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ALTERNATIVES IN INTIMACY
Sexual Intimacy for People with Herpes
by Dr. H, MD
www.herpes.org
updated December 1, 2017
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Perhaps the most commonly asked questions that we receive at www.herpes.org pertain to how individuals with Herpes can engage in sexual intimacy with their partner yet avoid transmitting infection. Although there are no guarantees, there are numerous measures that will greatly reduce the risks of infecting a partner during sexual activities. As well, there are different ways to think about sexual intimacy that may be helpful to those with Herpes and their partners.
Firstly, the drive to reach orgasm is a healthy normal human desire. As a physical fact, it is intensely pleasurable, as well as being the manner in which we reproduce as a species. Stereotypically, heterosexual sex* is considered penis in vagina thrusting intercourse until one (or hopefully both) people come to orgasm. However, direct, vigorous, unprotected, penis-in-vagina intercourse is the most common manner in which genital herpes is spread (followed closely by oral to genital contact). So what can you do?
If you are having an active Herpes outbreak, you should abstain from sexual activities that could likely transmit the infection to a partner for the duration of the outbreak. Even if you are not actively showing symptoms but have a genital herpes infection, viral shedding may occur which can pass along the virus. As stated elsewhere on the site, Protecting Uninfected Partners: Important Results from a New Study, (Partner Protection) an important research study has determined that a daily dose of the anti-viral medication Valtrex, prescribed by your Physician, greatly reduces but does not eliminate the risk of this viral shedding.
There are additional preventive methods to limit the risks of spreading Herpes to your partner during sexual activities, as well as behavioral changes that you may wish to consider.
PREVENTIVE METHODS
1) CLEANLINESS- Warm soapy water kills virus. Thus it is advised that you wash your hands and under your fingernails thoroughly with soap and warm water before and after all sexual activities. Taking a warm soapy shower before and after sexual intimacy may also limit the spread of virus.
2) CONDOMS- The male should always wear a lubricated condom on the penis during vaginal or anal intercourse or when being stimulated manually (by hand) or orally (by mouth). While latex condoms are preferred, polyurethane condoms may also be used (Avanti is one U.S. brand) with or without spermicidal lubricant. During oral sex, a non-spermicidal lubricant is recommended.
Additional Notes:
a) Do not use lambskin condoms as they do not effectively block the transmission of virus.
b) While spermicidal jelly (nonoxynol-9) is known to kill virus, its use actually slightly INCREASES the risk of virus transmission during intercourse or in stimulation of the male by the partner. It appears that the chemical in spermicidal may have toxic effects on genital skin which may "open the barrier" to virus transmission.
c) If the condom develops a leak, throw it away and use a new condom.
d) Additional lubricant can be used and is especially important during anal sex or when for whatever reason, additional vaginal moisture is needed.
e) Use only those lubricants meant for sexual use such as KY-Jelly, Astroglide, etc. Do not use petroleum jelly, baby oil, or moisturizing body lotions as they can cause condom breakage.
f) Condoms can be purchased at any drugstore or through on-line retailers.
*** REMEMBER TO MAKE SURE THAT NEITHER PARTNER HAS A LATEX ALLERGY. LATEX ALLERGIES ARE FAIRLY COMMON AND CAN BE ASSOCIATED WITH SERIOUS PHYSICAL EFFECTS INCLUDING LIFE-THREATENING ANAPHYLACTIC REACTIONS. ***
3) THE FEMALE CONDOM- Though not as widely used, the Female Condom is a safe option both for birth control and prevention of viral transmission. It consists of a polyurethane sheath (safe for those with latex allergies) which is inserted into the woman's vagina prior to intercourse. It completely lines the vagina and has two rings. One ring, at the closed end of the sheath, is inserted in the vagina and positioned against the cervix, and one ring, at the open end of the sheath, hangs outside of the vagina. An additional benefit of the Female Condom is that the outer end of the sheath provides a barrier to the external genitalia. Thus it can help to prevent viral transmission to the mouth, eyes, or nose while a partner engages in oral sex with the woman. It can also serve as protection when genitals are rubbed against each other.
Additional Notes:
a) The Female Condom should not be used at the same time as a male condom as the friction between them can cause breakage.
b) Should the Female Condom develop a tear, discontinue sexual activity, throw it away, and replace with a new one.
c) The Female Condom does contain a silicone lubricant but more can be added. Spermicidal jelly has antiviral properties as mentioned above but it probably does not offer protection against transmission.
d) Use only those lubricants meant for sexual use such as KY-Jelly, Astroglide, etc. Do not use petroleum jelly, baby oil, or moisturizing body lotions as they can cause condom breakage.
e) The Female Condom is available at most drugstores and on-line pharmacies.
4) THE DENTAL DAM - Named for its common use over a dental patient's mouth, the Dental Dam is a square piece of thin latex that is placed over the female genitalia (or over the female or male's anus.) This permits the person to perform oral sex on their partner's vaginal or anal opening, while preventing viral particles from getting into the mouth, eyes, and nose. This device is also sufficient to protect the hands of the person who wishes to perform manual stimulation of the infected partner's genitalia or anus.
Additional Notes
a) Genital or anal to fingers transmission though not common, is possible if the skin of the fingers has a small crack or laceration.
b) Should the Dental Dam develop a tear, discontinue sexual activity, throw it away, and replace with a new one.
c) It is important for one or the other partner to help hold the dental dam in place during sexual activity to prevent slippage and exposure to viral particles.
d) It is recommended that you avoid hard pressing of the mouth, eyes, or nose to the genital or anal areas during oral sex.
e) If you do not have a dental dam, you can create one by cutting down the side of a male condom and spreading it out. If you do not have a male condom, a piece of Saran Wrap plastic wrap, though not as sturdy of a barrier, can be used.
f) Do not re-use the dental dam and do not use the same one for both the vagina and the anus.
f) Dental Dams can be purchased at some specialty drugstores but are easier to find at sexual paraphernalia shops or on-line condom shops.
*** REMEMBER TO MAKE SURE THAT NEITHER PARTNER HAS A LATEX ALLERGY. LATEX ALLERGIES ARE FAIRLY COMMON AND CAN BE ASSOCIATED WITH SERIOUS PHYSICAL EFFECTS INCLUDING LIFE-THREATENING ANAPHYLACTIC REACTIONS. ***
5) PROTECTIVE GLOVES- Latex (or polyurethane gloves) may be worn on the hands while stimulating the infected partner's genitalia or anal areas. A lubricating jelly should be placed on the fingers to prevent the latex glove from irritating the partner.
Additional Notes:
a) Genital (or anal) to fingers transmission, though less likely, is possible if the skin of the fingers has a small crack or laceration.
b) Do not use vinyl gloves (aka kitchen gloves) as they do not prevent spread of virus.
c) Should a glove develop a hole, discontinue sexual activity, throw it away, and use a new one.
d) Latex gloves can be purchased at most drugstores. Polyurethane gloves, while not as commonly available in drugstores, can be purchased at medical supply stores or on-line.
*** ONCE AGAIN, REMEMBER TO MAKE SURE THAT NEITHER PARTNER HAS A LATEX ALLERGY. LATEX ALLERGIES ARE FAIRLY COMMON AND CAN BE ASSOCIATED WITH SERIOUS PHYSICAL EFFECTS INCLUDING LIFE-THREATENING ANAPHYLACTIC REACTIONS. ***
NEW BEHAVIORS TO CONSIDER REGARDING SEX
1) TRY IT SLOWER - Gradual sexual stimulation and slower and more even thrusting during sex can be pleasurable and orgasmic for both partners, as well as a way to reduce viral transmission. These less forceful sexual activities are far less likely to create the microscopic "tears" in genital tissue that allow for the virus to spread. Couples may also find that taking their time during sex and paying greater attention to their partner's response can produce a much more intense, erotic, and intimate experience.
2) TAKE THE FOCUS OFF ORGASM- Many people don't realize that the sexual experience can be intensely pleasurable and complete without achieving orgasm. Arousal and sexual play that is not orgasm-focused tends to be slower and more intimate, again reducing the risk of viral transmission through microscopic skin "tears". As well, a less pressured sexual experience creates less stress for both partners as well as a longer period of closeness. And often when the high performance expectations are removed, orgasm happens naturally as a result.
3) STIMULATE YOURSELF- Stimulating your own genitalia creates no risk of spreading infection, as long as you remember to wash your hands afterwards before touching your partner. Many partners also enjoy stimulating themselves side by side.
4) USING OBJECTS FOR AROUSAL- Stimulating yourself or your partner using objects such as vibrators, dildos, and other sexual toys is another way to reduce viral transmission rates to zero. However if inserting the object into the vagina or anus would result in hand to external genital or anal contact with an infected partner, you may wish to wear protective gloves as detailed above.
** DO NOT EVER INSERT ANYTHING GLASS OR BREAKABLE INTO THE VAGINA OR ANUS **
** AS BREAKAGE COULD CAUSE SERIOUS INJURY **
5) TRY "PSEUDO-SEXUAL" ACTIVITIES- Passionate kissing, touching non-sexual body parts (neck, arms, chest, abdomen, legs), giving your partner a massage, and rubbing bodies with clothes on can all be stimulating and erotic, as well as free from risk of spreading virus. Some infected people have genital herpes outbreaks on their buttocks so you may wish to avoid that area. If they have never had an outbreak there, there is still a minor risk of this area being contagious.
6) EXAMINE YOUR MOTIVES- We understand that there are many different motivations for sexual intimacy throughout one's lifetime. Often what motivated you when you were younger is not what drives your desires in middle-age. Wherever you are in life, we suggest that you take a moment to think about what you really want when you are planning to (or about to) have sex with a partner. Sometimes it isn't sex that we're seeking but closeness. If this is the case, try to communicate that with your partner. Perhaps they too would prefer to talk intimately, cuddle, hug, spoon, and get a good night's sleep.
**The suggestions in this article are equally applicable to gay (same-sex) sexual relationships with the obvious exception of those pertaining to penis in vagina intercourse and additionally for lesbians, those pertaining to oral sex performed on a penis.**
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