Diligent Oral Sex

Dear Dr. G,

I read with horror the article and video you published two weeks ago, indicating oral sex is safe.

I traced back your articles from the past and realised medical colleagues have never put you on the spot. Therefore, it’s about time we do so today.

First of all, I am surprised you discuss such private matter of oral sex in public forum like this. I think in a conservative society like Malaysia, we should really remain conservative.

Secondly, you gave the impression that oral sex is a risk-free sexual practice. Correct me if I was wrong, is it true some reports indicated that chlamydia and gonorrhoea are on the rise as unsuspecting clients of sex workers contracted the diseases through oral sex?

Besides, didn’t the infamous Michael Douglas admit to contracting HPV and ended up with oral cancer.

In view of the above, I would like to put Dr. G on the spot to ask him to clarify exactly what diseases are transmissible by oral sex.

More importantly, for younger couples have just started having sex, or older couples for that matter, what measures can be taken to protect oneself from the pathogen?

Yours truly,
Diligent Doctor

The practise of oral sex, or fellatio, indeed is commonly regarded as taboo in most conservative societies. Some segment of the society may even have negative feelings towards giving or receiving oral sex, as the practice is considered unclean and unnatural. Most countries do not ban oral sex, and the incitement of sexual arousal performed by oral stimulation is also regarded as “non-proper” sex, as the practice preserves the virginity of either partner.

The concept of “technical virginity” is often associated with non-penetrative sexual act, such as penile-vaginal or anal penetrative intercourse. Therefore, mutual masturbation and fellatio are popular amongst teenagers, in the initial stages of the sexual experience, as this is commonly used as a mean of “preserving virginity”.

A report was produced by the National Centre for Health Statistics in 2005, highlighting a survey of over 12,000 Americans between the ages of 15 and 44. The study revealed over half of the teenagers admitted to regular oral sex. The Centers for Disease Control and Prevention (CDC) also echoed the same findings in 2009, demonstrating oral sex is very common amongst adolescents, as well as indicating males are more likely than females to have received oral sex, whereas equal proportions of men and women have given fellatio.

Despite not having any statistics on such sexual practice amongst Malaysian youths, I make no apologies for touching on such a sensitive (but important) subject in our conservative society.

Like any form of sexual act, involving the exchange of bodily fluid, oral sex can pose a risk of contracting sexually transmitted infections (STI). The pathogens recognised to be transmissible through oral-genital contacts are chlamydia, gonorrhoea, herpes, hepatitis, HIV, HPV and even TB.

Indeed the famous Michael Douglas confessed to excessive oral sex resulting in contracting HPV and ended up with oral cancer. In reality, it is unclear the exact risk of infections with oral sex itself, however, it is generally agreed amongst experts the risk for transmission is significantly lower than vaginal or anal sex.

There is an increased risk of STI if the receiving partner has wound on his or her genitals, or the giving partner has sores or bleeding gums in the mouth. Brushing

teeth, flossing and dental work prior to fellatio can enhance the transmission. Generally, clinicians would advise for the use of condoms or other effective forms of barrier methods when engaging in oral sex, especially when the infectious status of the partner is unknown.

Confucius famously warned: “The expectation in life depends upon diligence, the mechanic that would perfect his work must first sharpen his tools”. I confess, and apologise, for not being diligent enough and giving out the impression oral sex is a form of safe sex.

Protection from STI is paramount for all, even for the “benign” practice of fellatio. The use of condoms, makeshift dental dams made out of nitrile gloves and even plastic wraps during oral sex have been suggested for protection during oral sex.

In practice, the cumbersomeness of plastic in the mouth and the repulsive taste of rubber on the tongue will be even more off-putting than the unflattering comparison of “taking a shower in a raincoat” for those repulsed by barrier technique during penetrative intercourse.

When Dr. G is put on the spot to be more diligent in commenting on safe oral sex, his advice is: “The protective from infection depends upon diligence. However mutual trust and monogamous relationships would be perfect protection before he whips out his sharpen tool for oral sex”.