SEXUAL PRACTICES & SAFER SEX

1. SEXUAL PRACTICES & SAFER SEX Venkatesan Chakrapani, M.D. cvenkatesan@hotmail.com

2. Penetrative sexual practices • Vaginal sex (peno-vaginal intercourse) • Anal sex – insertive, receptive (peno-anal intercourse) • Oral sex – Fellatio (Peno-oral sex) • Anilingus (oro-anal sex) • Cunnilingus (oro-vaginal) • Fingering – introducing finger into rectum or vagina • Fisting – introduction of fist into rectum or vagina Venkatesan C, Sxl practices & Safer sex

3. Dry kissing Wet (French) kissing Sensual touching Self-masturbation Mutual Masturbation Necking Caressing Hugging Frottage Breast caressing Breast sucking Erotic talk Using sex toys Sharing fantasies Telephone sex Cyber sex Bubble bath Water sports OTHER SEXUAL / EROTIC PRACTICES (Partial list) Venkatesan C, Sxl practices & Safer sex

4. Vaginal sex • Use male condoms correctly and consistently. • Female condom can be used by females. • Water-based lubricants can be used. (Condoms are usually pre-lubricated) Venkatesan C, Sxl practices & Safer sex

5. FEMALE CONDOM Venkatesan C, Sxl practices & Safer sex

6. Anal sex • A single male condom – to be correctly applied • Water-based lubricants to be used (oil-based lubricants to be avoided). • Whether to use double condoms? • Whether female condoms can be used for anal sex? • Need to teach condom negotiation skills to our patients (besides providing condoms) Venkatesan C, Sxl practices & Safer sex

7. Oral Sex (Fellatio) • Oral sex is not absolutely risk-free of HIV infection • Risk of HIV infection if semen is swallowed? • Some STDs can be acquired or transmitted by oral sex (warts, herpes) • Flavored condoms (strawberry, chocolate) are available for oral sex. Venkatesan C, Sxl practices & Safer sex

8. Rimming (Oro-anal sex) • Some STDs can be transmitted by rimming. • HIV risk is very minimal • Dental Dam or Oral dam can be used to decrease risk of acquiring STDs. Venkatesan C, Sxl practices & Safer sex

9. Cunnilingus and Dental Dam Venkatesan C, Sxl practices & Safer sex

10. Fingering • Finger gloves – can be made from hand gloves. • Some infections can be passed on if finger gloves are not used in fingering. • Sometimes a condom can worn in the finger in absence of finger gloves (beware of slipping!) Venkatesan C, Sxl practices & Safer sex

11. HIV-INFECTED PERSONS - addressing safer sex issues

12. HIV-INFECTED PERSONS - addressing safer sex issues • Highly active antiretroviral therapy (HAART) does not eliminate the risk of transmitting HIV to others; • A person with undetectable viral load can still transmit HIV infection • A person with HIV-2 infection needs to use condoms even though HIV-2 is “less infectious”. • “Nonoccupational postexposure prophylaxis” is of uncertain effectiveness for preventing infection in HIV-exposed partners. Venkatesan C, Sxl practices & Safer sex

13. HIV-INFECTED PERSONS - addressing safer sex issues… Explain to HIV-infected persons about how safer sex practices can help them? • prevention of acquiring new STDs • prevention of superinfections with other HIV type/strains (virulent and drug-resistant) • STDs can accelerate progression to AIDS Venkatesan C, Sxl practices & Safer sex

14. How doctors can better equip themselves to serve their patients better? • Be open-minded • Understand our own moral values and biases • Don’t let our moral values affect the quality of clinical care we provide to our patients. • Improve our knowledge and skills to effectively provide clinical care to persons belonging to diverse sexualities Venkatesan C, Sxl practices & Safer sex

15. Conclusion Clinicians have professional and ethical responsibility to address sexuality issues with their patients so as to - give them appropriate clinical care and - to prevent their patients from STD and HIV. Venkatesan C, Sxl practices & Safer sex