Sexual Health and Pleasure

Origins of “safer sex”
The phrase “safer sex”itself did not emerge until the beginning of the AIDS epidemic in the 1980s. In “How to Have Sex in an Epidemic”, AIDS activists Richard Berkowitz and Michael Callen introduced the concept of “safer sex” as methods gay men could use to reduce the possibility of infecting one another with the pathogen causing AIDS (later identified as HIV). Today “safer sex”, based on the understanding that having sex brings some level of risk and that people can be proactive about minimizing this risk, is widely recommended as a practice for sexually active people.

STI Risks and Risk Reduction
Many people think of oral sex or anal sex as safer sex because pregnancy cannot occur. Yet engaging in any intimate contact in which you or others are exposed to body fluids (vaginal fluids, semen, blood, and pre-ejaculate) carries risks for all partners. Barrier methods (e.g. condoms, dental dams, gloves) prevent STI (sexually transmitted infection) transmission by blocking the exchange of body fluids.

Some STIs, such as HPV (human papilloma virus) and herpes, can be transmitted via skin-to-skin contact through warts/sores that may not be visible or covered by barriers. Therefore, STI transmission can occur even when barrier methods are used. Employing practices such as using barriers reduces harm, but does not make sex completely safe.

Some Great Ways to Have Safer Sex

• Use barrier methods (with lubricant) correctly and consistently on body parts or toys involved in any type of sex
• Get immunized against some viral STIs (e.g. Hepatitis B and HPV)
• Get a full screening for STIs (and get treatment if you test postive):
  • at least once a year
  • before starting a new sexual relationship
  • after having unprotected sex
  • if you think your partner has an STI
• Choose intimate acts that don’t involve exposure to others’ body fluids (e.g. masturbation, phone sex, cuddling, etc.)
• Make lifestyle choices such as:
  • avoiding sex when drinking alcohol or using drugs
  • having mutually exclusive sexual relationships
  • limiting number of partners

Safer Sex is Better Sex
Safer sex practices can seem challenging, unfun and unsexy — focused on the negative. Instead of thinking of safer sex as a list of things that you have to do or should not do, think of it as a way to practice self-care and care for others. Make it a part of your lifestyle, just like brushing your teeth!

Sex is about intimacy, eroticism, fantasy, and desire, and we engage in it for pleasure and connection. Make it a habit to communicate openly with your partners and incorporate safe practices into sex play.

Myth: If I put a condom on inside-out and haven't ejaculated yet, I can flip it over to the correct side to use it again.

Truth: There is always the possibility that pre-ejaculate (pre-cum) may have gotten on the condom. Pre-cum may contain fluid containing viruses, bacteria or sperm from a prior ejaculation. It is better to put on a new condom than to put your partner at risk for pregnancy or infection.

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Myth: I don’t need to use protection for oral sex.

Truth: Certain sexually transmitted infections can be spread via oral sex. These include but are not limited to: herpes, gonorrhea, human papilloma virus (HPV), and chlamydia. For all types of oral sex, using barriers such as condoms or dental dams can reduce the risk of STI transmission.

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Myth: I just tested negative for HIV, so I can have unprotected sex without fear of infecting my partner.

Truth: HIV tests work by measuring the antibodies that our immune systems produce to fight the virus. A person can have HIV and still receive a negative test result if the test does not detect HIV specific antibodies. It can take our bodies up to 1 month to develop enough antibodies for a positive test result. This is called the “window period.” Not only is HIV transmission possible, but a person is also the most infectious during this window period. So, getting tested at least once a year is good practice if you are sexually active.

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Myth: If I had an STI, I’d have symptoms.

Truth: Many STIs do not immediately cause signs and symptoms. Depending on the person, an STI may be asymptomatic, meaning that no symptoms ever appear. For example, gonorrhea and chlamydia are often asymptomatic. Even without signs and symptoms, STIs can have serious health consequences, such as pelvic inflammatory disease and infertility. It is best to get tested regularly to make sure you’re STI free.

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Myth: The condoms I get at the student health center are more likely to break than the condoms I buy at the pharmacy.

Truth: The condoms at the Student Health Center are the same mainstream brands as ones sold at your drugstore or bodega, and they meet high safety and quality criteria. When condoms break, it’s often due to incorrect usage. Know the steps to putting on one correctly (listed above) and use lubricant every time. 

Do you have questions about other sex myths? Email the NYU Sexpert at: sexpert@nyu.edu  

Communication is an important aspect of sexual health and pleasure. An open, honest dialogue with a sexual partner supports gratifying and safe sexual experiences. It may seem challenging or awkward at first, but the more you practice, the easier and more comfortable it will be.

Talking with Your Partner
The goal is to create and foster an environment where you and your partner can talk freely about sex. In this environment, someone can say “no” without judgment, fear, or pressure to change their mind, and someone can say “yes” with the understanding that “yes” now does not mean “yes” every time.

If you want to have an honest and open dialogue with your partner(s), try:

• asking about preferences: What are you into? What turns you off?
• sharing favorite and least favorite words for body parts and sexual acts
• sharing what you think is silly and what you think is sexy
• using phrases such as: I prefer when you..., I love when you..., or I want you to ... instead of: I hate when you..., or I don’t like when you...

Checking In
People have different desires, limits, and curiosities that can change over time. Whether you have just met your partner or you know each other well, it is important to check in and talk with one another. Talk before sex in order to avoid “trial and error’ situations, talk during sex to provide guidance and receive feedback, and talk after sex to reinforce what worked for each partner.

Pro Tips for Communication

• Confirm consent via verbal affirmation
• Listen just as much as you are asking and telling
• Respond accordingly and with respect
• Make specific requests
• Speak up if you are unsure or change your mind
• Continue to check in with your partner

Like sex itself, sexual communication gets better, and sexier, with practice. Start with what is most comfortable for you. Have fun!

Using condoms is a safe and simple way to prevent pregnancy and reduce the risk of sexually transmitted infections. The steps and tips below will help ensure a safe and pleasurable experience.

1. Check the expiration date on the package and squeeze the package for punctures. Discard and get a new one if it’s expired or punctured.     
   • Old condoms can be dry or weakened and can break more easily
   • If there is no expiration date, don’t use it
2. Carefully open the package using the perforated edges, pushing the condom away from the tear.                            
   • Avoid using your teeth, sharp nails, or anything that could accidentally tear the condom as you open the package
3. Put the condom on as soon as the penis is erect, prior to any genital contact. Semen can be released from the penis before and after ejaculation.
   • If you are uncircumcised, pull back your foreskin before rolling the condom on
4. Making sure the condom is in the shape of a sombrero, not a beanie, place it on the tip
   of the penis.
   • If you put the condom on inside out, remove and get a new condom
   • Leave a half-inch space at the tip to collect semen
5. Squeeze the air out of the tip and use your other hand to unroll the condom all the way down the shaft.
6. If you're not using a lubricated condom, add some water or silicone-based lubricant to the outside of the condom.
7. After ejaculation, while the penis is still erect, hold on to the condom at the base of the penis and carefully withdraw away from your partner.
8. Gently pull the condom off the penis, making sure that semen doesn't spill out.
9. Wrap the condom in a tissue and throw it in the trash — don’t flush it down the toilet.

Tips

• Have extra condoms available in case the first is damaged or torn before use, is put on incorrectly, or if you have repeated intercourse.
• Tie up the condom after sex and squeeze to see if there are holes or tears you did not notice occurring during sex.
• If you feel the condom break, stop immediately, withdraw, remove the broken condom, and put on a new condom.
• You have up to 5 days after a condom breaks to take emergency contraception (EC), also called the morning after pill or Plan B, to prevent pregnancy. Effectiveness decreases daily, so the earlier you take the pill, the better your chances are at preventing pregnancy.
• Store condoms in a cool and dry place, out of direct sunlight. Don’t store condoms in your wallet for more than a few hours!
• Use only water or silicone-based lubricants with latex condoms (e.g., KY, Astroglide, Uber Lube), not oil-based lubricants (e.g., Vaseline, body lotion, massage oil, or baby oil). For polyurethane or polyisoprene condoms, water, oil-based, or silicone lubricant can be used.
• Animal skin condoms do not prevent STIs, only pregnancy.
• For increased pleasure, add a few drops of lubricant inside the tip of the condom.
• Use a new condom for every new sexual act (such as vaginal, oral and anal).
• Never double bag - using two condoms at once increases friction and can lead to the condoms breaking. If your partner is wearing a condom, you do not need to wear one also.
• If a condom feels stiff, sticky, or looks damaged in any way, throw it away, regardless of its expiration date.

Using internal condoms, also known as the female condom or FC2, is a safe and simple way to prevent pregnancy and reduce the risk of sexually transmitted infections. The steps and tips below will help ensure a safe and pleasurable experience.

1. Check the expiration date on the package and squeeze the package for punctures. Discard and get a new one if it’s expired or punctured.     
   • Old condoms can be dry or weakened and can break more easily
   • If there is no expiration date, don’t use it
2. Carefully open the package using the perforated edges, pushing the condom away from the tear.                            
   • Avoid using your teeth, sharp nails, or anything that could accidentally tear the condom as you open the package
3. Place the condom internally (anus or vagina) using your fingers. If placed in the anus, make sure to remove the internal ring. The closed end should go inside towards the back of the anus or vagina. Push the condom as far back as it will go, leaving the outer ring outside the anus or vagina. When worn correctly, the condom should not feel painful or uncomfortable.
4. Adding lubrication directly to the anus or vagina prior to insertion can decrease any discomfort and increase pleasure. If you continue to feel discomfort, remove the condom and reposition the inner ring.
5. An internal condom can be put in up to 8 hours before sex. You do not have to wait for a penis to become erect, but the condom should be placed prior to genital contact. Semen can be released from the penis before and after ejaculation.
6. During sex, take care to guide the penis directly into the internal condom.
7. After ejaculation, withdraw away from your partner and remove the internal condom by squeezing and twisting the outer ring, making sure that semen doesn’t spill out.
8. Wrap the condom in a tissue and throw it in the trash — don’t flush it down the toilet.

Tips

• Have extra condoms available in case the first is damaged or torn before use, is put on incorrectly, or if you have repeated intercourse.
• Tie up the condom after sex and squeeze to see if there are holes or tears you did not notice occurring during sex.
• If you feel the condom break, stop immediately, withdraw, remove the broken condom, and put on a new condom.
• You have up to 5 days after a condom breaks to take emergency contraception (EC), also called the morning after pill or Plan B, to prevent pregnancy. Effectiveness decreases daily, so the earlier you take the pill, the better your chances are at preventing pregnancy.
• Internal condoms are made from nitrile. Nitrile condoms do not need to be stored in a controlled temperature. The material is not affected by heat or humidity.
• You can use water, oil, and silicone-based lubricants with internal condoms (e.g., KY, Astroglide, Uber Lube, Vaseline, body lotion, massage oil, or baby oil) since it is non-latex. For polyurethane or polyisoprene condoms, water, oil-based, or silicone lubricant can also be used. Latex condoms require water-based lubrication.
• For increased pleasure, add a few drops of lubricant inside and outside the condom.
• Use a new condom for every new sexual act (such as vaginal, oral and anal).
• Never double bag - using two condoms at once increases friction and can lead to the condoms breaking. If your partner is wearing a condom, you do not need to wear one also.
• If a condom feels stiff, sticky, or looks damaged in any way, throw it away, regardless of its expiration date.

In an ideal world, condoms are used consistently and correctly, and they remain intact to prevent unintended pregnancies and the transmission of sexually transmitted infections. In the real world, we may not always use condoms correctly, even if we use them consistently. Sometimes we get caught up in the moment and make mistakes that cause condoms to break and fail to protect us.

Here are several reasons why a condom might break during sex:

• The receiving partner is not adequately lubricated during sex
• Two condoms are used at the same time (aka: double bagging)
• Room for ejaculate is not left at the tip of the condom before it is rolled down
• Water or silicone-based lubricant is not applied to both the inside and outside of
  the condom
• The condom is expired
• An oil or petroleum-based lubricant is used (these eat away at latex)
• The condom has not been stored correctly (e.g. a wallet is too warm and moist to properly store condoms)
• The condom is used for more than one sex act
• The condom package is opened with teeth, scissors, or another sharp object
• The condom is not checked for physical damage
• The condom is not the right size for the person who wears it

It’s easy to rush when you’re in the moment. Prepare in advance. Learn how to use a condom (listed above) and prevent condom fails. The more you avoid these common mistakes, the safer sex you’ll have.

New and exciting options are now available for HIV prevention and treatment. PrEP and PEP treatments are allowing people who are HIV negative to maintain their status, and making it easier for couples in serodiscordant relationships (one person positive and another negative) to protect each other. Live healthy and smart by learning more about PrEP and PEP below.

Pre-Exposure Prophylaxis (PrEP)
PrEP stands for Pre-Exposure Prophylaxis. PrEP is the daily use of antiretroviral medication to reduce the risk of HIV infection. Currently, the only FDA approved form of PrEP is a tablet called Truvada.  When taken daily, the presence of the medicine in your bloodstream can help to stop HIV from establishing itself in your body even if you’ve been exposed to the virus.  

PrEP is available by prescription only. To find out if PrEP is right for you, please visit https://shcportal.nyu.edu and schedule an appointment with the HIV counselor.

Condoms and PrEP used together offer the best form of protection against HIV. PrEP taken by itself does not prevent transmission of other sexually transmitted infections (STIs).

Post-Exposure Prophylaxis (PEP)
PEP stands for Post-Exposure Prophylaxis. PEP is a regimen of antiretroviral medications that can help to prevent HIV infection if you think you may have been exposed to HIV. PEP must be started as soon as possible to be effective, but no more than 3 days (72 hours) after a possible exposure. PEP must be taken every day for 28 days, and it is available by prescription only.  

If you think you need PEP, come to the Student Health Center (726 Broadway, 3rd Floor) Urgent Care as soon as possible. If the Student Health Center is closed, call the NYU SHC on-call provider (212-443-1000) to discuss your care options, or go to your nearest hospital or emergency room.  Your health care provider can help you determine whether PEP is right for you based on the risk of your exposure.