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Oral Sex Safety

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My teenage daughter has become sexually active recently and in a passing comment she told me that all her friends think that oral sex is the safest sex they could have and that they feel like it doesn’t even count as real sex. What are the health risks associated with oral sex and are there any precautions short of “just say no” that can make a difference?

It is true that many teenagers consider oral sex “safe sex” and not the real thing.  A recent survey of over 12,000 teens aged 15-17 reported that more than 1/3 of both male and female respondents had reported both giving and receiving oral sex.  By the age of 18-20 the percentages jump to 2/3.  Another recent study published in the Journal of Pediatric Psychology surveyed a group of 10th graders about their thoughts and perceptions on sex.  The survey found teenagers were having oral sex more often than intercourse and with many more partners. The majority of the teens surveyed said they did not use condoms during oral sex.

The most commonly transmitted STD during oral sex is herpes.  The incidence of oral herpes is very high; more than 50% of a random sample have antibodies to the virus, indicating some level of infection. Both strains of herpes can live in the mouth or the genitals and can be passed between locations, especially during outbreaks. Other STDs like chlamydia and gonorrhea can also be passed during oral sex. Most STDs are curable with antibiotics, but can be tricky because the symptoms can resemble other illnesses like strep. Sometimes they can be entirely asymptomatic.

While there have been reported cases of HIV infection through oral sex, the risk is extremely low compared with unprotected penetrative sex. HIV-infected semen or vaginal fluid must enter through an open wound in the mouth. According to several studies, the risk of transmitting HIV through unprotected oral sex was so low, that in some studies the risk was reported at zero.

Perhaps the most significant health risk associated with unprotected oral sex is the spread of the HPV virus, which has long been associated with cancer growth in the cervix. The recent surge in throat cancers associated with the rise in oral sex practices have shown that men carry and transmit HPV as frequently as women, often times unknowingly through unprotected oral sex.   A 2007 study in the New England Journal of  Medicine showed that both men and women who reported having six or more oral sex partners during their lifetime had a nearly nine-fold increased risk of developing mouth or throat cancers. This is a new trend that reflects a change in sexual behavior over the last decade.  Oral sex is not risk-free and one of the most significant risks that young people face now is the risk of developing cancer.

One of the most basic preventive measures that young people can take is to give up the idea that oral sex is not real sex and save the act for real relationships. Just by limiting the number of sexual partners and not being pressured into ‘casual’ sex with an unfamiliar partner is an important way of reducing infection risk. Consider how many other partners your partner may have, or have had, and what their infection status might be, before putting yourself at any risk.

Unless you are intimate and know the health history of your partner, limit exposure to sexual fluids and ensure that no cuts or lesions are present in mouth or on genitals. Use barrier methods such as condoms (don’t use those with spermicide because it kills tastebuds) or dental dams.  Even saran wrap will protect against STDs.   Although many young people feel that barrier methods detract from oral sex, they are the best bet for  preventing STD transmission.