sexually transmitted infections (STDs/STIs) are again on the rise with massive increases of prevalance over the past 10 years in Western cultures due to failure of safe sex practices which had been more adhered to in the 1990's when HIV / AIDS fears were at the forefront.
sexual activity can never be made 100% safe without any risk of adverse sequeleae however many of these risks can be managed to minimise the unwanted consequences which fall into the following general categories:
physical trauma including genital laceration or retained foreign bodies requiring surgery
emotional consequences such as regret, guilt, marital or partner resentment/anger/jealousy which can lead to suicide or criminal behaviours and even homicide as well as financial ruin from failed relationships or unplanned pregnancies
non-consensual behaviour with potential serious ramifications for both parties
vertebral artery dissection - (rare) can be triggered by aggressive neck pressures, especially if recent chiropractic neck manipulation, and then progressed due to transient hypertension of orgasm
stroke (CVA) - may result from over-enthusiast love bites on the neck or from attempts to induce cerebral hypoxia
retinal haemorrhage
post-coital or orgasm headache - severe sudden onset headache, but fortunately for most, it tends to last only an hour or so
allergic reactions to rubber, topical substances and in rare cases to semen
unwanted publicity
this may have potential career, family or relationship ramifications, or just social embarassment
it is very unlikely that public knowledge of your sexual activities will be a positive outcome
the wise will be discrete
many of the above risks become much higher when alcohol or other substance usage is a added into the mix or there are pre-existing psychological or mental issues
preventing unwanted pregnancy
unfortunately for the male, they cannot always rely upon the female to have taken appropriate precautions, particularly as some may wish to become pregnant to access some 28% of your gross income for the next 18 years, while others may not be compliant with their pills, and the only ways for the male to reduce this risk at present is vasectomy or to use condoms
vaccination for hepatitis B virus is important, as although hepatitis B is primarily transmitted by infected blood, it is very contagious and sexual activity can readily result in its transmission
if one partner is diagnosed with a sexually transmitted infections (STDs/STIs) such as Chlamydia, then BOTH partners should be treated for it concurrently to avoid being reinfected after treatment finishes
hormonal status
high levels of progresterone without combined use of oestrogen (eg. progesterone-only mini pills) cause a 10-fold reduction in levels of interferon epsilon from the endometrial epithelial cells, potentially raising the risk of sexually acquired infections suggesting that risk of infection may change throughout the normal menstrual cycle in those not taking hormonal contraception 1)
UTI's are caused by bowel bacteria entering the urethra and passing up into the bladder, this is mainly an issue for women as they have much shorter urethras than men
females should pass urine soon after sex to ensure their bladder is emptied and the bacteria flushed out
despite best intentions, even restricting to oral sex may result in infection:
most commonly used to reduce risk of HIV / AIDS but studies suggest doxycycline does reduce risk of bacterial STIs
reducing risk of physical trauma or dysfunction
each week, a major urban hospital is likely to treat at least one patient with a sexual misadventure, most commonly, a rectal foreign body, but also those with steel cock rings which create a one-way valve effect on blood supply to the scrotum and penis - these are PREVENTABLE by using devices which will not go all the way into the rectum, and by using cock rings which can be easily removed such as those made of rubber
concerns have also been raised by the apparent rise in consensual strangulation during sex to heighten orgasms but at significant long term neurologic risk
the frequency of these mishaps suggests that there needs to be community education to address misinformation on the net or in whatever advice people are getting if any at all
avoid use of potentially dangerous objects
patients commonly present to emergency departments with retained rectal foreign bodies such as glass bottles, light globes, vibrators, etc
unfortunately many such patients require general anaesthetic to have them removed, and in some patients, may require surgery to their bowel with a temporary colostomy bag required if the bowel was damaged (eg. by broken glass)
anal sex toys should always have a flange or similar mechanism to prevent inadvertent complete insertion into the anus
even the long length of a double-ended dildo can be fully placed into the bowel and require surgical removal
fragile objects such as light bulbs and other glass objects are particularly dangerous as they may require surgical removal, bowel repair and a colostomy
sharp objects or vigourous use of high risk objects in the vagina may result in perforation or tears which may require surgical repair
use of strangulation or other mechanisms to induce hypoxia to augment orgasms is clearly dangerous and potentially life threatening
there is risk of damage to the carotid arteries resulting in permanent stroke
if you become unconscious, you may not be able to reverse the hypoxic causative agent which then may result in permanent hypoxic brain damage or death
introducing objects down the urethra (“sounding”) is just asking for infection, urethral damage and long term scarring which may cause chronic problems
use of metal cock rings has a high risk of being unable to be readily removed resulting in massive swelling to penis and scrotum with potential for testicular ischaemia
these may not be able to be removed readily using standard ring cutters and may require a dremel tool and modified pliers which can separate the cut ends of the ring - call the fire brigade to assist if the ED does not have the tools
do not inject anything into the genital area
injecting “sterile” saline into the scrotum to make it larger is unwise and has a major risk of introducing infection into the scrotum which may need surgical drainage
injecting substances into the penile skin (eg. microwaved lard) to make it thicker is likely to result in severe skin necrosis due to inflammatory response and this may require penile amputation
avoid use of potentially dangerous topical substances
the genital area is not only sensitive but the mucosal area can absorb substances into the body rapidly with resultant toxicity
incorrectly selecting a GTN gel as a lubricant will give you a headache and drop your blood pressure
many substances can result in chemical burns
only use erectile dysfunction medications as prescribed
excessive use may result in priapism which will require emergent treatment by drainage of blood from the corpus callosum to prevent permanent penile damage
prevent falls and other injuries
sex in the shower can be fatal if the glass shower screen breaks
sex in association with slippery massage gels such as Nuru gel significantly increases the risk of falls and other injuries
sex in association with alcohol or other substances increases risky behaviour and falls
excessive forcing an erect penis downwards (eg. falling on the floor or the female falling backwards during sex) can result in “fractured penis” and the risk of permanent damage to the ability of the penis to become erect
reduce risk of violence
choose your partner well
avoid excessive alcohol or substance use
avoid potential unwanted third party involvement including strangers, friends, and pets (apparently cats can be problematic by jumping on the bed and causing scratches and bites)
lubricants can help to reduce frictional issues and reduce rupture of condoms (risk of condom rupture in anal sex is over 20% without lubricant and reduces to 3% with a water-based lubricant) 2)
if using condoms or similar, ensure lubricants are water-based or silicone-based to reduce risk of failure of condom due to petroleum-based lubricants such as Vaseline 3)
try to be aware of surroundings before commencing sexual activity
sexual arousal tends to cause reduced awareness of surroundings while the physical activity may cause objects to fall or break and cause injury
take extra care with placement of wine and beer glasses
be aware of picture frames, light fittings, etc
minor injuries are common such as bruises, strains, and carpet burns
care with oral sex
there have been rare cases of condoms being inhaled into the lungs during fellatio
dental braces can cause superficial injury
prolonged oral sex with mouth opened wide may cause increased risk of dislocated mandible
blowing air into the vagina has been reported to cause pneumoperitoneum (air in the abdomen) which can be dangerous
get fit
sex tends to be a vigorous exercise and may cause muscle strains
regular exercise is also thought to be the main risk preventer for post-coital headache