Oral sex with a condom or dental dam: It’s one of those things things that sexual health educators preach but which people rarely practice. A reminder of that came earlier this week with the release of a CDC report noting that “adolescents perceive fewer health-related risks for oral sex compared with vaginal intercourse” and, as a result, young people may “be placing themselves at risk of STIs or HIV before they are ever at risk of pregnancy.”
My immediate reaction to that was: Well, but there are fewer health-related risks, right? Then I came across this remark in HealthDay from Christopher Hurt, a professor in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill: “I would say that the risk of STD transmission through oral sex is underappreciated and underestimated. As part of sex education programs, kids need to be made aware of that fact that oral sex is not a completely risk-free activity.” But, I wondered, just how dangerous is it?
It turns out that putting a solid figure on the danger is difficult. Nikki Mayes of the CDC’s media office says, “As far as I’m aware, no studies have quantified the exact risk for all STIs [through oral sex],” and the CDC doesn’t gather data on STIs contracted through oral sex. It’s difficult to attribute infections to any single sex act — most people who contract STIs engage in a variety of potentially risky sexual practices.
But we can look at what we know about the transmission risks of particular STIs, starting first with the one that scares people the most: HIV. The greatest danger when it comes to oral sex is believed to be with fellatio for the “receptive partner.” (Now here’s a mind fuck: In clinical lingo, “receptive oral sex” refers to performing oral sex on someone — or “giving head,” as the kids say — not to “receiving it.” You can think of it this way: The receptive partner is receiving the penis or vagina in their mouth.) The website of AVERT, an international HIV and AIDS charity, explains that transmission can occur when “sexual fluid (semen or vaginal fluid) or blood (from menstruation or a wound somewhere in the genital or anal region) [gets] into a cut, sore, ulcer or area of inflammation somewhere in their mouth or throat.”