Sexual Health Resource Centre at Queen's University

Safer Sex

There are four general categories of contraceptive methods: abstinence, barrier methods, spermicidal methods, and hormonal methods. The only method that prevents transmission of STIs is using a barrier method.

Abstinence

Abstinence is a choice. It's the decision not to engage in some kind of sexual activity right now.

Abstinence is the only way to be 100% safe from sexually transmitted infections. This means abstaining from all activities that involve intimate contact. This means abstaining from intercourse, oral sex and anal sex. It also means abstaining from touching someone else's genitals and then touching your own genitals without washing your hands first. It means abstaining from touching someone else's genitals if you have cuts on your hands.

There are many different levels of abstinence. Every time you make a choice not to engage in sexual activity right now, you are abstaining.

Barriers

There are two barrier methods that can protect you and your partner from pregnancy: "male" condoms and reality or "female" condoms. Male condoms, reality condoms, dental dams, and gloves are all barrier methods that help prevent STI transmission.

(Male) Condoms: Usually made out of latex, but can be made out of polyurethane or sheep skin for those who are allergic to latex. The SHRC carries Durex Avanti condoms, which are made of polyurethane. Condoms are worn by a male and can be used for vaginal, oral or anal sex.

To prevent breakage, use lots of water-based lubricant (though not necessarily for oral sex, in which saliva acts as an excellent lubricant all on its own). For additional birth control, use contraceptive foam, spermicidal lubricant, vagincal contraceptive film, or hormonal birth control. There are ten steps to putting on a condom.

Reality/Female Condom: The Reality/Female Condom is a non-latex, polyurethane pouch with a small ring on one end and a larger ring on the other. In vaginal intercourse, the smaller ring fits over the woman's cervix allowing the pouch to hang out of the vagina. The larger ring remains outside the vagina protecting the vulva. In anal intercourse the small ring is removed and the large ring remains outside to protect the external anal tissue. The penis is inserted into the opening of the pouch.

This contraceptive method protects against STIs such as herpes or venereal warts that may have been outside of the barrier area with a male condom. Water-based lubricant is recommended for use with a reality/female condom to prevent friction and tearing.

Dental Dams: Dental dams are small flavoured sheets of latex that are used for safer oral sex. Place one side down on the vulva or anus and touch the other side with your tongue and mouth. This ensures there is a barrier between the genitals and mouth, preventing transmission of STIs.
Some STIs can be passed by direct skin-to-skin contact. Cut a hole in a dental dam and place it around an erect penis, coupled with a male condom to provide more protection.

Gloves: Gloves can be used for manual stimulation of the genitals or anus, fingering, or fisting. Latex or alternatives can be found at most drug stores.

Condoms and Lubricant: The Perfect Couple!

The more lubricant you use with a condom, the less the chance of breakage and the greater the chance of increased pleasure for both partners.
Safe with condoms: water-based lubes, silicone lubes, and saliva!
May weaken condoms: Monistat/Estrace/Femstat/Vagisil vaginal creams
Do not use: anything oil-based, for example Vaseline (petroleum jelly), massage oils, baby oil.

Spermicides

There are a number of spermicidal methods to choose from, including the diaphragm, the sponge, spermicidal foam, and vaginal contraceptive film.

Diaphragm: A diaphragm is a non-latex rubber dome that is inserted before intercourse and fits snugly over the cervix to prevent sperm from entering the cervical opening. To insert the diaphragm, put about a tablespoon of spermicidal jelly inside the diaphragm and a little around the rim. Next, squeeze the cup in half and slide it into the vaginal canal, adjusting it until it sits over (or cupping) the cervix. When positioned properly, the diaphragm should not restrict sexual activity. The diaphragm does NOT offer any protection against STIs. When used properly the diaphragm has a 4-8% failure rate of preventing pregnancies. The diaphragm can be inserted up to six hours before intercourse, but it MUST be left in for 6 hours following the last act of intercourse in order to be effective, however, to avoid risk of TOXIC SHOCK SYNDROME the diaphragm should be removed as soon as possible right after those 6 hours have passed. If you start to experience two or more of the warning signs of toxic shock syndrome (fever, rash, dizziness, vomiting, diarrhea, or muscular pain) take the diaphragm out immediately AND see a physician immediately.

When removing the diaphragm, wash it with soap and water and pat dry. Sprinkle the diaphragm with cornstarch (not talcum powder!), and store in a dry container. Before using the diaphragm again, ensure that there are no holes or tears (i.e. hold it up to the light, fill it with water, etc.).

Lastly, be aware that the diaphragm must be prescribed and fitted by a doctor, and that changes in weight of 10 pounds can affect the efficacy of the diaphragm, and may require that you purchase a new one.

The diaphragm can be used in conjunction with a condom without the same risks associated as using two condoms at once.

>> The diaphragm is associated with Toxic Shock Syndrome (TSS). Please see below for more information.

Foam: Contraceptive foam is a product that looks much like shaving cream. It comes in an aerosol can with a plastic reusable applicator. The foam has a sperm-killing ingredient in it called nonoxynol-9. The foam is inserted into teh vaginal prior to intercourse. It is water-soluble will break down inside the vagina and simply leak out. Reinsert foam between additional intercourse periods.

Sponge: Contraceptive sponges, which come soaked in nonoxynol-9, must be inserted into the vagina and wedged over the cervix 5-15 minutes before intercourse. In order to be effective, however, the sponge must be left in for 6 hours following the last act of intercourse. Note: the sponge is not designed to be reused. For each subsequent round of intercourse, a new sponge must be inserted (without removing the old one before the 6 hours have elapsed). The sponge offers NO protection against STIs. The sponge should be left in the vagina for a MAXIMUM OF 12 HOURS. The sponge is not recommended if the client has a prolapsed or reversed uterus. If you have ever had TOXIC SHOCK do not use the sponge. If you start to experience two or more of the warning signs of toxic shock syndrome (fever, rash, dizziness, vomiting, diarrhea, or muscular pain) take the sponge out immediately AND see a physician immediately.

>> The sponge is associated with Toxic Shock Syndrome (TSS). Please see below for more information.

Vaginal Contraceptive Film: This product is a paper-thin clear film that must be inserted into the vagina 5 minutes before intercourse but not more than 2 hours before. It needs to be pushed up to the cervix. The film dissolves so no removal is necessary. Additional film is inserted for each act of intercourse. The film contains nonoxynol-9 spermicide and does not protect against STIs. It is recommended for use with a condom only when STI transmission is not of concern.

Issues With Spermicides and STIs

Nonoxynol-9, the active ingredient in spermicide has been shown to cause microscopic tears in tissue lining of the vagina and anus and penis. If the condom were to break or fall off, the chance of STI transmission from an infected individual to an uninfected individual would increase. In order to ensure the highest level of STI protection, spermicide is not recommended for use with condoms. In order to ensure the highest level of contraceptive protection, spermicide is recommended for use in conjunction with condoms. It depends on the ultimate goal of the individual.

Spermicide Allergies

Some people are allergic to nonoxynol-9 and may develop a rash on their skin where it it applied. Come to the SHRC and try applying some on your wrist to test it first.

Hormonal Contraception

There are a number of hormonal methods to choose from, including the birth control pill, the mini-pill, EVRA, the Nuva Ring, and Depo-Provera. Hormonal birth control methods provide no STI protection.

All hormonal contraception involves the hormones (estrogen, progesterone, or both) being released into the body. They mimic a pregnancy, thus preventing ovulation. If no egg is released, then sperm have nothing to fertilize and pregnancy is avoided.

Birth Control Pill (BCP): The Pill should be taken every day at about the same time (within 1 hour) to ensure that the hormone levels remain the same. For example: when you put your underwear on in the morning or just before dinner/bed etc. Follow the markings on the packaging of the Pill to ensure you are taking the correct one on the correct day. On the 21st day you will either finish your pack (21 day pack) or start taking the placebo pill (28 day pack) for seven days. During this time you will have your period. After seven days you will start a new pack of Pills. Note: The pill must be taken for at least a month before it becomes fully effective.

If you miss a pill, be sure to use an additional method of contraception to protect yourself from unwanted pregnancy. If you forget to take your pill, take it as soon as you remember. Read the insert provided with your pills for further instructions.

Many women ask about taking the pill continually in order to avoid getting a menstrual period. It is okay to do this but not for many months in a row. This means that if one month you want to avoid getting your period, because of a vacation for example, you can start a new pack the day after the last pack. However, if you do this repeatedly the lining of your endometrium (the wall of your uterus that you shed during your period) will continue to grow and you may have breakthrough bleeding. When you finally do take the week off or the week of placebo pills, your period will be heavier due to thicker build up of the endometrial layer.

The BCP must be prescribed by a doctor. Talk with your doctor about whether BCP is right for you. It is not covered by Queen's or Ontario Health Plan.

Depo-Provera: This is an injection of hormones that is given once every 3 months by a nurse. It must be prescribed by a doctor, and it is not covered by Queen's or Ontario Health Plan.

Patch: The patch releases hormones into the body though the skin. It is placed somewhere on the body where it will not be rubbed off by friction. A new one is applied every week for three weeks. On the fourth week no patch is applied and menstruation occurs. The patch is prescribed by a doctor, and it is not covered by Queen's or Ontario Health Plan.

The Nuva Ring: The Nuva Ring is a ring of silastic tubing filled with slow release hormones that are released into the body through the vaginal wall. The ring is inserted into the vagina and sits around the cervix for three weeks. It is removed for the fourth week at which point you will get your period. After one week a new ring is inserted. This method requires you be comfortable inserting, removing and adjusting the placement of the ring in the vagina. It can be worn during sexual activity.

The IUD: The intrauterine device is a small t-shaped device that is composed of some copper wire and it releases progesterone. A physician inserts it into the uterus, and two small wires remain outside the cervix to help verify position and placement. The progesterone release prevents pregnancy in a similar method to the pill. The t-shape and the copper wire make the uterine wall inhospitable to implantation. The IUD has to be removed by a physician and is not a commonly recommended contraceptive method for younger women.

>> The IUD is associated with Toxic Shock Syndrome (TSS). Please see below for more information.

Natural Family Planning: This method is not recommended for young people. There are four methods:; These methods can be used to increase or decrease chance of pregnancy. Contraceptive effectiveness is very low since sperm can live in the female body for at least 48 hours.

Emergency Contraceptive Pill (ECP): This is NOT a form of birth control or a form of abortion. ECP can be taken within 72 hours of unprotected intercourse to prevent pregnancy for occuring. It consists of 2 large hormone doses (taken 12 hours apart) that prevent the egg from implanting in the uterus. You can get the ECP over the counter at most pharmacies.

>> More information about ECP

Toxic Shock Syndrome (TSS)

The diaphragm, sponge, and IUD are all associated with Toxic Shock Syndrome, a rare but serious, rapidly-developing illness. If you are using one of these contaceptive methods and you experience two or more of the following symptoms, seek medical attention immediately:

a sudden high fever (sudden high body temperature)
vomiting
a sunburn-like rash
diarrhoea
fainting or feeling faint
muscle aches
dizziness
confusion

If using a diaphragm or sponge, remove it immediately. An IUD must be removed by a doctor.

The Diva Cup (an alternative menstrual product) is NOT associated with TSS.

If you have any further question, please contact the Sexual Health Resource Centre by calling (613) 533-2959 or visiting our office in person in Room 223 of the John Deutsch University Centre at Queen's University.