngeal cancers. To reduce the risk of transmission, dental dams and condoms should be used while practising cunnilingus and fellatio.  

For more information, please visit: https://www.cdc.gov/std/healthcomm/stdfact-stdriskandoralsex.htm

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Anal sex 

Anal sex is sexual intercourse involving the anal region. This includes not only penile penetration, but also includes fingering, sex toys as well as oral contact (aka rimming). It is a popular sexual activity, and anyone of all sexual orientation can enjoy anal sex. While it is often considered a taboo and some may even think that anal sex is painful, it should not be seen that way and can be pleasurable for both partners. 

For the purposes of this article, the giver is defined as the one penetrating the anus, while the receiver is the one being penetrated. 


Beginner’s guide to anal sex


This guide provides an overview of some tips and tricks to incorporate into your life if you are thinking of having anal sex for the first time. It is good to use this guide with an open mind; you are encouraged to discuss your concerns openly with professionals or people that you trust. In addition, if you find yourself feeling uncomfortable at any stage when you are exploring anal sex for the first time, please know that you are able to pause and take a step back at any point. Please also approach anal sex with an open mind - if you dislike it the first time it does not always necessarily mean that it is not for you; there are many ways to enjoy anal sex, so feel free to discuss this with your partner and explore other ways to incorporate anal sex into your sexual routine. 

Most importantly, like all other forms of sexual activity, anal sex has to be CONSENSUAL. You should not feel obligated to perform anal sex with someone - whether or not you are at the giving or receiving end. It is highly recommended that you are able to discuss this openly with your partner(s). 


Toys for anal sex 


If you are venturing into the world of anal sex for the very first time, here are some toys to get you started. Toys often provide a safe space for us to explore and have an insight into what it is like to have anal sex for the first time. You may use it when you are alone or incorporate it into your sexual routine with your partner(s). You are highly encouraged to use lubricant to minimise the possibility of pain or injury as the anal region does not secrete natural lubricant fluids unlike the vagina. There are also lubricants specifically made for anal sex. 

Butt plugs are some of the most commonly used toys for anal sex and are often used by people of any gender. They come in various shapes and sizes and are made of different materials such as silicone, steel and glass. It is recommended that you use butt plugs instead of household objects or even some dildos and vibrators as they are made specially for anal sex - most butt plugs have a flared base to prevent them from being stuck further up the anus or even the rectum. There are many features of butt plugs. Some are textured to stimulate the anus, others feature various designs (e.g., tails and jewels) or made of glass for aesthetic purposes.

Anal beads are several balls joined together in a series. They are often thought to enhance anal stimulation as the act of removing the beads one by one are said to stimulate the nerve endings of the anal region. They vary in diameter and length, and like butt plugs, are made of different types of materials (often silicone, steel or glass). It is highly encouraged that you purchase good quality anal beads, as beads may be detached during removal. Therefore, extra precaution should be taken when removed, and should be counted after complete removal from the anus to ensure they are intact. 

Prostate toys often feature a curved tip designed specifically to stimulate and massage the prostate. These are often used on men or those with a prostate. Some are designed for masturbation when alone, and they can be hooked on the penis or feature an additional end to stimulate the penis and testicles at the same time. Most prostate toys come with a vibrating effect. 

Anal dildos are dildos designed for anal sex. Dildos are phallic-shaped objects designed to resemble a real-life penis. Commonly made of silicone, they can also be made of rubber, plastic, and even glass. The main difference between regular dildos for vaginal penetration and anal dildos is that anal dildos feature a flared base (see above for why flared bases are recommended). They can also be attached to a harness for a woman or someone without a penis, so that anal sex can be enjoyed by people of any gender. This is called pegging, an act involving the penetration of a strap-on dildo into an anus. When used amongst heterosexual couples, the gender roles are often reversed such that the wearer (often a woman or one without a penis) can penetrate their partner’s anus. 

There are other sex toys for anal sex out there, including anal hooks. When used correctly, these toys can be very stimulating and pleasurable for both partners. However, if you are exploring anal sex for the first time, you are encouraged to stick with the basics before venturing beyond your comfort zone. 

 

Having anal sex for the first time


It is highly encouraged that you openly discuss your concerns with your partner before having anal sex for the first time. When in bed, foreplay is an excellent way to get you in the mood. If you are sexually aroused, anal sex is often more enjoyable. We also recommend that you use lubricant. 

It is normal to have some concerns about hygiene. While it is not compulsory, you may consider having a shower before. You may even use an enema to clear your bowels. However, it is not always necessary - simply lay a towel on top of the bedsheets if you are worried about any faecal residue on your bed! Note that it is normal to feel like you want to poop or accidentally poop yourself during anal sex. Pooping is a natural process that is part of your body - everyone poops - there is nothing embarrassing about that. If you are concerned about the mess you have made, simply have a shower after. 

If you are having anal sex for the first time with a new partner, you should consider using a condom. The guidelines for regular sexual health screening apply to anal sex too. Refer to the section below for sexually transmitted diseases (STDs).

If you or your partner is the giver, you may start out with rimming (oral sex of the anal region) and fingering the anal region to get yourselves comfortable. Always go slow for the first time. You may encounter some resistance, which is common. Do not try to force your way into the receiving partner and try using more lube. Once the anal sphincter is fully relaxed, you may try to push gently inwards. Note that you or your partner can always stop at any point if you feel uncomfortable. 

Remember to clean up any toys that you have used during anal sex. You should also have a shower after, and clean up any dirty bed sheets and/or towels. 

Remember: do not double dip! This refers to vaginal penetration after anal penetration, which may increase the likelihood of urinary tract infections. 


Safe anal sex


Like all other forms of sex, it is important to practise safe sex habits. Having multiple sexual partners increases your chances of STDs such as HIV, chlamydia and gonorrhoea. Therefore, you should be tested regularly for STDs and to use barrier contraception such as condoms when having anal sex.


Anorectal symptoms 


Anal fissure is a tear in the lining of the anus. The most common cause of anal fissure is trauma-related. People who have anal fissure will experience an excruciating pain especially when passing motion. Bleeding may also occur. Most times, the tears will resolve on their own. Treatment includes stool softeners, sitz bath and increased fibre in the diet. And ointments may sometimes be given to relax the anal sphincter muscles. Patients should refrain from receiving anal sex during this period.

Anal warts may be found on people who have anal sex but can occur from other forms of sex. They arise from HPV infection. They usually do not present with symptoms. However, it is important to be treated and tested for HPV as untreated HPV can lead to anal cancers.

Proctitis, which refers to the inflammation of the rectum, can occur amongst people who receive anal sexual intercourse. There are other non-infective causes of proctitis such as inflammatory bowel diseases. Infective causes of proctitis include gonorrhea, chlamydia, syphilis and herpes simplex. People who have proctitis may experience pain in the anal and rectal region, bleeding or pus. Treatment includes a course of antibiotics. 
 

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