How risky is oral sex?
After Michael Douglas's revelation that his throat cancer was caused by oral sex, Justin Hancock, a sex educator, explains the risks and how best to protect yourself.
It's difficult to answer the question 'how risky is oral sex?' because many people who have oral sex also have other kinds of sex which may have put them at risk of infections. The risks of STIs (sexually transmitted infections) for oral sex are generally much lower than for unprotected penetrative vaginal or anal sex. Just how risky oral sex is depends on where the people concerned are having oral sex (eg penis, testicles, clitoris, labia, vagina, anus), whether they are giving or receiving and what infection we are talking about.
HPV, (human papillomavirus), which is what Douglas said he contracted and led to his throat cancer (the sexually-transmitted virus is best known as a common cause of cervical cancer), can be transmitted from unprotected oral sex but so can chlamydia, gonorrhoea, syphilis, HSV and Hepatitis. It is worth also mentioning that HIV can be transmitted via oral sex, but the risk is very, very low indeed.
Some of these are more problematic than others – for instance HSV (herpes simplex virus) can easily be passed on through oral sex but (apart from for pregnant women) presents few, if any, long term effects.
Remember you can only pick up an STI from someone who has one. However, it is not always easy to know whether you have an STI or not. Most cases of STIs are either symptomless or have symptoms which are mild and go unnoticed. Often the only way of finding out whether we have an STI is by having a check up and the relevant tests.
Most areas have services where you can get a check up for STIs: they are either called GUM clinics, or sexual health clinics. Many 'family planning' services are now able to offer STI screening too, as do increasing numbers of GPs. These clinics are confidential: currently GUM clinics keep their own clinical records, meaning they don't even have to be shared with a GP. All tests and treatment are also completely free.
The staff will recommend which tests to have depending on the kind of sex that someone has been having and with whom. They will determine this by asking a series of questions as part of taking a 'sexual history'. Generally tests involve urine tests, vaginal swabs (self swabs are often available), blood tests (including a rapid finger prick test for HIV) and just a visual examination.
Sometimes the mouth and throat may be examined if the staff feel that someone has been at risk or has reported certain symptoms (persistent sore throats, unusual growths at the back of the throat or trouble swallowing for instance). However, this isn't something that is recommended by all clinicians. Also tests for HPV aren't routinely offered unless it's part of a smear test. So it's difficult to be sure whether someone has an STI which can be transmitted through oral sex even if all parties have had a check up.
Oral sex can be made safer by using condoms (this is why we have flavoured condoms) on the penis or on the vulva or anus (cut them in half and they form a barrier). Sexual health clinics also stock dams which are thin sheets of latex similar to a condom. Non-microwavable cling film (usually the cheap stuff in supermarkets) can also be used as a barrier. It's also a good idea to avoid unprotected oral sex with someone with a coldsore (HSV1).
However, many people choose not to use protection when engaging in oral sex and will not get an STI from it, nor will not realise they have one. For instance - the immune system effectively deals with most cases of HPV and most cases don't have any symptoms. (But please note one symptom of HPV is genital warts). Most people who have oral sex won't get the strain of HPV which is thought to be linked to throat cancers, that Douglas has said he contracted. And even if someone does, this doesn't necessarily mean that they will get throat cancer. We still don't know enough about the link between HPV and mouth and throat cancers, but we do know that smoking and alcohol are other risk factors which may have a role to play combined with the risks of HPV.
Lastly there is no such thing as 100 per cent safe sex, which is why us sex educators always say any precautions lead to ‘safer sex’.
We need to be sensible with our sexual health to try to make it as safe as possible.
But we also need to accept there are small risks that we can't eliminate and weigh this up with the pleasures of having the kind of sex we want to have.
Thank you for reading, God bless you!
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