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Is oral sex safer?

Preventing HPV and other STIs
Monday, June 10, 2013
Knowing your partner’s history is crucial. People must be selective about who they choose to become sexually active with.

With the rise of sexually transmitted diseases such as HIV, there is a perception that oral sex is a “safer” option than penetrative sex. 


Popular hip hop songs like Lil Wayne’s Lollipop and Flo Rida’s Blow my Whistle give explicit details about the pleasures of oral sex. 


Becoming an expert at it remains high on the agenda for many people, but few are aware that it may expose you to a range of sexually transmitted infections (STIs) including the Human papillomavirus (HPV), which causes cervical cancer. But last week Hollywood actor Michael Douglas brought the issue into the spotlight when he was reported as having said he got throat cancer from cunnilingus.


In a BBC news story published recently, Prof Robin Weiss, an expert in viral oncology at University College, London, said although throat cancer was relatively uncommon in the adult population, oral sex is common and far more people carry the virus in their throats than actually develop the cancer. The World Health Organisation says HPV can cause cancer of the head and neck. 


Sex therapist Ferose Abdool, who runs a practice in south Trinidad, said popular culture in the western world has been a driving force behind the increased focus on oral sex. 


But because of the risk of disease, Abdool believes there must be public education about the dangers of oral sex, which was traditionally considered an unmentionable subject. 


“Schoolchildren are now bombarded with information about the risks of sex, particularly HIV/Aids, so they believe that oral sex can be safer than penetrative sex. Young people who feel they are not yet ready to engage in sex may choose to engage in oral sex without recognising the dangers therein,” Abdool said. He added, “While sex as we know is only part of human sexuality, we must be careful. Couples may need to pleasure each other in different forms and fashions, but they must be aware of the dangers in certain types of practices.”


Abdool said knowing your partner’s history is crucial, adding that one must be selective about who one chooses to become sexually active with. He said the use of dental dams and condoms may provide a measure of protection.


However, Abdool said HPV is not the only threat. Other STIs that are commonly caught via oral sex are gonorrhoea, genital herpes and syphilis. Infections that are less frequently passed on through oral sex include chlamydia, HIV, hepatitis A, B and C, genital warts and pubic lice.


Abdool said there was a need for a public awareness campaign to make people aware of proper oral sex practices.


Doctors: it’s still safer


However, in a telephone interview, Health Minister Dr Fuad Khan said the connection between HPV and oral sex had not been proven.


“This link has not been proven to be internationally accepted as a concern. There is nothing in the literature that indicates any correlation between oral sex and disease processes,” Khan said.


He added “Saliva has protective ingredients and anti-bacterial and virucidal elements, so to engage in a discussion based on subjectivity at this point will be futile and unnecessary.”


STI specialist Dr Colin Furlonge said oral sex was a safer option than penetrative sex, and there was no statistical proof that oral sex was on the rise, nor was there undisputed proof that it was the sole cause of viral infections. In his clinical practice, he said, he had not seen a rise in conditions associated with oral sex over the past 20 years.


“Oral sex is less risky than penile or anal sex,” he concluded.


He said male and female condoms can be used to prevent STDs. 


Gynaecological oncologist Dr Anthony Pottinger said it would be ridiculous to educate people about the “dangers” of oral sex, because people get throat and neck cancer mainly because of cigarette and alcohol usage and not necessarily because of HPV transmission through oral sex. He said the comparative risks were 80:20.


Instead, Pottinger recommended a public education campaign on the spread of HPV.


“It would be more wise to educate people about HPV because everybody is exposed to HPV once they become sexually active,” Pottinger said.


He said three strains of HPV are responsible for 93 per cent of cervical cancer.


“Out of this HPV 16 is the worse, because it is responsible for 50 per cent of cervical cancer. HPV 45 and HPV 31 are the least rated, as they account for ten to 15 per cent of cervical cancers.”


He said in T&T, HPV strains 16, 18, and 45 were responsible for 93 per cent of cervical cancer. 


“The main target of the virus is the cervix,” Pottinger said. He noted that 80 per cent of vaginal and vulval cancers were caused by HPV while 100 per cent of anal cancer is due to HPV.


Pottinger recommended that the ministry should educate women about the need to get the HPV vaccination, and said vaccinating young girls who are not yet sexually active was a good initiative. 


However, he said sexually active women should seek to get their three vaccinations within a six-month period to eliminate their chances of getting HPV, and regular Pap smears were also necessary. 


Pottinger said vaccinations are available at medical health institutions and offer protection against the virus.




On June 3, the UK Guardian published an interview with the actor Michael Douglas in which he said that his cancer was "caused by HPV (human papillomavirus), which actually comes from cunnilingus".


Allen Burry, a spokesman for the actor, has since denied that Douglas said that oral sex was the cause of his own cancer, but was merely one of the many causes of oral cancer. "In a discussion with the newspaper," the Associated Press quotes Burry as saying, "they talked about the causes of oral cancer, one of which was oral sex, which is noted and has been known for a while now."


The Guardian firmly denied this charge of misrepresentation. Mr Burry was not present at the Guardian's interview with Michael Douglas; the only two people present were Mr Douglas and the Guardian writer, Xan Brooks. 


Here is a verbatim transcript of that section of the interview


Xan Brooks: Do you feel, in hindsight, that you overloaded your system? Overloaded your system with drugs, smoking, drink?


Michael Douglas: No. No. Ah, without getting too specific, this particular cancer is caused by something called HPV, which actually comes about from cunnilingus.

Source: Guardian


How to prevent STIs during oral sex


Use a latex barrier from start to finish of oral sex.


Use a non-lubricated or a flavoured condom on a penis or sex toy. Condoms with spermicide can numb the mouth and don't taste very good.


Don't use food products like whipped cream or chocolate sauce with the condom or dental dam because they may be oil-based, and oil-based lubricants break down latex.


For oral sex on a woman or for oral-anal stimulation, use a dental dam or plastic food wrap, or cut a condom lengthwise to make your own dental dam.


You have increased risk of being exposed to STIs during oral sex if: 


•you have gum disease, cuts or sores, 


•you've had recent dental work that bruised any tissue in your mouth


•you have vigorously brushed or flossed. 


During the six weeks after any type of oral or genital piercing, avoid any type of oral sexual contact. 


Wait six weeks even if you are in a mutually monogamous relationship, because until it is completely healed, the piercing is an open wound and provides easy access for bacteria and viruses.



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