Washington, DC -- When counseling patients about preventing sexually transmitted diseases (STDs), it's important for physicians to ask direct questions about both intercourse and noncoital sexual activity, according to a new Committee Opinion issued today by The American College of Obstetricians and Gynecologists (ACOG).
Noncoital sexual behavior includes mutual masturbation, and oral and anal sex and is common among adults and adolescents. Despite concerns expressed in the popular media about an increase in oral sex among adolescents and young adults, there is no evidence that this is the case. However, research does show that oral sex is much more common among adolescents who have already had vaginal intercourse, suggesting that these sexual activities occur at about the same time and with the same partner.
"Most people, including adolescents, are unlikely to use condoms during oral sex, which places them at risk for acquiring an STD," said Richard Guido, MD, chair of ACOG's Committee on Adolescent Health Care, which issued the opinion along with ACOG's Committee on Gynecologic Practice. "This unlikelihood is partly because of a greater perceived safety compared with intercourse. Although sexual behavior is a sensitive issue to address for both patients and physicians, it's important to discuss sexuality frankly and without judgment so that we can help our patients fully protect themselves against STDs."
The Committee Opinion notes that the risk of getting certain STDs varies depending on the specific disease and the sexual behavior. For instance, the risk of acquiring HIV through oral sex is less than through vaginal sex, with receptive anal sex having the highest risk. Herpes, however, is commonly transmitted through kissing and through oral, vaginal, and anal sex. Herpes simplex virus Type 1 (HSV-1), typically associated with oral herpes (ie, "cold sores"), can be transmitted to the genitals through oral sex. And, herpes simplex virus Type 2 (HSV-2), typically associated with genital herpes, can be transmitted to the mouth through oral sex. Nonviral STDs, including gonorrhea, chlamydia, and syphilis, also can be transmitted through noncoital sexual activity.
"Our lesbian and bisexual patients also need be screened for STDs based on the same risk factors as other women," Dr. Guido noted. "Most lesbians have been sexually active with men at some point. Even without this sexual history, there are some STDs that can be transmitted between two women during sexual activity."
According to ACOG, physicians should ask more direct questions about a patient's sexual behavior so that they can provide counseling on ways to lower the risk for STDs. Since most women who engage in noncoital sexual activity are also having intercourse, clinicians need to consider whether these noncoital behaviors add any additional risks to those already posed by intercourse. Risk-reduction strategies include limiting the number of sexual partners, STD testing before engaging in sexual activity with a new partner, correct and consistent use of condoms, abstinence, and/or mutual monogamy.
Committee Opinion #417, "Addressing Health Risks of Noncoital Sexual Activity," is published in the September 2008 issue of Obstetrics & Gynecology.