Oral Sex

Oral Sex: What Is It?
Oral sex refers to oral (mouth and tongue) stimulation of the genitals. Fellatio is the Latin term for oral stimulation of the male genitals; cunnilingus is the Latin term for oral stimulation of the female genitals. Anilingus (sometimes called "rimming") refers to oral-anal contact.

Is Oral Sex Sex?
Many people wonder if oral sex is sex. And the answer is that it depends on the individual. Some people consider oral sex sex and some people don't.1 Regardless of your definition of sex, it's important to realize that oral sex has some level of risk associated with it.

Studies indicate that oral sex is commonly practiced by sexually active male-female and same-sex couples of various ages, including adolescents.

Is Oral Sex Safe?
Some individuals consider oral sex to be a safe or no risk sexual practice. Many people feel safe engaging in this behavior because there is no risk of pregnancy. There are, however, other considerations. Many sexually transmitted infections (STIs) such as gonorrhea, herpes, hepatitis B, HIV, and syphilis can be transmitted through oral-genital contact. The risk of contracting chlamydia and HPV through oral sex is much less, although possible. It is difficult to determine exact rates of transmission of STIs through oral sex since many sexually active individuals practice oral sex in addition to other, higher risk activities, such as vaginal and/or anal sex. In addition, if a male ejaculates during oral sex, then the risk to his partner becomes higher.

Everyone needs to be most concerned about gonorrhea herpes, hepatitis B, HIV and syphilis when engaging in oral sex.

Chlamydia and Oral Sex
Oral sex is not considered a common cause of Chlamydia infection, but it is a possibility. If the vagina, cervix, anus, penis or mouth come in contact with infected secretions or fluids, then transmission is possible.

Gonorrhea and Oral Sex
Gonorrhea can be passed during oral sex (either giving or receiving). Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea survives well in the throat, and gonorrhea throat infections from oral sex are relatively common.

There is no data to indicate how often gonorrhea is transmitted through oral sex. Gonorrhea can be transmitted if the mucous membranes in the mouth and throat come into contact with infected secretions or fluids.

Herpes and Oral Sex
Genital Herpes can be transmitted via skin to skin contact, so the risks during oral sex are clear. It’s important to remember that transmission can occur even if there are no visible sores, and you or your partner may be infected with herpes and not know it. Some people are not aware that cold sores are a form of herpes.

Oral-genital contact can transmit herpes from the individual performing oral sex and from the individual receiving oral sex. Many individuals are not aware that cold sores (also called fever blisters) are actually herpes type I. Because of this, a person with oral herpes can transmit herpes to the genitals. Likewise, a person with genital herpes (typically type II) can transmit herpes to the mouth, though this route of transmission is not as common. Between 30 and 56% of genital herpes cases are type I, which is usually oral herpes.3,4 This does not clearly indicate contraction through oral sex (genital sex with someone who had type 1 herpes on the genitals could also have caused the transmission). The herpes virus can be passed without visible sores, so many individuals may not be aware that they are placing themselves at risk.

Hepatitis B and Oral Sex
There is no data to indicate how often hepatitis B is transmitted through oral sex. Hepatitis B is transmitted in the same manner as HIV (see below) and is considered 100 times more contagious.

HIV and Oral Sex
While the risk is considered to be low, there have been documented cases of HIV transmission where the most likely way it was transmitted was through oral sex via semen, vaginal secretions or blood. HIV is not transmitted via saliva, and deep kissing is considered a safe sexual behavior. There have been cases of oral sex transmission during fellatio (performing oral sex on a man) and cunnilingus (performing oral sex on a woman).

HIV may be transmitted through oral-genital contact when HIV in semen, vaginal secretions or blood enters the mucous membranes or abrasions in the mouth and throat. Saliva is not responsible for transmitting HIV. Deep mouth-to-mouth kissing is not a risky behavior for HIV unless blood is present in the mouth (i.e. from sores, dental procedures, flossing, brushing, etc.).

The risk of HIV transmission from an infected partner through oral sex is much smaller than the risk of HIV transmission from anal or vaginal sex, but there is still a risk.5 Several co-factors can increase the risk of HIV transmission through oral sex, including: oral ulcers, bleeding gums, genital sores, and the presence of other STIs.

The Options Project found that 7.8% (8 of 102) of recently infected men who have sex with men in San Francisco were probably infected through oral sex. Most of these men believed that the risk was minimal or non-existent. Nearly half (3 of 8) of these cases reported oral problems, including occasional bleeding gums. Almost all (7 of 8) of these men reported oral contact with pre-ejaculate or semen.6 More recent studies have placed the risk at a much lower rate, .06% for oral-penile contact with an HIV-positive partner and .04% with partners of unknown status.5

When scientists describe the risk of transmitting an infectious disease, like HIV, the term "theoretical risk" is often used. Very simply, "theoretical risk" means that passing an infection from one person to another is possible, even though there may not yet be any actual documented cases. "Theoretical risk" is not the same as "likelihood". In other words, stating that HIV infection is "theoretically possible" does not necessarily mean it is likely to happen—only that it might. Documented risk, on the other hand, is used to describe transmission that has actually occurred, been investigated, and documented in the scientific literature.

For HIV, there have been documented cases of HIV being transmitted to a receptive partner through oral-penile contact, even in cases when the insertive partner didn't ejaculate. Likewise, there have been a few cases of HIV transmission most likely resulting from oral-vaginal sex. As of December 2000, there has only been one published case of HIV transmission associated with oral-anal contact,7 though other studies have shown that oral-anal contact is a marker for other high risk behaviors.5

HPV and Oral Sex
Oral sex is considered a less common cause of HPV infection, although it has been documented. HPV virus is shed from the surface of warts and any form of direct physical contact may result in transmission.

NGU and Oral Sex
Most of the germs that cause NGU can be passed during oral sex, even if the penis or tongue doesn’t go all the way in to the vagina, mouth or rectum and even if body fluids are not exchanged. A recent Australian study provided further evidence for oral sex as a transmission route for NGU.

Syphilis and Oral Sex
Oral sex is considered an efficient way to transmit syphilis, with one CDC study reporting that more than 13% of syphilis cases in a geographic area were attributed to oral sex. Transmission usually occurs during vaginal, anal or oral sex when syphilitic sores or patches come in to contact with slightly abraded skin or mucous membranes.

Syphilis can be transmitted when infected lesions come into contact with the mouth during oral sex. According to a study conducted by the Chicago Department of Public Health, approximately 14% of syphilis cases were attributed to oral sex. This percentage might be low given that people who engaged in anal and/or vaginal sex and oral sex were not included in the reported 14%. In the reported cases, persons only engaged in oral sex.8.

For oral sex on a man, using a flavored latex condom can reduce STI transmission. Some people complain that condoms have a rubbery taste and lessen the sensation on the penis. Spermicides on the condoms may also numb the tongue. Using flavored condoms that may make the idea of using a condom more appealing, but be sure that the condom is not a novelty condom. Condoms that say "for novelty use only" should not be used for protection from STIs. Using a small amount of lubricant inside the condom may help increase sensation. If a condom is not being used, avoid ejaculation in your or your partner's mouth. If ejaculate does enter the mouth, spitting out the semen immediately can reduce risk. Condoms are available in the Health Promotion Department or for purchase at a reduced cost at the UGA University Health Center Pharmacy.

For oral-anal contact, a barrier is strongly recommended. Contracting Hepatitis A and B in addition to other bacterial infections (such as giardiasis and amebiasis)are a concern.3 Using a Sheer Glyde dam or plastic wrap will reduce possible transmission.

Regardless of the sex of your partner, if there is a sore or discharge on your partner's genitals or an unusual odor, avoid any type of contact with the genitals including oral sex. If a partner's mouth has a sore, also avoid oral sex. Do not brush or floss your teeth right before you have oral sex. Flossing and brushing may tear the lining of the mouth, increasing the exposure to any viruses that may be present. If you wish to freshen your breath before kissing, try mouthwash instead.

Avoid deep thrusting in oral sex. This highly physical form of oral sex may increase the risk of infection because it may cause damage to the throat tissues, which increases susceptibility for throat-based gonorrhea, herpes and abrasions.

Some individuals laugh or are uncomfortable at the idea of using a Sheer Glyde dam or a condom for oral sex. Communication with your partner is important when exploring protection during oral sex. Talking with your partner about his/her feelings, the reason for those feelings, and the issue of risk can help both of you make appropriate decisions.

Is Oral Sex For Me?
Individuals have different sexual likes and dislikes. There is a range of feelings expressed about performing oral sex. Some individuals truly enjoy performing oral sex; some don't find it particularly special, but want to do it for their partner; some don't want to engage in it all.

A person's feelings about oral sex can change over time and from one partner to another. Other concerns, such as infection transmission or hygiene, can impact your or a partner's willingness to engage in oral sex. See above for information about how to make oral sex safer.

Regarding hygiene, think about what you would like in a partner if you were planning to engage in oral sex with him or her. Cleanliness would probably be near the top of the list. Having showered or bathed that day would be a requirement for many people. For women, douching is not necessary. If your partner doesn't like the way you smell, they may be hesitant to perform oral sex on you. If you don't like the way your partner smells, perhaps you could suggest taking a shower together.

The decision to engage in oral sex needs be made individually and as a couple. Being sensitive and respectful of your partners' wishes and concerns is important regardless if you and your partner decide to incorporate oral sex into your sexual repartee.

Safer Oral Sex Tips
Using barrier methods, including condoms and dental dams, is the best way to make oral sex safer. A lot of people who are worried about dealing with bodily fluids find that flavored condoms and dams also reduce their inhibitions and make them better at going down on their partners.

If a man ejaculates during oral sex in or around the mouth of his partner or if any ejaculate gets in his partners eyes, it greatly increases the risk of STD infection (if he is infected with an STD).

In many cases, a STD can be transmitted even if the penis or tongue doesn’t go all the way in to the vagina, mouth or rectum and even if it isn’t obvious that body fluids are exchanged.

Some educators suggest you avoid brushing your teeth prior to performing oral sex as you can cause small cuts or abrasions that could increase the risk of fluid transmission.

Please visit our Sexual Health Advice & Leaflets for more general information about Sexually Transmitted Infections.

SOURCES

1. Pitts, M., & Rahman, Q. (2001). Which behaviors constitute “having sex” among University students in the UK? Archives of Sexual Behavior, 30 (2), 169-176.

2. University of Georgia Health Center. (2004). National College Health Assessment of University of Georgia students, Fall 2003. Baltimore, MD: American College Health Association.

3. Ebel, C. (1998). Managing Herpes: How to Live and Love with a Chronic STD. Research Triangle Park, NC: American Social Health Association.

4. Scoular, A., Norrie, J., Gillespie, G., Mir, N., & Carman, W.F. (2002). Longitudinal study of genital infection by herpes simplex virus type 1 in western Scotland over 15 years. British Medical Journal; 324 (7350), 1366-1367.

5. Lane, T. & Palacio, H. (December, 2003). Safe Sex methods HIV InSight Knowledge Base Chapter. Retrieved January 5, 2004, from www.hivinsite.org/InSite.jsp?page=kb-07-02-02

6. Centers for Disease Control and Prevention. (February 2001). Primary HIV Infection Associated with Oral Transmission. Retrieved February 9, 2002 from http://www.cdc.gov/hiv/pubs/facts/oralsexqa.htm.

7. Centers for Disease Control and Prevention. (2000). Preventing the Sexual Transmission of HIV, the Virus that Causes AIDS: What you Should Know about Oral Sex, Fact Sheet. Atlanta: Centers for Disease Control and Prevention.

8. Centers for Disease Control and Prevention. (October 2004). Transmission of primary and secondary syphilis by oral sex. Morbidity and Mortality Weekly Report, 53, 966-968.

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