The repertoire of human eVorts to avoid sexually transmissible diseases: past and present. Part 2: Strategies used during or after sex

Background/objective: Despite the focus by public health programmes on condoms, chastity, or monogamy, people use a much wider variety of strategies to minimise their personal risk of sexually transmissible disease (STD). The objective of this study was to compile a comprehensive list of personal and societal STD avoidance strategies. Methods: Data from clinical and research observations, computer searches, and historical texts were pooled. Results: A variety of behaviours during or after sex, other than condoms, were identified that have been perceived to alter STD risk. STD avoidance strategies were often poorly documented and diYcult to disentangle from other drives such as aesthetics, sexual variety, and contraception. They also varied in popularity in time and place. Some examples were douching; systemic and topical prophylactic antimicrobials; non-penetrative sexual practices, post-coital urination; and examining sexual partners’ genitalia. Interest in some practices has been recently revived—for example, vaginal microbicides and post-exposure chemoprophylaxis, while others—for example, withdrawal and non-penetrative sexual practices, receive scant attention but may be much more widely used. Conclusion: The full spectrum of STD avoidance strategies warrants further study because some are ubiquitous across cultures and because they have the potential to complement or undermine safer sex programmes. Because of their greater acceptability, some less eYcacious strategies may have greater public health importance than less popular but more eYcacious strategies such as condoms. (Sex Transm Inf 2000;76:88–93)