Many consider oral sex to be a safer form of sexual activity compared to vaginal or anal intercourse. For this reason, they might put less emphasis on the use of latex barriers, such as dental dams and condoms, during oral sex. Unfortunately, this idea is misguided and can lead to the transmission of preventable infections.
It is generally true that oral sex presents less of a risk for contracting sexually transmitted infections (STIs) – but this risk is not trivial, especially when people are under the impression that they don’t need to use barrier methods during oral sex. Most sexually transmitted infections can be passed along by oral sex, including chlamydia, gonorrhea, syphilis, hepatitis B, herpes (which can be transmitted back and forth from the mouth, as cold sores, to the genital region, as genital herpes), human papillomavirus (HPV), and HIV. Even pubic lice can be transferred from the genital region to eyelashes and eyebrows! Additionally, intestinal parasites are more likely to be transmitted via oral sex than through vaginal sex. A microscopic amount of fecal matter containing parasites can be infectious, and can be unknowingly ingested when present on genitals.
Seventy percent of adolescents who reported engaging in oral sex had never used a barrier to protect themselves from sexually transmitted infections during oral sex.
Some bacterial STIs, such as gonorrhea and syphilis, can do permanent damage if not treated in time. Furthermore, gonorrhea of the throat is much more difficult to treat than gonorrhea in the genital or rectal areas. And some viral STIs can’t be cured (such as herpes and HIV), while others can cause chronic infections that have been linked to cancer (such as hepatitis, which is associated with liver cancer, and HPV, which is associated with throat cancer as well as cervical cancer and anal cancer).
According to a study published in Pediatrics, among California ninth graders oral sex was more prevalent than vaginal sex, and considered to pose much less of a risk than vaginal sex. A small but significant number of these students believed that the risk of STI transmission during oral sex was zero – not just low-risk, but no-risk. While these data were self-reported, they do point to an overarching trend, one in which people falsely believe that oral sex will protect them from acquiring STIs. Another study carried out in Washington, D.C., by researchers with the University of Maryland had similar findings – adolescents considered oral sex to be less risky than vaginal sex, they were unlikely to use protection if they engaged in it, and they were less likely to believe that oral sex could transmit HIV than they were to believe it could be transmitted via vaginal sex.
HIV, however, can indeed be transmitted orally, as the virus can be found in blood, vaginal fluids, seminal fluids, and pre-ejaculate. According to the researchers at the University of Maryland,
Cells in the mucous lining of the mouth may carry HIV into the lymph nodes or the bloodstream. Also, blood from the mouth may enter the urethra, the vagina, the anus, or directly into the body through small cuts or open sores.
One study carried out by researchers at Yale University found that 70 percent of adolescents who reported engaging in oral sex had never used a barrier to protect themselves from STIs during oral sex – and only 17 percent reported using barriers every time. The same study found that only 9 percent never used protection during vaginal intercourse, and 61 percent reported using protection every time. These lopsided data indicate that there seems to be a prevailing view among young people that oral sex is low-risk or even risk-free, though they still recognize the importance of using barrier methods for vaginal intercourse.
Another study, which focused on teenagers who took “virginity pledges,” found that these adolescents were more likely to have oral or anal sex (ostensibly to “preserve their virginity”), and condom use during oral sex was “almost completely absent” among this population. This study found no difference in STI rates among pledgers versus nonpledgers, and this may be due to pledgers’ propensity toward unprotected oral sex as well as a greater reluctance to use barrier methods even after starting to engage in vaginal intercourse. Pledgers were also found to be less likely to be screened for STIs.
It is possible that many adolescents have been conditioned to think of oral sex as not “real” sex. Especially within a heterosexual context, sexually active people might be more likely to regard vaginal intercourse as “real” sex, with other activities ranking lower. Additionally, abstinence-only-until-marriage programs, intentionally or not, seem to be correlated with the idea among students that one’s virginity can be “preserved” by having oral or anal sex in lieu of vaginal intercourse. Because these programs are not likely to provide students with accurate information about barrier methods, those who engage in oral or anal sex to preserve their virginity are less likely to use condoms or dental dams.
These attitudes – that oral sex is not “real” sex and is therefore less risky, along with ignorance regarding STI transmission and methods of prevention – give rise to higher STI transmission rates among the sexually active population. It is important that sexually active people are able to know and evaluate the risks inherent to sexual activity, but when the belief that oral sex is “low-risk” persists, they cannot make decisions based on accurate information.