Question:
Dr Turner, you are using the term "safer" sex. I've always just heard "safe" sex. What's the difference?

Answer:
What a great question!
 
Safer sex behavior is an updated term from "Safe Sex"-- the reason why the term has been updated to "safer" rather than "safe" is because there are always going to be some amount of risk taken with sexual activity. Safer sex means that precautions have been taken in an aim to reduce the risk of transmitting STI's. This can be achieved through use of condoms, regular STI screenings, and STI screenings being performed before having intercourse with new sexual partners. It also includes using barriers such as condoms, and latex or polyurethane dams for oral sex (for more information on the other barrier methods, check tomorrow's blog!)

Some more terminology:

Possibly safer sex behaviour: Using condoms prevents the fluid transmission but not skin to skin contact; which means STIs that can be transferred through skin to skin contact like herpes and HPV can both be transferred even when someone is using a condom. Also, couples who are fluid bonded (meaning they only have sex without barriers with each other) or who are monogamous can have possibly safer sex: assuming that both people are 100% monogamous and or using safer sex barriers when engaging in sexual behaviors with other people. If both partners adhere to those agreed upon regulations, then it would be safer sex, but if not then it wouldn't be safer sex....which is where the "possibly" comes in.  There are also some sexual behaviors that are on a higher risk level even with barriers being used, and also barriers are not 100% (condom breakage, dam slippage, etc.). 

Unsafe sex behaviour: There is different risk levels associated with all sexual behaviours, and the only way to completely eliminate risk is to not have sex at all. However, there are ways to reduce the risk, and when those options are not employed, it can be unsafe sex behaviour. For example; vaginal sex and anal sex both carry a higher risk level due to the fluid exchange, as well as the genital skin to genital skin contact. If barrier devices are not used, the risk level increases greatly.

  When people decide to engage in sexual activity where risks are involved; if condoms and other barrier devices are not used to prevent sexually transmitted infections, the sexual behaviour may be deemed unsafe. Unsafe sex behaviour is essentially sex where the adequate precautions of preventing transmission of STI’s have not been taken.

People can choose what level of risk they are willing to take. For some people the benefits of not using protective barriers such as condoms, outweigh the risk factors of contracting an STI. For others, it is important to decrease their risk as much as possible by getting regular testing, fluid bonding with one partner only, and using additional protective methods. Ultimately it is a decision to be made by the individual and as a couple.

Thanks again for asking! If you have any additional questions about safer sex behaviours, please email Dr. Turner.

Hello all! This is the third part of the Safer Sex Condom series.I hope you're enjoying learning about safer sex methods, and about how to make condoms more fun.  Today's blog answers more condom questions. Enjoy!

Why should I use condoms? (The list below has been adapted from a fabulous resource website Avert.org. Check out their website for additional condom tips and information!)

There are many advantages to using condoms when having sex.

• Condoms are the only contraceptive that helps prevent both pregnancy and the transmission of sexually transmitted infections (including HIV) when used properly and consistently.
• Condoms are one of the most reliable methods of birth control when used properly and consistently.
• Condoms don’t have the potential medical side-effects that some other birth control methods may have.
• Condoms are available in various shapes, colours, flavours, textures and sizes. These can all increase the fun of having sex with condoms.
• Condoms are widely available in pharmacies, supermarkets and convenience stores. You don't need to visit a doctor or have a prescription.
•  Condoms make sex less messy.
• Condoms are user friendly. With a little practice, they can also add confidence to the enjoyment of sex.
•   Condoms are only used when you are having sex, unlike some other contraceptives.
• Condoms are inexpensive.
• Condoms can be combined with other contraceptive methods to increase reliability.
•   Condoms are light-weight, easy to pack, and easy to dispose of!
• Both males and females can be responsible for the contraceptive method!
•   Condoms make it easy to keep sex going when wanting to move from anal sex to vaginal sex- just use a new condom!
• Condoms with lubricant can reduce the friction of skin to skin contact!
  

(List adapted from Avert.org)

Ihate buying condoms! I get embarrassed!
When buying condoms, it’s important to remember why you’re buying them- no, not just to have sex, but also to keep yourself safe! Buying condoms shows that you’re taking responsibility for your own sexual health. However, if it is something that embarrasses you, there are lots of other options than going to the drug store:          

• Go to the Opt clinic or youth clinic in your area. Clinics provide free condoms! You can take as many as you need, and also ask for some tips on how to use them properly.
• Condoms can be ordered online! Good Vibrations, Womyn’s Ware, One Condoms, and numerous other retailers will ship them straight to you!
• Go with a friend, and ask the friend to help you purchase the condoms.
  

I’ve heard that I shouldn’t use oil with a condom. Why not?
Most condoms are made with latex, a type of rubber that can be easily broken down with oil. The oil eats away at the condom, weakening it and potentially causing micro-tears in the condom, large enough for STI bacteria and viruses as well as sperm to get through. It takes less than 60 seconds for the oil to completely break down the latex!

Do polyurethane/polyisoprene condoms break down like latex condoms?
No. Polyurethane and polyisoprene condoms are made of plastics, and do not break down the same way as latex condoms do. With the plastic condoms, it is possible to use oil-based lubricants because they won’t break down. Also, plastic condoms won’t break down with heat. This is both a positive and a negative: although the non-latex plastic condoms last longer, don’t break down with heat, and can be used with oil lubricants, they also don’t biodegrade, and are not the most environmentally friendly option. Also, even though they won't break down in heat, all plastics do break down with UV exposure, so try to keep them away from direct sunlight!

Can I use a condom underwater/in a hot tub/in the shower/in the bath?
Yes- however there are extra precautions to take:

• Make sure the condom is put on before getting into the water.
• Remember that chlorine and other chemicals used to keep pool and hot tub water clean can break down the condoms
• Bubble bath and bath oils can break down condoms quickly!
• Natural lubrication as well as water based lubricants might wash away in the water. Using a silicone based lube might be helpful!
  

How do I make using condoms fun/pleasurable?
Using condoms can actually be a lot of fun! For many male partners, one of the biggest benefits is that they are able to prolong ejaculation- a benefit that both partners typically enjoy! Some other ways to make using condoms more pleasurable are:

• Use lots of lube! Lube helps reduce the friction caused by the condom. Using a little on the inside of the condom is okay too: use enough to fill the reservoir tip
• Try lots of different styles. Condom manufacturers have come out with a variety of sizes, styles, shapes, and thicknesses to help ensure that there is a condom for everyone. The condoms that are available in drugstores are just the tip of the iceberg (no pun intended!) and there are many other styles available at specialty stores.
• As technology improves, condoms are becoming thinner and less sensory depriving! Yippee!
• Use trying different condoms as a way to improve communication about sex between you and your partner—talk about which condoms you like and dislike and why. Plus, you get to go shopping, and buy different types that you want to try!
• Although condoms will never be the same as naked skin, there are pleasurable aspects to latex (and non-latex, too!). Condoms can provide different sensations!
• Try doing a blind taste test to see which condom flavour you enjoy the most!
• Start interjecting condoms and safer sex practices into your fantasies. Get used to imagining them as part of your sexual play.
• Many couples find that with a condom on, they are free to enjoy sex more, and become less sexually inhibited when they are less concerned about pregnancy and STI risks.
  

 Why would I use a condom with a sex toy?
Using condoms on a sex toy allow for the toys to be shared between partners, using a new condom for each partner. Putting a condom on the toy also allows for the toy to be used both anally and vaginally- as long as you use a new condom each time you switch from anus to vagina, as you don’t want any bacteria from the anus entering the vagina or urethra.

Can I still buy condoms with spermicide?
Spermicidal Condoms are still available at some drug stores. If you like using spermicide in combination with condoms, we would actually recommend that you use additional spermicidal (foam, jelly or film) as the spermicidal condoms don’t actually have enough spermicide to be used as a back up method. Also, the condoms with spermicide have been known to cause irritation, and definitely are not meant to be used for oral sex.

Why would anyone want to use an internal condom? It looks like a plastic bag!
Why we love the internal condom:

• It’s an alternative to the external condom, which some people find restrictive
• It helps female partners take control of their own STI prevention
• It warms up with body heat
• It can be inserted vaginally up to 8 hours ahead of use (which makes it warm and decreases the squeaking that some people have experienced with use)
•  It covers more of the genital or anus, and reduces skin to skin contact, which increases protection from HPV and HSV
• It can be used by those with latex allergies
• You can use oil-based lubes because it’s polyurethane not latex!
• It’s easy to use, and reduces the mess to clean up
• It has almost all of the benefits associated with external condom use
  

Tomorrow's blog topic: Hot Dam! Other safer sex methods that you may or may not know about!

As always, any questions can be directed to drashleighturner@gmail.com, or a comment can be left on the blog. Enjoy!

As important as it is to always practice safer sex, there are some obstacles that tend to come up to doing this and still making sex pleasurable and enjoyable for both partners.
I work with Options for Sexual Health as part of their Community Relations team, and we go to many different events around British Columbia. We have been asked almost every possible condom question imaginable! Here are some of the questions I've been asked, and my responses on how to solve this conundrums in a pleasurable way! Enjoy!

How reliable are condoms?
When used perfectly, external condoms are 98% effective in protecting against pregnancy. In typical use, they are 85% effective. Internal/female condoms are relatively new to the market, and in theoretical perfect use are shown to be 95% effective and 79% effective in typical use.

Why such a big gap in theoretical use to typical use? Many people don’t use condoms properly 100% of the time, which is why it’s important to learn the steps to putting a condom on or in, and to use those steps every time someone engages in sexual activity. The more comfortable someone is with condom application, the more likely they are to use a condom properly every time, thus increasing the effectiveness.

Condoms are also an excellent method of reducing the risk of transmission Condoms are very effective at keeping bodily fluids apart thus preventing transmission of most STIs (Chlamydia, Gonorrhea, Syphilis, HIV). However, it is important to note that not all STIs are transmitted through bodily fluid; for example HPV and HSV can be transmitted through skin to skin contact on areas of the body not covered completely by condoms.

What if I’m allergic to latex?
If you’re allergic or sensitive to latex, you might experience a skin rash, dry skin, itching, and-in rare cases, welts. People with latex allergies can use polyurethane condoms for men or polyurethane internal/female condoms. Lifestyles has also brought out a new condom, “Skyn” that is made of polyisoprene, which is softer and more flexible than polyurethane.

There are also latex free options for dams (Hot Dams are polyurethane) and latex free gloves can be purchased at most drugstores.

Why do I lose my erection when I fool around with my partner or try to put on a condom?
This is a very common problem that can definitely be overcome. By practicing putting condoms on and getting comfortable with the idea of condoms, anxiety and nerves will be greatly reduced. Communicating with a partner before sexual activity can also reduce anxiety and nerves. Another good tip is to relax and take the focus off of intercourse for a while, and enjoy sexual intimacy in other ways. This can be really erotic and exciting!

What if my partner doesn’t want to wear one?
There can be a number of reasons why a man doesn’t want to wear a condom. Numerous excuses can include “I can’t feel anything when I wear a condom”, “I don’t have any diseases”, “I lose my erection when I have to put one on”, “I don’t have a condom”, and so forth. In an ideal situation, having the condom discussion prior to being naked would be helpful. But that doesn’t always happen! Here are some other tips on ways to make condoms more fun:

•  Help your partner put the condom on.
•  It doesn’t have to be a clinical procedure! Practice using condoms and getting comfortable with the proper steps to putting a condom on, and then when it’s time to use them on a partner, have fun putting the condoms on!
•  Lube isn’t just for the outside of the condom!
•  Putting a drop of lube inside the condom into the reservoir tip can help reduce the friction of the latex and can improve sensation! Just make sure not to put too much or the condom might slip off!
• Offering a partner the opportunity to try out as many different kinds as they’d like might help motivate them.
  

What are the best condoms to use for anal sex?
Almost all condoms that are used for vaginal intercourse can also be used for anal intercourse, with the exception of condoms with spermicidal nonoxynol-9, as the chemicals used can actually damage the rectal tissue. Also, because there is more friction when having anal sex, using the thin and ultra thin condoms might increase the risk of breakage, but using lots of lubricant decreases that risk. Some men find that they have a preference for different condoms during anal sex. It is important however, that when engaging in anal sex additional lubricant is used. The anus doesn’t produce natural lubrication like the vulva, so using additional lubricant is essential.

Some people also like using the internal/female condom with anal sex, as they find it to be more comfortable. When using the internal condom for anal sex, removing the ring is recommended. The partner who is inserting the penis into the anus should place the condom onto the penis. The condom will stay in place once inserted.

Where should we keep the condoms?
The best answer to this question is “Keep the condoms where you will remember to use them!” For some people, this means in their wallet or purse, maybe even in a pocket. Although rubber will break down with continued exposure to heat, if the person forgets their condoms in their bed side table, and decides not to use one, that’s less productive than keeping it in their wallet!

That being said, the best location for condoms to be kept is in a cool, dry place away from heat sources. This is why the bedside table is usually a good option!

Another tip is to check the expiry date on the condoms before placing them in the bedside table, so there is no fumbling for lights to check the expiry date. As condoms do break down over time, if they are past their best before date, it’s worth it to throw them out, and stock up on new supplies!

What if the condom breaks or slips off?
Don’t panic. There are steps in place to deal with things like this! First thing: talk to your partner and make sure they know that this has happened. For female partners who are concerned about pregnancy, it is important to get Plan B (or another emergency contraceptive option) as soon as possible (within 5 days of the condom breakage). Two weeks after, it is recommended to go to a clinic and have STI testing done. Even though it might be tempting to go right away, the screening process requires a two week window between the incident and the testing.

Tomorrow: Part 3 of 4: More Condom Troubleshooting!

Any questions can be directed to Dr Turner at drashleighturner@gmail.com

  “They don’t feel good!” We often hear comments about condom use: “Why do I have to?” “I’m allergic to latex” “they’re too tight” etc. Today, I'm going to start a 4 part series on condoms and other safer sex barrier methods to help increase the pleasure of safer sex! Today I'll be covering how a condom works, and how to properly put a condom on. As always, if you have any questions, post a comment, or send an email and I will address them in the next blog!

  How a condom works:

A condom provides a barrier between the person wearing the condom and the other partner. If the condom is being used to prevent pregnancy, the condom collects the ejaculate and prevents the sperm from coming in contact with a female partner’s ovum. Condoms also work to reduce other bodily fluids from coming in contact with any of the STI receptor cells that are found around the genitals, mouth and anus. They can be used on penises, and also on sex toys.

 Types of external condoms:

1)       Lubricated: Most condoms that are available commercially or through clinics come pre-lubricated. In some cases this is beneficial. However, the lubricant might not be sufficient for some people, and it is okay to add more. Other people might experience irritation from the pre-lubricated condoms, and may find that they don’t like them.

2)       Non-lubricated: There are condoms available without lubricant. For most people, adding lubricant to these condoms helps reduce friction. By choosing non-lubricated condoms, people have the ability to choose their favourite water or silicone based lubricant. This can be important for people who have sensitivities to certain lubricants, in particular the lubricant on the pre-lubed condoms.

3)       Non-latex: Many name brands have their own version of non-latex condoms; polyurethane is one material that has become increasingly popular. The benefit of polyurethane is that it warms up and becomes softer, resulting in a more natural feeling. They are also typically thinner than conventional condoms allowing for a ‘closer to skin on skin’ feeling. Non-latex condoms are also a great option for people who have latex allergies. However, non-latex condoms are also made of plastics, which are not biodegradable and are not the most environmentally friendly option.


Types of internal condoms:

Reality/Female condom: At this point, there is only one option for internal condoms. It is called “Reality” or “Female” condom. They are made from polyurethane, and are approximately $2.50-$3.00 for one condom. They are shaped like a tube, with a ring at the bottom that fits against the external body, and a loose ring on the inside that can help with insertion, but can be removed if uncomfortable.

They are not as cost-effective as external condoms; however, they are a latex-free alternative, as well as an excellent option for partners who do not want to wear an external condom, and it can also be inserted up to 8 hours before sex! They are also not biodegradable. Although they have not been officially approved for use with anal sex, many people have started using them for anal sex. When using it for anal sex, some people prefer to take the inner ring out, which doesn’t detract from the effectiveness of the internal condom.

Condom Brands:

• Durex
• Lifestyles
• One
• Sheik
• Trojan
• Kimono
• Reality
  
• Etc.
  

  Condom Styles:

• Regular cut
• Slim fit
• Ultra thin
• Flared head
• Coloured
• Flavoured
• Glow in the dark
• For her pleasure
• Ribbed
• Studded
• Pleasure shaped
• French ticklers
• Textured
• Warming
• Tingling
• Magnum (large/extra large)
• Vibrating Ring
• Spermicidal
• Etc.

  What’s the difference?

When walking down the condom isle at a drug store, the choices may seem quite overwhelming. A lot of the choices make no difference on how sex will feel for either partner, and in reality is simply a way to market condoms. Many people don’t notice much of a difference between all of the brands or styles. However, some people have preferences for certain types or styles of condoms. For example, some men prefer a magnum condom or a flared head condom to give a bit more room for movement inside the condom, and some men prefer a slim fit condom that is more snug and allows them to feel less of the condom and more of their partner. Another example is a man who has not been circumcised may prefer a condom without a flared head because the extra room might reduce the movement of his foreskin, or he might prefer the flared head because it might allow the foreskin to move more freely. Some people prefer the ones they get at the 

Which condom works best?

Condom selection is an individual process where people can do some of their own consumer research: Have fun trying out different brands and styles! A lot of the specialty stores (Womyn’s Ware, Art of Loving, etc) have the option to purchase individual condoms, and some of the drug stores sell packs of 3 condoms.

The difference between novelty and approved condoms:
There are many different types of condoms, and most of them are approved for use for the prevention of pregnancy and reducing the transmission of HIV and many other STIs. However, there are also condoms that are produced as ‘novelty’ condoms, and may not be meant for use in the prevention of pregnancy and reduction of HIV/STI transmission. How can someone tell? The condoms that have been approved have a statement similar to this one on the package:

“When used properly latex condoms will help to prevent pregnancy and reduce the risk of transmission of HIV (AIDS) and many other STIs. No condom, however, will eliminate risk.”

If there is no approval message printed on the condom package, or if the condom is clearly marked as novelty, it might not offer the same protection.  

The “How to” of putting on a condom!

Believe it or not, there are 10 steps to putting a condom on properly! Why is this important to know? Using a condom properly reduces the chances of breakage, slippage, and other accidents that can lead to accidental pregnancy or STI transmission.

Steps to putting on a condom:
1)       Check the expiry date!

•   It’s often difficult to read the date- especially in the dark! It is a good idea to check the date on the package of condoms before putting them into the bedside table/purse/etc.

2)       Check the air in the package!

• If there is no air in the package, it can indicate that the package has been punctured. Since there is no way to tell where the package was punctured, it’s a good idea to throw out that condom and start again!

3)       Using the serrated (rough) edge of the package, open the condom (much like you’d open a ketchup package)

4)       Take the condom out of the package and identify which way the condom rolls    

• The Blow test: By blowing some air into the condom, you should be able to quickly identify which way the condom should roll (the rolled bit should be on the outside).
•   If the condom is placed the wrong way, it will not roll down. 
•  Because pre-ejaculate can have a high concentration of STIs if the person is infected, it is important to NOT use a condom that has been placed the wrong way. Throw the condom out and start again with a new one!
  

5)       Pinch the tip of the condom, and roll it all the way down to the base of the penis/sex toy

• Another method is to add lubricant to the reservoir tip of the condom. This helps reduce the friction of the condom on the penis, and makes for more movement
• Some men like to pull the foreskin back before putting the condom on as it helps add more sensation. 
•  The reason for pinching the tip is so that there is somewhere for the ejaculate to be contained. If there is an air bubble the condom may be more likely to break when the penis ejaculates.
  

6)       Lubricate and enjoy!

• Using lubricant with condoms reduces the risk of condoms tearing!

7)       While holding on to the base of the condom, withdraw the penis or sex toy from the partner

•   It is important to withdraw the penis before it gets soft

8)       Move away from the partner, and carefully remove the condom from the penis or sex toy- try not to spill any fluid

9)       Tie the used condom and wrap in tissue or package

10)   Throw used condom into the garbage can (not into the toilet!)

 

Tomorrow: Part 2: Condom Trouble Shooting!

  Lubricant is a wonderful thing! All too often, lubricant is left out of the safer sex discussion. Not only is lube is a wonderful thing, it can also decrease the risk of tearing the condom, as lube reduces friction between skin and rubber. There are 3 main types of lube:

1.       Water-based

2.       Silicone-based

3.       Oil-based

Only water-based and silicone-based lubricants can be used with latex condoms, and not oil-based, as the latex gets broken down by oil in less than 60 seconds! Oil-based lubricants can be used with non-latex plastic condoms such as polyurethane and polyisoprene condoms.

Water based lubricants often contain glycerin to help them stay slippery and wet. However, some women have sensitivity to glycerin and end up with yeast infections or urinary tract infections when they use products with glycerin. Sugars are also often in water based lubricant. If someone has a concern about this, they can purchase glycerin and sugar-free water-based lubricants.

Water-based lubricants also have a tendency to become sticky when being used. If this happens, adding a bit of water to the sticky spots can be helpful. Silicone-based lubricants typically stay slippery for longer than the water-based lubricants, however, some people don’t enjoy the clean up that follows.

Some companies have come up with flavoured lubricants. As with most water based lubricants, they often contain glycerin, sugars, or other non-vulva friendly materials. If you or your partner is interested in trying flavoured lubes for use during oral sex, check out the ingredients first: Sugar is not good for vulvas, sucralose doesn’t promote bacterial growth, so it’s typically a better option. Also, if you’re purchasing the lubricant at a store that has them on display; ask a staff member if it’s alright to do a taste test. Many sex toy stores have done their research and are carrying vulva-friendly lubes, and that sometimes means that they’ve cut back on the number of flavoured lubes available.

There are additional options for people who do not want to purchase lubricants. Saliva has long been a trusted lubricant and is readily available. Egg whites are also recommended in some resources as a natural alternative to commercially available lubricants.

Be aware that many of the “Natural” or “organic” lubricants may have oil in them! They may be fabulous products made with only the finest of ingredients but if they contain oils or butters, they are not latex compatible.  Which ever lubricant someone chooses, it is important that it works for them. Most drug stores provide a minimal selection, and primarily they are from pharmaceutical companies (for example KY Jelly is a Johnson and Johnson product). Specialty stores like Womyn’s Ware and Art of Loving have a wide variety of water-based, silicone-based and oil-based lubricants.

It's official! I have a clinic space! I will be working at the Crossroads Medical Clinic starting February 8th. If you would like to book an appointment, please call 778-995-7499.

Check your medical coverage plan! Some medical companies cover visits to Sexologists, providing it has been recommended by a doctor. 

Are you ready to start a new year with renewed sexuality? Call for an appointment, or for an information session on how we can work together!

I look forward to hearing from you!

Once upon a time, not so very long ago, pornography showed normal people engaging in somewhat typical sex acts.

For the most part, this is no longer the case.

Porn sex is bigger, bolder and porn-ier than ever, and unfortunately, it is what many people consider "the norm". They believe that if they are not having porn sex, then they, or their partner(s) is doing something wrong.

There is an entire generation of people who have grown up with accessibility to online porn, who are now having so-called porn sex, complete with porn-gasms. Does this mean they're enjoying it, or simply mimicking what they've seen, and believe that it should be enjoyable?

In my travels, I have come across a website, MakeLovenotPorn.com
It definitely helps to distinguish between porn and real life. This can be a valuable resource not only for young adults but also for those of us who might have forgotten that porn is for entertainment and enjoyment!

Welcome to my website and blog! As a clinical sexologist, there are many topics that I'll be covering, and I invite you to visit my blog for updates and information.

For many people, sex is a topic that is only talked about after a bottle of wine, a romantic dinner, and when the lights are low. For me, sex is something I talk about every day; I won't get weird when I talk about sex! I would love to see couples having the ability to talk about sex openly and honestly, and not just when they're in the midst of it!

How can you start making that change in your life? Here are some of my pointers:

• Make a list of fantasies with your partner: it's an easy way to open the lines of communication- even if you don't act on the fantasies
  
• Discuss sex prior to having it:Obviously, if something isn't working you will need to tell your partner, but to really gain insight and progress, try discussing your likes and dislikes when your clothes are still on!
• Make your own list: Make a list of your sex likes and your dislikes, and if you feel comfortable, share it with your partner. If you're not comfortable, at least you have started to understand your own body!
• Self Pleasure: Self-pleasuring/masturbation is a great way to learn about yourself. Again, this might not be something your ready to share with your partner, but by understanding how you liked to be touched, you have taken a big step. If you are comfortable, try talking to your partner about which touches felt best for you!

That's all for now- come back and visit soon for more information!

New Blog on the new website!
Come back often for updates!