How To Prevent STIs During Oral Sex Beyond Dental Dams

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In this week's Sex IDK column, Emma McGowan, certified sex educator and writer, answers your questions about STI protection for queer people with vaginas.

Q: Why isn't there better protection for lesbians? Who the f*ck wants to use a dental dam?

As the title of Anna Waters’ excellent exploration of dental dams in The Atlantic so clearly states, nobody uses dental dams. And, sure, that title is exaggerating a bit. Waters actually found that, of the little research there is on the topic, only about 10% of women who had sex with women had ever used them, compared with 93% of women who had used a male condom for penis-in-vagina sex. So while it would seem that someone is using dental dams, it’s certainly not a lot of “someones.”

And, honestly, who could blame them? As Waters outlines in her piece, the dental dam was originally created to keep saliva off of teeth during dental surgery back in 1864 — hence the name. It wasn’t until just under 130 years later, in 1993, that they started being produced for and marketed as a barrier method for oral sex on people with vaginas. And it’s not like a whole bunch of research went into figuring out how best to serve the needs of the vagina-having community. It was really, more than anything, a reaction to the HIV/AIDs crisis, Waters writes.

Long story short, when HIV/AIDs was first spreading in the United States among gay men, and researchers didn’t yet know all the details about how it spread, lesbians were like, “Wait, what about us?” Closely aligned with the gay male community at the time, they were (rightfully) nervous about HIV transmission from oral sex on a vagina.

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But that was the early ‘90s. Today, in 2019, we know that it’s very, very, very unlikely that someone will transmit HIV/AIDs via oral sex on a person with a vagina. The virus just doesn’t like to travel that way. Scientists aren’t totally sure why yet, but they hypothesize it’s because the skin on the vulva is much more like the skin on other outward facing parts of the body (think like, your thigh) than it is like the internal mucus membranes that are exposed during vaginal or anal penetration. Also, while anal and vaginal penetration can both lead to tearing pretty easily, that’s not as likely with oral sex on a vagina. In other words, it’s just harder for the virus to get in there.

As for other STIs, there is a risk of transmission with oral sex on a vagina. Anything that’s spread from skin-to-skin contact — like herpes, HPV, syphilis, and trichomoniasis — can be spread via “tribbing,” which is when two people rub their vulvas together. Tribbing can also up the risk of transmitting an STI that’s spread through bodily fluids — like chlamydia and gonorrhea — because it increases the likelihood of tiny tears opening in the vulva. And that could let those infections in. When it comes to oral sex, it’s possible to spread herpes, chlamydia, and gonorrhea, although it’s still a pretty low-risk activity.

One important thing to note is that if the person you’re having sex with doesn’t have an STI, then there’s no way for you to get an STI. I know that sounds kind of obvious, but it’s worth saying. The way sex ed is taught in the United States, it can sometimes seem like STIs just magically manifest out of nothing and take over your genitals. Not the case! If neither person has an STI, there will be no sharing of STIs.

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With that in mind, a great step that people with vaginas who have sex with other people with vaginas can take is to get tested! If you both get tested before you started touching vaginas with any body part, you can take care of any infections that might be present. Or, if you find out that neither of you have an infection, you can know that you won’t get or give one.

But while getting tested before having sex with a new partner is technically sexual health best practices, I also like to be realistic about how often that happens. That is to say: Probably not 100% of the time. Probably not even close to 25%. Maybe not even 10% of the time. So if you’re not into doing an at-home STI test with every new partner, there are other steps you can take to protect yourself against STIs.

For example, it’s always a good idea to utilize lube. Lube prevents those tiny tears from forming in the skin of the vulva and the vagina, which makes it more difficult for viruses and infections to get into the body. Lube for hand-to-vagina, toy-in-vagina, and vagina-to-vagina sex is a great idea, but you’ll probably want to skip it for oral. (Blech.)

Another thing you can do is use condoms on sex toys, especially if you’re going to use them with multiple people or in multiple orifices. That way, it’s easy to strip the condom off and put on a new one when you’re switching between partners or going from anal to vaginal, for example. For extra clean toys, you can run dishwasher-safe ones (glass, metal, and silicone) through the sanitize cycle on your dishwasher. And when it comes to sex toys, make sure to wash all harness straps between uses, even if you’re having sex with the same partner, because bacteria can breed, baby.

Finally, if you have cold sores in, on, or around your mouth, don’t have oral sex. Herpes that presents as mouth sores can also causes sores on your (or your partner’s) genitals. So if there are cold sores present, it’s probably a good idea to do something else until they go away.

But to answer your bigger question about why there isn’t “better” protection for lesbians, my answer is two-fold. First, it’s only very recently that we as a culture have cared at all about women’s sexual pleasure, much less queer women’s sexual pleasure. As a result, we simply haven’t developed products that actually help people protect their health and don’t interfere much with pleasure.

Second, all of the above-mentioned risk factors illustrate the fact that most sex between people with vaginas is low risk for STI transmission. Zero risk? No. But life includes risk. Remember: All STIs are treatable and most are curable. Be aware, but there's no need to live in fear. You’ll miss out on so much, otherwise.

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