Sexual Risk Behavior

Sexual Behaviors and Associated Risk

Sexual behaviors comprise a wide array of acts ranging from minimal contact to penetration. Abstinence from vaginal intercourse is the only completely effective method for preventing unintended pregnancy. Abstinence from oral, vaginal, and anal intercourse, as well as autoeroticism (otherwise known as masturbation)—fulfilling individual sexual needs without a partner—is the only truly effective means for preventing STIs. When more than one individual is involved in a sexual act, sexual behaviors fall along a continuum of risk. At the low end of the risk continuum are behaviors that consist of minimal physical contact, including kissing, frottage (rubbing against the body of another individual), and fondling.

Oral sex, the act of orally stimulating the penis, vagina, or the anus (termed anilingus or rimming), is toward the middle of the risk continuum when no barrier method is used. While the risk for STI transmission during oral sex is lower than the risk associated with vaginal or anal sex, the risk is still present. The theoretical risk of STI transmission from oral-penile contact is present due to infected preejaculate or semen, penile fissures, open sores on the penis, bleeding gums, or open sores in the mouth. The theoretical risk from oralvaginal contact is present due to infected vaginal fluid or blood from menstruation, open sores in the vulva or vagina, or bleeding gums or open sores in the mouth. The theoretical risk from oral-anal contact is present due to infected blood in fecal matter, anal fissures, open sores in the anal area, or if infected blood from the mouth enters the rectal lining.

Vaginal-penile intercourse is at the high end of the risk continuum when no barrier method is used. The consequences of unprotected vaginal intercourse include STIs, including HIV, and unintended pregnancy. The risk of HIV transmission from unprotected vaginal intercourse is present for either partner due to infected semen, infected vaginal fluid or menstrual blood, or open sores in the vulva or vagina. STI transmission also occurs through these pathways; however, certain STIs can be transmitted solely through contact with mucosal surfaces or infected skin.

While unprotected insertive anal intercourse is at the high end of the risk continuum, the riskiest sexual behavior is unprotected receptive anal intercourse. The risk consequences of unprotected anal intercourse are HIV and other STIs. The risk of infection is present in methods used without a barrier due to infected semen (including preejaculate), open sores in the anus, or tears in the lining of the anus.

...