Oral Sex (Fellatio)
Basic Information
Oral sex (fellatio) is a common sexual practice about which there are many unresolved questions, especially in this day of HIV and other sexually transmitted diseases. Both women and gay males perform fellatio ("blowjob", "giving head", "cocksucking") on their partners. While most partners manage to enjoy this sexual experience, in some it creates psychological feelings of stress since this is purely a sex act and procreation is not involved. Thus for some there is a feeling of forbiddenness or guilt associated with the act. If you and/or your partner wish to include fellatio as part of your sexual activities but have psychological feelings of distress surrounding it, it is wise for either you and/or you and your partner to seek counseling from a skilled, nonjudgmental health care provider who will discuss the issue sensitively and make you aware as well of the possible health risks involved. There have been many questions about safety of having oral sex in the face of AIDS. It is important to be educated about the possibility of HIV transmission during fellatio to know what you can do to reduce the risk of transmission. It is also important to know as much about the status of your partner's health as possible so that you can approach oral sex with knowledge and comfortableness should you choose to engage in this activity.
Medical studies and research that have been carried out in the last fifteen years concerning modes of HIV transmission have concluded that HIV transmission during fellatio is a much smaller risk than transmission during anal intercourse. The two highest risk behaviors are known to be unprotected anal sex and IV drug use with shared needles. Oral sex transmission rates have shown to be much lower. But is it completely safe? One reason why research studies are conflicted about the risk of HIV transmission via oral sex may be because respondents are not always truthful about the kind of sex they are having. It is believed that a number of gay men have been infected with HIV through unprotected anal sex but in research studies they have denied, out of guilt or shame, participating in this activity so that research would conclude that they became HIV positive through oral sex. The problem is they may well have been but they may not have been as well so the jury is still out about the safety of performing fellatio. That is why the Center for Disease Control recommends condom use over the penis during all stages of oral sex as HIV exists in precum as well as in the full semen load. Condom use is also recommended by the Center because other STDs can be transmitted during unprotected oral sex as well and not necessarily be easily diagnosed because of the difficulty distinguishing certain symptoms from a normal sore throat, and the same STDs that infect both oral and genital areas may present symptoms that are quite different even if it is the same disease.
The oral receptive partner is at greater risk for HIV and STD transmission than the oral insertive partner though the oral insertive partner is at risk for certain diseases because of the bacteria that exists in the mouth. While it is deemed unlikely that HIV transmission occurs in the oral insertive partner, urinary tract infections are not uncommon since the bacteria can travel down the urethra.
It is important to understand about the gag reflex and about the passages (trachea and esophagus) at the back of the mouth. To prevent injury, especially from a large or rigid penis, the oral receptive partner wants to align the penis with his or her esophagus as opposed to the back of the throat. The feeling of suffocation which can cause the panicked partner to bite will be reduced by good alignment and breathing in when going down on the penile shaft. Gagging can be reduced by relaxation, proper alignment and communication between partners.
It is important to remember to inspect your partner's penis before putting it into your mouth. You want to be sure that there are no obvious signs of redness, swelling, scars, fungal infection or smegma. You do not want to put what is obviously an unclean penis into your mouth. It is a good idea to have an agreement with your partner to bathe the penis or have a shower or bath before engaging in oral sex to remove unwanted bacteria and sweat.
Symptoms
As mentioned, the oral insertive partner is at risk for certain diseases from bacteria in the receptive partner's mouth. The oral insertive partner may have symptoms associated with:
- urethritis
- prostatitis
- urinary tract infection
- epididymitis
- gonorrhea
- herpes
The oral receptive partner may show symptoms associated with:
- gonorrhea
- herpes
- syphilis (symptomatic or asymptomatic)
- If there is thrush (candida) this can be one of the first signs of HIV infection and should be looked at immediately by a health care provider.
Diagnosis/Treatment
If you are the oral insertive partner you may be diagnosed with a urinary tract infection which, depending on the kind you have, will need to be treated accordingly. It is also possible for the oral insertive partner to have teeth cuts or scrapes in which blood is drawn. Use of an antibacterial soap should keep the wound clean and allow it to heal. Antibiotic creams may also be recommended for use after cleaning the penis. If the wound does not heal properly or in a timely fashion, please see your health care provider.
The oral receptive partner is at risk for all kinds of STDs including HIV. When you have one sexually transmitted disease you are likely to have others and should most likely be tested for herpes, hepatitis, gonorrhea, chlamydia, and syphilis. Also, a discussion about HIV is important and an HIV test may be indicated.
A question has arisen about the advisability of not brushing one's teeth to avoid bleeding gums before engaging in oral sex. Since most of the sores in the mouth are very small, almost always present irritations on the gum. it is likely that HIV in precum and semen will find transmission through these small irritations that are always there so it is doubtful that whether or not you brush your teeth before engaging in oral sex will affect oral HIV transmission.
Questions have also arisen about whether to swallow or not to swallow semen. Again, swallowing is believed to have little effect when HIV transmission is involved. It is true that acid in the stomach kills HIV but the risk of transmission occurs before swallowing when semen is around the gums and inside the mouth where it can come into contact with chronic small tears or sores. So swallowing is not really the issue but deciding whether to let a partner ejaculate in your mouth and/or around your gums is.
To decrease the risk even further of a fairly low way of HIV transmission, condoms are definitely recommended. If the thought of oral sex with a condom is a turn-off, there are ways you can try to make this situation erotic and tasteful. You can find flavored condoms or decorate the condom with jams, jellies, whipped cream, chocolate syrup, etc. If you are the oral insertive partner try to understand if your partner insists on using a condom. Healthwise it makes sense for both of you. Also, do not use force in pushing your penis in the throat as the chance of injury to the throat or tearing the throat will increase risk of infection..
Women must be aware of the risks associated performing fellatio especially on high risk partners, i.e. bisexual men and IV drug users.
It is important to have honest discussions with a health care provider you can trust to be sensitive and knowledgeable so that you can understand the ways to reduce the risk of HIV and STD infection, and to be aware of ways the throat or penis can be injured during oral sexual intercourse.
If you have questions concerning oral sex, please see your health care provider.