Aa
Safer sex protocol for open relationship?
Hi Docs,
My wife and I (I am male) are embarking on an open relationship, and we are trying to devise a safer sex protocol that maximizes fun, while still mitigating risks to a reasonable level.
Background: We intend to test ourselves every 6 months to a year, presuming we are active with outside partners. Most of our outside partners will be friends from swing or BDSM clubs; recurrent play partners with whom we would communicate about their STI protocols. Occasional one night stands are possible.
We’re both straight, and would be having limited to no sexual contact with members of the same sex.
We realize that nothing in life is risk free; there's a chance of dying in a car wreck every day you drive. We just want to take realistic precautions that allow us to have fun and be safe. Most choices are clear (condoms for vaginal / anal penetration, no protection for cunnilingus or masturbation) but fellatio seems less obvious. We also have a question about pregnancy risk.
1) Within our sex-positive community, condoms for fellatio are rarely used. Is this risky behavior? It seems as though STIs other than Herpes that could be transmitted can also be treated. Therefore, is no condoms for oral, along with regular testing, a safe approach?
2) Does it make any difference one “spits or swallows?”
3) Surprisingly, one partner of ours who does engage in sex with many others is not on birth control. (She is 41.) Because of condom usage failure rates (15% according to Wikipedia), my wife and I had previously agreed that we would only have intercourse with others who were on some other form of birth control, in addition to condoms. However, would another reasonable approach be to combine condoms with the withdrawal method, figuring the yearly failure rate to be about 2.7%? (.15 condoms * .18 withdrawal = .027 combined?)
What are your thoughts on this approach? Is there anything I need to be concerned about that I’m missing?
My wife and I (I am male) are embarking on an open relationship, and we are trying to devise a safer sex protocol that maximizes fun, while still mitigating risks to a reasonable level.
Background: We intend to test ourselves every 6 months to a year, presuming we are active with outside partners. Most of our outside partners will be friends from swing or BDSM clubs; recurrent play partners with whom we would communicate about their STI protocols. Occasional one night stands are possible.
We’re both straight, and would be having limited to no sexual contact with members of the same sex.
We realize that nothing in life is risk free; there's a chance of dying in a car wreck every day you drive. We just want to take realistic precautions that allow us to have fun and be safe. Most choices are clear (condoms for vaginal / anal penetration, no protection for cunnilingus or masturbation) but fellatio seems less obvious. We also have a question about pregnancy risk.
1) Within our sex-positive community, condoms for fellatio are rarely used. Is this risky behavior? It seems as though STIs other than Herpes that could be transmitted can also be treated. Therefore, is no condoms for oral, along with regular testing, a safe approach?
2) Does it make any difference one “spits or swallows?”
3) Surprisingly, one partner of ours who does engage in sex with many others is not on birth control. (She is 41.) Because of condom usage failure rates (15% according to Wikipedia), my wife and I had previously agreed that we would only have intercourse with others who were on some other form of birth control, in addition to condoms. However, would another reasonable approach be to combine condoms with the withdrawal method, figuring the yearly failure rate to be about 2.7%? (.15 condoms * .18 withdrawal = .027 combined?)
What are your thoughts on this approach? Is there anything I need to be concerned about that I’m missing?
MEDICAL PROFESSIONAL
Sorry I missed your reply. These replies will be brief- typically we do not encourage follow-up questions that are longer than the original question.
1. Gonorrhea of the penis is typically symptomatic (more than 95% of the time). In contract, most throat infections due to gonorrhea and the few that occur due to chlamydia are asymptomatic.
2. There are no scientific data to answer this question. It is clear that fellatio without ejaculation into the mouth can lead to infection. it is logical that ejaculation might deliver more bacteria to the site of potential infection than if ejaculation did not occur but how much of a difference this might make is unknown.
3. I think the true answer is somewhere in between. Logically, withdrawal would be expected to reduce the amount of sperm delivered into the vagina and thus would be associated with a reduction in pregnancy risk. At the same time, there are many, many pregnancies that have resulted from reliance of withdrawal for pregnancy avoidance. It is clear that pre-ejaculatory fluid can be a source of sperm/pregnancy (as well as infection). I would not encourage anyone who really wants to avoid pregnancy to rely on withdrawal as their sole means of contraception.
I hope these clarifications are helpful. EWH
1. Gonorrhea of the penis is typically symptomatic (more than 95% of the time). In contract, most throat infections due to gonorrhea and the few that occur due to chlamydia are asymptomatic.
2. There are no scientific data to answer this question. It is clear that fellatio without ejaculation into the mouth can lead to infection. it is logical that ejaculation might deliver more bacteria to the site of potential infection than if ejaculation did not occur but how much of a difference this might make is unknown.
3. I think the true answer is somewhere in between. Logically, withdrawal would be expected to reduce the amount of sperm delivered into the vagina and thus would be associated with a reduction in pregnancy risk. At the same time, there are many, many pregnancies that have resulted from reliance of withdrawal for pregnancy avoidance. It is clear that pre-ejaculatory fluid can be a source of sperm/pregnancy (as well as infection). I would not encourage anyone who really wants to avoid pregnancy to rely on withdrawal as their sole means of contraception.
I hope these clarifications are helpful. EWH
I'm bumping this in the hopes of a follow up. It looks like my additional comments had not been noticed. Could you please take a look? Thanks!
Hi Dr. Hook,
Thanks for your thorough response; my wife and I appreciate it. I have a couple of follow ups.
You wrote, "It appears that the decision/preferences of your potential partners do not include condoms which are the best way to reduce risk for infection and conversely, choosing not to increases risk."
To clarify, condoms are regularly used in our local community for vaginal (and presumably anal) sex, from what I've seen. It's really just oral that I had noted people don't seem to use barriers. Based on your advice, and other posts I've read here from Dr. HHH, it seems like that is a lower risk activity.
re: Q1 - We both plan to get tested frequently all the same, but are Gonorrhea and oral chlamydia asymptomatic only in the throat? I seem to recall reading here that penile Gonorrhea is generally symptomatic. Are there special tests my wife should have done if they are testing for these in the throat?
re: Q2 - Follow up from my wife - does fellatio without a condom risk decrease at all if she ceases fellatio before the other man ejaculates?
re: Q3 - To be honest, I was surprised to read that your response that withdrawal would not at all further reduce pregnancy risk if combined with condoms. I had read conflicting information around the 'net, which is why I asked about it here.
In particular, there is this article (http://www.guttmacher.org/pubs/journals/reprints/Contraception79-407-410.pdf) from Contraception 79 in 2009 that states:
"Withdrawal may be an effective back-up method for couples who have difficulties using other contraceptives, including women who have trouble taking pills regularly and couples who irregularly use condoms. It is unfortunate that some couples do not realize they are substantially reducing their risk of pregnancy when using withdrawal, as these misperceptions may cause unnecessary levels of anxiety."
Further, the planned parenthood website also states, "You can make condoms more effective if you use spermicide with them pull out before ejaculation," on this site (http://www.plannedparenthood.org/health-topics/birth-control/condom-10187.htm) and they further discuss the topic here (http://asktheexperts.plannedparenthood.org/?p=3922) and here (http://asktheexperts.plannedparenthood.org/?p=4060).
To be honest, after reading so many posts here, I tend to put a lot of faith in what you and Dr. HHH have to say, so I don't know what to make of this. Could you perhaps elaborate, based on the information in the cited articles?
Thanks again for such an informative, and unbiased resource.
Thanks for your thorough response; my wife and I appreciate it. I have a couple of follow ups.
You wrote, "It appears that the decision/preferences of your potential partners do not include condoms which are the best way to reduce risk for infection and conversely, choosing not to increases risk."
To clarify, condoms are regularly used in our local community for vaginal (and presumably anal) sex, from what I've seen. It's really just oral that I had noted people don't seem to use barriers. Based on your advice, and other posts I've read here from Dr. HHH, it seems like that is a lower risk activity.
re: Q1 - We both plan to get tested frequently all the same, but are Gonorrhea and oral chlamydia asymptomatic only in the throat? I seem to recall reading here that penile Gonorrhea is generally symptomatic. Are there special tests my wife should have done if they are testing for these in the throat?
re: Q2 - Follow up from my wife - does fellatio without a condom risk decrease at all if she ceases fellatio before the other man ejaculates?
re: Q3 - To be honest, I was surprised to read that your response that withdrawal would not at all further reduce pregnancy risk if combined with condoms. I had read conflicting information around the 'net, which is why I asked about it here.
In particular, there is this article (http://www.guttmacher.org/pubs/journals/reprints/Contraception79-407-410.pdf) from Contraception 79 in 2009 that states:
"Withdrawal may be an effective back-up method for couples who have difficulties using other contraceptives, including women who have trouble taking pills regularly and couples who irregularly use condoms. It is unfortunate that some couples do not realize they are substantially reducing their risk of pregnancy when using withdrawal, as these misperceptions may cause unnecessary levels of anxiety."
Further, the planned parenthood website also states, "You can make condoms more effective if you use spermicide with them pull out before ejaculation," on this site (http://www.plannedparenthood.org/health-topics/birth-control/condom-10187.htm) and they further discuss the topic here (http://asktheexperts.plannedparenthood.org/?p=3922) and here (http://asktheexperts.plannedparenthood.org/?p=4060).
To be honest, after reading so many posts here, I tend to put a lot of faith in what you and Dr. HHH have to say, so I don't know what to make of this. Could you perhaps elaborate, based on the information in the cited articles?
Thanks again for such an informative, and unbiased resource.
MEDICAL PROFESSIONAL
Welcome to the Forum. I'll be happy to comment. Your approach is thoughtful and, as you point out, there are ways to modify the risk for acquisition of STIs, as well as to moderate their consequences should you get infected. The major issue in play here is the matter of just how "open" are the relationships of your other partners. Risk for STIs is a numbers game and as persons have more partners, who in turn have had other partners, the risk for infection goes up. Testing for STIs before entering into such relationships is a good way to reduce risk as is periodic checkups’ Subsequently as persons have sex with other partners who may have had sex with others themselves. It appears that the decision/preferences of your potential partners do not include condoms which are the best way to reduce risk for infection and conversely, choosing not to increases risk.
As for your specific questions:
1) Within our sex-positive community, condoms for fellatio are rarely used. Is this risky behavior? It seems as though STIs other than Herpes that could be transmitted can also be treated. Therefore, is no condoms for oral, along with regular testing, a safe approach?
The risks for STI transmission through oral sex are lower than for vaginal sex, both because of the fact that such infections are somewhat less common than genital infections and because the act itself is less likely to lead to transmission. Herpes is a consideration for persons who have not yet had HSV-1 infection (about 60% of people have, even though most who have been infected do not know it). Gonorrhea occurs infrequently and oral chlamydia is rare but does occur. In both cases these infections can be asymptomatic and therefore testing is important for detection, treatment and prevention of transmission to others. Syphilis is very, very rare and transmitted by direct lesion/sore contact. Finally, there has been much in the news recently about oral HPV infections and cancer risk- the risk of this occurring is quite low- here is a like to another post in which Dr. Handsfield discusses this topic - http://www.medhelp.org/posts/STDs/HPV-and-oral-sex/show/1515473 ; and http://www.medhelp.org/posts/STDs/Oral-HPV-Cancer-Risk/show/1512873 ;.
2) Does it make any difference one “spits or swallows?”
No, spitting vs swallowing oral sex is not known to impact STI risk in any way.
3) Surprisingly, one partner of ours who does engage in sex with many others is not on birth control. (She is 41.) Because of condom usage failure rates (15% according to Wikipedia), my wife and I had previously agreed that we would only have intercourse with others who were on some other form of birth control, in addition to condoms. However, would another reasonable approach be to combine condoms with the withdrawal method, figuring the yearly failure rate to be about 2.7%? (.15 condoms * .18 withdrawal = .027 combined?)
Withdrawal is ineffective as a pregnancy prevention measure and wold not add to reduced risk. The only other thing I would add to your thoughts above is that as persons become older fertility (i.e. the likelihood of becoming pregnant) diminishes. Thus this woman's risk for pregnancy may be lower than that of a woman half her age.
I hope these comments are helpful to you. As you imply, being attuned to the possibility of STIs and regular testing will be an important of assuring and preserving sexual health for you and your wife. EWH
As for your specific questions:
1) Within our sex-positive community, condoms for fellatio are rarely used. Is this risky behavior? It seems as though STIs other than Herpes that could be transmitted can also be treated. Therefore, is no condoms for oral, along with regular testing, a safe approach?
The risks for STI transmission through oral sex are lower than for vaginal sex, both because of the fact that such infections are somewhat less common than genital infections and because the act itself is less likely to lead to transmission. Herpes is a consideration for persons who have not yet had HSV-1 infection (about 60% of people have, even though most who have been infected do not know it). Gonorrhea occurs infrequently and oral chlamydia is rare but does occur. In both cases these infections can be asymptomatic and therefore testing is important for detection, treatment and prevention of transmission to others. Syphilis is very, very rare and transmitted by direct lesion/sore contact. Finally, there has been much in the news recently about oral HPV infections and cancer risk- the risk of this occurring is quite low- here is a like to another post in which Dr. Handsfield discusses this topic - http://www.medhelp.org/posts/STDs/HPV-and-oral-sex/show/1515473 ; and http://www.medhelp.org/posts/STDs/Oral-HPV-Cancer-Risk/show/1512873 ;.
2) Does it make any difference one “spits or swallows?”
No, spitting vs swallowing oral sex is not known to impact STI risk in any way.
3) Surprisingly, one partner of ours who does engage in sex with many others is not on birth control. (She is 41.) Because of condom usage failure rates (15% according to Wikipedia), my wife and I had previously agreed that we would only have intercourse with others who were on some other form of birth control, in addition to condoms. However, would another reasonable approach be to combine condoms with the withdrawal method, figuring the yearly failure rate to be about 2.7%? (.15 condoms * .18 withdrawal = .027 combined?)
Withdrawal is ineffective as a pregnancy prevention measure and wold not add to reduced risk. The only other thing I would add to your thoughts above is that as persons become older fertility (i.e. the likelihood of becoming pregnant) diminishes. Thus this woman's risk for pregnancy may be lower than that of a woman half her age.
I hope these comments are helpful to you. As you imply, being attuned to the possibility of STIs and regular testing will be an important of assuring and preserving sexual health for you and your wife. EWH
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
