Your Guide to Safer Sex

Unprotected sex is like a game of roulette: The more you play, the greater the chance your number comes up.

And like roulette, it only takes one turn to change your life forever. But unlike winning it big at a casino, the odds of getting a lifelong, even life-threatening, sexually transmitted disease or complication, or of winding up with an unplanned pregnancy are much, much greater — and more devastating.

Still, despite knowing these consequences, many people don’t practice safe sex. Ingrid A. Rodi, MD, associate clinical professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA, has a theory as to why. According to Dr. Rodi, “One reason that young men and women have a difficult time practicing safe sex is that the consequences of getting chlamydia or gonorrhea, for example, may not become apparent for many years.” Dr. Rodi says that many women don’t even realize they have a sexually transmitted infection (STI) until they try to become pregnant and can’t. (Untreated chlamydia or gonorrhea can lead to blocked fallopian tubes and infertility). Many men never have any symptoms.

Sometimes, symptoms can be mild and mistaken for another health problem, like a yeast infection or bladder infection. But often, STIs don’t show any symptoms, or can take weeks, months or even years to appear. Meanwhile, the disease is active inside the body and can be passed to others. (That is why, among health professionals and health educators, the term STI has replaced the term STD, or sexually transmitted disease. Medically speaking, an infection is called a disease only when it shows symptoms.)

Dr. Rodi also believes people underestimate their risk of contracting an STI. “Many women will use birth control to avoid getting pregnant, but they will not be as careful avoiding getting STIs,” she says.

But the risks are very real. In fact, an estimated 19 million people in the U.S. will become infected with an STI this year. Anyone who has sex is at risk, with young adults having the highest risk: Nearly half of people diagnosed with an STI are between the ages of 15 and 24. Plus, 3 million women will have an unintended pregnancy this year — that accounts for nearly half of the pregnancies in the U.S.

Long-Term Risks of Unprotected Sex

It’s difficult to consider the long-term consequences of unprotected sex “in the moment.” But you need to. An STI and/or an unplanned pregnancy can lead to tough decisions and dramatic implications to your health. The long-term risks of STIs include:

Cancer. The human papillomavirus (HPV) is the most common STI, and it’s also the leading cause of cervical cancer.
Other dangerous health problems. For example, untreated syphilis can cause blindness, paralysis, brain damage or even death, (which is tragic considering syphilis is easily treated with penicillin, the first antibiotic ever developed).
Higher risk for HIV and AIDS. A person with an STI is two to five times more likely to contract HIV through sex than a person without an STI.
Pelvic inflammatory disease. PID is an infection of a woman’s pelvic organs, and most cases are caused by the bacterial infections gonorrhea and chlamydia.
Infertility. It’s estimated that 24,000 women in the U.S. become infertile each year as a result of untreated chlamydia and gonorrhea.
Pregnancy complications and birth defects. Having an STI during pregnancy can bring on preterm labor or a uterine infection after birth. Some STIs can be passed from mother to baby during pregnancy or childbirth. Babies born to mothers with STIs have a higher risk for low birth weight, infections, brain damage, deafness, blindness and stillbirth.

10 Rules of Safe Sex

To avoid an unwanted pregnancy and STIs, it’s essential to protect yourself by doing the following:

Use a condom every time you have vaginal, anal and oral sex. Latex male condoms are the most effective type of contraceptive for preventing STIs.
Limit sexual partners. The more sexual partners you have, the higher your risk for STIs.
Be honest with your partner about any STIs you’ve had. If you’re diagnosed with an STI, contact your sex partners going back a year or more and make them aware of your diagnosis so they can be tested, get treatment and warn other partners.
Know your partner's sexual history. The saying "you have sex with everyone who your partner has had sex with" is true when it comes to STIs.
Be mindful even if you’re in a monogamous relationship. Both you and your partner should be tested for STIs before you have sex without a condom.
Don’t ignore signs of STIs. Seek treatment right away if you have any worrisome symptoms, such as sores, itching, pain when urinating, unusual discharge or abnormal bleeding from the genitals.
Get vaccinated. The CDC recommends that preteen boys and girls ages 11 to 12 be vaccinated, and women through 26 years of age and men through 21 years of age who were not vaccinated when they were younger be vaccinated for HPV. Men and women 19 years and older who are at higher risk may also be advised to get vaccinated against hepatitis A and hepatitis B; talk to your doctor.
Avoid drugs and limit alcohol consumption. Using these substances impairs judgment and can lead to risky behaviors, such as not using a condom.
Get tested for STIs regularly. Not all STIs have symptoms, so regular checkups from your doctor are essential. Get tested whenever you have a new partner, or as often as your doctor recommends.
Demand your partner be tested before you have sex. Before having sex with any new partner, make sure you both are tested. It’s not unreasonable to ask your partner to get tested, so don’t feel uncomfortable doing so. If they’re serious about you and your well-being (as well as their own!), they won’t mind getting tested before you have sex.

Don’t Fall for These STI Myths

Myth: If you take birth control pills, you don't need any other form of protection.

Truth: Hormonal types of contraception, such as birth control pills, skin patches, vaginal rings, birth control shots, implants and intrauterine devices (IUDs), only prevent pregnancy, not STIs. For STI protection, use a condom each and every time you have sex unless you’re in a mutually monogamous relationship and are certain both you and your partner are STI-free.

Myth: Intercourse is the only way to get an STI.

Truth: STIs are spread through unprotected vaginal and anal sex and, less frequently, oral sex; through blood by sharing needles with an infected person; and from mother to child during pregnancy and childbirth. Herpes (HSV) can also be spread through genital touching since the virus can be shed from skin that doesn’t even look infected.

Myth: You’ll be able to tell if your partner has an STI.

Truth: You cannot always tell if someone has an STI just by looking at him or her. Many STIs don’t come with any visible symptoms. STI symptoms can also go away on their own, without treatment, but the disease may still be present and transmittable to sexual partners. The only way to know if someone has an STI is through testing. In some cases, the tests may miss an infection. That’s why it is important to always use a male condom.

Myth:Once you’ve been treated for an STI, you can’t get it again.

Truth: You can become reinfected with an STI even if you’ve been diagnosed and treated before. Some STIs, like herpes and HIV, can only be treated, but not cured. And some STIs can still spread while you’re receiving treatment — so it’s critical to communicate your STI status with your current sex partner and to use protection when having sex.

Jenilee Matz is a medical writer, health educator and triathlete based in Charlotte, N.C.

Reviewed by Elaine Brown, MD on November 11, 2013