Safety and hygiene

Sexually transmitted infections (STI) sexually transmitted infections, STI)

The primary protection against sexually transmitted infections are condoms, which are highly effective when stored properly and used within their expiry date. The more people you have sex with, the greater the risk of infection. The risk of infection depends on the level of bacteria or viruses in the infected person’s body, the amount of infectious fluid (including but not limited to vaginal secretions, sperm, blood), the portal of entry (including but not limited to vagina, anus, oral cavity, broken skin continuity/wound), and the length of contact between the infectious fluid and the potential portal of entry. Infectious fluid also includes pre-ejaculate, which is a substance that can come out of the penis before semen is ejaculated. Therefore, any unprotected intercourse (oral, vaginal or anal) is risky, even if there is no ejaculation of semen in the other person’s body.

Increasingly, dermatology and venereology clinics are reporting sexually transmitted infections (not only HIV). Testing for infection is carried out using a blood sample or a swab from a body cavity. The most common infections are:

bacterial infections:

• syphilis - in the first stage, it may manifest as small ulceration. It disappears after a few days, and the infection goes into a latent phase. Untreated, it can lead to serious health problems, including damage to the nervous system;
• gonorrhoea - an infection of the urethra, cervix, throat or anus. It is usually accompanied by pain or stinging. Gonorrhoea is now one of the fastest mutating bacteria, making its treatment more problematic;
• chlamydia - another infection that can develop in body cavities (at the urethral opening). If left untreated, this infection can cause inflammation of the genital organs. Chlamydia infection can be symptomatically similar to gonorrhoea infection;

Skin infections:

• The most common of these are scabies and lice - sexual contact is not the only route of infection, but it does increase the risk. Parasites easily pass from one person to another. Treatment can be lengthy, and it is not easy.

Sexually transmitted viruses:

• HPV (human papillomavirus) – skin lesions usually in the form of warts, the treatment of which is unsuccessful in about 50% of cases. It is particularly dangerous in female reproductive organs;
• HSV (herpes simplex virus) – skin lesions that can affect the mouth (TYPE 1) or genital area (TYPE 2). Most people infected with the virus do not have any symptoms. They can nevertheless transmit the infection to other people;
• viral hepatitis (HAV, HBV, HCV) - extremely viable viruses. Difficult to treat and invasive to the body (especially B and C types). They cause serious infections of the liver and may eventually lead to cirrhosis;
• HIV (human immunodeficiency virus) – is most commonly transmitted through sexual intercourse without a condom. Current treatments are at a very high level. People taking the right medication can have undetectable levels of the virus in their bodies and function as they did before the infection. Untreated infection, on the other hand, leads to acquired immunodeficiency syndrome - AIDS;

Sexually transmitted infections (not diseases!) are not just HIV. Other infections are much more common. In recent years, the most common is gonorrhoea, which can take an asymptomatic form.

Prevention of infection is based on protection during sexual intercourse, education and testing. It is a good idea to test regularly for infection. On the website of the National AIDS Centre , there is a list of places where one can get tested for HIV anonymously and free of charge. Some of these centres also offer tests for syphilis and HCV. Other infections can be diagnosed in private or public health care facilities..

Contraception

Contraception is a set of methods and measures to prevent pregnancy. It is a shared responsibility between people who have sex. Its method should therefore be chosen in agreement and with the consent of the parties. It is advisable to have a gynaecological consultation and, in some cases, a specialist medical examination. When choosing a method of contraception, you should pay attention to its effectiveness, reversibility, as well as safety of use. Among 16-17 year-olds, the most common method of contraception during sexual initiation are condoms. In the second place is withdrawal (or pull-out method), which is not an effective form of protection.

• Barrier contraception - condoms are one of the most popular methods of contraception and also the best method of preventing sexually transmitted infections. The unreliability of this method is most often caused by incorrect condom insertion or storage, resulting in damage and reduced durability. The advantages of this method are ease of use and availability. A condom applied to the penis is still much more popular. Vaginal condoms are not as popular, although the effectiveness is similar. Other methods of this type of contraception include spermicides, cervical caps and diaphragms;
• Hormonal contraception - contraceptive pills (combined pills and single-ingredient pills), contraceptive patches, vaginal rings, implants, hormonal injections, ’72 hours after’ pills, hormone-releasing intrauterine devices (IUDs). These methods are based on supplying the body with hormones (estrogen and progestogen) that inhibit ovulation, thicken the mucus in the vagina, prevent the implantation of the embryo and slow down the transport of eggs in the fallopian tubes;
• Fertility awareness methods - involve examination and observation of the body and periodic sexual abstinence. The calendar method consists of observing the menstrual cycle and having intercourse only at certain times since conception can occur only during ovulation. The temperature method involves taking the body temperature in the vagina or mouth just after waking up because it is slightly higher during ovulation. It requires extreme accuracy, meticulousness, and attention to other factors that can alter body temperature, such as infections. The Billings ovulation method is based on the daily observation of vaginal mucus and its characteristics determining the fertile days. Ovulation tests - they are available in pharmacies and can be used to easily check fertility by examining urine (similar to a pregnancy test);
• IUD - a T-shaped IUD containing copper or levonorgestrel that prevents the embryo from implanting. The IUD can cause inflammation in the vagina that prevents the embryo from implanting and changes the mucus, which prevents sperm from entering the uterus. It is a safe and reversible form of contraception;
• Sterilisation - involves ligating the fallopian tubes or vas deferens. This is the most effective method of contraception, but it should be carefully considered. Fertility restoration, in this case, is characterised by low effectiveness.

Unfortunately, withdrawal is also often used. It involves sliding the penis out of the vagina just before ejaculation so that ejaculation occurs outside the birth canal. It is ineffective due to the presence of pre-ejaculate, which may contain sperm. The negative effects of this method may also include stress and the resulting problems with orgasm.

Withdrawal is not a method of contraception. Moreover, it does not protect against sexually transmitted infections.

The effectiveness of contraceptive methods is determined by the Pearl Index. This index is determined as the ratio of the number of unintended conceptions to the number of cycles examined, using the established method of contraception. The lower the index, the more effective the method. Hormonal contraception has the best effectiveness (Perl index close to 0), fertility awareness methods are the worst.

Condoms

They are a kind of basic barrier contraception, protecting against both unwanted pregnancy and infections. There are several types of condoms.

• Classic condoms - usually made of latex, used to protect vaginal intercourse (penis-to-vagina);
• Flavoured condoms - used to protect oral intercourse (penis-to-mouth);
• Dental dams - made of latex or polyurethane, rectangular sheet applied to the vagina or anus, used to protect oral intercourse or analingus (vagina-to-mouth, anus-to-mouth);
• Thick condoms - for anal intercourse protection (penis-to-anus);
• XL condoms- for those who feel uncomfortable using a classic size condom due to the greater thickness of the penis. The pressure caused by using a condom that is too tight can cause erection loss. This type of condom has a larger diameter. The length of all condoms is similar;
• Polyurethane condoms - for people who are allergic to latex (which is what most condoms are made of);
• Female condoms - used instead of condoms on the penis for protection during vaginal intercourse (penis-to-vagina).

It is a myth that condoms have ‘micropores’ that let sperm or viruses through. A statistical few per cent when a condom doesn’t work is nothing more than human error - usually during the putting-on process.

Such a mistake can lead to the condom slipping or breaking and the secretions coming into contact with the mucous membrane of the other person. Opening the packet with teeth, using two condoms at the same time or stretching the condom to put it on the penis might also cause problems. It is best to buy condoms in pharmacies or at prevention centres. Do not keep them in your pocket or wallet, as the latex can be damaged this way.

Another issue is the lubrication of the body cavities. The vagina has the capacity for natural lubrication. Sometimes, however, lubricants should be used. During anal sex, additional lubrication is a must. Only water-based or silicone gels should be used. All fats (animal or vegetable, including oils) can react with latex. It’s best to choose gels that are odourless and tasteless to avoid possible genital irritation.

Sexual norms

Sets of principles and rules regarding sexual behaviour, which can be divided as follows:

• Legal norms - these define which sexual behaviour is criminalised, i.e. punishable. They refer to, for example, crimes of a sexual nature. The legal scope of this theory is clearly described, among others, in Chapter 15 of the Penal Code;
• Medical norms - refer to the diagnosis of sexual disorders according to, for example, World Health Organisation (ICD) or American Psychiatric Association (DSM) standards;
• Statistical norms - the most popular sexual practices in a given community;
• Psychological norms - mainly refer to individuals’ perceived comfort or discomfort. They are linked to emotions related to gender identity, sexual identity or sexual preference;
• Cultural norms - define the most desirable sexual behaviour in a community. Usually passed down from generation to generation;
• Moral norms - are derived from morality, interpreted from philosophy or created by religious circles, often linked to cultural norms;
• Partnership norms - these are the arrangements between people who are in a relationship. They concern the model of their relationship (e.g. monogamous, sexually open or polyamorous) and sexual behaviour.

It should be noted that some aspects and behaviours meet the criteria of one standard and are not acceptable according to another. Consensual sexual contacts between adults of the same gender are a good example. They meet legal, medical, psychological norms but may not conform to moral or cultural norms.