Safer Sex Update

Although people have grown tired of hearing the same old finger-wagging 'always use a condom' message, a whole generation is coming of sexual age without having feared the specter of imminent death from AIDS complications. Well, never one to care about fads, I, for one, would like to review the latest about safer sex. The rather wide range of what people consider sexual activity limits a comprehensive list of the dos, don'ts, and maybes of safer sex. Hence, I am able to present only some of the more common behaviors that humans find pleasurable in bed. If you don't find one of your favorites below, just remember that anything in which the exchange of bodily fluid is possible'for example, blood, semen, precome, vaginal secretions, or breast milk'can be dangerous. The Highs, Lows, and In-betweens For simplicity's sake, I will divide my list of activities into these three simple categories: ' Very safe (low risk)'Dry, or closed-mouth, kissing; wet, open-mouth kissing if there is no damage to the gums or skin in the mouth; mutual masturbation; body-to-body rubbing (with intact skin); oral, vaginal, or anal sex with a properly used, intact latex or polyurethane condom; giving or receiving anilingus ('rimming'); external water sports (getting urine on your body); fisting or being fisted with a partner wearing a clean glove; use of clean, nonshared dildos; fetish play without fluid exchange; phone sex or cybersex. ' Somewhat safe (intermediate risk)'Unprotected oral sex without coming in someone's mouth, internal water sports (getting urine in your body), being fisted or fisting without wearing gloves. ' Dangerous (high risk)'Vaginal or anal sex without a condom, unprotected oral sex with ejaculation, sex while intoxicated, sex with a person with another sexually transmitted disease that causes open sores and that can disrupt intact skin (like herpes, syphilis, chancroid). Other Situations to Avoid Heads up, people! Here are two situations that you might not have thought of but that may put you at high risk for acquiring HIV: ' The turkey baster'This is where one partner has potentially infected body fluids on his or her hands or fingers and then inserts them into the partner's body. Wash your hands, everybody! ' The condom flip'This happens when someone starts to place a condom on the tip of an erect penis and then realizes that the condom is rolled backward. The person then flips the condom over after it has touched the head of the penis (with potentially infectious precome on it) and rolls it onto the erect penis. The problem is that this fluid-contaminated condom is no longer safe, since it has been flipped and the fluid is now on the outside. When in doubt, throw it out! At the Quick and Ready Finally, here's a short list of stuff that you should have handy to make safer sex more likely to happen when romance sneaks up on you: ' Latex or polyurethane condoms'Make sure that they are new, intact, and rolled properly. Heat, old age, insufficient lubrication, oil-based lube, and air bubbles can all contribute to condom failure. ' Water-based lubricants'Avoid anything containing oils or the spermicide nonoxynol-9. ' Dental dams, finger cots, latex gloves, plastic wrap'If you plan to use or insert fingers or hands during sex, wrap 'em up. ' Your doctor's phone number'If all else fails and you think a potentially serious exposure has just occurred, immediately call your doctor to discuss postexposure prophylaxis. A four-week regimen of anti-HIV medications, if started within the first 36 to 72 hours after exposure, might provide a decent chance to keep your partner from becoming HIV-positive. Cohan is an attending physician and managing director with Pacific Oaks Medical Group, one of the nation's largest practices devoted to HIV care, located in Beverly Hills, Calif.