1. SEXUAL PRACTICES & SAFER SEX Venkatesan Chakrapani, M.D. cvenkatesan@hotmail.com

2. Venkatesan C, Sxl practices & Safer sex Penetrative sexual practices Vaginal sex (peno-vaginal intercourse) Anal sex – insertive, receptive (peno-anal intercourse) Oral sex – Fellatio (Peno-oral sex) Anilingus (oro-anal sex) Cunnilingus (oro-vaginal) Fingering – introducing finger into rectum or vagina Fisting – introduction of fist into rectum or vagina

3. Venkatesan C, Sxl practices & Safer sex OTHER SEXUAL / EROTIC PRACTICES (Partial list) Dry kissing Wet (French) kissing Sensual touching Self-masturbation Mutual Masturbation Necking Caressing Hugging Frottage Breast caressing Breast sucking Erotic talk Using sex toys Sharing fantasies Telephone sex Cyber sex Bubble bath Water sports

4. Venkatesan C, Sxl practices & Safer sex Vaginal sex Use male condoms correctly and consistently. Female condom can be used by females. Water-based lubricants can be used. (Condoms are usually pre-lubricated)

5. Venkatesan C, Sxl practices & Safer sex FEMALE CONDOM

6. Venkatesan C, Sxl practices & Safer sex Anal sex A single male condom – to be correctly applied Water-based lubricants to be used (oil- based lubricants to be avoided). Whether to use double condoms? Whether female condoms can be used for anal sex? Need to teach condom negotiation skills to our patients (besides providing condoms)

7. Venkatesan C, Sxl practices & Safer sex Oral Sex (Fellatio) Oral sex is not absolutely risk-free of HIV infection Risk of HIV infection if semen is swallowed? Some STDs can be acquired or transmitted by oral sex (warts, herpes) Flavored condoms (strawberry, chocolate) are available for oral sex.

8. Venkatesan C, Sxl practices & Safer sex Rimming (Oro-anal sex) Some STDs can be transmitted by rimming. HIV risk is very minimal Dental Dam or Oral dam can be used to decrease risk of acquiring STDs.

9. Venkatesan C, Sxl practices & Safer sex Cunnilingus and Dental Dam

10. Venkatesan C, Sxl practices & Safer sex Fingering Finger gloves – can be made from hand gloves. Some infections can be passed on if finger gloves are not used in fingering. Sometimes a condom can worn in the finger in absence of finger gloves (beware of slipping!)

11. HIV-INFECTED PERSONS - addressing safer sex issues

12. Venkatesan C, Sxl practices & Safer sex HIV-INFECTED PERSONS - addressing safer sex issues Highly active antiretroviral therapy (HAART) does not eliminate the risk of transmitting HIV to others; A person with undetectable viral load can still transmit HIV infection A person with HIV-2 infection needs to use condoms even though HIV-2 is “less infectious”. “Nonoccupational postexposure prophylaxis” is of uncertain effectiveness for preventing infection in HIV-exposed partners.

13. Venkatesan C, Sxl practices & Safer sex HIV-INFECTED PERSONS - addressing safer sex issues… Explain to HIV-infected persons about how safer sex practices can help them? –prevention of acquiring new STDs –prevention of superinfections with other HIV type/strains (virulent and drug- resistant) –STDs can accelerate progression to AIDS

14. Venkatesan C, Sxl practices & Safer sex How doctors can better equip themselves to serve their patients better? Be open-minded Understand our own moral values and biases Don’t let our moral values affect the quality of clinical care we provide to our patients. Improve our knowledge and skills to effectively provide clinical care to persons belonging to diverse sexualities

15. Venkatesan C, Sxl practices & Safer sex Conclusion Clinicians have professional and ethical responsibility to address sexuality issues with their patients so as to - give them appropriate clinical care and - to prevent their patients from STD and HIV.