Q&A: What's so "unsafe" about "safe sex"?

Question: I’ve heard groups like yours talk about "the myth of safe sex." This message runs counter to everything I’ve ever heard on the subject from my teachers at school and other responsible adults. What’s so "unsafe" about "safe sex?"

Answer:

There are at least three major "sub-myths" that fall under the larger heading of "the myth of safe sex." Let’s analyze each one of them in detail.

Myth #1: If I limit the number of partners with whom I have sex, I’ll be safe 

This sounds good, but in the final analysis numbers have very little to do with it. It’s true that having fewer partners means fewer chances for exposure to disease. But as in Russian roulette, it only takes one bullet to kill; and in the game of promiscuous sex, it only takes one contact to become pregnant or to acquire a significant or lethal infection. Of course, if that one contact happens to be your husband or wife, and if both of you have kept yourselves pure until marriage and are currently committed to building a home in which children can be raised in a context of security and love, then the risk is reduced to almost nil. The possibility of disease invading the closed circle of that exclusive union is extremely remote, and the advent of a child will only bless and enrich it.

Myth #2: If I know something about a potential partner’s sexual history and avoid having sex with someone who has had many partners, I’ll be safe

This, too, sounds reasonable, but in actuality it’s a tricky business pinning down somebody’s sexual history, even in a doctor’s office. A prospective partner may not be willing to reveal the whole truth if plans for a pleasurable evening might be called off as a result. Unless you’re prepared to do the blood work, there’s no way to verify his or her story. What’s more, it’s virtually impossible to discover anything about the history of the prospective partner’s previous partners, or those partners’ partners, and so on. From an infectious-disease standpoint, one has sex not with just one person, but with all of that individual’s previous sexual contacts, and all of their contacts’ contacts. To complicate matters, a significant number of people who are infected with STIs have no symptoms and don’t even know that they’re infected. 

Myth #3: If we use a condom every time, I’ll be safe

True, using a condom correctly (a multi-step procedure) during each act of intercourse will reduce the risk of pregnancy and some STIs. But condoms are not a terribly effective form of birth control, with failure rates commonly estimated at fifteen per cent during the first year of typical use. This means that out of one hundred women who are sexually active, ten to fifteen will become pregnant within a year if condoms are the only form of contraception used. Among adolescents, these failure rates are generally higher for a variety of reasons. Not only are teens more likely to forget or mismanage some of the fine points of condom use (including having one available in the first place) during the heat of the moment, but many teenagers, and older men as well, simply resist wearing them. 

Since condoms have been so widely promoted as a fail-safe defence against the risks of promiscuous sex, it’s worth taking a closer look at this particular aspect of the myth. It’s important to realize that, even when used correctly and consistently, condoms can break, leak or fall off during intercourse. And while the risk for condom breakage and slippage during a single sexual act may be quite small (one to four per cent in most studies), the cumulative risk when condoms are used as a long-term prevention strategy is significant. These failure rates are even more alarming if you remember that intercourse can lead to pregnancy only a few days each month, while STIs can be transmitted every single day. 

Scientific evidence demonstrates that, while condoms can reduce the transmission of STIs to a variable degree, they are nevertheless far from one hundred per cent protective. Against some infections they aren’t particularly effective at all. Consistent condom use – that is, use during every sexual encounter – has been shown to reduce the risk of transmitting HIV about 85 per cent. For gonorrhea, herpes, syphilis and chlamydia the numbers are closer to 50 per cent. One reason for this incomplete protection is that a number of infections such as syphilis, herpes and especially human papillomavirus (HPV) are often spread through contact between skin surfaces that a condom does not cover. The majority of research on condoms and HPV transmission suggests that the level of protection offered by condoms against the spread of this particular disease is modest at best.

Here’s the bottom line: "Safe sex" and "safer sex" presentations send a dangerously mixed and strangely paradoxical message. No one would argue that using filtered cigarettes constitutes "safer smoking." Similarly, we don’t give lessons in "safer driving while under the influence." When it comes to sex, however, contemporary culture says, "We know you can’t control yourself, so be sure to put on a condom and hope for the best. And by the way, we won’t mention that for many STIs condoms aren’t terribly effective, because full disclosure would erode your confidence in them, and then you wouldn’t bother to use them." That, in a nutshell, is what’s so "unsafe" about "safe sex."