Safe sex 101: What are the different forms of contraception, and a word on oral sex

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Being intimate with your partner is a wonderful way to spend Valentine’s Day — or any day, for that matter.

But before hopping into bed with them, consider this: According to the World Health Organization, over “one million curable sexually transmitted infections (STIs) are acquired every day worldwide in people 15 to 49 years old.”

That's not mentioning unplanned pregnancies and the host of complications that entails.

So before we go labing-labing with our SO, perhaps let’s get into a few reminders about safe sex. You might even learn something new!

Consent is key

Consent is a big part of sex. This is where the conversation between you and your partner begins. This doesn’t just involve obtaining their matamis na oo (sweet affirmation). More importantly, it includes you being comfortable giving it to them. 

That’s according to venereologist Dr. Deano Reyes, who specializes in STIs. He is also the medical director of Pasig City's Hara Clinic, a pioneering holistic gender and sexual health clinic.

His next piece of advice is to be smart about sex. “Okay lang naman lumandi, basta lumandi responsibly.”

(“It’s okay to flirt, but flirt responsibly.”) 

“You have to understand what the risks of having sex [are]. You can have unwanted pregnancies, you can have STIs, you can have HIV depending on what kind of partnership this is, whether it’s straight or LGBTQ,” he explains. 

The kind of protection you need to seek then depends on the risk you may face.

Which kind of protection is for you?

The Pinay’s Guide to Modern FP (Family planning), updated in May 2020 and published on the website of the Commission on Population and Development, lists nine methods of contraception.

Note that the language is geared towards women. 

• Implant: “You get a small, flexible rod, about the size of a matchstick, placed under the skin of your arm. The implant will prevent pregnancy for three to five years, depending on the brand.” 
• IUD (Intrauterine device): “You get a small piece of flexible plastic shaped like a T with a short piece of string at the end inserted in your uterus. It’s long-term and reversible. It will prevent pregnancy for up to ten years.”
• Injectable: “You get an injection every two or three months, depending on the injectable brand. It works really well if you always get it on time.”
• Pills: “You take a tiny pill with a small amount of hormones every day. It comes in a monthly pack.... The pill is safe, affordable, and effective if you always take it on time.”
• Condoms: “Your partner puts this thin rubber cover over his erect penis before sex to keep sperm out of your vagina. It protects against pregnancy and [STIs].... You must use it correctly every time you have sex.”
• Fertility awareness methods: “You use these to track days when you are fertile (ovulating) so you can avoid sex and not get pregnant.... These methods are effective if you are able to monitor and chart your fertility daily and if you have a regular cycle. You and your partner must avoid sex or use another type of FP during fertile days.”
• LAM (Lactational amenorrhea method): “LAM is a type of FP that is effective if these three conditions are strictly met: You are exclusively breastfeeding.... You don't have your period. Your baby is less than six months old.”
• Ligation (BTL): “Bilateral tubal ligation is a safe and permanent FP if you do not want to get pregnant again. It is a procedure done by a doctor to cut and tie the tubes that your egg cell travels through, making sure that the egg cannot meet a man’s sperm.”
• Vasectomy (NSV): “No-scalpel vasectomy is a safe and permanent FP for men who don't want any more children. It is a procedure done by a doctor to cut and seal the tubes that carry sperm out of the body.”

The method that Filipinos practice the most is the pull-out method, says Reyes, with the man pulling his penis out from the woman’s vagina before he ejaculates. “It’s only about 78% effective. Meaning, one in five couples practicing the pull-out method will have an accidental baby," Reyes explains.

Gay couples, meanwhile, are mainly concerned about HIV and STIs. 

“Condoms are the most cost-efficient way to prevent everything because it’s a physical barrier and it’s very, very effective, especially when used properly,” Reyes says. 

He also points to pre-exposure prophylaxis or PrEP, a medication that is 99% effective at preventing HIV when taken correctly. Patients regularly take one pill every day, although there is also event-driven PrEP where patients take two pills of PrEP between two and 24 hours before they anticipate having sex.

“As a very sex-positive sexual health doctor, I don’t like being draconian about these rules. Because doctors have been trying to push for condoms for decades. And I do also push for condoms. But when I have a patient in front of me who says, ‘Doc, condoms really aren’t for me,’ I really like that I am able to give them different options,” Reyes says. 

Before we get to another option, remember: 

Oral sex is still sex. So get protected.

Reyes cannot stress this enough: “Oral sex is sex. And with oral sex, the risks of STIs and HIV might be lower, but they’re not zero.”

“It’s around 9-15% chance to catch gonorrhea from oral sex. And it's not always symptomatic, so you won’t know. So nakatago lang ‘yan (it’s just hidden) in your throat. For chlamydia, it’s around 1%.” 

Citing the United States’ Centers for Disease Control and Prevention (CDC), Reyes said cases of oropharyngeal cancer among males have been increasing by 2.7% annually. Compare this to how cervical cancer rates have been decreasing by 1.6% annually. 

“We’ve done a very good job encouraging women to get HPV (Human papillomavirus) vaccines to prevent cervical cancer…. But there is an emerging population that is suddenly at risk for HPV-related cancers outside of the cervix. And the highest one is the oropharyngeal area, which is basically the back of your mouth to your throat.” 

Men don’t get HPV-vaccinated because they don’t think they need it. But if they like to perform fellatio, Reyes advises that they get vaccinated right away. 

“Everybody deserves protection. In my field, one of the things I ask my patients is, ‘How often do you use protection when you have sex?’ And they say, ‘Doc, 90%, 100%.” And I say, ‘Okay, but that’s for penetrative sex, vaginal or anal.’ They say, ‘Yeah.’ And I say, ‘How about for oral sex?’ Almost all the time, they say zero.”

He reminds us that flavored condoms were invented precisely for that purpose. 

“But it’s still weird, I guess…. It’s weird because of the texture, the body heat, it gets in the way, it wrecks the mood. So while I do encourage people to try their best to utilize condoms even during oral sex, I do understand why that might not be easily or effectively implemented or performed by people. So if you can’t do that, another way to protect yourself is the HPV vaccine.”

Now go landi responsibly!

— LA, GMA Integrated News