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Along the Latex Highway

An Oral Examination

May 1998

"Blowjob" is a stupid word. I mean, you don't actually blow on it. And I would hardly consider it a job. Who comes up with this stuff?

I was first introduced to the blowjob concept as a teenager while perusing the pages of my older brother's Penthouse magazines. This same magazine taught me all about the blowjob's distaff equal, cunnilingus. I'm sure lots of other teenage boys learned these words the same way I did. This would explain why classmate Mike Boyer asked me if I was taking Connie Lingus to the junior prom.

Perhaps not the best educational resource available, Penthouse (and Playboy) certainly defined these particular sexual acts in ways my parents never would. Today I read epidemiological and community studies focusing on sexual behavior and HIV infection. There are no pictures and the language is usually very obtuse. Instead of "blowjob" and "cunnilingus" you get phrases like "oral-genital contact" and "orogenital intercourse." These are simply clinical ways of describing oral sex between a man and a woman or two men. In other words, sex involving a penis and a mouth, or a mouth and a vagina.

The risk of HIV transmission through oral sex is genuinely difficult to assess. To my knowledge, there have been at least 65 studies conducted since 1984 that offer conclusions about sexual risk behavior and HIV infection. I found 14 studies since 1984 that explicitly assess the risk of oral sex for men who have sex with other men. Experts and AIDS groups have reviewed and interpreted these studies and other evidence. Generally, there is wide consensus that oral sex poses a lower risk than unprotected anal sex. For instance, the New York State AIDS Institute concluded: "The risk for contracting AIDS through oral intercourse is not zero, but is lower than associated with anal or vaginal intercourse." In 1993, an AIDS Institute panel concluded that "the number of documented cases of oral transmission is very small," but "oral-penile sex poses a real risk of HIV transmission, although the risk is far lower than for anal or vaginal sex." Remember that most studies address only homosexual male transmission of HIV.

The most recent study I found, The Chicago MACS/CCS Cohort (1995), conducted by David G. Ostrow, M.D., Ph.D, used 590 subjects. The conclusion: "Did not support the hypothesis that receptive oral intercourse ... replaced unprotected receptive anal intercourse as important risk behaviors in homosexual transmission of HIV.... None of the intercourse measures except receptive anal intercourse were statistically significant." But even the study's author later suggests, "It may be appropriate to label oral intercourse 'safer' rather than 'safe' in terms of HIV-1 transmission."

So let's talk about the circumstances that make oral sex risky and how we can make it safer. Your risk is increased by taking ejaculate (semen or "cum") in your mouth. Experts say HIV can infect the linings of your throat, tonsils or esophagus and possibly even a stomach ulcer. So you can reduce your risk by having your partner ejaculate outside your mouth (on healthy, unbroken skin). Bottom line: don't swallow an infected partner's semen.

There's also "pre-cum," the clear liquid discharge most men experience during an erection. It contains HIV as well. Some findings suggest that it contains a higher concentration of HIV than semen. Remember that there is usually much less "pre-cum" than semen, though, and that some men don't have the discharge at all (although it exists in the urethra). Some studies suggest components of saliva inhibit HIV and make it less infectious. It's your call here; there doesn't seem to be a simple answer.

My answer? Know your oral health. Know what's going on inside your own mouth. If you just bit you lip or your cheek, avoid oral sex until it's healed. Did you just burn your mouth with hot food? Did you eat a bag of corn chips and tear your gums? Avoid the semen or vaginal secretions of an infected partner until you've healed. Also, don't perform oral sex on a man or woman with HIV immediately after brushing or flossing your teeth. If your gums are bleeding or tender, you increase the chance of transmission that way. If this is a recurring problem, talk to a dentist and get checked for gingivitis, a common gum disease. Good oral health and hygiene reduce the risk of HIV and sexually transmitted disease transmission. Cuts, abrasions and bleeding are red flags. And by the way, cleaning your mouth out with hydrogen peroxide may be preferable to using mouthwash. Most mouthwashes contains alcohol and may irritate your mouth. Or you can also simply place a condom on the penis. Try the unlubricated, flavored ones.

For oral-vaginal sex (yes, cunnilingus), consider using a dental dam (a square of latex sold at some drugstores, medical supply places and adult shops) or just buy some plastic wrap at the grocery store. Tear off a sheet, place it over the vagina and do business as usual. Remember that vaginal secretions do contain HIV, and it increases when menstrual blood is present.

Avoiding vaginal secretions or semen/pre-cum in the mouth or using a condom for oral sex will certainly lower the risk of HIV transmission and the risk for other sexually transmitted diseases as well. Here are specific circumstances that increase an individual's risk:

  • cuts, abrasions or infections in the mouth or throat.
  • vigorous, prolonged oral sex: "deep-throating."
  • mouth or throat trauma caused by a large number of partners in a short period of time.

The reports and behavioral data I read suggest that HIV infection through oral sex is not statistically significant. But in the past three years I've had three men approach me after safer sex presentations to tell me they were exposed to HIV through oral sex. They've ruled out anal intercourse, injection drug use and blood transfusions as possible causes. All three were sincere, articulate men who have nothing to gain from lying to me. I believe them. I believe it is possible under specific circumstances. The risk, however statistically insignificant, is yours to weigh.

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